Sialochemistry: a diagnostic tool?

Field effect transistor based wearable biosensors for healthcare monitoring

The rapid advancement of wearable biosensors has revolutionized healthcare monitoring by screening in a non-invasive and continuous manner. Among various sensing techniques, field-effect transistor (FET)-based wearable biosensors attract increasing attention due to their advantages such as label-free detection, fast response, easy operation, and capability of integration. This review explores the innovative developments and applications of FET-based wearable biosensors for healthcare monitoring. Beginning with an introduction to the significance of wearable biosensors, the paper gives an overview of structural and operational principles of FETs, providing insights into their diverse classifications. Next, the paper discusses the fabrication methods, semiconductor surface modification techniques and gate surface functionalization strategies. This background lays the foundation for exploring specific FET-based biosensor designs, including enzyme, antibody and nanobody, aptamer, as well as ion-sensitive membrane sensors. Subsequently, the paper investigates the incorporation of FET-based biosensors in monitoring biomarkers present in physiological fluids such as sweat, tears, saliva, and skin interstitial fluid (ISF). Finally, we address challenges, technical issues, and opportunities related to FET-based biosensor applications. This comprehensive review underscores the transformative potential of FET-based wearable biosensors in healthcare monitoring. By offering a multidimensional perspective on device design, fabrication, functionalization and applications, this paper aims to serve as a valuable resource for researchers in the field of biosensing technology and personalized healthcare.

Fluid-based wearable sensors: a turning point in personalized healthcare

Nowadays, it has become very popular to develop wearable devices that can monitor biomarkers to analyze the health status of the human body more comprehensively and accurately. Wearable sensors, specially designed for home care services, show great promise with their ease of use, especially during pandemic periods. Scientists have conducted many innovative studies on new wearable sensors that can noninvasively and simultaneously monitor biochemical indicators in body fluids for disease prediction, diagnosis, and management. Using noninvasive electrochemical sensors, biomarkers can be detected in tears, saliva, perspiration, and skin interstitial fluid (ISF). In this review, biofluids used for noninvasive wearable sensor detection under four main headings, saliva, sweat, tears, and ISF-based wearable sensors, were examined in detail. This report analyzes nearly 50 recent articles from 2017 to 2023. Based on current research, this review also discusses the evolution of wearable sensors, potential implementation challenges, and future prospects.

Performance of Oral Cavity Sensors: A Systematic Review

Technological advancements are enabling new applications within biomedical engineering. As a connection point between the outer environment and the human system, the oral cavity offers unique opportunities for sensing technologies. This paper systematically reviews the performance of measurement systems tested in the human oral cavity. Performance was defined by metrics related to accuracy and agreement estimation. A comprehensive search identifying human studies that reported on the accuracy or agreement of intraoral sensors found 85 research papers. Most of the literature (62%) was in dentistry, followed by neurology (21%), and physical medicine and rehabilitation (12%). The remaining papers were on internal medicine, obstetrics, and aerospace medicine. Most of the studies applied force or pressure sensors (32%), while optical and image sensors were applied most widely across fields. The main challenges for future adoption include the lack of large human trials, the maturity of emerging technologies (e.g., biochemical sensors), and the absence of standardization of evaluation in specific fields. New research should aim to employ robust performance metrics to evaluate their systems and incorporate real-world evidence as part of the evaluation process. Oral cavity sensors offer the potential for applications in healthcare and wellbeing, but for many technologies, more research is needed.

Optimisation of saliva volumes for lipidomic analysis by nanoflow ultrahigh performance liquid chromatography-tandem mass spectrometry

Saliva is a readily accessible and clinically useful biofluid that can be used to develop disease biomarkers because of a variety of biologically active molecules in it that are also found in blood. However, even though saliva sampling is simple and non-invasive, few studies have investigated the use of salivary lipids as biomarkers, and the extraction of lipids from saliva needs to be examined thoroughly. In the present study, methods (i.e., saliva sample volume, 0.1-1.0 mL) for the extraction and analysis of salivary lipids by nanoflow ultrahigh performance liquid chromatography-tandem mass spectrometry (nUHPLC-ESI-MS/MS) were evaluated according to the matrix effect, extraction recovery, and number of quantifiable lipids. A total of 780 lipids were identified in a pooled saliva sample from 20 healthy volunteers, and 372 lipids without differentiating acyl chain structures were quantified, along with comprehensive information on salivary lipid composition and individual lipid levels. Even though extraction recovery was maintained at saliva sample volumes as low as 0.2 mL, the matrix effect and limit of detection (LOD) were relatively large with 1.0 mL. Considering the matrix effect, LOD, and number of quantifiable lipids (>limit of quantitation), the minimum volume of saliva sufficient for lipidomic analysis using nUHPLC-ESI-MS/MS was determined to be 0.5 mL.

Electron transfer studies of a conventional redox probe in human sweat and saliva bio-mimicking conditions

Modern day hospital treatments aim at developing electrochemical biosensors for early diagnosis of diseases using unconventional human bio-fluids like sweat and saliva by monitoring the electron transfer reactions of target analytes. Such kinds of health care diagnostics primarily avoid the usage of human blood and urine samples. In this context, here we have investigated the electron transfer reaction of a well-known and commonly used redox probe namely, potassium ferro/ferri cyanide by employing artificially simulated bio-mimics of human sweat and saliva as unconventional electrolytes. Typically, electron transfer characteristics of the redox couple, [Fe(CN)₆]^3−/4− are investigated using electrochemical techniques like cyclic voltammetry and electrochemical impedance spectroscopy. Many different kinetic parameters are determined and compared with the conventional system. In addition, such electron transfer reactions have also been studied using a lyotropic liquid crystalline phase comprising of Triton X-100 and water in which the aqueous phase is replaced with either human sweat or saliva bio-mimics. From these studies, we find out the electron transfer reaction of [Fe(CN)₆]^3−/4− redox couple is completely diffusion controlled on both Au and Pt disc shaped electrodes in presence of sweat and saliva bio-mimic solutions. Moreover, the reaction is partially blocked by the presence of lyotropic liquid crystalline phase consisting of sweat and saliva bio-mimics indicating the predominant charge transfer controlled process for the redox probe. However, the rate constant values associated with the electron transfer reaction are drastically reduced in presence of liquid crystalline phase. These studies are essentially carried out to assess the effect of sweat and saliva on the electrochemistry of Fe^2+/3+ redox couple.

Quantification of Bacteria in Mouth-Rinsing Solution for the Diagnosis of Periodontal Disease

This study aimed to evaluate the feasibility of diagnosing periodontitis via the identification of 18 bacterial species in mouth-rinse samples. Patients (n = 110) who underwent dental examinations in the Department of Periodontology at the Veterans Health Service Medical Center between 2018 and 2019 were included. They were divided into healthy and periodontitis groups. The overall number of bacteria, and those of 18 specific bacteria, were determined via real-time polymerase chain reaction in 92 mouth-rinse samples. Differences between groups were evaluated through logistic regression after adjusting for sex, age, and smoking history. There was a significant difference in the prevalence (healthy vs. periodontitis group) of Aggregatibacter actinomycetemcomitans (2.9% vs. 13.5%), Treponema denticola (42.9% vs. 69.2%), and Prevotella nigrescens (80% vs. 2.7%). Levels of Treponema denticola, Prevotella nigrescens, and Streptococcus mitis were significantly associated with severe periodontitis. We demonstrated the feasibility of detecting periopathogenic bacteria in mouth-rinse samples obtained from patients with periodontitis. As we did not comprehensively assess all periopathogenic bacteria, further studies are required to assess the potential of oral-rinsing solutions to indicate oral infection risk and the need to improve oral hygiene, and to serve as a complementary method for periodontal disease diagnosis.

Wearable Biosensors: An Alternative and Practical Approach in Healthcare and Disease Monitoring

With the increasing prevalence of growing population, aging and chronic diseases continuously rising healthcare costs, the healthcare system is undergoing a vital transformation from the traditional hospital-centered system to an individual-centered system. Since the 20th century, wearable sensors are becoming widespread in healthcare and biomedical monitoring systems, empowering continuous measurement of critical biomarkers for monitoring of the diseased condition and health, medical diagnostics and evaluation in biological fluids like saliva, blood, and sweat. Over the past few decades, the developments have been focused on electrochemical and optical biosensors, along with advances with the non-invasive monitoring of biomarkers, bacteria and hormones, etc. Wearable devices have evolved gradually with a mix of multiplexed biosensing, microfluidic sampling and transport systems integrated with flexible materials and body attachments for improved wearability and simplicity. These wearables hold promise and are capable of a higher understanding of the correlations between analyte concentrations within the blood or non-invasive biofluids and feedback to the patient, which is significantly important in timely diagnosis, treatment, and control of medical conditions. However, cohort validation studies and performance evaluation of wearable biosensors are needed to underpin their clinical acceptance. In the present review, we discuss the importance, features, types of wearables, challenges and applications of wearable devices for biological fluids for the prevention of diseased conditions and real-time monitoring of human health. Herein, we summarize the various wearable devices that are developed for healthcare monitoring and their future potential has been discussed in detail.

Flexible potentiometric pH sensors for wearable systems

There is a growing demand for developing wearable sensors that can non-invasively detect the signs of chronic diseases early on to possibly enable self-health management. Among these the flexible and stretchable electrochemical pH sensors are particularly important as the pH levels influence most chemical and biological reactions in materials, life and environmental sciences. In this review, we discuss the most recent developments in wearable electrochemical potentiometric pH sensors, covering the key topics such as (i) suitability of potentiometric pH sensors in wearable systems; (ii) designs of flexible potentiometric pH sensors, which may vary with target applications; (iii) materials for various components of the sensor such as substrates, reference and sensitive electrode; (iv) applications of flexible potentiometric pH sensors, and (v) the challenges relating to flexible potentiometric pH sensors.

Analytical Strategies in Lipidomics for Discovery of Functional Biomarkers from Human Saliva

Human saliva is increasingly being used and validated as a biofluid for diagnosing, monitoring systemic disease status, and predicting disease progression. The discovery of biomarkers in saliva biofluid offers unique opportunities to bypass the invasive procedure of blood sampling by using oral fluids to evaluate the health condition of a patient. Saliva biofluid is clinically relevant since its components can be found in plasma. As salivary lipids are among the most essential cellular components of human saliva, there is great potential for their use as biomarkers. Lipid composition in cells and tissues change in response to physiological changes and normal tissues have a different lipid composition than tissues affected by diseases. Lipid imbalance is closely associated with a number of human lifestyle-related diseases, such as atherosclerosis, diabetes, metabolic syndromes, systemic cancers, neurodegenerative diseases, and infectious diseases. Thus, identification of lipidomic biomarkers or key lipids in different diseases can be used to diagnose diseases and disease state and evaluate response to treatments. However, further research is needed to determine if saliva can be used as a surrogate to serum lipid profiles, given that highly sensitive methods with low limits of detection are needed to discover salivary biomarkers in order to develop reliable diagnostic and disease monitoring salivary tests. Lipidomic methods have greatly advanced in recent years with a constant advance in mass spectrometry (MS) and development of MS detectors with high accuracy and high resolution that are able to determine the elemental composition of many lipids.

Continuous noninvasive glucose monitoring; water as a relevant marker of glucose uptake in vivo

With diabetes set to become the number 3 killer in the Western hemisphere and proportionally growing in other parts of the world, the subject of noninvasive monitoring of glucose dynamics in blood remains a "hot" topic, with the involvement of many groups worldwide. There is a plethora of techniques involved in this academic push, but the so-called multisensor system with an impedance-based core seems to feature increasingly strongly. However, the symmetrical structure of the glucose molecule and its shielding by the smaller dipoles of water would suggest that this option should be less enticing. Yet there is enough phenomenological evidence to suggest that impedance-based methods are truly sensitive to the biophysical effects of glucose variations in the blood. We have been trying to answer this very fundamental conundrum: "Why is impedance or dielectric spectroscopy sensitive to glucose concentration changes in the blood and why can this be done over a very broad frequency band, including microwaves?" The vistas for medical diagnostics are very enticing. There have been a significant number of papers published that look seriously at this problem. In this review, we want to summarize this body of research and the underlying mechanisms and propose a perspective toward utilizing the phenomena. It is our impression that the current world view on the dielectric response of glucose in solution, as outlined below, will support the further evolution and implementation toward practical noninvasive glucose monitoring solutions.

Saliva as a forensic tool

Forensic science is a branch that deals with a wide plethora of areas such as anthropology, migration studies and criminology. Various biological samples have been utilized to assist a scientist towards getting answers to the myriad of questions in the field. Saliva is an easily available source from victim as well as aggressors, parent-child and siblings. Various tests have been devised to aid in identifying salivary sample constituents. This paper deals with the wide utility of saliva as a forensic tool.

An Intra-Oral Optical Sensor for the Real-Time Identification and Assessment of Wine Intake

Saliva has gained considerable attention as a diagnostics alternative to blood analyses. A wide spectrum of salivary compounds is correlated to blood concentrations of biomarkers, providing informative and discriminative data regarding the state of health. Intra-oral detection and assessment of food and beverage intake can be correlated and provides valuable information to forecast the formation and modification of salivary biomarkers. In this context, the present work proposes a novel intra-oral optical fiber sensor, developed around an optical coupler topology, and exemplified on the detection and assessment of wine intake, which is accounted for example for the formation of N^ε-carboxymethyllysine Advanced Glycation End-products. A laboratory proof of concept validates the proposed solution on four white and four red wine samples. The novel optical sensor geometry shows good spectral properties, accounting for selectivity with respect to grape-based soft drinks. This enables intra-oral detection and objective quality assessment of wine. Moreover, its implementation exploits the advantages of fiber-optics sensing and facilitates integration into a mouthguard, holding considerable potential for real-time biomedical applications to investigate Advanced Glycation End-products in the saliva and their connection with consumption of wine, for the evaluation of risk factors in diet-related diseases.

Wearable biosensors for healthcare monitoring

Wearable biosensors are garnering substantial interest due to their potential to provide continuous, real-time physiological information via dynamic, noninvasive measurements of biochemical markers in biofluids, such as sweat, tears, saliva and interstitial fluid. Recent developments have focused on electrochemical and optical biosensors, together with advances in the noninvasive monitoring of biomarkers including metabolites, bacteria and hormones. A combination of multiplexed biosensing, microfluidic sampling and transport systems have been integrated, miniaturized and combined with flexible materials for improved wearability and ease of operation. Although wearable biosensors hold promise, a better understanding of the correlations between analyte concentrations in the blood and noninvasive biofluids is needed to improve reliability. An expanded set of on-body bioaffinity assays and more sensing strategies are needed to make more biomarkers accessible to monitoring. Large-cohort validation studies of wearable biosensor performance will be needed to underpin clinical acceptance. Accurate and reliable real-time sensing of physiological information using wearable biosensor technologies would have a broad impact on our daily lives.

Bio-Integrated Wearable Systems: A Comprehensive Review

Bio-integrated wearable systems can measure a broad range of biophysical, biochemical, and environmental signals to provide critical insights into overall health status and to quantify human performance. Recent advances in material science, chemical analysis techniques, device designs, and assembly methods form the foundations for a uniquely differentiated type of wearable technology, characterized by noninvasive, intimate integration with the soft, curved, time-dynamic surfaces of the body. This review summarizes the latest advances in this emerging field of "bio-integrated" technologies in a comprehensive manner that connects fundamental developments in chemistry, material science, and engineering with sensing technologies that have the potential for widespread deployment and societal benefit in human health care. An introduction to the chemistries and materials for the active components of these systems contextualizes essential design considerations for sensors and associated platforms that appear in following sections. The subsequent content highlights the most advanced biosensors, classified according to their ability to capture biophysical, biochemical, and environmental information. Additional sections feature schemes for electrically powering these sensors and strategies for achieving fully integrated, wireless systems. The review concludes with an overview of key remaining challenges and a summary of opportunities where advances in materials chemistry will be critically important for continued progress.

Could the biomarker levels in saliva help distinguish between healthy implants and implants with peri-implant disease? A systematic review

BACKGROUND

The most accurate data help to minimize possible mistakes on a patient´s evaluation, as more robust findings are necessary to establish a correct diagnosis, prognosis and, consequently, better treatment.

PURPOSE

Could biomarker levels in the saliva help to distinguish between healthy implants and implants with peri-implant disease?

MATERIALS AND METHODS

An electronic database search of Pubmed/MEDLINE, Web of Science, the Cochrane Library, OVID and Scielo was performed. The articles and abstracts identified were considered relevant if they compared cytokine levels in saliva from patients with healthy implants to those in saliva from patients with untreated peri-implantitis.

RESULTS

Lower salivary levels of interleukin 1β were found in healthy implants than in inflamed implants. A significantly positive correlation was found between the salivary levels of IL-6 and peri-implant inflammatory conditions. The salivary concentrations of total antioxidants, urate and ascorbate were higher in healthy implants than in inflamed implants. The data extracted from the 6 studies evaluated in this review revealed heterogeneity in relation to the clinical parameters assessed, implant restoration, bone loss and peri-implant disease definitions.

CONCLUSIONS

There was no clear, developed basis for using any specific biomarker in a clinical setting to distinguish between healthy implants and those with peri implant disease.

Wearable Chemosensors: A Review of Recent Progress

In recent years, there has been growing demand for wearable chemosensors for their important potential applications in mobile and electronic healthcare, patient self-assessment, human motion monitoring, and so on. Innovations in wearable chemosensors are revolutionizing the modern lifestyle, especially the involvement of both doctors and patients in the modern healthcare system. The facile interaction of wearable chemosensors with the human body makes them favorable and convenient tools for the detection and long-term monitoring of the chemical, biological, and physical status of the human body at a low cost with high performance. In this Minireview, we give a brief overview of the recent advances and developments in the field of wearable chemosensors, summarize the basic types of wearable chemosensors, and discuss their main functions and fabrication methods. At the end of this paper, the future development direction of wearable chemosensors is prospected. With continued interest and attention to this field, new exciting progress is expected in the development of innovative wearable chemosensors.

Salivary Protein Roles in Oral Health and as Predictors of Caries Risk

This work describes the current state of research on the potential relationship between protein content in human saliva and dental caries, which remains among the most common oral diseases and causes irreversible damage in the oral cavity. An understanding the whole saliva proteome in the oral cavity could serve as a prerequisite to obtaining insight into the etiology of tooth decay at early stages. To date, however, there is no comprehensive evidence showing that salivary proteins could serve as potential indicators for the early diagnosis of the risk factors causing dental caries. Therefore, proteomics indicates the promising direction of future investigations of such factors, including diagnosis and thus prevention in dental therapy.

Organic Transistor Arrays Integrated with Finger-Powered Microfluidics for Multianalyte Saliva Testing

A compact multianalyte biosensing platform is reported, composed of an organic electrochemical transistor (OECT) microarray integrated with a pumpless "finger-powered" microfluidic, for quantitative screening of glucose, lactate, and cholesterol levels. A biofunctionalization method is designed, which provides selectivity towards specific metabolites as well as minimization of any background interference. In addition, a simple method is developed to facilitate multi-analyte sensing and avoid electrical crosstalk between the different transistors by electrically isolating the individual devices. The resulting biosensing platform, verified using human samples, offers the possibility to be used in easy-to-obtain biofluids with low abundance metabolites, such as saliva. Based on our proposed method, other types of enzymatic biosensors can be integrated into the array to achieve multiplexed, noninvasive, personalized point-of-care diagnostics.

Evaluation of salivary procalcitonin levels in different periodontal diseases

BACKGROUND

The present study aims to investigate the levels of salivary procalcitonin (ProCT) in patients with different periodontal diseases.

METHODS

Seventy-two non-smokers are included in this study: 21 individuals with chronic periodontitis (CP), 14 individuals with generalized aggressive periodontitis (GAgP), 18 individuals with gingivitis (G), and 19 periodontally healthy (H) participants. Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), plaque index, and gingival index (GI), were assessed in all participants. Saliva samples were collected and examined for evaluating ProCT levels.

RESULTS

It was found that the median (interquartile range) salivary ProCT level was lowest in the H group: 0.00 (0.09) ng/mL; followed by the G group: 0.09 (0.11) ng/mL; the CP group: 0.15 (0.29) ng/mL; and highest in the GAgP group 0.28 (0.68) ng/mL. These differences were statistically significant between the H group and the other groups (P <0.05). There were positive correlations between the mean salivary ProCT level and GI, CAL, and PD.

CONCLUSION

According to the present results, ProCT might play a role during periodontal inflammation, and an elevated salivary ProCT level is suggested as a potential biomarker for periodontal diseases.

Non-invasive mouthguard biosensor for continuous salivary monitoring of metabolites

The present work describes the first example of a wearable salivary metabolite biosensor based on the integration of a printable enzymatic electrode on a mouthguard. The new mouthguard enzymatic biosensor, based on an immobilized lactate oxidase and a low potential detection of the peroxide product, exhibits high sensitivity, selectivity and stability using whole human saliva samples. Such non-invasive mouthguard metabolite biosensors could tender useful real-time information regarding a wearer's health, performance and stress level, and thus hold considerable promise for diverse biomedical and fitness applications.

The scientific exploration of saliva in the post-proteomic era: from database back to basic function

The proteome of human saliva can be considered as being essentially completed. Diagnostic markers for a number of diseases have been identified among salivary proteins and peptides, taking advantage of saliva as an easy-to-obtain biological fluid. Yet, the majority of disease markers identified so far are serum components and not intrinsic proteins produced by the salivary glands. Furthermore, despite the fact that saliva is essential for protecting the oral integuments and dentition, little progress has been made in finding risk predictors in the salivary proteome for dental caries or periodontal disease. Since salivary proteins, and in particular the attached glycans, play an important role in interactions with the microbial world, the salivary glycoproteome and other post-translational modifications of salivary proteins need to be studied. Risk markers for microbial diseases, including dental caries, are likely to be discovered among the highly glycosylated major protein species in saliva. This review will attempt to raise new ideas and also point to under-researched areas that may hold promise for future applicability in oral diagnostics and prediction of oral disease.

Alterações sialoquímicas e sialométricas de pacientes com paralisia cerebral: uma revisão de literatura

TEMA: paralisia cerebral e alterações salivares. O paciente com paralisia cerebral é acometido por diversas desordens no Sistema Estomatognático, sendo muitas delas expressas sob a forma de alterações no fluxo e composição salivar. A variação da concentração de constituintes da saliva está diretamente relacionada com sua capacidade tampão, antioxidante, imunológica, digestiva e lubrificante, além de sofrer variações em função da velocidade do fluxo salivar, o qual está intimamente relacionado à eficiência dos estímulos mecânicos e neurais do trato salivar. Alterações na deglutição, da percepção gustativa, do processo de mineralização dos dentes e da propriedade protetora da saliva contra lesões cariosas, infecções e inflamações, freqüentemente observadas em pacientes com paralisia cerebral, podem ser avaliadas pelo exame da saliva. OBJETIVO: realizar uma revisão de literatura relacionando as principais alterações sialométrica e sialoquímica de pacientes com paralisia cerebral e seus efeitos na saúde bucal. CONCLUSÃO: a análise sialométrica e sialoquímica oferece informações extremamente úteis no diagnóstico e no direcionamento do tratamento desses pacientes, e pode ser considerada uma indicadora prática e objetiva dos processos de doença e disfunções.

Thickened saliva after effective management of drooling with botulinum toxin A

AIM

The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections.

METHOD

We enrolled 15 children (11 males and six females; age range 3-17 y, mean age 9 y 10 mo) diagnosed with spastic (n=9) or dyskinetic (n=6) quadriplegic cerebral palsy (CP); Gross Motor Function Classification System level IV or V; and two children with intellectual disability (IQ<70) who experienced moderate to severe drooling. Salivary flow rate and drooling quotient were measured at baseline and at different times after BoNT-A injections up to 24 weeks. The mucin concentration of saliva was analysed before and after BoNT-A treatment.

RESULTS

Both submandibular salivary flow rate (baseline 0.38 mL/min; 24 wks after injection 0.26 mL/min) and drooling quotient (baseline 42.5%; 24 wks 28.80%) were substantially reduced, with a concomitant increase in mucin concentration within 8 weeks after BoNT-A injection (from 0.612 to 1.830 U/mL). The parents of nine children observed thickened saliva. Swallowing and chewing were problematic in seven children. Two of these children needed treatment with mucolytics because of pooling of thickened saliva in the throat.

INTERPRETATION

When making decisions about the use of BoNT-A, the risk of problems with masticatory and swallowing functions as a result of thickening of saliva after BoNT-A treatment should be taken into account.

Diagnostic applications of saliva in dentistry

Background: The use of saliva to identify individuals with disease and to follow the progress of the affected individual has attracted the attention of numerous investigators. Its noninvasive method of collection, simplicity, and cost effectiveness make it a useful tool not only to the general practitioner but also to the pediatric dentist.

Aim: The aim of this paper is to provide the clinician with a comprehensive review of the diagnostic uses of saliva in dentistry.

A Novel Caries Risk Test

A diagnostic test is particularly beneficial if it reveals the level of susceptibility prior to onset of a disease process. In the case of childhood caries, such a diagnostic test affords the opportunity for preventive measures to be implemented before caries begins. Salivary glycoproteins contain a wealth of individually specific oligosaccharide motifs. Depending on microbial compatibilities and individual genotypes, the glycoproteins that form the pellicle coating of teeth may provide attachment sites that foster colonization leading to cariogenesis. Alternatively, certain oligosaccharides, when present in nonpellicle glycoproteins, can interact with planktonic bacteria and lower their ability to interact with the tooth surface. We have found that in young adults the ratio of the two classes of oligosaccharides present in resting saliva exhibits a strong correlation with caries history (DFT: number of decayed and filled teeth). Oligosaccharide moieties associated with the test are quantitated in dried spots of whole saliva on nitrocellulose using commercially available biotinylated lectins with a variety of reporters. A combination of multiple linear regression and neural net analyses were used to develop the algorithms that describe the relationship between oligosaccharide patterns and DFT. During test development several different groups of adults and children have been studied. The correlation algorithms routinely exceed an R(2) (coefficient of determination) of 0.96. When the test is applied to the saliva of children, it yields a projection of their future caries history. Modifying the test result metric to reflect the groups of teeth with caries in young adults, the test identifies those teeth at risk for future caries in children. This test outcome can then be accompanied with suggested specific preventive measures for each tooth group-based risk level.

Evaluation of the use of salivary lead levels as a surrogate of blood lead or plasma lead levels in lead exposed subjects

We conducted a study to evaluate the use of parotid salivary lead (Pb-saliva) levels as a surrogate of the blood lead (Pb-B) or plasma lead levels (Pb-P) to diagnose lead exposure. The relationship between these biomarkers was assessed in a lead exposed population. Pb-saliva and Pb-P were determined by inductively coupled plasma mass spectrometry, while in whole blood lead was determined by graphite furnace atomic absorption spectrometry. We studied 88 adults (31 men and 57 women) from 18 to 60 years old. Pb-saliva levels varied from 0.05 to 4.4 microg/l, with a mean of 0.85 microg/l. Blood lead levels varied from 32.0 to 428.0 microg/l in men (mean 112.3 microg/l) and from 25.0 to 263.0 microg/l (mean 63.5 microg/l) in women. Corresponding Pb-Ps were 0.02-2.50 microg/l (mean 0.77 microg/l) and 0.03-1.6 microg/l (mean 0.42 microg/l) in men and women, respectively. A weak correlation was found between Log Pb-saliva and Log Pb-B (r=0.277, P<0.008), and between Log Pb-saliva and Log Pb-P (r=0.280, P=0.006). The Pb-saliva/Pb-P ratio ranged from 0.20 to 18.0. Age or gender does not affect Pb-saliva levels or Pb-saliva/Pb-P ratio. Taken together, these results suggest that salivary lead may not be used as a biomarker to diagnose lead exposure nor as a surrogate of plasma lead levels at least for low to moderately lead exposed population.

Application of microchip assay system for the measurement of C-reactive protein in human saliva

In the last decade, saliva has been advocated as a non-invasive alternative to blood as a diagnostic fluid. However, use of saliva has been hindered by the inadequate sensitivity of current methods to detect the lower salivary concentrations of many constituents compared to serum. Furthermore, developments in the areas related to lab-on-a-chip systems for saliva-based point of care diagnostics are complicated by the high viscosity and heterogeneous properties associated with this diagnostic fluid. The biomarker C-reactive protein (CRP) is an acute phase reactant and a well-accepted indicator of inflammation. Numerous clinical studies have established elevated serum CRP as a strong, independent risk factor for the development of cardiovascular disease (CVD). CVD has also been associated with oral infections (i.e. periodontal diseases) and there is evidence that systemic CRP may be a link between the two. Clinical measurements of CRP in serum are currently performed with "high sensitivity" CRP (hsCRP) enzyme-linked immunosorbent assay (ELISA) tests that lack the sensitivity for the detection of this important biomarker in saliva. Because measurement of salivary CRP may represent a novel approach for diagnosing and monitoring chronic inflammatory disease, including CVD and periodontal diseases, the objective of this study was to apply an ultra-sensitive microchip assay system for the measurement of CRP in human saliva. Here, we describe this novel lab-on-a-chip system in its first application for the measurement of CRP in saliva and demonstrate its advantages over the traditional ELISA method. The increased sensitivity of the microchip system (10 pg ml(-1) of CRP with 1000-fold dilution of saliva sample) is attributed to its inherent increased signal to noise ratio, resulting from the higher bead surface area available for antigen/antibody interactions and the high stringency washes associated with this approach. Finally, the microchip assay system was utilized in this study to provide direct experimental evidence that chronic periodontal disease may be associated with higher levels of salivary CRP.

Effect of Saliva Composition on Experimental Root Caries

The aim of this study was to determine the effect of saliva composition on caries lesion development independently of the flow rate of unstimulated whole saliva (UWS) and other caries-related variables such as lesion progression time, oral hygiene level, and fluoride exposure. We hypothesized that this could be done by developing experimental root caries under carefully controlled conditions in situ in test subjects with UWS flow rates within a narrow window of normalcy. Fifteen female and 5 male subjects (66 +/- 6 years) were selected for the study according to their UWS flow rates between 0.2 and 0.4 ml/min. All subjects developed experimental root caries lesions during a 62-day period in which UWS as well as stimulated whole saliva (SWS) were repeatedly collected and analysed for flow rate, pH, buffer capacity, inorganic, and organic composition. Caries lesion development was determined by quantitative microradiography. The mean UWS flow rate was 0.30 +/- 0.05 ml/min. Significant negative correlations were obtained between UWS total phosphate concentration and mineral loss (DeltaZ; r(s) = -0.72, p < 0.001) and UWS total protein concentration and DeltaZ (r(s) = -0.70, p < 0.01). SWS and its constituents had only limited or no effect on DeltaZ. Qualitative UWS protein analysis (SDS-PAGE) revealed that subjects with low DeltaZ values had broader and more stained amylase bands than subjects with high DeltaZ values. These findings were confirmed quantitatively by HPLC. We conclude that, within a group of subjects with normal UWS flow rates, the UWS composition was more important for caries lesion development than the SWS composition. Furthermore, high UWS concentrations of phosphate, protein, and amylase were caries-protective.

Electrophoretic analysis of whole saliva and prevalence of dental caries. A study in Mexican dental students

BACKGROUND

Variability in salivary proteins and their posttranslational modifications may play an important role in determining their protective features against dental caries. Knowledge of molecular content of saliva in different populations is important for a better understanding of protective properties of this biological fluid. Aims of this study were to analyze electrophoretic pattern and protein composition in resting human whole saliva (HWS) of a Mexican population and to correlate these data with decayed, missing, and filled teeth (DMFT) index in these subjects.

METHODS

Resting human whole saliva samples were collected from 120 healthy Mexican dental students. Salivary flow rate, protein concentration, and electrophoretic profile analyzed qualitatively by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were correlated with DMFT index. Gels were successively triple-stained with Coomassie brilliant blue R250, periodic acid Schiff (PAS), silver stain, and salivary molecules were scored as absent (-), present (+/-), and high intensity and size (+).

RESULTS

These showed no substantial differences in number of bands between males and females; however, a slight correlation between total protein concentration and sex was found (p <or=0.05). With regard to salivary proteins and DMFT index, subjects with higher DMFT indices presented significant reduction or absence of high-molecular-weight mucin glycoprotein-1 (MG1), low-molecular-weight mucin glycoprotein-2 (MG2), and acidic proline-rich protein-1 (PRP-1), differing from subjects with lower DMFT indices (p <or=0.001).

CONCLUSIONS

This study concludes that genetic phenotypic polymorphism is present in the population studied and has correlations with oral health. We found specific characteristics and individual variability in number, intensity, and apparent molecular weight of band features in this Mexican population. These studies provide the initial step for creating an HWS database in this population.

Flow cytometry as a new method to quantify the cellular content of human saliva and its relation to gingivitis

BACKGROUND

Determining the cellular content of saliva by means of conventional microscopy chamber counting is a very time-consuming and operator-sensitive procedure. This study concentrated on the use of flow cytometry to examine the cellular content of saliva. Erythrocytes, leukocytes, epithelial cells and bacteria were quantified and the results were compared with caries experience and the presence of gingivitis.

METHODS

258 uncentrifuged vortexed paraffin-stimulated saliva samples (112 males and 146 females) were analyzed with the UF-100 flow cytometer. Salivary reference values were established for erythrocyte, leukocyte, epithelial cell and bacterial count. Caries experience (DMF) and the presence of gingivitis were recorded.

RESULTS

Caries experience or caries risk could not be assessed with flow cytometry. However, salivary flow cytometry may be useful in determining an individual's risk for gingivitis: a significant increase in salivary leukocytes was observed in individuals with gingivitis. At a cut-off level of 10(3) leukocytes micro l(-1) saliva, a sensitivity of 76% and a specificity of 45% was obtained. Other analytes were not significantly different between individuals with and without gingivitis.

CONCLUSION

Flow cytometry of paraffin-stimulated human saliva seems a promising diagnostic or predictive tool and further investigations of diseases of the oro-pharyngeal loge, such as tonsillitis and periodontitis, should be carried out in the future.

Saliva as a diagnostic fluid

In the last 10 years, the use of saliva as a diagnostic fluid has become somewhat of a translational research success story. Technologies are now available enabling saliva to be used to diagnose disease and predict disease progression. This review describes some important recent advances in salivary diagnostics and barriers to application and advancement. This review will also stimulate future research activity.

Oral colonization and cariogenicity of Streptococcus gordonii in specific pathogen-free TAN:SPFOM(OM)BR rats consuming starch or sucrose diets

The significance of Streptococcus gordonii in dental caries is undefined, as is that of other alpha-amylase-binding bacteria (ABB) commonly found in the mouth. To clarify the ecological and cariological roles of S. gordonii our specific pathogen-free Osborne-Mendel rats, TAN:SPFOM(OM)BR, were fed either diet 2000 (containing 56% confectioner's sugar, most of which is sucrose) or diet 2000CS (containing 56% cornstarch, in lieu of confectioner's sugar) and inoculated with S. gordonii strains. Uninoculated rats were free of both indigenous mutans streptococci (MS) and ABB, including S. gordonii, as shown by culture on mitis salivarius and blood agars of swabs and sonicates of dentitions after weanlings had consumed these diets for 26 days. ABB were detected by radiochemical assay using [125I]-amylase reactive to alpha-amylase-binding protein characteristic of the surface of S. gordonii and other ABB. No ABB were detected (detection limit < 1 colony-forming units in 10(6) colony-forming units). Thus the TAN:SPFOM(OM)BR colony presents a 'clean animal model' for subsequent study. Consequently, S. gordonii strains Challis or G9B were used to inoculate weanling rat groups consuming either the high-sucrose diet 2000 or the cornstarch diet 2000CS. Two additional groups fed each of these diets remained unioculated. Recoveries of inoculants were tested 12 and 26 days later by oral swabs and sonication of the molars of one hemimandible of each animal, respectively. Uninoculated animals were reconfirmed to be free of ABB and mutans streptococci, but inoculated ones eating diet 2000CS had S. gordonii recoveries of 1-10% or, if eating diet 2000, 10-30% of total colony-farming units in sonicates. There were no statistically significant differences among the inoculated and uninoculated animal groups' caries scores when they ate the cornstarch diet. Lesion scores for sucrose-eating rats were, however, from 2.4-5.1-fold higher than for cornstarch-eating rats, P < 0.001, and were still higher if animals had been inoculated with either Challis (1.41-fold) or G9B (1.64-fold), than if uninoculated, both P < 0.001, so long as the rats ate the sucrose diet. Therefore, TAN:SPFOM(OM)BR rats do not harbour ABB or S. gordonii but can be colonized by S. gordonii. Colonization levels of S. gordonii on the teeth are higher in the presence of high sucrose than with high starch-containing diets. Caries scores are augmented by sucrose compared with starch, and are further augmented by S gordonii colonization. S. gordonii is thus cariologically significant in the presence of sucrose, at least in this rat.

A review of saliva: normal composition, flow, and function

An adequate supply of saliva is critical to the preservation and maintenance of oral tissue. Clinicians often do not value the many benefits of saliva until quantities are decreased. Much is written on the subject of salivary hypofunction, but little attention is paid to normal salivary flow and function. This article is a brief, up-to-date overview of the literature on the basics of normal salivary composition, flow, and function. A review of the literature was conducted using MEDLINE and Healthstar (1944 through 1999); articles were selected for inclusion on the basis of relevance and significance to the clinician.

Saliva and dental plaque

Dental plaque is being redefined as oral biofilm. Diverse overlapping microbial consortia are present on all oral tissues. Biofilms are structured, displaying features like channels and projections. Constituent species switch back and forth between sessile and planktonic phases. Saliva is the medium for planktonic suspension. Several major functions can be defined for saliva in relation to oral biofilm. It serves as a medium for transporting planktonic bacteria within and between mouths. Bacteria in transit may be vulnerable to negative selection. Salivary agglutinins may prevent reattachment to surfaces. Killing by antimicrobial proteins may lead to attachment of dead cells. Salivary proteins form conditioning films on all oral surfaces. This contributes to positive selection for microbial adherence. Saliva carries chemical messengers which allow live adherent cells to sense a critical density of conspecifics. Growth begins, and thick biofilms may become resistant to antimicrobial substances. Salivary macromolecules may be catabolized, but salivary flow also may clear dietary substrates. Salivary proteins act in ways that benefit both host and microbe. All have multiple functions, and many do the same job. They form heterotypic complexes, which may exist in large micelle-like structures. These issues make it useful to compare subjects whose saliva functions differently. We have developed a simultaneous assay for aggregation, killing, live adherence, and dead adherence of oral species. Screening of 149 subjects has defined high killing/low adherence, low killing/high adherence, high killing/high adherence, and low killing/low adherence groups. These will be evaluated for differences in their flora.

Isolation and physical characterization of the MUC7 (MG2) mucin from saliva: evidence for self-association

Saliva contains two major families of mucins (MG1 and MG2); the polypeptide of the smaller of these glycoproteins (MG2) has been assigned as the product of the MUC7 gene. In this study we have devised a rapid two-step procedure that recovers this glycoprotein essentially free of other components and in sufficient quantity to enable physical and self-interaction studies. Raw saliva was solubilized in 4 M guanidinium chloride and thereafter subjected to Sepharose CL-4B chromatography. The MG2-rich fraction was recovered free from the larger MG1 glycoproteins and also smaller proteins/glycoproteins (molecular mass less than 100 kDa). MG2 glycoproteins were finally purified by anion-exchange chromatography on Mono Q. The purity of the preparation was assessed by SDS/PAGE after radiolabelling of the molecules with [14C]acetic anhydride. Peptide mapping, N-terminal sequencing and amino acid analysis verified the polypeptide of the mucins as the MUC7 gene product. The isolated molecules were examined by electron microscopy and appeared as short flexible worm-like structures 30-120 nm in length. The distribution was heterogeneous, containing a major component with number-average and weight-average lengths of 52 and 55 nm respectively and a minor component with number-average and weight-average lengths of 94 and 98 nm respectively. We propose that the two differently sized populations represent monomeric and dimeric species of the mucins. Gel chromatography performed in 0.2 M NaCl indicated the presence of monomers, dimers and tetramers; an average molecular mass for the preparation was 192 kDa. However, in 4 M guanidinium chloride the molecular mass was 158 kDa and a similar molecular mass (155 kDa) was determined for the mucin preparation after reduction. These results suggest that the mucins might self-associate via a protein-mediated interaction. On the basis of the results a model is proposed for the self-association of the MUC7 mucin, which might be important for its biological function.

A possible role for saliva as a diagnostic fluid in patients with chronic pain

OBJECTIVES

The focus of this review was on proteins and peptides found in saliva. Of greatest interest were those neuropeptides relevant to nociception and to the pathogenesis of chronic pain syndromes. An additional goal was to develop a standardized protocol to collect saliva for laboratory assessment.

METHODS

Data were obtained through discussion with experts at the medical schools in San Antonio and Heidelberg and a Medline literature search involving all relevant studies from 1966 to 1997. The literature search was based on the following key terms: saliva, serotonin, neuropeptide, substance P (SP), calcitonin gene-related peptide (CGRP), and nerve growth factor (NGF).

RESULTS

The mean concentration of SP in the saliva of healthy normal controls ranged from 9.6 to 220 pg/mL. Generally, the concentration of SP was approximately three times higher in saliva than in plasma. In a number of painful conditions, particularly tension headache, substantial elevations of salivary SP were found. Mean values for salivary CGRP in healthy controls were approximately 22 pmol/L and were significantly elevated in patients with migraine attacks or cluster headache. There were no data to indicate prior quantitative determination of NGF in human saliva.

CONCLUSIONS

After sampling and processing techniques have been standardized, measurement of neuropeptides in human saliva could provide a valuable tool for study of patients with chronic painful disorders such as rheumatoid arthritis, osteoarthritis, and even fibromyalgia syndrome.

Oral microbial ecology and the role of salivary immunoglobulin A

In the oral cavity, indigenous bacteria are often associated with two major oral diseases, caries and periodontal diseases. These diseases seem to appear following an imbalance in the oral resident microbiota, leading to the emergence of potentially pathogenic bacteria. To define the process involved in caries and periodontal diseases, it is necessary to understand the ecology of the oral cavity and to identify the factors responsible for the transition of the oral microbiota from a commensal to a pathogenic relationship with the host. The regulatory forces influencing the oral ecosystem can be divided into three major categories: host related, microbe related, and external factors. Among host factors, secretory immunoglobulin A (SIgA) constitutes the main specific immune defense mechanism in saliva and may play an important role in the homeostasis of the oral microbiota. Naturally occurring SIgA antibodies that are reactive against a variety of indigenous bacteria are detectable in saliva. These antibodies may control the oral microbiota by reducing the adherence of bacteria to the oral mucosa and teeth. It is thought that protection against bacterial etiologic agents of caries and periodontal diseases could be conferred by the induction of SIgA antibodies via the stimulation of the mucosal immune system. However, elucidation of the role of the SIgA immune system in controlling the oral indigenous microbiota is a prerequisite for the development of effective vaccines against these diseases. The role of SIgA antibodies in the acquisition and the regulation of the indigenous microbiota is still controversial. Our review discusses the importance of SIgA among the multiple factors that control the oral microbiota. It describes the oral ecosystems, the principal factors that may control the oral microbiota, a basic knowledge of the secretory immune system, the biological functions of SIgA, and, finally, experiments related to the role of SIgA in oral microbial ecology.

Human salivary mucin MG1 selectively forms heterotypic complexes with amylase, proline-rich proteins, statherin, and histatins

Heterotypic complexes between the high-molecular-weight mucin MG1 and other salivary proteins in human submandibular/sublingual secretion (HSMSL) could have a significant impact on the biological properties of these proteins in oral fluids in both health and disease. We describe a mild procedure for isolation and purification of native MG1 by gel filtration chromatography on Sepharose CL-2B which does not involve dialysis, lyophilization, use of denaturing agents, or covalent modification. Western blots of native MG1 probed with antibodies against 8 different salivary proteins showed that complexing occurs between MG1 and salivary amylase, proline-rich proteins (PRPs), statherins, and histatins but not MG1, sIgA, secretory component, or cystatins. When native MG1 was placed in 4 M guanidine hydrochloride and chromatographed on Sepharose CL-4B, ELISA measurement of column fractions showed that amylase, PRPs, statherins, and histatins were released. Interestingly, gel filtration resolved the material which eluted into 4 or 5 distinct peaks, suggesting that the released entities were heterotypic complexes. From these studies, the occurrence of at least three different types of complexes between MG1 and other salivary proteins has been identified. Type 1 complexes are dissociated by SDS-PAGE and in 4 M guanidine hydrochloride. Type II complexes are not dissociated under these conditions. Type III complexes are dissociated during SDS-PAGE and by 4 M guanidine hydrochloride, but the released proteins appear to be complexes containing amylase, PRPs, statherins, and histatins. The possible functional role of heterotypic complexes between MG1 and other salivary proteins as a physiologic delivery system, a mechanism for protection against proteolysis, a repository for precursors of the acquired enamel pellicle, and a vehicle for modulation of the viscoelastic and rheological properties of saliva is discussed.

Saliva protein binding to streptococcal layers placed at different oral sites in 48 persons

Preliminary studies of 10 subjects suggested that saliva protein binding to oral bacteria might vary among oral sites. This study investigated saliva protein binding to layers of oral streptococci in an expanded sample of 48 subjects. Those persons were at opposite extremes for unstimulated whole saliva amylase, sIgA, lactoferrin, and lysozyme in an initial screening of 128 individuals. Layers of Streptococcus gordonii Blackburn or Streptococcus oralis 10557 on enamel chips were placed on buccal left and right upper premolars and molars (UL, UR), labial upper central incisors (UC), and lingual lower central incisors (LL). After a 10-minute exposure to saliva, bacterial extracts were assayed for bound amylase, sIgA, lactoferrin, and lysozyme. Those proteins also were quantified in unstimulated whole saliva collected after chip exposure. Both strains bound significantly more amylase at UL and UR, and significantly less at UC. Blackburn bound more amylase than 10557 at all sites. Significantly less sIgA was bound at UC; strain differences for sIgA were inconsistent across sites. Significantly more lactoferrin and lysozyme were bound at LL. There were no strain differences for lactoferrin; 10557 bound significantly more lysozyme at UL and UR. Subjects at opposite extremes for saliva protein concentrations differed for bound amylase and lactoferrin; those differences were smaller than site and strain differences. Bound protein levels were correlated across sites and strains. Correlations between whole saliva and bound proteins were moderate and were most consistent at LL. These findings suggest that saliva protein effects on oral ecology may vary among oral sites.

Does variability in salivary protein concentrations influence oral microbial ecology and oral health?

Salivary protein interactions with oral microbes in vitro include aggregation, adherence, cell-killing, inhibition of metabolism, and nutrition. Such interactions might be expected to influence oral ecology. However, inconsistent results have been obtained from in vivo tests of the hypothesis that quantitative variation in salivary protein concentrations will affect oral disease prevalence. Results may have been influenced by choices made during study design, including saliva source, stimulation status, control for flow rate, and assay methods. Salivary protein concentrations also may be subject to circadian variation. Values for saliva collected at the same time of day tend to remain consistent within subjects, but events such as stress, inflammation, infection, menstruation, or pregnancy may induce short-term changes. Long-term factors such as aging, systemic disease, or medication likewise may influence salivary protein concentrations. Such sources of variation may increase the sample size needed to find statistically significant differences. Clinical studies also must consider factors such as human population variation, strain and species differences in protein-microbe interactions, protein polymorphism, and synergistic or antagonistic interaction between proteins. Salivary proteins may form heterotypic complexes with unique effects, and different proteins may exert redundant effects. Patterns of protein-microbe interaction also may differ between oral sites. Future clinical studies must take those factors into account. Promising approaches might involve meta-analysis or multi-center studies, retrospective and prospective longitudinal designs, short-term measurement of salivary protein effects, and consideration of individual variation in multiple protein effects such as aggregation, adherence, and cell-killing.

Saliva-bacterium interactions in oral microbial ecology

Saliva is thought to have a significant impact on the colonization of microorganisms in the oral cavity. Salivary components may participate in this process by one of four general mechanisms: binding to microorganisms to facilitate their clearance from the oral cavity, serving as receptors in oral pellicles for microbial adhesion to host surfaces, inhibiting microbial growth or mediating microbial killing, and serving as microbial nutritional substrates. This article reviews information pertinent to the molecular interaction of salivary components with bacteria (primarily the oral streptococci and Actinomyces) and explores the implications of these interactions for oral bacterial colonization and dental plaque formation. Knowledge of the molecular mechanisms controlling bacterial colonization of the oral cavity may suggest methods to prevent not only dental plaque formation but also serious medical infections that may follow microbial colonization of the oral cavity.