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SALIVA: THE SIGNIFICANCE FOR THE ORGANS AND TISSUES IN THE ORAL
CAVITY IN HEALTH AND DISEASE
Abdullaeva Parizoda Rustamovna
Numonova Dilnoza Ulug`bek kizi
Akhmedov Dilshod Khabibulloevich
Ilkhomjonova Sevara Tulkinovna
Department of Biological Chemistry, Samarkand State Medical University
https://doi.org/10.5281/zenodo.14842468
Annotation.
Saliva plays an important role in oral health regulation and salivary
diagnostics is now entering to the modern dentistry. In modern medical literature there are
many papers on methods of diagnosis of general diseases by analyzing the mineral
composition and properties of saliva. Some properties of saliva are sensitive indicators of
serious systemic disorders and conditions of the div. The article contains data on the saliva
of children with different somatic diseases.
Key words:
saliva, reduction of salivary secretion, mineralizing properties of saliva,
dental status, systemic disorders.
Saliva is a complex biological fluid, which is a complex secretion of the major and minor
salivary glands. Being a physiological "external" environment for the teeth and the mucous
membrane of the oral cavity, saliva provides lubrication of the organs and tissues of the
mouth, moistens dry food, participates in the digestive process, performs trophic and
protective functions [44]. This small-volume secretion plays a vital role in maintaining the
normal functioning of all organs and tissues of the oral cavity.
Oral fluid consists of mixed saliva and organic impurities. Mixed saliva consists of the
total secretion of the parotid, submandibular and sublingual salivary glands, as well as small
salivary glands of the tongue, floor of the mouth and palate. Organic impurities are
represented by microbial, epithelial cells, serum components, blood cells, food debris, etc.
Oral fluid is 99% water and only 1% mineral and organic substances, which determine its
unique properties and functions. Impaired salivation can negatively affect the patient's quality
of life. Adequate knowledge of saliva and its role in ensuring oral health is necessary for
dentists to promptly identify and treat possible deviations from the norm.
As Claude Bernard noted, we recognize the functions of an organ by identifying the
consequences of its absence. The important role of saliva is best demonstrated in those
patients in whom salivary secretion does not actually enter the oral cavity. Hyposalivation and
xerostomia are increasingly common in the population of developed countries, where the
average life expectancy is higher. Decreased salivary secretion is observed in Sjogren's
syndrome, diabetes mellitus, in the condition after radiotherapy of the head and neck, in the
treatment of oncological diseases, with a decrease in the chewing function, and mental
disorders [48,49].
Hyposalivation entails a decrease in the cleansing ability of saliva, a deterioration in its
antimicrobial, buffering, and remineralizing functions, and, as a consequence, a decrease in its
caries-protective properties. The less saliva is secreted, the lower its buffering capacity and
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the longer the pH value of the biological film remains in the acidic region after each meal. This
significantly increases the risk of developing caries [42].
Clinical review
The condition of tooth enamel is largely determined by the characteristics of oral fluid.
The period of enamel maturation after tooth eruption is the most important stage in the
formation of its resistance or caries susceptibility [26]. Oral fluid plays a vital role in
maintaining the physiological balance of de- and remineralization processes. Enamel and
dentin do not dissolve in saliva because it is supersaturated with calcium, phosphate and
hydroxyl ions. These ions are the basis of apatite, from which enamel prisms are built. The
degree of mineral supersaturation is even higher in dental plaque, especially in the
extracellular liquid phase, which is in direct contact with the tooth surface. In the dynamic
equilibrium of the exchange process, the supersaturation of saliva provides a barrier to
demineralization and is the driving force of remineralization. The supersaturated state of
saliva is overcome only when the pH of dental plaque falls below a critical value [16].
The pH of dental plaque decreases mainly after the consumption of sugars. Saliva, in
turn, acts as a buffer due to the phosphates, bicarbonates and proteins it contains,
neutralizing the effect of acids on the tooth. It has been found that stimulated saliva has a
higher pH value compared to unstimulated saliva [35]. In unstimulated saliva, the bicarbonate
level is low, whereas with an increase in the rate of salivary secretion, the bicarbonate
concentration and the buffering capacity of saliva increase significantly. The average pH of
unstimulated saliva is 6.75 (from 6.2 to 7.4) [32, 39]. At a very low secretion rate, the pH can
drop to 5.3, and at a high rate, it rises to 7.8. The pH value of saliva changes during the day: in
the morning, the indicator is significantly lower than in the middle of the day, increases in the
evening, and then decreases again during sleep. The indicator also changes in connection with
food intake: the pH increases during meals due to an increase in the rate of salivation and
decreases after eating. The average pH value is restored after 1-2 hours. An increase in the pH
of saliva is observed after chewing cheese, nuts, other alkalizing products, as well as sugar-
free chewing gum [5]. In children who underwent endogenous fluoride prophylaxis, a reliable
increase in the pH of saliva was observed [29]. A number of studies have established a close
relationship between “acidic” pH (below 6.9) and high intensity of dental caries. In this
regard, it is recommended to conduct pH-metry for all patients for an informed choice of
individual oral hygiene products and filling materials [2].
In childhood, the composition and properties of saliva have their own differences. The
concentration of calcium ions in both stimulated and unstimulated saliva in children is
significantly lower than in adults (0.28/0.31 and 0.48/0.53 mmol/l, respectively), and the
critical pH value of saliva is significantly higher compared to those (6.27/6.19 and 6.07/5.97,
respectively). Consequently, in childhood, enamel demineralization processes begin at higher
pH values. Due to the larger volume of stimulated saliva, the restoration of the acid-base
balance after its decrease to a critical level occurs faster in adults than in children [33].
Therefore, children are at greater risk of demineralization of tooth enamel than adults.
In adolescents of pubertal age, a relatively high percentage of ionized calcium and a low
concentration of inorganic phosphorus are determined in unstimulated saliva. This fact
indicates a violation of the remineralizing properties of saliva in adolescents aged 12-14 years
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and can be regarded as a variant of adaptation of the salivary glands to the phenomena of
“physiological dysharmonosis” [16].
The crystal-forming properties of saliva are largely determined by the somatic state of
the individual’s div. [15, 18] A number of works by domestic and foreign authors are
devoted to the study of saliva micro crystallization in various somatic pathologies. In the
study by N.A. Zabelina (2001) found that the average MPS values in children with atopic
dermatitis or childhood eczema were significantly lower in all age groups compared to
healthy children [12]. According to the author, the underlying disease caused changes in oral
homeostasis and contributed to the development of dental caries.
A decrease in the mineralizing properties of oral fluid was found in children with
rheumatoid arthritis [27]. In the study by A.F. Khamzina (2008), a reliable correlation was
found between the crystal-forming function of saliva and the level of psychophysiological
personality traits in adolescents aged 15-18 years [28]. Thus, negative changes in the
crystallograms of oral fluid were observed in individuals with certain personality
deformations.
A decrease in the mineralizing potential of mixed saliva is also observed in patients with
thyroid pathology, in which the content of inorganic calcium, phosphorus, and pH values of
the environment decrease. These indicators are restored only after complex remineralizing
therapy, which ensures a stable increase in the concentration of mineral components of mixed
saliva and pH of the environment [9]. According to Klenovskaya M.I. (2001), a decrease in the
mineralizing capacity of oral fluid was found in children operated on for thyroid cancer (TC),
regardless of the method of oncotherapy. The average value of MPS in the group of sick
children was 1.91±0.05, which is significantly lower than in practically healthy children in two
comparison groups (2.75±0.19 and 3.1±0.21). In children operated on for thyroid cancer, a
decrease in salivation and an increase in the viscosity of oral fluid were also found compared
to similar indicators in their healthy peers [14].
Another important indicator of the mineralizing function of saliva is the value of its
microcrystallization. As a result of a comparative assessment of the microcrystallization
indices of three biological fluids (blood serum, oral fluid, urine) of experimental animals and
humans, experts came to the conclusion that saliva microcrystallization (SMC) is a general
indicator of the div's homeostasis, which can be used both to assess the effectiveness of
preventive, therapeutic and rehabilitation measures, and to predict the course of diseases
[10].
Depending on the nature of the pattern on the glass after the saliva drop dries, three
types of microcrystallization are distinguished. The first type of SMC is characterized by the
presence of elongated, prismatic crystalline structures, often with a radial orientation. The
second type of microcrystallization looks like isometrically located crystals, without a clear
orientation. The third type is scattered small, single, unoriented crystals [10]. There are a
number of studies proving the connection of this indicator with the intensity of the carious
process in both children and adults [22,23,25].
It has been established that with a compensated course of dental caries in children, the
second type of MCS predominates (74%), the first type is much less common. In children with
a decompensated course of the carious process, the third type of MCS predominates [25].
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After carrying out complex measures: sanitation, professional oral hygiene and oral hygiene
training - the ratio of MCS values changes to types I and II, respectively. However, the
obtained positive results are observed for a short time: when re-examined a month later, the
values of saliva microcrystallization return to the initial level, which may indicate the formed
constancy of the saliva composition, as well as the insufficiency of only measures to improve
the hygienic condition of the oral cavity to enhance the remineralizing function of oral fluid.
Significant changes in the properties of oral fluid are noted in children suffering from
cystic fibrosis [24]. In this group of patients, with an increase in the severity of the disease, the
viscosity of mixed saliva increases and the rate of salivation decreases, which can provoke the
accumulation of plaque. The severity of changes in these indicators reaches a maximum in
severe cases.
Similar changes in the properties of saliva were found in patients with Prader-Willi
syndrome [45]. However, despite the decrease in the amount of saliva secreted and its
increased viscosity, in people suffering from this genetic disease, an increase in the intensity
of dental caries has not been established. Nevertheless, the gingival index in patients with
Prader-Willi syndrome is higher than in the control group.
Changes in the properties of saliva have been identified in children with Down
syndrome [30]. In this group of patients, the oral environment is more acidic than in their
healthy peers. Researchers suggest that trisomy of Down syndrome has similar
manifestations in the properties of the secretion of the salivary glands.
In modern medical literature, there are many works devoted to methods of diagnosing
common diseases by analyzing the mineral composition and properties of saliva. The study of
saliva for many clinical and biochemical indicators has advantages over laboratory
diagnostics of blood. Unlike blood, saliva is an easily accessible biological fluid, its protein
composition is largely identical to blood serum, and is physiologically associated with
homeostasis. Saliva is collected without invasive interventions, and it can be widely used in
hygienic, toxicological, and immunological studies [10, 17].
Moreover, some saliva parameters are sensitive indicators of serious systemic diseases
and conditions of the div. Even short-term and minor chemical and metabolic disorders in
the div, accompanying general somatic pathological conditions, are capable of changing the
rheological properties of saliva [1,4, 10].
According to a number of authors, the salivary glands accurately reflect the state of the
excretory system [7,11]. One of the main signs of kidney pathology, based on the toxic-allergic
nature of the violation of protein and water-salt metabolism, are changes in protein
metabolism and disturbances of the mineral balance. Profound changes occur in the
composition and properties of saliva in diseases of the gastrointestinal tract, pancreas, rickets,
etc., which are manifested in a violation of the crystal-forming function of saliva [3,4,25].
Based on the dynamics of some indicators of saliva, one can judge the occurrence of a
number of diseases of the gastrointestinal tract [6]. Thus, against the background of a
decrease in the pH of mixed saliva, an increase in the number of colonies of opportunistic
microbes in the oral cavity (Leptotrichia buccalis, Fusobacterium spp., Candida spp.) and on
the gastric mucosa was revealed, which, in turn, reduce the protective functions of the entire
div [19].
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Numerous literary data indicate the impact of psycho-emotional states on the content of
individual biochemical components in saliva. Thus, the concentration of cortisol in the saliva
of children correlates with their behavioral reactions [36], the level of testosterone in the
saliva of children - with their learning ability [46]. A certain relationship is observed between
psychological stress and the level of cortisol [38], as well as between some depressive states
and the level of testosterone [47]. Fluctuations in secretory IgA have been reported against
the background of negative emotions [40].
The number of publications devoted to the study of saliva is growing every year.
Undoubtedly, the secretion of the salivary gland is one of the most promising objects for
research. Saliva is the only biological fluid with a unique set of research possibilities,
providing for complete non-invasiveness, multiple and almost unlimited in volume collection
of material. Unfortunately, the mechanism regulating the maintenance of a certain
composition of saliva still remains unclear. The main attention of clinical specialists is
attracted by new laboratory methods of saliva analysis in order to obtain a variety of
diagnostic information. In the next few years, achievements in the field of diagnostics of
diseases of the maxillofacial region are predicted taking into account the properties of saliva
[37].
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