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NORMAL FLORA IN THE ORAL Normal microflora = endogenous flora...

NORMAL FLORA IN THE ORAL Normal microflora = endogenous flora CHARACTERISTIC DAFTAR PENYUSUN & PENGAJAR CAVITY = Normal microbiota 1. - No harm / Non pathogen (Comensal) - Some : opportunistic pathogen they may cause disease if their Sidarningsih, drg, M.Kes (Penyusun) environmenal condition change, Prof. Dr. Retno Indrawati, drg, M.Si are the microorganisms that live on another Prof. Dr. Indah Listiana Kriswandini, drg, M.Kes living organism (human or animal) or inanimate 2. - symbiotic relationship with the host - is acquired at birth, Prof. Dr. Rini Devijanti, drg, M.Kes Prof. Dr. M. Luthfi, drg, M.Kes object without causing disease 3. Habitat : localized in certain regions of the body, stay and colonize Prof. Dr. Ira Arundina, drg, M.Si Population of microorganism that inhibit the skin When leave their habitat, they can cause disease Prof. Dr. Hendrik Setia Budi, drg, M.Kes Dr. Indeswati Diyatri, drg, M.S or mucous membran of healhty normal person → Behave pathogen if in other location Dr. Pratiwi Soesilawati, drg, M.Kes The microorganism of normal flora grow in or on 4. Some, produce useful substance such as vitamin K and some B vitamins as nutrition in intestine Dr. Anis Irmawati, drg, M.Kes Dr. Christian Khoswanto, drg., M.Kes the body without producing obvious harmful Tantiana, drg, M.Kes effect on the host. 5. Local immunity toward pathogen. Endogenous microbiota is an important component of the innate host defence system , Aqsa Sjuhada Oki, drg, M.Kes prevent pathogen from colonizing the host by : Yuliati, drg, M.Kes - Compete for nutrition and receptor with exogenous microorganis - Producing antimicrobial substances to the pathogens : such as : bacteriocin, fatty acid, peroxide pH and oxygen availibility. - Antibody toward microbiota cross reaction with pathogen Most of normal flora are bacteria ORAL MICROFLORA Origin of Oral Microflora Microbe in the oral cavity Several bacteria are localize NORMAL FLORA IN ORAL CAVITY in one or more body region. The number of organism - RESIDENT MICROFLORA. Stay in certain location Habitat : - hard tissue. Normal flora - Soft tissue A new bone babys have no bacteria in their mouths. The -TRANSIENT MICROFLORA. Temporaly….. hour/days microflora present in our mouth is aquired from birth if resident ↓ → transient ↑ → cause disease teeth The present of nutrients, epithelial debris, secretion makes the mouth have favourable habitat In overtime, the oral cavity becomes colonized by the strain of for a great variety of bacteria bacteria that eventualy form the resident microflora, wich the flour Gingiva of the establish a permanent population in the mouth mouth Many organism can be found in the oral cavity, aerobic and an aerobic bacteria, even some fungi, viruses and protozoas There are over 700 species member. microflora Overtime is the individuals is further expose to external sources, Community of these microorganism coexisting in the oral cavity as its primary habitat palatum tongue the biodiversity of oral cavity increases, to a point where stability Difference strains of bacteria colonize the various different surface , and communicate each is reached term Climax community Buccal & other. vestibular mucous Poor dental hygiene help bacteria to grow and cause dental caries and periodontitis The body’s defences play a role in maintaining balance and ensuring healthty oral environment Ecology and developmental stages Tooth eruption O2 consumption Creating anaerobic FACTORS AFFECTING ORAL MICROBIAL COLONIZATION Denture wearing Microbial Food chains the mouth possesses a variety of Antimicrobial agent succession other surface : buccal and vestibular provide environment, In healthy oral environment ,oral microflora minutely changing, but the with microflora Receptor exposure – Birth: sterile. Contaminated with for attachment mucosa, hard palate, tongue and the unique habitat for community kept in balance.→ Microbial homeostatis flour of the mouth microbial colonization mother’s vagina bottle feeding Climax community BAKTERI positif DEAD mother and fam Microorganism COLONIZATION Baby’s equipment Microorganisma in fluctuation in oral Temperatur, the mouth is very environment Salivary antimicrobial oxigen availability, Organism sequentially inhabit in altered environment. The process continues to yield parameter occur Adherence mouth within 4-12 hours : lactobacilli, streptococci complex. These Mechanical abrasive force such as : pH Bacterial sinergic Neonate : Streptococcus salivarius, staphylococci, Neisseriae, Moraxella catarrhalis a greater diversity and complexity of biota only up to a certain point. Eventually, a complexity of the Bacterial antagonistic time comes when no additional niches are created after a new organism joins the variability in the Physicochemical factors oral microbial community. At the point , the evironment becomes stabile ( that is, the number of composition and The primary microorganism colonize in the mouth term : Pioneer species ecology cause by frequency of Balance species does not change) until another pertubation of environment occurs. The community of organism associated wih this state is called : Climax community The oral tissue are bathed in saliva , exposure to Teeth appear (Streptococcus mutans, Streptococcus parasanguis) which provide physical cleansing by dietary Those condition can be imbalance if environmenal condition change virtue of fluid flow and dilution effect constituent. → disease ( endogenous infection) Gingival crevice area : Anaerobic species, yeasts Puberty (Bacteroides, spirochete Adult Host immun defence : AGE >> → Environment >> → Microflora >> climax community innate & adaptif FACTORS AFFECTING ORAL MICROBIAL COLONIZATION FACTORS AFFECTING ORAL MICROBIAL COLONIZATION FACTORS AFFECTING ORAL MICROBIAL COLONIZATION FACTORS AFFECTING ORAL MICROBIAL COLONIZATION d. Available of Nutrient b. Oxygen tension Interactions between specific microorganisms and nutritional factor provided by the host A number of factors determine which organism are able to live in the mouth and c. Hydrogen Ion Concentration (pH) Different location in the oral cavity vary widedly. that selectively determine the kinds of microorganisms which willinitially reside in the oral which of the oral micro environments they inhabit A neutral pH is required for the growth of most bacteria in the oral cavity, extremes of pH cavity and the sites which they will colonize. The persistence of these original "colonists" in The majorities of organisms are facultative anaerobes. Most of the oxygen in the oral are not suitable for the growth of microorganisms. their respective ecologic niches will depend in part on the accessibility of endogenous cavity derives from saliva where it is in solution readily available to bacteria for The factors can be divided into three categoris :: Physicochemical factor metabolism. nutrients variously provided by saliva, tissue exudates, crevicular fluids, or degenerating SALIVA → The main source of maintaining the pH of oral cavity is the host cells. or exogenous. Host factor. Aerob : buccal and palatal mucosa It has been found that different areas of oral cavity have different pHs. Bacterial factor Nutrient requirement of oral microbiota can be divide in two major environment system dorsum of the tongue Initial plaque The pH of plaque → sensitive to the pH of saliva. After consumption of acidic diet the pH of Habitat Bath in Source of nutrient Nutrien 1. PHYSICOCHEMICAL FACTOR Anaerob : sub gingiva, mature plaque plaque drops to around 5.0 due to formation of lactic acid by carbohydrate metabolism. This drop in pH slowly recovers with the passage of time. Supragingival plaque SALIVA Exogenous nutient Food ingested a. TEMPERATURE. Favultative anaerob periodically in diet Mucosal surface The human mouth is kept at a relatively stable oral temperature i.e. 35–36 °C. Resting pH in plaque results from a delicate balance between alkali and acid generation, which Endogenous nutrient Mainly from saliva : This temperature is vital for the growth of various microorganisms. is in turn dependent both on the bacterial composition of the plaque and on the supply of Carbohidrate, amino acid, peptides, proteins, Sulcus gingiva 33-360 C substrates and buffers from and metabolite clearance into flowing oral fluid. glycoproteins, vitamins In periodontal pockets with active disease : + 39 °C → higher than healthy Resting pH will vary with site-specific changing saliva flows. Subgingival crevice Sub gingival fluid Endogenous nutrient Crevicular fluid, plasma protein albumin, The pH of healthy gingival crevice : around 6.9, increase to about 7.2–7.4 during disease Periodontal pocket glikoprotein,haem. Temperature in healthy mouth person can vary considerable, max. 680 C, min. 15,40 C Host tissue that Ex. If eat a hot drink or food and then cold degraded by bacterial enzime. Degraded of periodontal tissue FACTORS AFFECTING ORAL MICROBIAL COLONIZATION FACTORS AFFECTING ORAL MICROBIAL COLONIZATION FACTORS AFFECTING ORAL MICROBIAL COLONIZATION ORAL MICROBIOTA 2. HOST FACTOR c. Host genetic b. Interactin with other microbes TEETH a. Saliva. Gender and race can influence the oral microflora. Interaction - inhibitory dental plaque Several salivari components have been shown to kill or inhibit the growth of bacteria. Porphyromonas gingivalis and Peptostreptococcus Stimulatory Non specific factor : were asociated more with black subject Fusobacterium nucleatum found more commonly in white individuals Stimulatory : 2 mechanism Bacterial attachment to the tooth Lysozyme Histatins Ex. Present Actinomyces viscousus in sub gingiva enhance ability of Spesific Non- Spesific force 3. BACTERIAL FACTOR Porphyromonas.gingivalis to colonize Salivary peroxidase and thiocyanate Bacteria Ionic Lactoferrin a. Adherence Veilonella parvula, some Gram + organism Hydrophobic Anti-viral factor One of the major ways in which bacteria choose the appropriate milleu to colonize is reseptor in the aquired → sinthesis menadione which in turn is used to advantage P gingivalis, Hydrogen by selective adhesion. pellicle of saliva bounding Prevotella intermedia Specific factor Spesific bacteria have a predilection for colonizing spesific surface. Van der Waals Inhibitory The predominant antibody : Secretory IgA (SIgA) Ex. Streptococcus salivarius – adheres preventialy to ephytelial surface metabolic product from bacteria → inhibit other organims IgA Streptococcus mutans - adheres selectively to tooth surface Colisin, Bacteriocin → bactericidal to other bacteria Function : inhibit adherence of bacteria Plaque consist : microorganism Teeth Covered with SALIVA nutrition from metabolis of host product ( salivary protein etc) Salivary flow Mucosa dietary constituent ( sugar, amino acid from foods) Reseptor for adesin spesific of bacteria b. Crevicular fluid Bacteria attach to spesific surface Atibody : IgG Complement ORAL MICROBIOTA Refferences : THE MUCOSAL MICROBIOTA 1. Dahlén DMG , Fiehn NE, Olsen I, Dahlgren U, 1st e-book Thank you in the ephitelium covering gingiva, buccal ang palatal The surface cells ( shedding attach bacteria)of ephitelia desquamate at regularly edition. 2014. Oral Microbiology and Immunology. → soft tissue do not support the voluminous microbiota seen on the surface of teeth. 2. Lamont RJ, Hajishengallis GN, Jenkinson HF. 2014.Oral Tongue. Covered with papilae. microbiology and immunology, 2nd Ed Dorsum of the tongue have a greater microbial biomass than other site. Microbiota → same with microbial colonis in teeth 3. Samaranayake LP.2018. Essensial Microbiology for Dentistry. 5nd Ed. Churchil Livingstone, London. Oral microflora as a ecosystem in oral cavity : comunication, symbiosis : microorganism with microorganism Microorganism with host Change the environment in Oral cavity : Sistemic infection Denture Bad oral hygiene Smooking Diet Cancer Antibiotic therapy Change in hormonal Radiotherapy Defence mechanism decrease → Microflora change → microorganisme opportunistic pathogen → opportunistic infection/ endogenous infection  DAFTAR PENYUSUN & PENGAJAR DENTIN – hard connective 1. Dr. Christian K., drg., M.Kes (Penyusun) tissue 2. Yuliati, drg, M.Kes (Penyusun) Bone and Teeth’s Formation 3. Prof. Dr. Retno Indrawati, drg, M.Si 4. Prof. Dr. Indah Listiana Kriswandini, drg, M.Ke. ENAMEL – acellular mine- Consist of 2 phase : ralized tissue (the hardest Bone and Dental Tissue 5. Prof. Dr. Rini Devijanti R, drg, M.Kes 6. Prof. Dr. M. Luthfi, drg, M.Kes 1. Bone matrix formation tissue of the body) Mineralization,De-mineralization 7. Prof. Dr. Ira Arundina, drg, M.Si 8. Prof. Dr. Hendrik Setia Budi, drg, M.Kes 2. Mineralization CEMENTUM covers root, and Regeneration 9. Dr. Indeswati Diyatri, drg, M.S 10. Dr. Pratiwi Soesilawati, drg, M.Kes The process of bone and teeth hidroksiapatite’s bone-like calcified tissue 11 Dr. Anis Irmawati, drg, M.Kes formation arranged by interaction between bone’s 12. Sidarningsih, drg. M.Kes matrix and mineral. 13. Tantiana, drg, M.S DENTAL PULP – highly 14. Aqsa Sjuhada Oki, drg, M.Kes vascularized and sup- Departemen Biologi Oral plied by abundant nerves Tooth tissues DENTIN is hard CT produced by odontoblasts (O), ENAMEL covers the crown of the teeth Peritubular dentin is highly mineralized. Deposition and reabsorption occur mainly in the ODONTOBLASTS (ODs) produce dentin and cementum and to a limited extent in the Acellular, mineralized - the hardest substance in dentin; form a layer of columnar enamel. the body Extracellular matrix cells located on the inner surface of 96-98 % of inorganic salts Organic matrix similar to that in bone, consists of: Tf PD the dentin, i.e., basal surfaces of the In the enamel, these processes occur mostly by ODs are in the contact with the pulp diffusional exchange of minerals with the saliva ( hydroxyapatite, CaF, CaCO3, MgCO3) type I collagen fibrils (B). Apical surface of ODs is in mature enamel contains : ground substance ( chondroitin- and instead of with the fluids of the pulp cavity. contact with the forming dentin (i.e. very little organic material, water keratinsulfate PGs, osteocalcin, dentin predentin = PD). The cementum has characteristics almost identical phosphoprotein and sialoprotein ) to those of usual bone, including the presence of Hydroxyapatite crystals 70 % inorganic salts (hydroxyapatite crystals) osteoblasts and osteoclasts, whereas dentin does not 40-60 nm long, 2 nm thick, 30 nm wide B Tf = Tom‘s fiber PREDENTIN – newly secreted, nonmineralized have these characteristics dentin - Dinamika pd jaringan gigi → tidak sedinamis tulang The main bacteria that cause caries: - Sel pembentuk dentin adl. Odontoblast According to the definition of the World Health Organization (WHO), dental cariesis a local pathological - Homeostasis gigi dipertahankan oleh jar pulpa process of the extrasomatic background, leading to enamel Streptococcus mutans ( Gram positive coccus) - Terdapat hubungan antara jar pulpa dg dentin → acidogenic & aciduric Mikrosirkulasi decalcification, decomposition of dental hard tissue, and in - Odontoblast mensekresi protein dan consequence to formation of a dental cavity. faktor-faktor pertumbuhan Streptococcus sobrinus (scr autokrin atau parakrin) → Streptococcus sanguis Dentin sekunder → respons terhadap kerusakan Demineralization of Lactobacillus acidophilus Lactobacillus casei Dental Hard Tissue Actinomyces viscosus Dental Tissue Dental Caries Main cause A. Initial attachment B. Accumulation The initial process begins with colonization of S. mutans on the After accumulation of S. mutans on the tooth surface. Sucrosa tooth enamel surface. S. mutans has predominant extracellular enzymes The enamel surface is coated by an acquired pellicle membrane (Glucosyltransferase (GTF) which catalyzes polyglucans formed by salivary components from Sucrose (sucrosa → glucosa + fructosa) First: If there is sucrose, the bacterial attachment will be more Initial interaction occurs between S. mutans and the tooth complex, because adhesion will be assisted by Glucan surface mediated by Adhesin, that is the specific receptors which is synthesized by the enzyme Glucosyltransferase present in S. mutans (pellicle binding protein) binds to the (GTF), Fructan synthesized by Fructosyltransferase (FTF) salivary pellicle (pellicle glycoprotein) through a reversible and Glucan Binding Protein with Sucrose dependent independent Sucrose mechanism. This attachment can be mechanism, so that the attachment of S. mutans to the tooth separated by salivary flow or gargling. A.Initial Attachment surface is irreversible Molecular Pathogenesis  Organic Component – Chiefly osteocollagenous fibers Fibers are held together with a special glue consisting No sucrosa of glycosaminoglycans (a glycoprotein). 1. Growth fase : intramembranous & endochondral 2. Mature bone : compact (cortical) & cancellous The Inorganic Component – The inorganic (sponge) component is principally calcium phosphate crystals. 3. Formation of new bone : woven & lammellar These crystals are deposited within the cement between the osteocollagenous fibers. Typically, bony matrix is deposited in layers or lamellae 3 to 7 um thick. The presence of discrete layers around the central canal Bone Tissue Tipe of Bone Tissue Osseous Matrix Osteoprogenitor cells are proliferating cells Osteoblasts are cells that synthesize and appearing on bone surface that differentiate into secrete the osteoid (collagen) and calcify it. osteoblasts control calcium and mineral deposition. found on the surface of the new bone. Osteoclasts are the cells involved in bone resorption (bone breakdown), by releasing Osteocytes are inactive osteoblasts that have lysosomal enzymes. completed their function in matrix formation. Consist of two or more cells that They are cells inside the bone. fuse together ➔ have more than one nucleus. send out long branches that connect to the Found on the surface of the bone other osteocytes. mineral next to the dissolving bone. can sense pressures or cracks in the bone and help to direct where osteoclasts will dissolve the Types of bone cells bone. Osteoblast synthesize and extrude collagen ➔ Osteoid Osteoclast originate from same precursor cells as circulating monocyte and tissue macrophage Ca2+ is deposited as Ca2+PO 4 ➔multinucleate cells that form by fusion of several Hydroxide and bicarbonate are added, forming precursor cells mature hydroxiapatite The process of bone resorption involves loss of As the bone become mineralized and surrounds bone matrix, and thus, loss of bone mass the osteoblast ➔ Osteocyte Bone Formation Bone Resorption Healing process without membrane Socket filled by blood clot 3th months to 4th months tulang Healing process with membrane’s barrier After 2 month blood combine with granulation spongiosa bone start to change Fracture tissue and blood vessel to cortical bone Hypervascularisation, connective tissue 4th months cortical bone toward Dental Implan maturation phase → haver’s Bone formation starting from the edge Blood supply distrubance system Healing’s process Activation of bone Post extraction After 2 month  Refferences : Samaranayake LP, Jones BM and Scully C. Microbiology of Periodontal desease. In Essensial Microbiology Dentistry 2 nd ed.China , RDC Group Limited; 2002 Ten Cate's Oral Histology, Development, Structure, and Thank You… Function, 9th Edition, Elsevier; 2018 Young B, Heath,JW. Functional Histology, 4th ed: Terimakasih. London, Churchil Livingstone; 2004. Anthony L Mescher, Basic Histology, Text & Atlas, 15th ed., 2018, Mc Grawhill  DAFTAR PENYUSUN & PENGAJAR 1. Dr. Christian Khoswanto, drg., M.Kes (Penyusun) 2. Dr. Pratiwi Soesilawati, drg, M.Kes (Penyusun) 3. Prof. Dr. Retno Indrawati, drg, M.Si Anatomy & Histology of 4. Prof. Dr. Indah Listiana Kriswandini, drg, M.Kes 5. Prof. Dr. Rini Devijanti, drg, M.Kes Salivary glands are classified as either major or minor depending on their size and the amount of their secretion. Salivary Glands Exocrine glands in the mouth produce saliva, which has digestive, 6. Prof. Dr. M. Luthfi, drg, M.Kes The major glands carry their secretion some distance to the oral lubricating, and protective functions. With a normal pH of 6.5-6.9, 7. Prof. Dr. Ira Arundina, drg, M.Si cavity by means of a main duct. 8. Prof. Dr. Hendrik Setia Budi, drg, M.Kes saliva also has an important buffering function 9. Dr. Indeswati Diyatri, drg, M.S The smaller minor glands empty their products directly into the 10. Dr. Anis Irmawati, drg, M.Kes mouth by means of short ducts 11. Sidarningsih, drg. M.Kes 12. Tantiana, drg, M.Kes 13. Aqsa Sjuhada Oki, drg, M.Kes 14. Yuliati, drg, M.Kes Three epithelial cell types comprise the salivary secretory units The functional unit of the salivary gland is the alveolus or acinus. Each cell type provides a different type of secretion. The serous and mucous cells of the major glands secrete An acinus is a cluster of pyramidal cells Serous cells secrete mostly proteins and small amounts of 85% to 90% of saliva. Their combined secretions produce Serous cells are polarized protein-secreting cells, usually carbohydrates → secretion also contains zymogen granules, the viscosity as well as the important buffering actions of either mucous or serous or a combination of the two, that secretes saliva into a terminal collecting duct. pyramidal in shape, with round nuclei precursors of the enzyme amylase, which functions in the breakdown Mucous cells are more columnar in shape, with more of carbohydrates. The collecting duct is termed the secretory end piece or intercalated duct. compressed basal nuclei Serous cell secretion has a watery consistency. Myoepithelial cells are found inside the basal lamina Mucous cells are high in carbohydrates and low in proteins and surrounding acini, tubules, and the proximal ends of the duct discharge a viscous product called mucin system MAJOR SALIVARY GLANDS The salivary glands are also important for the production of The major salivary glands are present as three bilateral pairs. growth factors The parotid glands are located on the sides of the face in front of the nerve growth factor (NGF) and epidermal growth factor ears; (EGF) The submandibular glands, are inside the angle of the mandible belongs to a family of growth factors that stimulates cell The sublingual glands, are on either side of the midline beneath the growth, proliferation and differentiation mucosa of the anterior floor of the mouth Salivary acinar cells. The serous, mixed, and mucous alveoli Parotid, submandibular & sublingual glands The parotid glands produce a nearly pure serous secretion The parotids are the largest glands, although they contribute only The parotid ducts extend anteriorly across the masseter muscles and The submandibular gland produces a mixed serous and mucous 25% of the total saliva. then bend toward the mouth, opening adjacent to the crowns of the secretion The submandibular glands are intermediate in size, but they produce second maxillary molar teeth The sublingual gland’s secretion is nearly pure mucous 60% of the saliva. The ducts of the submandibular and sublingual glands have a The sublingual glands are the smallest, contributing 10% to the total common opening in the anterior floor of the mouth, located at the salivary flow. sublingual papillae on either side of the frenulum and at the tongue’s tip The minor salivary glands located throughout the oral cavity contribute about the same amount as the sublingual glands. Histologic features of the parotid gland  MINOR SALIVARY GLANDS The minor salivary glands are classified as serous, mucous, and mixed The tongue contains lingual glands, which are mixed glands at the types, the same as the major glands tongue’s tip. The glands of the cheeks and lips are termed the buccal and labial Serous glands of Von Ebner are located at the junction of the glands tongue’s body and base The glands of both the posterior hard palate and soft palate are called The watery secretion washes off the taste buds of the circumvallate palatine glands papillae. The glands of tonsillar folds are the glossopalatine glands. The tongue has mucous glands in the posterior region under the lingual tonsillar tissue Histologic features of the submandibular gland Histologic features of the sublingual gland REFFERENCES : 1. Anthony L Mescher, Basic Histology, Text & Atlas, 15th ed. 2018, Mc. Grawhill. 2. Daniel J Chiego, Essentials of Oral Histology & Embriology, 5th ed., 2019, Elsevier.  BIOMARKER Introduction : DAFTAR PENYUSUN & PENGAJAR Prof. Dr. Indah Listiana Kriswandini, drg, M.Kes (Penyusun) Definition : ❖ Saliva is an accessible biofluid that contains components derived Prof. Dr. Retno Indrawati, drg, M.Si from the mucosal surfaces, gingival crevices, and tooth surfaces of "a characteristic that is objectively measured and INTERRELATION OF MICROBIAL AND Prof. Dr. Rini Devijanti, drg, M.Kes Prof. Dr. M. Luthfi, drg, M.Kes evaluated as an indicator of normal biological the mouth. Saliva also contains microorganisms that colonize the mouth and other exogenous substances and so can potentially Prof. Dr. Ira Arundina, drg, M.Si SALIVARY PROTEIN IN CAUSING Prof. Dr. Hendrik Setia Budi, drg, M.Kes Dr. Indeswati Diyatri, drg, M.S processes, pathogenic processes or provide an insight into the relationship of the host with the environment DISEASES Dr. Pratiwi Soesilawati, drg, M.Kes Dr. Anis Irmawati, drg, M.Kes pharmacological responses to a therapeutic ❖ Most metabolites, cytokines, signal molecules, or hormones move in Dr. Christian Khoswanto, drg., M.Kes Sidarningsih, drg. M.Kes intervention." a certain amount by passive filtration into saliva and their levels in Tantiana, drg, M.Kes saliva reflect their levels in plasma. Therefore, detection of these Aqsa Sjuhada Oki, drg, M.Kes molecules in saliva is only a matter of the detection limits of new DEPARTEMEN BIOLOGI ORAL Yuliati, drg, M.Kes analytical methods. The potential of saliva as a biomarker fluid has FAKULTAS KEDOKTERAN GIGI UNIVERSITAS been transformed by the development of highly sensitive proteomic analysis, which has identified the presence of over 2,000 proteins, AIRLANGGA approximately 25–30% of which are shared with blood. 2020 PHYSIOLOGY OF SALIVA DIAGNOSTIC TOOL Methods for collection of saliva ❖ Physiological function of secreted saliva. Most saliva is produced by ❖ Salivary diagnostics is very attractive due to scope of non invasive ❖ Whole Saliva :- stimulated and Unstimulated the three major glands; submandibular (about 65%), parotid (about 23%) collection, constant availability, feasible to study without complex - Whole salivary collection is easy and non- invasive. and sublingual (about 4%).... By these components saliva facilitates instrumentation, and very cost effective process. - more relevant in the assessment of overall salivary gland dysfunction speech, mastication and swallowing, and initiates the digestion process ❖ This most suits mass screening for disease detection. Salivary proteins whole saliva contains non – salivary elements such as desquamated of certain food types by various enzymes. like any other would carry genetic imprint of differences and disorders. epithelial cells, bacteria, GCF and leukocytes. ❖ There is promising perspective of phenotyping and understanding ❖ Regulation of salivary pH pathogenesis of genetic diseases. Many plasma compartment proteins ❖ Gland Specific / Glandular Saliva Maintenance of oral pH above 5.5 is necessary to avoid dissolution of freely appear in saliva. Includes parotid saliva, submandibular / sublingual saliva and calcium salt from enamel leading to tooth erosion. Normal salivary pH ❖ Comparative protein profiling of saliva and plasma would reveal the secretions from minor salivary varies in the range from 5.75 to 7, which may rise further up to 8 upon overlapping moieties that may be candidates to serve as valid systemic stimulated secretion. biomarkers in health and disease. ❖ Changes in salivary proteins can help in principle, diagnosis and ❖ Several physical and pathological conditions can modify saliva monitoring of disease activity including response to therapeutic production quantitatively interventions. The use of salivary biomarkers SALIVA FUNCTIONS AND COMPOSITION Antibacterial Properties and Participation in Film and LYSOZYME : can hydrolyze the cellular wall of some bacteria, and because it is strongly cationic, it can activate the bacterial “autolisines” which are ❖ Taste Calculus Formation able to destroy bacterial cell wall components. Gram-negative bacteria are ❖ DNA : Genotyping standard; genetic information throughout the ❖ Protection and Lubrication Secretory Ig A (sIgA) more resistant to this enzyme due to the protective function of their external human body; bacterial infections (oral microbes); diagnose head and ❖ Dilution and Cleaning The largest immunologic component of saliva. It can neutralize lipopolysaccharide layer. Other antibacterial mechanisms have been neck carcinoma; Forensic purposes ❖ Buffer Capacity viruses, bacterial, and enzyme toxins. It serves as an antibody for proposed for this enzyme, such as aggregation and inhibition of bacterial ❖ mRNA. : information of transcription speed bacterial antigens and is able to aggregate bacteria, inhibiting their adherence. ❖ Integrity of Tooth Enamel ❖ RNA : virus / bacterial identification adherence to oral tissues. ❖ Protein : Genetic information; regulation of translation ; diagnose of ❖ Digestion Other immunologic components, such as IgG and IgM, occur in LACTOFERRIN :links to free iron in the saliva causing bactericidal or ❖ Tissue Repair bacteriostatic effects on various microorganisms requiring iron for their periodontitis; detect of dental caries less quantity and probably originate from gingival fluid. Among the survival such as the Streptococcus mutans group. Lactoferrin also provides ❖ Immunoglobulin : diagnose the presence of a virus ❖ Antibacterial Properties and Participation non-immunologic salivary protein components, there are enzymes fungicidal, antiviral, anti-inflammatory, and immunomodulatory functions. ❖ Metabolites : detect of periodontal deseases (lysozyme, lactoferrin, and peroxidase), mucin glycoproteins, agglutinins, histatins, proline-rich proteins, statherin, and cystatins. PEROXIDASE / SIALOPEROXIDASE: offers antimicrobial activity because it serves as a catalyst for the oxidation of the salivary thiocyanate ion by hydrogen peroxide into hypothiocyanate, a potent antibacterial substance. PROLINE-RICH PROTEIN & STATHERINS : HISTATINS : As a result of its consumption, proteins and cells are protected from the Inhibit the spontaneous precipitation of calcium phosphate salts a family of histidine-rich peptides, have antimicrobial activity against some and the growth of hydroxyapatite crystalson the tooth surface, strains of Streptococcus mutans and inhibit hemoagglutination of the preventing the formation of salivary and dental calculus. They periopathogen Porphyromonas gingivalis, neutralize the LPS of the external favor oral structure lubrication, and it is probable both are memb of Gram pos bacteria, potent inhibitors of C.albicans. Participation in important in the formation of acquired film. Another function acquired film formation & inhibition of histamin release by the mastocytes, suggesting a role in oral inflammation. proposed for the proline-rich proteins is the capacity to selectively mediate bacterial adhesion to tooth surfaces. SALIVARY AGGLUTININ The cystatins are also related to acquired film formation and to A highly glycosylated protein frequently associated with other salivary hydroxyapatite crystal equilibrium. Due to its proteinase inhibiting proteins and with secretory IgA, is one of the main salivary components properties, it is surmised they act in controlling proteolytic activity. responsible for bacteria agglutination. HISTATINS a family of histidine-rich peptides, have antimicrobial activity against some strains of Streptococcus mutans and inhibit hemoagglutination of the periopathogen Porphyromonas gingivalis  Diagnosis of Oral Diseases by Saliva ORAL-CANCER DIAGNOSIS OF SYSTEMATIC DISEASES BY SALIVA CARIES The onset and development of malignancy are relate