Sialochemistry: a diagnostic tool?

Saliva has proven to be a discriminating element in forensic arenas, an effective indicator of acute diseases of salivary glands, and a promising probe for drug monitoring. With the advent of sensitive immunochemical assays, the compositional profile of human salivary secretions has been expanded considerably. Thus, the establishment of a range of "normal values" for a variety of "intrinsic" and "extrinsic" salivary components represented the initial step to use saliva as a diagnostic tool of oral health status. Unfortunately, numerous cross-sectional studies have shown a wide individual variation in the salivary composition of healthy populations, thus precluding its use as a diagnostic chair-side test for the screening of the most common chronic oral diseases (e.g. caries and periodontal disease). A possible explanation may arise from the wide functional versatility of salivary molecules. For instance, it has been recognized recently that in addition to its digestive properties, salivary amylase may modulate bacterial colonization, whereas histatins are not only antifungal but also bactericidal. Thus, low levels of already known antimicrobial salivary molecules (e.g., secretory IgA, lactoferrin, and lysozyme) could be compensated with higher concentrations of other molecules with antimicrobial activity, such as amylase and histatins. Consequently, for caries and periodontal diseases, longitudinal sialochemical studies may yield more insight than cross-sectional studies.