INTRODUCTION:

Oral diseases ranging from cavities to cancer are all serious threats to oral health. Oral health is an important part of overall health. Research shows there may be a link between oral diseases and other health problems such as diabetes, heart disease and stroke. Threats to oral health such as gum diseases, root cavities, infections and oral cancer can lead to severe pain, loss of teeth and other serious health implications. Periodontal diseases ranges from simple gum inflammation to serious diseases.¹ The primary cause of gingivitis is ineffective oral hygiene, which leads to formation of dental plaque. It later progresses to periodontitis. Periodontitis is an infectious inflammatory disease. Bacteria initiates inflammatory response and alter the diversity of periodontal disease. Saliva, an oral fluid it contain an abundance f proteins and genetic molecules. It is a valuable source, which provides relevant information because it contains biomarkers specific for the unique physiological aspects of periodontal diseases.²it helps in the early detection of the disease for the successful treatment.

PERIODONTAL DISEASES:

Periodontal disease is a chronic disease of the oral cavity which consists of group of inflammatory conditions affecting the supporting structures of the dentition. ³Periodontitis is characterized by pocket formation and/or gingival recession. It is generally accepted that primary causative factor of periodontal disease is the dental plaque biofilm. Endogenous oral bacterial species such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, Streptococcus sobrinus, Bacteroides sp., Prevotella sp., Fusobacterium sp. and their metabolites play major role in the inititation and progression of these infections.⁴ Immunological, microbial, environmental, genetic factors, age, sex and race are risk factors with complex interactions which determine the severity and progression of the disease.

The local host response to periodontal diseases includes⁵

~Recruitment of leucocytes

~Subsequent release of inflammatory mediator

~Pro inflammatory cytokines

~Tumor necrosis factor-alpha induce and enhance production of prostoglandins E2.

SALIVARY BIOMARKERS:

Biomarkers are defined as cellular, biochemical and molecular characteristics by which normal/abnormal processes can be recognized and/or monitored. Salivary markers are non invasive diagnosis of diseases and monitoring of general health. Saliva has been evaluated as a diagnostic fluid for detecting breast cancer, oral cancer, caries risk, salivary gland diseases, periodontitis and systemic disorders such as hepatitis C. Various mediators of chronic inflammation and tissue destruction have been detected in whole saliva of patients with oral diseases. The salivary biomarkers for periodontal diseases included are serum and salivary molecules such as immunoglobulins, enzymes constituents of ginigival crevicular fluid, bacterial components, volatile compounds and phenotypic markers like epithelial keratins.⁶

SALIVARY MARKERS OF PERIODONTITIS:

SPECIFIC MARKERS ⁷

IMMUNOGLOBULINS:

Immunoglobulins are important specific defense factor of saliva. Patients with periodontal disease are shown to have higher salivary concentrations of IgA, IgG and IgM specific to periodontal pathogens. IgA, IgG and IgM influence the oral microbiota by interfering with the bacterial adherence or by inhibiting bacterial metabolism. Periodontitis patients have higher level of IgA and IgG to periodontal pathogens porphyromonas Gingivalis and Treponema denticola.

MMPs:

They are host proteinase . MMP-8 is the most prevelant MMP found in diseased periodontal tissue. It is a key enzyme in extracellular collagen matrix degradation ,derived predominantly from PMNs during acute stage of periodontal disease. MMP-1 also appeared to be activated in periodontitis.

ACID PHOSPHATASE (ACP) and ALKALINE PHOSPHATASE (ALP):

The increase in salivary ALP activity is associated with alveolar bone loss in periodontitis.

NON SPECIFIC MARKERS:

SALIVARY ENZYMES:

LYSOZYME, PEROXIDASE and LACTOFERRIN:

Lysozyme is an antimicrobial enzyme. Low level of lysozyme in saliva are more susceptible to plaque accumulation,which is considered a risk factor for periodontal disease. Peroxidase is a salivary enzyme which removes toxic hydrogen peroxide produced by oral microorganisms and reduces acid production in dental biofilm thereby decreasing plaque accumulation. Lactoferrin, is regulated in mucosal secretions during gingival inflammation and concentration in saliva is high in patients with periodontal disease.

INFLAMMATORY CELLS:

The majority of salivary leukocytes enter the oral cavity via gingival crevice. Klinkhammer standardized collection indicated that orogranulocytic migratory rate indicate the presence of oral inflammation which resulted in increased number of graulocytes in saliva before the appearance of clinical gingivitis.

BACTERIA:

Certain species of bacteria utilize salivary components as a complete nutrient source, which initiated the pathogenesis of periodontal diseases. In periodontal disease the periodontopathic microorganisms present in saliva are A.actinomycetemcomitans, P. gingivalis, Prevotella intermedia and T. denticola.

SALIVARY IONS:

Ca⁺ ions are the potential markers for periodontal disease in saliva. The concentration of Ca⁺ ions are elevated in periodontitis condition which is very characteristic.

LITERATURE REVIEW:

Studies reveal a promising outlook for saliva as a key diagnostic medium for determining systemic diseases or health status of individual. Many considerable research activities on salivary biomarkers were conducted for periodontal diagnosis. Several saliva samples were collected in sterile test tubes from patients suffering from periodontitis. The activities of the following salivary enzymes Asparatate aminotransfarase, Alanine aminotransfarase, Gamma glutamyl transferase, Alkaline phosphatase and Acidic phosphatase were determined spectrophotometrically , with the help of an autoanalyzer. The results obtained showed the increased activity of the examined tissue enzymes in the saliva of the patients with periodontal disease. The study showed increase level of salivary AST, ALT, GGT, ACP and ALP which indicated the pathological changes located in the soft tissue only, primarily in the gingival tissues, which could coincide wih the initial stage of periodontal disease.^8,9

CONCLUSION:

This review of the literature concerning the use of saliva-based oral fluid diagnostics confirms that the salivary enzymes can be considered as biochemical markers for evaluating the diagnosis and prognosis of the functional condition of periodontal tissues in disease and health. Saliva (oral fluid) is a mirror of the body. It could be used to monitor the general health and onset of specific diseases. Salivary biomarkers appear promising for future application to diagnose periodontal diseases thus providing new opportunities in making diagnosis and increasing the effectiveness of periodontal therapy in improving periodontal health.

ACKNOWLADGEMENT:

We thank the authors /editors /reviewers of various journals/ database where the content for the article is taken for compilation.

REFERENCES:

1. Geetha bhat, Praveen Kudva and Vidya Dodwad. Aloe vera: Nature’s soothing healer to periodontal disease. Journal of Indian Society of Periodontology 2011;15(3);205-209.

2. Sextan WM et al. Salivary biomarkers of periodontal disease in response to treatment. J Clin Periodontol. 2011:38(5):434-41.

3. OA Olayanju, SK Rahamon, IO Joseph, OG Arinola. Salivary immunoglobulin classes in Nigerians with Periodontitis. Journal of Contemporary Dental Pratice.2012;13(2)PP 163-166.

4. Mohammad Mehdi Fani and Jamshid Kohanteb. Inhibitory activity of Aloe vera gel on some clinically isolated cariogenic and periodontopathic bacteria. Journal of Oral Science. 2012; 54,(1),15-21.

5 Definition of biomarkers available at -www.slideshare.net/salivary-markers-of-systemic-diseases-ppt.

6. Himanshu Khashu, CS Baifu, Sumidha Rohatgi Bansal , Amit chillar. Salivary biomarkers: A periodontal overview. Journal of oral health and community dentistry,2012;6(1) 28-33.

7. Priti Basgauda Patil and Basgauda Ramesh Patil. Saliva: A diagnostic biomarker of periodontal diseases. Journal of Indian Society of Periodontology 2011;15(4)310-317.

8. Sarita Dabra, Kamalpreet China and Alka Kaushik. Salivary enzymes as diagnostic markers for detection of gingival/periodontal disease and their correlation with the severity of the disease. Journal of Indian Society of Periodontology, 2012 Jul-Sep;16(3):358-3642.

9 Jeffrey J. Kim ,Christine J. Kim and Paulo M. Camargo. Salivary biomarkers in the diagnosis of periodontal diseases. Journal of the California Dental Association. 2013 Feb.; 41(2):119-124.

Received on 30.07.2013 Modified on 15.09.2013

Research J. Pharm. and Tech. 7(1): Jan. 2014; Page 98-100