By Elicia Lupoli, RDH, BSDH s dental professionals, we can see a smile or a laugh and subconsciously complete a clin-ical exam and hone into poten-tial problems. The mouth is the "mirror" of the body’s health. 1 Research, select associations and institutes have embraced the relation-ship of the oral-systemic link and recognized the need for the library of information that saliva can provide, to be accessed to move beyond risk assessment, and advance towards detection of oral and systemic diseases. Evolving from the laborato-ries into clinical settings is the next step for salivary diagnostics. A WHAT IS THE ORAL LIBRARY OF SALIVA? First and foremost, without the National Institutes of Health (NIH), in collaboration with the National Insti-tute of Dental and Craniofacial Research (NIDCR), saliva may still only be significant during its absence. Addi-tionally, because of these foundations, the pioneers of salivary diagnostics were given a chance to demonstrate the potential saliva has to inform us about complete human health. These pioneers include David T.W. Wong, D.M.D., D.M.Sc, Daniel Malamud, Ph.D., MA and Eric Anslyn, Ph.D., to name a few. 2 Salivary diagnostics developed from the study of the "omic" technologies which include: genomics, epigenomics, transcriptomics, proteomics, and metabolomics. Each omic has their own-cataloged library available for free access online. 3 According to Dr. Wong, in an inter-view with Dr. Mike Milligan, salivary diagnostics started to truly mark its territory as a diagnostic biological fluid following two significant events. One event included the research and record-ing of the human salivary proteome, which classified all proteins from the three major salivary glands (The peri-odic table of major salivary glands). The other event was using engineered technologies that allowed researchers point-of-care (POC) discovery, of proteins and genomic biological mark-ers, from saliva. Further findings from human sali-vary analytes were then harnessed and defined into other diagnostics includ-ing: mRNA's (messenger RNA), miRNA's (micro RNA), metabolic compounds and microbes, which today is often referred to as "Salivaomics". Salivaomics is the biologic molecules of saliva 4,5 and also considered an open access database that contains studies from all sali-vaomic research. 6 secretes into the oral cavity, while saliva from the major glands arrives through a more complex process travel-ing through lymph, blood and nerve tissues. This complexity is why the major salivary glands have the ability for use in disease detection. All major salivary glands receive circulation from an artery. The parotid gland receives circulation from the carotid artery, the submandibular gland from the lingual and facial artery, and the sublingual gland receives blood from the sublingual and submental artery. Postganglionic nerve fibers from the parasympathetic (PANS) and sympa-thetic (SANS) nervous system, two branches of the ANS, innervate the sali-vary glands to increase protein secre-tions and volume flow. Blocking ANS innervation is why many medications lead to a reduction in salivary flow rate, which then causes adverse drug reac-tions (ADRs), like Xerostomia. HOW IS SALIVA SIGNIFICANT AS AN ORAL BIOLOGICAL FLUID? Saliva in daily practice often times becomes overlooked for the true potential it holds unless a deficiency is discovered. A number of profession-als still even consider saliva, as well as the oral cavity, a separate entity from the body. Saliva is introduced into the mouth via major salivary glands by certain stimulations, like chewing. This signals innervation of the trigeminal nerve, which then activates a branch of the autonomic nervous system (ANS). Saliva from the minor glands directly HOW IS SALIVA A RELEVANT MEDIUM FOR DIAGNOSTICS? Scientists have found a variety of biomolecules in saliva including: DNA, mRNA, miRNA, protein, metabolites (about 70% of the salivary genome) and microbiota (about 30% of the sali-vary genome). 7 The oral cavity is a known host to all kinds of diseases. The findings of quan-tifying biomarkers through salivary analytics have enabled detection of oral (and systemic) diseases in research, and proven to be an excellent alternative in disease detection rather than relying solely on invasive measures, such as obtaining blood and serum. 8-10 32 Summer 2016 JAOS
Journal of the American Orthodontic Society Summer 2016 / Buyer's Guide: Page 32
