public health significance of salive in modern day medicine

1. SEMINAR-2
SALIVA
By Dr.M.S.Bala Vidyadhar

2. CONTENTS
 Introduction
 Historical significance
 Composition & Flow of saliva
 Functions of saliva
 Salivary glands & their significance
 Salivary production/secretion
 Applied anatomy and physiology
 Public Health Significance
 Recent advances in research
 Conclusion
 References
 Previous year question papers

3. INTRODUCTION
 The word SALIVA is derived in early 15th century from Middle
French word salive, from Latin saliva "spittle“.
 Definition: by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous
fluid, consisting of the secretion from the parotid, sublingual, and
submandibular salivary glands and the mucous glands of the oral
cavity; its function is to keep the mucous membrane of the mouth
moist, to lubricate food during mastication, and, in a measure, to
convert starch into maltose, the latter action being effected by a
diastatic enzyme, ptyalin.

4. HISTORICAL SIGNIFICANCE
 Pavlov the Psychologist in his famous experiment discovered
the concept of Classical Conditioning based on stimulation of
salivary production in dogs.

5. GENERAL PROPERTIES
 Volume: 1000 to 1500 mL of saliva is secreted per day and, it is
approximately about 1 ml/ minute.
 Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
 Reaction: Mixed saliva from all the glands is slightly acidic
with pH of 6.35 to 6.85.
 Specific gravity: It ranges between 1.002 and1.012.
 Tonicity: Saliva is hypotonic to plasma.

6. SALIVARY FLOW
 Unstimulated Flow (resting salivary flow―no external
stimulus)
 Typically 0.2 mL – 0.3 mL per minute
 Less than 0.1 mL per minute means the person has hyposalivation
 Stimulated Flow (response to a stimulus, usually taste,
chewing, or medication [eg, at mealtime])
 Typically 1.5 mL – 2 mL per minute
 Less than 0.7 mL per minute is considered hyposalivation.

7.  The average person produces approximately 0.5 L –
1.5 L per day
 Salivary flow peaks in the afternoon
 Salivary flow decreases at night when the parotid gland
shuts down
 There is a difference in the quality between stimulated
and unstimulated saliva

8. COMPOSITION
 Mixed saliva contains 99.5% water and 0.5%solids.

9. CELLULAR COMPOSITION OF SALIVA
The cellular composition consists of:
 Epithelial cells
 Neutrophils
 Lymphocytes
 Bacterial flora

10. IONS AND SALIVARY FLOW
 As saliva passes through the salivary ducts, cations (sodium
and chloride) are reabsorbed into the adjacent blood vessels.
 In exchange, bicarbonates and potassium are transferred from
the blood vessels into the salivary ducts.

12. CHANGES WITH STIMULATION
P, K, duct cell proteins,
immunoglobulins decrease
Ca, Na, Cl, Bicarbonate,
secretory cell proteins increase

13.  Stimulated Salivary Flow
 Saliva passes through the salivary duct very rapidly (a negative
result of fast flow)
 It impedes the exchange of sodium and chloride for potassium
and bicarbonate
 Unstimulated Salivary Flow
 Has a high content of potassium and bicarbonate (a positive
result of slow flow)
 The quality of unstimulated saliva will change when flow
increases because of a stimulus (chewing gum, thinking about
lemons, looking at a food you crave)

14. STIMULATION AND GLAND OUTPUT
Level of stimulation
Low Moderate High
Parotid 25% 35% 44%
Submandibular 62% 53% 44%
Sublingual 5% 4% 4%
Minor 8% 8% 8%

15. FUNCTIONS OF SALIVA
 Saliva is a very essential digestive juice. Since it has many
functions, its absence leads to many inconveniences.

16. PREPARATION OF FOOD FOR SWALLOWING
 When food is taken into the mouth, it is moistened and
dissolved by saliva.
 The mucous membrane of mouth is also moistened by
saliva. It facilitates chewing.
 By the movement of the tongue, the moistened and
masticated food is rolled into a bolus.
 The mucin of saliva lubricates the bolus
and facilitates the swallowing.

17. APPRECIATION OF TASTE
 Taste is a chemical sensation.
 Saliva by its solvent action dissolves the solid food
substances, so that the dissolved substances can stimulate
the taste buds.
 The stimulated taste buds recognize the taste.

18. DIGESTIVE FUNCTION
 Saliva has three digestive enzymes namely,
1. Salivary amylase,
2. Maltase
3. Lingual lipase.

19. CLEANSING AND PROTECTIVE FUNCTIONS
 Due to the constant secretion of saliva, the mouth and
teeth are rinsed and kept free off food debris, shed
epithelial cells and foreign particles.
 In this way, saliva prevents bacterial groawth by
removing materials, which may serve as culture media
for the bacterial growth.

20.  The enzyme lysozyme of saliva kills some bacteria such as
staphylococcus, streptococcus, and brucella .
 The proline-rich proteins and lactoferrin present in saliva
possess antimicrobial property. These proteins also protect the
teeth by stimulating enamel formation.
 Saliva also contains secretory immunoglobulin IgA which has
antibacterial and antiviral actions.
 Mucin present in the saliva protects the mouth by lubricating
the mucous membrane of the mouth.

21. ROLE IN SPEECH
 By moistening and lubricating soft parts of mouth and
lips, saliva helps in speech.
 If the mouth becomes dry, articulation and pronunciation
become difficult.

22. EXCRETORY FUNCTION
 Many substances, both organic and inorganic, are
excreted in saliva.
 It excretes substances like mercury, potassium iodide,
lead, and thiocyanate.
 Saliva also excretes some viruses such as those causing
rabies and mumps.
 In some special conditions, saliva excretes certain
substances, which are not found in saliva under normal
conditions such as glucose in diabetes mellitus.

23.  In certain conditions, some of the normal constituents of
saliva are excreted in large quantities.
 For example, excess urea is excreted in saliva during
nephritis, and excess calcium is excreted during
hyperparathyroidism.

24. CARRIERS FOR BUFFERS & COAGULATION
FACTORS
 Bicarbonate-carbonic acid
 Maintenance of physiologic pH
 Factors VIII, IX and X, PTA; Hageman factor
 Fibrinolytic enzyme

25. REGULATION OF BODY TEMPERATURE
 In dogs and cattle, excessive dripping of saliva during
panting helps in loss of heat and regulation of body
temperature.
 However, in human being sweat glands play major role
in temperature regulation and saliva does not play any
role in this function.

26. REGULATION OF WATER BALANCE
 When the body water content decreases, salivary secretion also
decreases.
 This causes dryness of the mouth and induces thirst.
 When the water is taken, it quenches the thirst and restores the
body water content.

27. SALIVARY SECRETION
 In humans, the saliva is secreted by three pairs of major
(larger) salivary glands and some minor (small) salivary
glands in the oral and pharyngeal mucous membrane.
 The major glands are:
1. Parotid glands
2. Submaxillary or submandibular glands
3. Sublingual glands.

28. PAROTID GLANDS
 Parotid glands are the largest
of all salivary glands situated
at the side of the face just
below and in front of the ear.
 Secretions from these glands
are emptied into the oral
cavity by Stenson's duct that
opens inside the cheek against
the upper second molar tooth

29. SUBMANDIBULAR GLANDS
 Sub maxillary glands or sub
mandibular glands are located in
submaxillary triangle medial to
mandible.
 Saliva from these glands is
emptied into the oral cavity by
Wharton's duct.
 The duct opens at the side of
frenulum of tongue by means of a
small opening on the summit of
papilla called caruncula
sublingualis.

30. SUBLINGUAL GLANDS
 Sublingual glands are the smallest salivary glands situated in the
mucosa at floor of mouth.
 Saliva from these glands is poured into 5-15 small ducts called
ducts of Ravinus.
 These ducts open on small papillae beneath the tongue.
 One of the ducts is larger and it is called Bartholin's duct.
 It drains the anterior part of the gland and opens on caruncula
sublingualis near the opening of submaxillary duct.

32. MINOR SALIVARY GLANDS
 Lingual mucus glands situated in posterior1/3 of the
tongue, behind circumvallate papillae and at the tip and
margins of tongue.
 Lingual serous glands located near circumvallate
papillae and filiform papillae.

33.  Buccal glands present between the mucous membrane
and buccinator muscle. Four to five of these are larger
and situated outside the buccinator around terminal part
of parotid duct. These glands are called molar glands.
 Labial glands situated beneath the mucous membrane
around the orifice of mouth.
 Palatal glands found beneath the mucous membrane of
the soft palate.

35. CLASSIFICATION OF SALIVARY
GLANDS
 Salivary glands are classified into three types based on
the type of secretion:
1. Serous Glands
2. Mucus Glands
3. Mixed Glands

36. SEROUS GLANDS
 This type of gland is predominantly made up of serous
cells.
 These glands secrete thin a watery saliva.
 Parotid glands and lingual serous glands are serous
glands.

37. MUCUS GLANDS
 This type of glands is made up of mainly the mucus
cells.
 These glands secrete thick, viscous saliva with high
mucin content.
 Lingual mucous glands, buccal glands and palatal glands
belong to this type.

39. MIXED GLANDS
 Mixed glands are made up of both serous and mucus
cells.
 Submandibular, sublingual and labial glands are the
mixed glands.

40. STRUCTURE AND DUCT SYSTEM OF
SALIVARY GLANDS
 Salivary glands are made up of acini or alveoli.
 Each acinus is formed by a small group of cells which surround
a central globular cavity.
 The central cavity of each acinus is continuous with the lumen
of the duct.

41.  The fine duct draining each acinus
is called intercalated duct.
 Many intercalated ducts join
together to form intralobular
duct.
 Few intralobular ducts join to
form interlobular ducts, which
unite to form the main duct of the
gland.
 The gland with this type of
structure and duct system is called
racemose type (racemose = bunch
of grapes).

42. REGULATION OF SALIVARY SECRETION
 Salivary secretion is regulated only by nervous
mechanism.
 Autonomic nervous system is involved in the regulatory
function.
 NERVE SUPPLY TO SALIVARY GLANDS:
Salivary glands are supplied by parasympathetic
and sympathetic divisions of autonomic nervous system

43. PARASYMPATHETIC FIBERS
 Parasympathetic Fibers to Submandibular and Sublingual Glands:
 The parasympathetic pre ganglionic fibers to submandibular and
sublingual glands arise from the superior salivatory nucleus situated in
pons.
 After taking origin from this nucleus, the pre ganglionic fibers run
through nervous intermedius of Wrisberg, geniculate ganglion, the motor
fibers of facial nerve, chorda tympani branch of facial nerve and lingual
branch of trigeminal nerve and finally reach the submaxillary ganglion.
 The postganglionic fibers arise from this ganglion and supply the
submandibular and sublingual glands.

45.  Parasympathetic Fibers to Parotid Gland:
 The parasympathetic pre ganglionic fibers to parotid gland arise
from inferior salivatory nucleus situated in the upper part of
medulla oblongata.
 From here, the fibers pass through the tympanic branch of
glosso pharyngeal nerve, tympanic plexus and lesser petrosal
nerve and end in otic ganglion.
 The postganglionic fibers arise from otic ganglion and reach the
parotid gland by passing through the auriculotemporal branch
in mandibular division of trigeminal nerve.

47. FUNCTION OF PARASYMPATHETIC FIBERS
 When the parasympathetic fibers of salivary glands are
stimulated, a large quantity of watery saliva is secreted with
less amount of organic constituents.
 It is because the parasympathetic fibers activate the acinar
cells and dilate the blood vessels of salivary glands.
 The neurotransmitter is acetylcholine.

48. SYMPATHETIC FIBERS
 The sympathetic preganglionic fibers to salivary glands
arise from the lateral horns of first and second thoracic
segments of spinal cord.
 The fibers leave the cord through the anterior nerve roots
and end in superior cervical ganglion of the sympathetic
chain.
 The postganglionic fibers from this ganglion are
distributed to the salivary glands along the nerve plexus
around the arteries supplying the glands.

49. FUNCTION OF SYMPATHETIC FIBERS
 The stimulation of sympathetic fibers causes less
secretion of saliva, which is thick and rich in mucus.
 It is because these fibers activate the acinar cells and
cause vasoconstriction by secreting nor adrenaline.

50. REFLEX REGULATION OF SALIVARY
SECRETION
 Salivary secretion is regulated by nervous mechanism
through reflex action.
 Salivary reflexes are of two types:
1. Unconditioned reflex
2. Conditioned reflex.

51. UNCONDITIONED REFLEX
 Unconditioned reflex is the inborn reflex that is present
since birth.
 It does not need any previous experience.
 This reflex induces salivary secretion when any
substance is placed in the mouth.
 It is due to the stimulation of nerve endings in the
mucous membrane of the oral cavity.

52.  Examples:
1. When food is taken
2. When any unpleasant or unpalatable substance enters
the mouth
3. When the oral cavity is handled with instruments by
dentists.

53. CONDITIONED REFLEX
 Conditioned reflex is the one that is acquired by
experience and it needs previous experience
 Presence of food in the mouth is not necessary to elicit
this reflex.
 The stimulus for this reflex is the sight, smell, hearing or
thought of food.
 It is due to the impulses arising from eyes, nose, ear, etc.

54. EFFECT OF DRUGS AND CHEMICALS
ON SALIVARY SECRETION
 Substances which Increase the Salivary Secretion:
1. Sympathomimetic drugs like adrenaline and ephedrine
2. Parasympathomimetic drugs like acetylcholine,
pilocarpine, muscarine and physostigmine
3. Histamine.

55.  Substances which Decrease the Salivary Secretion:
1. Sympathetic depressants like ergotamine and
Dibenamine
2. Parasympathetic depressants like atropine, and
scopolamine.

56. APPLIED ASPECTS
 HYPOSALIVATION
 Reduction in the secretion of saliva is called hyposalivation.
 It is of two types, namely temporary hyposalivation and
permanent hyposalivation.
Temporary hyposalivation occurs in:
i. Emotional conditions like fear.
ii. Fever.
iii. Dehydration.
Permanent hyposalivation occurs in:
i. Sialolithiasis (obstruction of salivary duct).
ii. Congenital absence or hypoplasia of salivary glands.
iii. Bell palsy (paralysis of facial nerve).

57. HYPERSALIVATION
 The excess secretion of saliva is known as hypersalivation.
 The physiological condition when hypersalivation occurs is
pregnancy.
 Hypersalivation in pathological conditions is called ptyalism,
sialorrhea, sialism or sialosis.

58.  Hypersalivation occurs in the following conditions:
1. Decay of tooth or neoplasm (abnormal new growth or
tumor) in mouth or tongue – due to continuous
irritation of nerve endings in the mouth
2. Disease of esophagus, stomach and intestine
3. Neurological disorders such as mental retardation,
cerebral stroke and parkinsonism
4. Some psychological and psychiatric conditions
5. Nausea and vomiting.

59. ALTERED SALIVARY FLOW IS ALSO
SEEN IN…
1. Xerostomia
2. Drooling
3. Chorda tympani syndrome
4. Paralytic secretion of saliva
5. Augmented secretion of saliva
6. Mumps
7. Sjögren syndrome.
8. Salivary gland disorders

60. XEROSTOMIA
 Xerostomia means dry mouth. It is also called pasties or
cottonmouth. It is due to hyposalivation or absence of salivary
secretion (aptyalism).
 Causes of Xerostomia
1. Dehydration or renal failure.
2. Sjögren syndrome.
3. Radiotherapy.
4. Trauma to salivary gland or their ducts.
5. Side effect of some drugs like antihistamines,
antidepressants, monoamine oxidase inhibitors,
antiparkinsonian drugs and antimuscarinic drugs.
6. Shock.
7. After smoking marijuana (psychoactive compound from the
plant Cannabis).

61. CONTD…
 Xerostomia causes difficulties in mastication, swallowing
and speech.
 It also causes halitosis (bad breath; exhalation of unpleasant
odors).

62. DROOLING
 Uncontrolled flow of saliva outside the mouth is called drooling.
It is often called ptyalism.
 Drooling occurs because of excess production of saliva, in
association with inability to retain saliva within the mouth.
 Drooling occurs in the following conditions:
1. During teeth eruption in children.
2. Upper respiratory tract infection or nasal allergies in children.
3. Difficulty in swallowing.
4. Tonsillitis.
5. Peritonsillar abscess.

63. CHORDA TYMPANI SYNDROME
 Chorda tympani syndrome is the condition characterized by
sweating while eating.
 During trauma or surgical procedure, some of the
parasympathetic nerve fibers to salivary glands may be severed.
 During the regeneration, some of these nerve fibers, which run
along with chorda tympani branch of facial nerve may deviate
and join with the nerve fibers supplying sweat glands.
 When the food is placed in the mouth, salivary secretion is
associated with sweat secretion.

64. PARALYTIC SECRETION OF SALIVA
 When the parasympathetic nerve to salivary gland is cut in
experimental animals, salivary secretion increases for first three
weeks and later diminishes; finally it stops at about sixth week.
 The increased secretion of saliva after cutting the
parasympathetic nerve fibers is called paralytic secretion.
 It is because of hyperactivity of sympathetic nerve fibers to
salivary glands after cutting the parasympathetic fibers.

65.  These hyperactive sympathetic fibers release large amount of
catecholamines, which induce paralytic secretion.
 Moreover, the acinar cells of the salivary glands become
hypersensitive to catecholamines after denervation.
 The paralytic secretion does not occur after the sympathetic
nerve fibers to salivary glands are cut.

66. AUGMENTED SECRETION OF SALIVA
 If the nerves supplying salivary glands are stimulated
twice, the amount of saliva secreted by the second
stimulus is more than the amount secreted by the first
stimulus.
 It is because, the first stimulus increases excitability of
acinar cells, so that when the second stimulus is applied,
the salivary secretion is augmented.

67. MUMPS
 Mumps is the acute viral infection affecting the parotid glands.
 The virus causing this disease is paramyxovirus.
 It is common in children who are not immunized; It occurs in
adults also.
 Features of mumps are puffiness of cheeks (due to swelling of
parotid glands), fever, sore throat and weakness.
 Mumps affects meninges, gonads
and pancreas also.

68. SJÖGREN SYNDROME
 Sjögren syndrome is an autoimmune disorder in which the
immune cells destroy exocrine glands such as lacrimal glands and
salivary glands.
 It is named after Henrik Sjögren who discovered it.
 Common symptoms of this syndrome are dryness of the mouth
due to lack of saliva (xerostomia), persistent cough and dryness of
eyes.
 In some cases, it causes dryness of skin, nose and vagina.
 In severe conditions, the organs like kidneys, lungs, liver,
pancreas, thyroid, blood vessels and brain are affected.

70. PLUNGING RANULA
 Rare form of retention cyst
 May arise from SM/SL SG
 Mucous collects around gland
 Penetrates Mylohyoid muscle to
enter neck
 Soft painless fluctuant dumb-bell
shaped swelling
 Treatment: Surgical excision via
neck.

71. ACUTE SIALADENITIS
 Viral (Mumps)
 Secondary to Bacterial infection
1. More Common
2. Secondary to obstruction
3. Poor capacity to recover
4. Despite control with medication
chronicity follows and requires
surgical excision

72. CHRONIC SIALADENITIS
 Commonly due to obstruction
following stone formation
 80% salivary stones occur in SMSG
 High mucous content
 Acute painful swelling rapidly
precipitated by eating & resolves
within 1-2 hours
 Enlarged bimanually palpable SMG
 Marsuplisation/Excision

73. SIALADENOSIS
 Sialadenosis refers to noninflammatory, often recurrent,
enlargement of the salivary glands, most frequently the
parotids, which is almost always associated with an underlying
systemic disorder.
 Seen in:
1. Diabetes
2. Alcoholism
3. Endocrine disorders
4. Pregnancy
5. Bulimia

74. INVESTIGATIONS
 Sialometry
 Sialography
 Scintigraphy a radioactive tracer is given by vein that is
subsequently taken up by the salivary glands and
gradually eliminated within the salivary fluid
 Sialochemistry
 Ultrasonogram
 Labial or minor salivary gland biopsy

75. MANAGEMENT OF GLAND LESIONS
 Symptomatic treatment.
 From the systemic drug treatment standpoint,
immunosuppressive therapy in the form of
corticosteroids or cytotoxic drugs have proven effective,
in particular when symptoms are severe.
 A drug known as Plaquenil has also proven to be helpful
in some cases with open questions remaining as to the
role of alpha interferon and nonsteroidal anti-
inflammatory drugs.

76. PUBLIC HEALTH SIGNIFICANCE
 The chief Public Health Implications of saliva include
Procedures like :
1. Caries Activity Tests
2. Medium for fluoride supply to protect the teeth
3. As a biomarker for various substances
4. As a screening medium for many diseases and
conditions
5. Preventive indicator for neoplasia,etc.

77. CARIES ACTIVITY / SUSCEPTIBILITY TESTS
 Caries activity tests have been used in dental research for
many years and some tests have been adopted for routine
use in the dental office .
 In all the variety of tests practiced the common factor till
date remains the medium of testing i.e. Saliva.

78. A CARIES ACTIVITY TEST HELPS TO…
 Identify high-risk groups and individuals.
 Determine need for personalized preventive procedures and
motivation of the individual.
 Monitor the effectiveness of oral health education programs by
establishing a baseline level of cariogenic pathogens as a basis
for future evaluation.
 Ensure low caries activity before any restorative procedure.
 Serve as an index of the success of any therapeutic procedures
and also during counselling procedures to improve patient
behavior towards improving caries prevention.

79. EXAMPLES…
 Lactobacillus colony count test by Hadley.
 Colorimetric Snyder test.
 Swab test by Grainger.
 Dip-Slide method for S.mutans count.
 Salivary buffer capacity test.
 Salivary Reductase test.
 Alban test.
 Fosdick calcium dissolution test.

80. MEDIUM FOR FLUORIDE SUPPLY
 Saliva also acts as a carrier for fluoride used in many types of
fluoridation.
 Fluoride is also secreted in saliva.
 Unlike the ions in saliva, the fluoride content (level) is not altered
whether the salivary flow is stimulated or unstimulated.
 Fluoride levels in saliva and plaque are interindividually highly
variable.
 However, no significant difference in bioavailability between NaF
and amine fluoride, in saliva, or in plaque was found.

81. ACTA ODONTOL SCAND. 1997 APR;55(2):84-7
 Salivary fluoride concentration in adults after different
fluoride procedures.
 Seppä L, Salmenkivi S, Hausen H.
 To give advice on the choice of method, the dentist should have
information on how effective different fluoride treatments are in
increasing salivary fluoride concentration.
 To measure the fluoride concentration of saliva after the use of
four different fluoride methods commonly used in the Nordic
countries: F mouthrinse (0.023% F), F toothpaste (1.1% F). F
lozenge (0.25 mg F), and F chewing gum (0.25 mg F).

82. SALIVA AS A BIOMARKER
 A biomarker is defined as a pharmacological or
physiological measurement that is used to predict a toxic
event; a specific molecule in the body, which has a
particular feature that makes it instrumental for measuring
disease progression or the effects of treatment.
 Biomarkers are by definition suitable to develop new
diagnostic tools, alone or in combination with traditional
methods (Brinkman and Wong, 2006).

83.  Collecting saliva is often perceived as being distasteful by
research subjects, as well as clinician researchers.
 It is important to note that most salivary proteomic research has
been done in academic institutes that deal with oral heath, in
particular, dental schools.
 Note also that for several of these studies, the final research goal
is to seek a simple, noninvasive, and relatively inexpensive
diagnostic salivary tool.
 These rationales are perhaps some of the best arguments for
advocating salivary proteomic biomarker discovery research.

84. SALIVA: A DIAGNOSTIC BIOMARKER OF
PERIODONTAL DISEASES
 Priti Basgauda Patil and Basgauda Ramesh Patil
 Saliva, as a mirror of oral and systemic health, is a valuable
source for clinically relevant information because it contains
biomarkers specific for the unique physiologic aspects of
periodontal diseases.
 J Indian Soc Periodontol. 2011 Oct-Dec; 15(4): 310–317.
doi:10.4103/0972-124X.92560

85. SALIVA AS BIOMARKER CONTD…
 Clinical significance of salivary biomarkers in various
malignancies is studied by several investigators.
 They explored for the presence of salivary proteomics and
genomics signatures for breast cancer.
 Identification of the combination of three mRNA biomarkers
(acrosomal vesicle protein 1, ACRV1; DMX like 2,DMXL2
and dolichyl phosphate mannosyltransferase polypeptide 1,
catalytic subunit, DPM1) could differentiate pancreatic
cancer patients from chronic pancreatitis and healthy
individuals.

86.  Salivary transcriptomic biomarkers: At present, the main
strategy to identify salivary transcriptomic biomarkers is
through microarray technology.
 Cytokines , which include the interferons, tumour necrosis
factor, and the interleukins, are a burgeoning and diverse
family of peptide cell regulators
 Salivary biomarkers in oral cancer:
The prior salivary transcriptomic studies have discovered 7
OSCC-associated salivary RNAs (IL-8, SAT, IL-1B, OAZ1,
H3F3A, DUSP,S100P).

87. AS A SCREENING MEDIUM
 Serum components of
saliva are derived
primarily from the local
vasculature that
originates from the
carotid arteries.
 Saliva has a prodigious
fluid source that provides
many, if not most, of the
same molecules found in
the systemic circulation.
 This makes saliva a
potentially valuable fluid
for the diagnosis of
various systemic
diseases.

88. THE USE OF SALIVA FOR VIRAL DIAGNOSIS
AND SCREENING
 Diagnostics that involve the use of oral fluids have become
increasingly available commercially in recent years and are of
particular interest because of their relative ease of use, low cost
and non-invasive collection of oral fluid for testing.
 HIV, Hepatitis C virus (HCV) and HPV because these three
major viruses are responsible for a series of worldwide epidemics
that have had an enormous effect on morbidity and mortality.
 Most people now understand the impact and risk of HIV infection,
but the risk and sequelae of HPV and HCV infections are much
less recognized

89.  Neonatal screening for congenital cytomegalovirus
infection by detection of virus in saliva.
 Balcarek KB, Warren W, Smith RJ, Lyon MD, Pass RF.
 Screening saliva of newborns for CMV appears to be at
least as sensitive a method for detecting congenital
infection, as detection of virus in saliva can be collected
with less difficulty and expense than urine.

90. SALIVA DRUG TESTING/ORAL FLUID-BASED
DRUG SCREEN
 Detection in saliva tests begins almost immediately upon use of the
following substances, and lasts for approximately the following times:
Alcohol: 6-12 h
Marijuana: 1-24h
 A disadvantage of saliva based drug testing is that it is not approved
by FDA or SAMHSA for use with DOT / Federal Mandated Drug
Testing.
 Oral fluid is not considered a bio-hazard unless there is visible blood;
however, it should be treated with care.
 Many of the most commonly abused drugs can be detected in saliva
including marijuana, THC, heroin, cocaine and amphetamines

91. SAFER SCREENING FOR EBOLA VIRUS BY
TESTING SALIVA
 Ceres Nanosciences in December 2014 announced the
commencement of a development program, funded by the Gates
Foundation, to use Ceres’ Nano trap particle technology to develop
a new method of detecting the presence of the Ebola virus in saliva.
 The effective detection of Ebola, using a noninvasive sample
collection method, such as saliva collection, coupled with a highly
sensitive diagnostic test, all enabled by Nanotrap particle
technology, presents a very compelling solution for rapid
identification of infected individuals at an earlier stage of infection

92. CONCLUSION

93. REFERENCES
 Essentials of Medical Physiology by Sembulingam.
 Textbook of Physiology by Guyton and Hall.
 Preventive and Community Dentistry by Soben Peter.
 Textbook of biostatistics by Vishweswara Rao.
 Salivary Biomarkers – A Review by Sharmila Devi
Devaraj
 Wikipedia
 http://jpsr.pharmainfo.in/Documents/Volumes/vol5issue10/j
psr05101306.pdf
 http://www.ncbi.nlm.nih.gov/pubmed/9176654

94. REFERENCES CONTD…
 Neonatal screening for congenital cytomegalovirus infection by
detection of virus in saliva. Balcarek KB, Warren W, Smith
RJ, Lyon MD, Pass RF.
 Acta Odontol Scand. 1997 Apr;55(2):84-7. Salivary fluoride
concentration in adults after different fluoride procedures. Seppä
L, Salmenkivi S, Hausen H.
 Detecting viruses by using salivary diagnostics Paul L.A.M.
Corstjens, PhD; William R. Abrams, PhD; Daniel Malamud,
PhD
 Medical Dictionary Copyright © 2006 Lippincott Williams &
Wilkins

95. PREVIOUS YEAR QUESTIONS
 Saliva in health, RGUHS; April 2013 (10 mks)
 Saliva in health and disease; Sumandeep Vidyapeeth; April
2012 (20 mks)
 Saliva and oral Health ; RGUHS ; April 2011 (10 mks)
 Saliva and importance in Health; Manipal University; April
2010. (10mks)

96. QUESTIONS
 Statistical tests where both normal and non-normallly distributed
populations can be compared?
 Non Parametric tests are used to assume populations of non
normality.
 Every parametric statistical test has a non-parametric substitute.
 Kruskal–Wallis test instead of a one-way ANOVA
 Wilcoxon signed-rank test instead of a paired t–test
 Spearman rank correlation instead of linear regression/correlation.

97. QUANTILE-QUANTILE PLOT(QQ PLOT)
 The quantile-quantile (q-q) plot is a graphical technique for
determining if two data sets come from populations with a
common distribution.
 A q-q plot is a plot of the quantiles of the first data set against
the quantiles of the second data set.
 By a quantile, we mean the fraction (or percent) of points
below the given value. That is, the 0.3 (or 30%) quantile is the
point at which 30% percent of the data fall below and 70% fall
above that value.

98.  The advantages of the q-q plot are:
1. The sample sizes do not need to be equal.
2. Many distributional aspects can be simultaneously tested.
 For example, shifts in location, shifts in scale, changes in
symmetry, and the presence of outliers can all be detected
from this plot.
 For example, if the two data sets come from populations
whose distributions differ only by a shift in location, the
points should lie along a straight line that is displaced
either up or down from the 45-degree reference line.

99.  This q-q plot shows that:
 These 2 batches do not
appear to have come from
populations with a
common distribution.
 The batch 1 values are
significantly higher than
the corresponding batch 2
values.
 The differences are
increasing from values
525 to 625. Then the
values for the 2 batches
get closer again.

100. GAMMA DISTRIBUTION
 The gamma distribution is a two-parameter family of continuous
probability distributions.
 The common exponential distribution and chi-squared
distribution are special cases of the gamma distribution.
 There are three different parametrizations in common use:
1. With a shape parameter k and a scale parameter θ.
2. With a shape parameter α = k and an inverse scale parameter
β = 1/θ, called a rate parameter.
3. With a shape parameter k and a mean parameter μ = k/β.
 Both parameters are positive real numbers.