Sialochemistry; A Diagnostic Tool
lithium, theophylline, tolbutamide,
methotrexate, antibiotics, anticonvulsants, etc.) is becoming a conventional procedure. Oral fluid can be used to detect recent use of illicit drugs. Saliva may be used for monitoring patient compliance with psychiatric medications14 A significant correlation exists between the salivary and serum lithium levels in patients receiving lithium therapy.15 Saliva is also useful for the monitoring of anti-epileptic drugs. Salivary carbamazepine levels showed positive correlation with serum levels. In another study, salivary levels of phenobarbital and phenytoin demonstrated excellent correlations with serum levels of these medications. Salivary theophylline concentration demonstrated correlation with serum concentration of theophylline.17 Saliva may also be used for monitoring levels of anti-cancer drugs. Saliva was found to be a reliable alternative to serum for the monitoring of irinotecan levels18. Salivary ethanol concentration may be used as an index of the blood ethanol concentration, provided that the salivary sample is obtained at least 20 min following ingestion. This will allow for absorption and distribution of alcohol, and prevent a falsely elevated reading due to the oral route of consumption.19 Other recreational drugs that can be identified in saliva are amphetamines, barbiturates, benzodiazepines, cocaine, phencyclidine (PCP), and opioids.20 Saliva can also be used to detect recent marijuana use by means of
Radiommunoassay. Monitoring of salivary albumin can assist in the identification of stomatitis at a pre-clinical stage and enable the chemotherapy dosage to be adjusted or treatment for the stomatitis to be initiated at an early stage.
The diagnostic use of saliva has attracted the attention of numerous investigators because of the noninvasive nature and relative simplicity of collection. Saliva collection also simplifies the diagnostic process in special populations in whom blood drawing is difficult, i.e. individuals with compromised venous access (e.g., injecting drug users), patients with hemophilia and children.
The presence of six enzymes was established in parotid saliva: acid phosphatase, total esterases, cholinesterase, lipase, beta-glucuronidase, and lysozyme. Broth cultures used for this study with whole saliva indicated that all but sulfatase and lysozyme were produced by the oral flora.8
Higher enzyme activities were found in the adult periodontitis patients compared to the healthy controls for alkaline phosphatase, esterase, β-glucuronidase, β-glucosidase, and other aminopeptidases. Saliva from patients with localized juvenile periodontitis contained the highest levels of butyrate esterase and cystiene aminopeptidase12.
Sialochemistry can be expected to reveal the differentiation between normal and abnormal function of the glands, information about gland dysfunction and its impact on the oral environment, clues to homeostatic fluctuations as a result of circulatory, innervatory, or hormonal adjustments. The development of microchips for salivary components offers great possibilities to use oral fluid for point-of-care testing.13
Another fertile area of application for salivary analysis is in laboratory medicine, where determining and monitoring levels of various hormones (cortisol, progesterone, estriol, testosterone etc.) and drugs (diazepam, caffeine, lithium, theophylline, tolbutamide,
methotrexate, antibiotics, anticonvulsants, etc.) is becoming a conventional procedure. Oral fluid can be used to detect recent use of illicit drugs. Saliva may be used for monitoring patient compliance with psychiatric medications14 A significant correlation exists between the salivary and serum lithium levels in patients receiving lithium therapy.15 Saliva is also useful for the monitoring of anti-epileptic drugs. Salivary carbamazepine levels showed positive correlation with serum levels. In another study, salivary levels of phenobarbital and phenytoin demonstrated excellent correlations with serum levels of these medications. Salivary theophylline concentration demonstrated correlation with serum concentration of theophylline.17 Saliva may also be used for monitoring levels of anti-cancer drugs. Saliva was found to be a reliable alternative to serum for the monitoring of irinotecan levels18. Salivary ethanol concentration may be used as an index of the blood ethanol concentration, provided that the salivary sample is obtained at least 20 min following ingestion. This will allow for absorption and distribution of alcohol, and prevent a falsely elevated reading due to the oral route of consumption.19 Other recreational drugs that can be identified in saliva are amphetamines, barbiturates, benzodiazepines, cocaine, phencyclidine (PCP), and opioids.20 Saliva can also be used to detect recent marijuana use by means of
Radiommunoassay. Monitoring of salivary albumin can assist in