TopOpen Access Virtual Collections

• Aims and Scope
• Introduction
• About the free online version
• Table of contents   

Preface

Clinically, the management of most oral diseases exists outside the medical mainstream. This circumstance in part reflects the historical accident that resulted in the separation of dentistry from medicine. Because of this situation, patients, especially those with complex oral diseases, may not be timely beneficiaries of the dramatic advances being made in the biomedical sciences. As part of a broad effort to mitigate this possibility, and bring the best science to bear on oral diseases, the journal Oral Diseases is trying to provide dentists and other interested clinicians with timely updates in important areas of clinical science. Beginning in 2002, Oral Diseases started to publish 6-10 “state-of-the-art” articles/year on a common, important clinically relevant theme. The plan is for the themes to revolve, such that about every 8 years each topic would be re-visited, providing journal readers with a continuous snapshot of progress in the field. Following publication in the hard copy journal itself, the publisher, Blackwell Publishing, Inc, decided to post these thematic articles on this web site in order to make the information broadly accessible to all clinicians.

The theme that inaugurated the series in 2002, and now being presented here electronically, was saliva and the salivary glands. Saliva provides the primary protection for the mouth, with considerable benefit extended to other parts of the upper gastrointestinal tract (Mandel, 1989). Saliva maintains the integrity of the teeth and mucosa, facilitates food bolus formation and translocation, as well as regulates microbial (bacterial, fungal, viral) colonization. For their part, salivary glands also have been classical research models in biology, from the physiological studies of Claude Bernard and Ivan Pavlov to the more recent cell biological discoveries of Stanley Cohen and Michael Berridge.

The public's view of saliva and salivary glands is as a mixed blessing at best. Spitting can be seen as an act of contempt as well as a tool to fend off an evil curse (Loe, 1987). In the medical setting this easily accessed oral fluid is often ignored and certainly undervalued. Indeed, the xerostomia or dry mouth that accompanies several fairly common clinical conditions (e.g., Sjogren's syndrome, radiation damage subsequent to head and neck cancer therapy, pharmaceutically induced) is viewed by many dentists and physicians as a nothing more than a minor inconvenience to be tolerated by patients without complaint.

The saliva and salivary glands series begins with two papers that provide the foundation for the series. The first, by Turner and Sugiya, “Understanding salivary fluid and protein secretion”, gives readers a clear-cut description of the current molecular basis for understanding these two essential processes leading to saliva formation. As readers will see, the cellular physiology of salt and water secretion from these glands is reasonably well known, but the general operative mechanisms of protein release from salivary cells lack such similar detail. The second paper, “Saliva - the defender of the oral cavity”, by van Nieuw Amerongen and Veerman, provides an extensive yet comprehensible view of the proteins in salivary fluid that underlie its essential roles in human physiology. As these authors importantly point out, we likely can identify virtually all of the salivary proteins, and assign to them individual functions, but we are still not sure of how these components work harmoniously together in situ.

The next three papers build on these essential elements. In paper number 3, “Saliva as a diagnostic fluid”, Streckfus and Bigler describe several novel diagnostic applications for this easy to obtain fluid. Among many such uses of salivary fluid are rapid screening tests for HIV, measuring licit and illicit drugs, and monitoring for the presence of malignant lesions via secreted markers. In the following paper, “Diagnosing, managing and preventing salivary gland disorders”, Ship offers clinicians important, comprehensive and research-based practical information on how to evaluate and care for patients who present with salivary gland problems. The fifth paper in the series, “Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion”, by Nauntofte and her colleagues, gives the reader a critical assessment of saliva's major and ubiquitous role in alimentation. These key upper gastrointestinal tract functions are essential for maintaining a normal quality of life.

As mentioned earlier, there are three fairly common clinical conditions that result in xerostomia. By far the most frequent cause is that resulting as side effect of often prescribed medications. Paper number 6, “Drug effects on salivary glands: dry mouth”, by Scully, is both valuable and practical, especially for clinicians who care for elder and medically compromised patients who tend to utilize numerous xerostomic medications. The single most common disease affecting salivary glands is the autoimmune exocrinopathy Sjogren's syndrome. Jonsson and his colleagues, in the next paper, “Current issues in Sjogren's syndrome”, focus on problems in our understanding of this complex disorder affecting primarily peri-menopausal women. Radiation-induced salivary gland damage has been recognized clinically since the beginnings of radiation therapy in early 20th century. In paper number 8, “The enigmatic mechanism of irradiation-induced damage to the major salivary glands”, Nagler critically assesses and interprets major recent studies trying to understand the pathogenesis of this condition that is still inadequately managed.

The last two papers presented in the series digress somewhat from the progression of topics above, but they are nonetheless integral for any timely update of “all things salivary”. Paper number 9, “Salivary gland tumours”, by Speight and Barrett, addresses a small but clinically important subset of head and neck neoplasms. Finally, in “The use of gene transfer for the protection and repair of salivary glands”, Vitolo and I provide an update of this novel and potentially valuable approach to manage clinical problems that currently are without appropriate therapy.

The Editors and the Publisher firmly believe that better patient care is a natural product of applying the best science to difficult clinical problems. This series represents the best of the science, i.e., knowledge and understanding, in salivary gland biology, pathology and management as of 2002. We hope that these papers will be of real benefit to clinicians and most importantly to their patients.

References

Mandel ID (1989). The role of saliva in maintaining oral homeostasis. J Am Dent Assoc 119, 298-304.
Loe H (1987). Welcome. J Dent Res 66 (Spec Iss), 622.

Bruce Baum
Senior Editor