Saliva - A Review

1. Presented By:
Dr. Rupali Das
II year PG
Dept Of Periodontics
25-4-12

2. CONTENTS
1. Introduction
2. Composition of saliva
3. Functions of saliva
4. Salivary glands
a) Morphologic characteristics of Salivary glands
b) Formation & secretion of saliva
c) Ductal modification of saliva
d) Development of salivary glands
e) Blood supply & nerve supply
5. Collection of saliva
6. Physical properties of saliva
7. Flow rate
6. Factors affecting the salivary flow rate
7. Clinical Aspects
a) Salivary gland hypofunction & hypersalivation
b) Role of saliva in periodontal pathology
c) Saliva as a diagnostic marker
8. Conclusion
9. References

3. INTRODUCTION
• Is a clear, slightly acidic,mucoserous secretion,which provides chemical
milieu of the teeth and oral soft tissue.
• Saliva is composed of more than 99% water and less than 1% solids , mostly
electrolytes and proteins, the latter giving saliva its characteristic viscosity.
• Normally the daily production of whole saliva ranges from 0.5 to 1.0 litres

4. CLASSIFICATION
1.Based on anatomic location
– Parotid gland
– Sub mandibular gland
– Sub lingual gland
– Accessory glands (labial, lingual,
palatal buccal,glossopalatine and
retromolar)
2. Based on size and amount of
secretion
– Major salivary glands
– Minor salivary glands

5. 3. Based on type of secretion
– Serous
– Mucous
– Mixed
Parotid glands - Purely serous
Submandibular-Predominantly serous, Mixed
Sublingual - Predominantly mucous , Mixed
Labial,Buccal,Lingual{Ant.}- Mucous , Mixed
Palatine,Glossopalatine - Purely mucous.
Posterior part of the tongue - Purely mucous
Von Ebner’s Glands - Purely serous

6. COMPOSITION

7. • Saliva is made up of approx. 99% of water.
• Organic components
Protein
200mg/100ml.
enzymes,immunoglobulins,mucins,traces of albumin and
polypeptides and glycopeptides.
-amylase{Ptyalin}
60-120 mg/100 ml in parotid.
25 mg/100ml in submandibular.
Immunoglobulins
Ig A
Ig G
Ig M

8. Anti bacterial substances
Lysosyme
Lactoferrin
Sialoperoxidase
Glycoproteins
Proline rich glycoprotein seen in parotid saliva.
Other compounds
Siatherin
Sialin
Free amino acids
Urea
Glucose

9. • Inorganic constituents
Sodium
Potassium
Chloride
Bicarbonate
Calcium
Phosphorus
Flouride
Thiocyanate

10. FUNCTIONS

11. Functions of Saliva Components
Mucins Lubricate food
Protect teeth against acid
Help protect against bacteria, viruses, fungi
Digestive Enzymes α-Amylase – digests starches
Lipase – digests fats
Protease – digests proteins
Lysozyme
Peroxidases
Lactoferrin
Histatins
Cystatins
Anti-bacterial agents
Secretory Immunoglobulin A
Histatins
Cystatins
Anti-fungal, anti-viral agents

12. Bicarbonate ions
Phosphate ions
Proteins
Help protect teeth and soft tissues against
acidic conditions
Calcium ions
Phosphate ions
Proline-rich proteins
Help maintain mineral content of tooth
enamel

13. PROPERTIES OF SALIVA
• Consistency : Slightly cloudy
• Reaction : Usually slightly acidic
• PH : 5-8
• Specific gravity : 1.0024 – 1.0061
• Freezing point :0.07 – 0.34 degree Celsius
• Osmotic pressure : ( 700-1000m osmol/litre )

14. The Salivary Glands
Human saliva is produced by 3 Major salivary glands, The Parotid, the Submandibular,the
Sublingual, as well as numerous minor salivary glands.

15. Time of origin
Gland Location Intra uterine life
Parotid gland Corners of the stomodeum 6th week
Sub.Mand.gland Floor of the mouth End of 6th week
Sub.Ling.gland Lateral to S.m.primordium 8th week
Minor salivary Buccal Epithelium 2nd week
Glands

16. STAGES OF DEVELOPMENT
• STAGE I-Bud formation:
Induction of proliferation of oral epithelium by underlying
mesenchyme.

17. • STAGE II:Formation and growth of epithelial cord.

18. • STAGE III: Initiation of branching in terminal parts of epithelial
cord and continuation of glandular differentiation.

19. • STAGEIV: Dichotomous branching of epithelial cord and lobule
formation.

20. • STAGE V:Canalization of presumptive ducts.

21. STAGE VI: Cytodifferentiation.
Cells of  Terminal tubule cell  Proacinar cellsAcinar cells
Bulb region 
Intercalated duct cell

22. • Septa ( Thicker partitions of the connective
tissue ) which are continuous with the
connective tissue capsule surrounding the gland
parenchyma into lobes & lobules & carry the
blood vessels & nerves that supply the
parenchymal components & the excretoryducts.
Secretory end pieces & ducts - last 2 months of gestation.
The glands continue to grow postnatally upto 2 years of age.

23. MORPHOLOGIC CHARACTERISTICS OF
MAJOR SALIVARY GLANDS

24. Parotid gland
 Largest of all the salivary glands
 Purely serous gland that produce thin , watery amylase rich saliva
 Superficial portion lies in front of external ear & deeper portion lies behind
the ramus of mandible
 Stensen's Duct (Parotid Papilla) opens out adjacent to maxillary second
molar.

25. Submandibular Gland
 Second largest salivary gland
 Mixed gland
 Located in the posterior part of
floor of mouth,adjacent to
medial aspect of mandible &
wrapping around the posterior
border of mylohyoid muscle.
 Wharton's Duct opens beneath
the tongue at sub-lingual
caruncle lateral to the lingual
frenum

26. • Sublingual Gland
Smallest salivary gland
Mixed gland but mucous secretory
cells predominate.
Located in anterior part of floor of
mouth between the mucosa and
mylohyoid muscle
Opens through series of small ducts
(ducts of rivinus) opening along the
sub-lingual fold & often through a
larger duct (bartholin’s duct)

27. The minor salivary glands:
1.Estimated numbers is 600-1000.
2.Exist as small,discrete,aggregates of secretory
tissue present in the submucosa through out
most of the oral cavity, except the gingival &
anterior part of the hard palate.
3.Predominantly mucous glands,except for Von
Ebners glands(purely serous)
4.Here intercalated & striated ducts are poorly
developed.

28. VASCULAR SUPPLY
PAROTID GLAND
Arterial: Ext.Carotid Artery and its branches
Venous: Ext.Jugular Vein
Lymphatic: Parotid Nodes Upper deep cervical nodes
SUBMANDIBULAR GLAND
Arterial: Facial Artery , Lingual Artery
Venous: Common Facial Vein /Lingual Vein
Lymphatic: Submandibular Lymph nodes
SUBLINGUAL GLAND
Arterial: Lingual and Submental Arteries
Venous: Lingual Vein

29. INFLUENCE OF BLOOD SUPPLY ON SALIVARY SECRETION
 Extensive blood supply is required for rapid salivary secretion.
 Salivation indirectly dilates blood vessels providing increased
nutrition.
 Large increase in blood flow accompanies salivary secretion.

30. INNERVATION
Parasympathetic innervation to
major salivary glands
 Otic ganglion suplies the parotid
gland.
 Submandibular ganglion supplies
the other major glands.
Sympathetic innervation
Promotes the flow of saliva and
stimulates muscle contraction at
salivary ducts

31. Regulation of salivary secretion
Afferent signals from sensory receptors in mouth
(Trigeminal,facial,glossopharyngeal nerves)
Salivary nuclei in the medulla oblongata of brain
Parasympathetic nerve bundle sympathetic nerve bundle
salivary glands

32. Salivary Gland Structure
Composed of parenchymal elements supported by connective tissue
The types of cells found in the salivary glands are duct system cells,
acinar cells, and myoepithelial cells.

33. • Intercalated duct : main duct connecting acinar
secretions to rest of the gland, not involved in
modification of electrolytes
• Striated duct: electrolyte regulation in resorbing
sodium
• Excretory duct: continuing sodium resorption and
secreting potassium
• Inter cellular canaliculi : These are the extensions of
the lumen of the end piece between adjacent
secretory cells that serve to increase the terminal
surface area available for secretion.
• Secretory end pieces: branched ducts, terminating in
spherical or tubular secretory end pieces/ acini.

34. Secretory cells: There are two types of secretory cells.
1.serous cells
2.mucous cells

35. 1.SEROUS CELLS:
a) These are spherical, consisting of 8-12
cells surrounding a central lumen.
b) Cells are pyramidal with a broad base &
narrow apex
c) The lumen usually has finger like
extensions located between adjacent
cells called inter cellular canaliculi.
d) Spherical nuclei are located basally,
occasionally binucleated cells are seen.

36. e) Secretory granules are present in
the apical cytoplasm.
f) These cells are joined by
intercellular junctions.
a.Zonula occludens( tight junction)
b.Zonula adherens(Adhering
junction)
c.Macula adherens(desmosome)
These cells are attached to the basal
lamina & the underlying
connective tissue by
hemidesmosomes.

37. 2.MUCOUS ACINI:
a) These have a tubular
configuration.
b) In cross section, they appear as
round profiles with mucous cells
surrounding a central lumen of larger
size than that of serous end pieces
c) Mucous end pieces have serous
cells associated with them in the form
of a demilune or cresent covering the
mucous cells at the end of the tubule.

38. d) The most prominent feature -accumulation of large amounts of secretory product (mucus) in
the apical cytoplasm, which compresses the nucleus & endoplasmic reticulum & golgi complex
against the basal cell membrane.
e) Unlike serous cells, however, mucous cells lack intercellular canaliculi, except for those
covered by demilune cells.

39. MYOEPITHELIAL CELLS:
a) These are basket shaped cells
b) Cntractile in nature.
b) Located between the basal lamina & the secretory/duct cells & are
joined to the cells by desmosomes.
c) Similar to the smooth muscle cells but are derived from the epithelium.

40. e) Help to expel the primary saliva from the
endpiece into the duct system.
f) Provide signals to the acinar secretory cells for
maintaining cell polarity & structural organization
of the secretory end piece.
g) Produce a no. of proteins that have tumour
suppressor activity, such as proteinase inhibitors (
ex : tissue inhibitor of metalloproteinases ) &
antiangiogenesis factors
h) Provide a barrier against invasive epithelial
neoplasms.

41. FORMATION OF SALIVA
Formation of saliva occurs in 2 stages.
Stage 1 : Production of primary saliva from the cells
of secretory end pieces & intercalated ducts, which is
an isotonic fluid
Stage 2 : The primary saliva is modified as it passes
through the striated & excretory ducts mainly by
reabsorption & secretion of electrolytes. The final
saliva that reaches the oral cavity is hypotonic.

42. Salivary Gland Secretions
Gland type Saliva type
Parotid, and Von Ebner’s (on the tongue) Serous
Submandibular Mixed, more serous than mucous
Sublingual Mixed, but mostly mucous
Most minor Mucous

43. WHOLE SALIVA

44. COLLECTION OF SALIVA
• Non invasive, non painful techniques exist to collect whole saliva, as well as
saliva from the individual major & minor salivary glands .
• Whole saliva is easily obtained & is in most case a good indicator of whole
mouth dryness.
• Diseases of salivary gland can often be diagnosed from the secretions
obtained directly.
• The quantification of salivary output is referred to as sialometry.

45. University of Southern California School of Dentistry guidelines
• Unstimulated whole saliva collection always should precede stimulated
whole saliva collection.
• The patient is advised to refrain from intake of any food or beverage (water
exempted) one hour before the test session.
• Smoking, chewing gum and intake of coffee also are prohibited during this
hour.
• The subject is advised to rinse his or her mouth several times with distilled
water and then to relax for five minutes.
• Keep his mouth slightly open and allow saliva to drain into the tube.
• Should last for five minutes

46. Collection Of Stimulated Saliva
• Paraffin method (Masticatory stimulus )
• Citric Acid method ( Gustatory Stimulus )

48. Collection Of Unstimulated Saliva

49. SALIVARY FLOW RATE
• Salivary flow varies in the stimulated (eg, chewing) and
unstimulated state.
• Stimulated flow -
– 90% of average daily saliva production
– At a rate of between 0.2 and 7 mL/min
– Parotid glands contribute > 50% of total salivary flow.
• Unstimulated state –
– Normal flow > 0.1 mL/min
– Submandibular glands - 65% of total flow;
– Parotid glands - 20%
– Sublingual glands - 7%–8%.

50. Factors affecting salivary flow rate
Diurnal variation:
• Protein concentrations tend to be high in the afternoon.
• Sodium & chloride concentrations are high in the morning,
while potassium is high in the early afternoon.
• The calcium concentration increase at night.
Duration of stimulus:
• If the salivary glands are stimulated for long than 3 minutes,
the concentration of many components is reduced.
• Chloride concentrations fall during periods of stimulation.

51. Hormonal Influences
• Aldosterone: It results in increased sodium reabsorption in the striated
ducts.
• Antidiuretic hormone (ADH): Stimulates water reabsorption by the
striated duct cells.
• Other hormones: Thyroxine results in increase salivary secretion
• Local hormones: Bradykinin & its predecessor kallidin, result in increased
salivary secretion.

52. CONDITIONS AFFECTING SALIVATION
Physiologic
•Taste
• Surface texture
•Dehydration
• Age
•Mastication
• Emotion
Pathologic conditions
•GI irritants
• Ill fitting dentures/inadequate
interocclusal distance
•Vitamin deficiency
•Trauma from surgery
• Senile atrophy of the salivary
glands
• Irradiation therapy
• Dieseases of the brain stem
• Diabetes mellitus/ insipidus
• Diarrhoea
• Acute infectious diseases
Drugs
• Cholinesterase inhibitors-
Prostigmine
• Adrenergic stimulating drugs-epinephrine
• Sialogogues- pilocarpine.
• Antihistamines - Atropine
•Drugs for peptic ulcer –
Omeprazole, Ranitidine.
•Antihypertensives – Captopril.
•Antiparkinsonian drugs –
Levodopa.
•Antianxiety agents-
Benzodiazepines.
•Antidepressants – Olanzepine.
•Diuretics – Furesemide.

53. ANOMALIES
I.Developmental
Aberrant Salivary Glands
Aplasia and Hyperplasia
Atresia
II.Obstructive conditions
Sialolithiasis
Mucocele
Necrotizing Sialometaplasia
III. Inflammatory Diseases
Viral- Mumps , H.I.V. Associated
Bacterial - Sialadenitis

54. IV.Neoplastic Diseases
Benign
Malignant
V.Degenerative Conditions
Sjogren’s Syndrome
Ionizing Radiation
VI.Xerostomia

55. XEROSTOMIA
Systemic diseases
1. Rheumatoid conditions Collagen/vascular, connective tissue diseases, ex:
• It is a condition of reduced or absent salivary flow,leading to the
dryness of the mouth.
Sjogren’s syndrome
2.Dysfunction of the immune
system
AIDS
• It is not a disease by itself, but a symptom associated with alterations
3. Hormonal Disorders Diabetes mellitus
of salivary function.
4. Neurological disorders Parkinson’s disease
• The principal causes of salivary gland hypofunction & xerostomia
5. Dehydration
Therapeutic irradiation External beam, whole- body,131I
Drugs / medications Anticholenergics,Antidepressants,Antihypertensive
Antipsychotics,& Antiparkinsonism drugs
Psychogenic Disorders Depression
Surgical removal of the glands

56. Oral symptoms Clinical signs
1. Dry mouth ( xerostomia )
2. Often thirsty
3.Dysphagia (difficulty with
swallowing )
4. Dysphonia ( difficulty with
speaking )
5. Dysgeusia ( abnormal taste
sensation )
6. Difficulty with eating dry foods
7. Need to frequently sip water while
eating
8. Difficulty with wearing dentures
9. Often do things to keep mouth
moist
10.Burning, tingling,sensation on the
tongue.
11.Fissures & sores at corners of lips.
1. Dryness of lining oral tissues
2. Loss of glistening of the oral mucosa
3. Dryness of the oral mucous
membranes
4. Oral mucosa appears thin & pale
5. Tongue blade/mirror/a gloved finger
may adhere to the soft tissues
6. Fissuring & lobulation of the dorsum of
the tongue & lips
7. Angular cheilitis
8. Candidiasis on tongue & palate
9. Increased incidence of dental caries
10.Thicker, more stringy saliva
11.Swelling of glands
12.Increase in inflammatory gingival
diseases
13.Rapid tooth destruction associated
with cervical or cemental caries

57. Treatment of salivary hypofunction & xerostomia :
• Systemic Therapy:
Bromohexine, anethole, triothiline & pilocarpine Hcl all three should be
used under the care of a specialist & following medical examination.
• Local Therapy

58. SALIVARY SUBSTITUTES
Carboxy methyl cellulose (CMC) based
 Imparts lubrication and viscosity
 Sorbitol or xylitol are added to provide surface activity and as a
sweetner.
 Have surface tension greater than natural saliva.
Mucin based
Animal mucins derived from procine gastric tissues / bovine salivary
glands.
Salts are addeded to mimic the electrolyte content of natural saliva

59. Hypersalivation
• It is also known as sialorrhea, ptyalism.
• It may lead problems in oral motor coordination, including reduced muscle
tone around the mouth & a reduced ability to swallow.
• Causes:
1. After extensive surgery for oral or oropharyngeal disorders.
2. As a result of stomatitis, psychological factors, & the use of some
drugs, Ex: benzodiazepines,captopril
• Treatment
i) Drugs – anticholinergics.
ii) Surgical – depending on the nature of the anomaly.

60. SALIVARY MARKERS FOR PERIODONTAL
DIAGNOSIS
Enzymes Immuno
globulins
Proteins Phenotypi
c markers
Host cells Ions Hormone Bacteria Volatile
compounds
1.Alpha glucosidase
2.Alkaline Phosphates
3.amino peptidase
4.β galactosidase
5.β- glucosidase
6.collagenase
7.elastase
8.esterase
9.gelatinase
10.kallikrein
11.lysozyme
12. myeloperoxidase
13. trypsin.
IgA
IgG
IgM
sIgA
1.Cystatin
2.Epidermal
growth factor
3.fibronectin
4. lactoferrin
5.platelet
Activating
Factor
6.vascular
endothelial
growth factor
Epithelial
keratins
Leucocyte
(PMNs)
calcium cortisol A.actinomycetum
comitans
B.forsythus
mycoplasma
P.gingivalis
P.intermedia
P.micros
p.nigrescens
C.rectus
T.denticola
Hydrogen sulfide
Methyl
mercaptan
Picolines
Pyridines

61. DIGNOSTIC APPLICATIONS
How serum constituents(i.e., drugs and hormones) reach saliva
– Within the salivary glands
– GCF outflow
Saliva is used for the diagnosis of
1. Hereditary Diseases
2. Autoimmune Diseases
3. Malignancy
4. Infectious Diseases
5. Drug Monitoring
6. The Monitoring Of Hormone Levels
7. Diagnosis Of Oral Disease With Relevance For Systemic Diseases

62. COMPARE SALIVA AND SERUM
ADVANTAGES DISADVANTAGES
collected non-invasively, and by individuals
with limited training
samples are not sterile and are subject to
bacterial degradation over time.
No special equipment is needed Absorbing specimens on cotton may
contribute interfering substances to the extract
children and older adults as fewer compliance
problems
Interpretation of saliva assays is still difficult
Cost-effective approach for the screening of
large populations
contamination from bleeding gums
more accurate reflection of the active
hormone, especially for steroid hormones
A few kits offer saliva controls with the
reagents
stable at room temperature for extended
periods
Hazards associated with blood collection do
not apply to saliva
multiple samples

63. FDA APPROVED SALIVARY KITS
HIV, Drugs Of Abuse - Orasure Collection System ( Epitope)
Steroid Hormones - Diagnostic Systems Laboratories And Salimetrics
Secretory Iga And Melatonin - ALPCO

65. HEREDITARY DISEASES
Cystic fibrosis
• Elevated levels of calcium and proteins in submandibular saliva
• Higher occurrence of calculus (Wotman et al., 1973)
• The submandibular saliva contained more lipid
• Elevations in electrolytes (sodium, chloride, calcium, and phosphorus), urea and
uric acid, and total protein in the submandibuar saliva
• Minor salivary glands are also affected
• Parotid saliva does not demonstrate qualitative changes
• Unusual form of epidermal growth factor (EGF)
• Abnormally elevated levels of prostglandins E2 (PGE2) were detected in the saliva

66. Coeliac disease
• Serum IgA antigliadin antibodies (AGA) are increased
• Salivary IgA-AGA is a sensitive and specific method for the screening of
coeliac disease, and for monitoring compliance with the required gluten-free
diet (al-Bayaty et al., 1989; Hakeem et al., 1992).
21-Hydroxylase deficiency
• Early morning salivary levels of 17-hydroxyprogesterone (17-OHP) is an
excellent screening test for the diagnosis, since the salivary levels accurately
reflected serum levels of 17-OHP.

67. AUTOIMMUNE DISEASES—SJOGREN'S
SYNDROME
• The accepted investigation of salivary involvement is a biopsy of the minor salivary glands
of the lip.
• Presence of a lymphocytic infiltrate (predominantly CD4+ T-cells) in the salivary gland
parenchyma
• A low resting flow rate and abnormally low stimulated flow rate of whole saliva
• Elevated levels of rheumatoid factor, antinuclear antibody, anti-SS-A, and anti-SSB
• In sialochemistry –increased concentrations of sodium and chloride
• Elevated levels of IgA, IgG, lactoferrin, and albumin, and a decreased concentration of
phosphate
• Increased salivary concentrations of inflammatory mediators—i.e., eicosanoids, PGE2,
thromboxane B2, and interleukin-6
• Autoantibody, especially of the IgA class, is detected in the saliva of SS patients prior to
detection in the serum

68. MALIGNANCY
• Tumor markers that can be identified in saliva may be potentially
useful for screening for malignant diseases
– P53
– Defensins
– c-erbB-2 (erb)
– cancer antigen 15-3 (CA15-3)
– CA 125

69. INFECTIOUS DISEASES
• Helicobacter pylori infection
• Children infected with Shigella
• Pigeon breeder's disease
• Pneumococcal pneumonia
• Lyme disease
• Taenia solium

70. Role of salivary enzymes
• Salivary enzymes can be produced by salivary glands, oral micro organisms,
PMNs, oral epithelial cells, or be derived from GCF.
• Attempts have been made to correlate enzymatic activity in human saliva
with periodontal status.
• Studies have also assessed changes in salivary enzyme activity in response
to periodontal therapy.
• Enzymes may alter bacterial receptors & thus affect bacterial attachment on
the tooth (Gibbons & Etherden 1982 ), or they may be directly involved in
the pathogenesis of gingivitis & periodontitis ( Dewar 1958 ).( JPR 1983 18:
559-569 ).

71. • Those particularly relevant in this group of enzymes are:
1. aspartate and alanine aminotransferases (AST and ALT)
2. lactate dehydrogenase (LDH)
3. gamma-glutamyl transferase (GGT)
4. creatine kinase (CK)
5. alkaline phosphatase (ALP)
6. acidic phosphatase (ACP)

72. •Salivary proteases, alone or acting synergistically with hyaluronidase, are
capable of penetrating oral epithelium in areas of irritation & lysing the
collagen fibers & ground substance in the underlying connective tissue.This
could render a region more susceptible to bacterial invasion.( JADA vol 30,
1961 ).
•Watanable et al. found positive relationships between salivary protease
activity & calculus index, as well as between protease activity & periodontal
pocket depth.
•According to Nakamura & Slots, increased activity for alkaline phosphatase,
esterase, beta-glucosidase & other aminopeptidases was detected in saliva
from patients with chronic periodontitis, compared to healthy controls, but
patients with aggressive periodontitis exhibited greater amounts of salivary
butyrate esterase & cysteine aminopeptidase.

73. • Uittto et al. investigated increased collagenase activity in periodontal
patients compared to controls.
Collagenase is one of the important matrix metalloproteinases
responsible for the degradation of connective tissue. Because of its key
role in this process, collagenase in saliva may reflect the status of
periodontal health. .
• Zambon et al. found reduced amounts of leucine, valine, cysteine
aminopeptidases, caprylate esterase lipase, trypsin, beta-galactosidase,
beta-glucoronidase, & beta-glucosidase in whole saliva from chronic
periodontitis patients after periodontal therapy.The propotions of
subgingival black-pigmented bacteriods & motile organisms also
decreased in those patients.

74. •Makela et al. found the concentration of matrix metalloproteinase-9
(MMP-9 or 92 kDa gelatenase ) was significantly higher in whole saliva of
periodontitis patients compared with healthy subjects, & that
periodontal treatment resulted in reduced amounts of those enzymes.
•Hayakawa et al. reported that total TIMP-1 ( tissue inhibitor of
metalloproteinase-1 ) concentration in whole saliva of periodontally
patients was clearly lower than that of clinically healthy subjects.
•Studies have also shown that, the levels of aspartate aminotransferase
(AST) in saliva from patients presenting CPITN code 4 were higher than
from patients coded lower & could be detected by the evaluated
diagnostic system. Periodontal destruction such as periodontal pockets,
gingival bleeding & suppuration seems to be related to higher AST levels.

75. •In periodontal patients we can see the lower levels of lysozyme
concentration & higher levels of Myeloperoxidase ( MPO ).
•Patients with aggressive periodontitis are associated with significantly
elevated antibodies to A.actinomycetemcomitans, P.gingivalis, T.denticola, &
F.nucleatum compared with healthy controls.
•The leukotoxin produced by A.actinomycetemcomitans & proteases produced
by P. gingivalis are examples of factors that are believed to destroy neutrophils
or affect their function in aggressive periodontal patients.

76. Salivary hormones :
•A workshop on the immunoassay of steroids in saliva concluded that, “ All
steroids of diagnostic significance in routine clinical endocrinology can now be
measured in saliva”.
•The list of steroid hormones currently being assayed in saliva includes
cortisol,aldosterone, estriol,testosterone,progesterone etc.
•Salivary estriol measurement during pregnancy has been shown to be an
excellent means of detecting fetal growth retardation & estriol to
progesterone ratio shows promise as a predictor of preterm labor.
•Some investigators have found that salivary cortisol is a better measure of
adrenal cortical function than serum cortisol.

77. RESEARCH APPLICATIONS
Research currently is being conducted to
• saliva as a diagnostic aid for cancer and preterm labor.
• regenerative properties and functions of growth factors found in
saliva, such as EGF, TGF

78. CONCLUSIONS
•Saliva is an alternative to serum as a biological fluid that can be analysed for
diagnostic purposes.
•A number of markers show promise as sensitive measures of the disease &
the effectiveness of therapy.
• Longer - term longitudinal studies , however are required to establish the
relationship between specific markers & progression of periodontal disease.
• Further more, analysis of saliva may offer a cost effective approach to
assessment of periodontal disease in large populations.

79. REFERENCES
1. Clinical Periodontology 10th Edition; Carranza,Newmann.
2. Shafers textbook of oral pathology. 5th Edtn
3. Burkitt’s textboof of oral medicine. 11th edtn
4. Periodontology 2000 volume 34: 2004
5. Tencate’s Oral histology 6th edition
6. J. Clinical Periodontology 2003;30:752-755
7. J. Clinical Periodontology 2000,27:453-465
8. J. Periodontal Research 1990,1983
9. J. Oral Pathology Medicine 1990.
10.Dentomaxillofac Radiol 2007;36:59-62. T Bar, A Zagury, D London, R
Shacham, and O Nahlieli.
11.ImagingCONSULT.com

81. Antibacterial Factors
• Mucins:
 High molecular weight glycoproteins
 Lubricate the oral surfaces
 Exhibit some specificity for complexing oral bacteria,enhancing elimination .
 Help in prevention of dehydration of the oral epithelia, lubrication for solid
food & trapping of microorganisms.

82. • Lactoferrin :
 Derived from serous glands and gingival fluid
 Mediates its antibacterial effects through binding of iron necessary for
bacterial metabolism.
 Inhibition of bacterial adhesion to tooth surfaces.
 Activates phagocytic cells.
 It is effective against actinobacillus species.
• Lysozyme : Derived from the ductal epithelium of the salivary glands.It
provides
1. Muramidase activity ( lysis of peptidoglycan layer)
2.Cationic- dependent activation of bacterial autolysins
4.Inhibition of bacterial adhesion to the tooth surfaces.
5.Inhibition of bacterial glucose uptake & acid production
6.De-chaining of streptococci

83. • Histidine rich proteins ( histatins): Antifungal particularly against the C.
albicans.
• Proline rich proteins exhibit selective binding of certain oral species, which
may be beneficial to blocking more pathogenic species.
• Salivary peroxidase :
1. It acts on substrates in the saliva to form hypothiocyanate ions, which
are toxic to certain bacteria.
2.Inactivation of bacterial glucolytic enzymes
3.Inhibition of bacterial uptake & acid production
4.Inhibition of bacterial transport of aminoacids
5.Damage of bacterial cell wall
6.Inhibition of bacterial adhesion to saliva coated hydroxy apatite.

84. • Lactoperoxidase-thiocyanate system - Bactericidal to lactobacillus &
streptococcus by preventing the accumulation of lysine & glutamic acid,
both of which are essential for bacterial growth.
• Myeloperoxidase : Realeased by leukocytes & is bactericidal for
Actinobacillus & it inhibits attachment of Actinomyces strains to
hydroxyapatite.
• Cystatins ( Cysteine Protinase inhibitors):
 Constitutively secreted in saliva
 CystatinC levels are increased following severe inflammation in
periodontitis

85. • VonEbner glands protein (VEGh):
 Secreted by the Von ebner glands.
 Also known as “ tear specific pre albumin (TSPA)”.
 Belongs to Lipocalin super family
 Acts as an oxidative stress induced scavenger of peroxidation products.
• Immunoglobulins :
 Saliva contains antibodies that are reactive with indigenous oral bacterial
species
 The predominant immunoglobulin is IgA, although IgM & IgG are present.
 IgA antibodies present in parotid saliva can inhibit the attachment of oral
streptococcus species to epithelial cells.

86. Coagulation Factors
• Saliva also contains coagulation factors ( viii, ix, Plasma
Thromboplastin Antecedent, & the Hageman factor) that hasten
blood coagulation & protect wounds from bacterial invasion.
• The presence of an active fibrinolytic enzyme has been suggested.