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17 Systemische aandoeningen en speeksel

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Samenvatting

  • Hoewel analyse van de speekselsecretie en -samenstelling als een diagnostisch hulpmiddel kan worden gebruikt voor een aantal ziektebeelden, kan hiermee over het algemeen niet worden volstaan. De opgetreden veranderingen zijn veelal niet specifiek voor één bepaald ziektebeeld.

  • In een aantal ziektebeelden komt de directe of indirecte aantasting van de speekselklieren vooral tot uiting in niet-specifieke veranderingen, zoals verlaging van de secretiesnelheid en van de concentratie speekseleiwitten. Voorbeelden hiervan zijn diabetes mellitus, anorexia nervosa, drugsverslaving, weefselafstoting (graft-versus-hostziekte) en speekselkliertumoren.

  • Bij cystische fibrose is de viscositeit van serum, speeksel en sputum verhoogd als gevolg van een verhoging van de concentratie Ca2+, mucinen en lipiden, waaronder glycolipiden. Opvallend is de specifieke toename van het enzym RNase in speeksel, terwijl dit enzym aan de andere kant verlaagd is in pancreassap door de pancreasdisfunctie.

  • Het aantonen van een specifieke cystische-fibrosefactor in serum en speeksel, die een remming geeft van de ciliaire activiteit, wordt door enkele groepen geclaimd, maar is door andere groepen aangevochten.

  • Een aantal diermodelsystemen voor de nabootsing van cystische fibrose blijft twijfelachtig. Chronische reserpinering en het opwekken van acidose bij proefdieren lijken nog het meest betrouwbaar.

  • Personen met diabetes mellitus hebben een verhoogde kans op het ontwikkelen van hyposialie en hebben mede daardoor een verhoogd cariësrisico.

  • Overmatig alcoholgebruik is ook nadelig voor de mondgezondheid; het verhoogt de kans op mucosale ontstekingen en tanderosie; de speekselsecretie is verlaagd.

  • Speekselcomponenten, waaronder mucinen, zijn in staat om hiv te remmen; sereus speeksel vertoont een minder remmend effect dan muceus speeksel; veelvuldig treedt bij aids een candidiasis op als orale manifestatie, hoewel in klierspeeksel de antischimmelpeptiden (histatinen) zijn toegenomen. Deze eiwitten worden in de mondvloeistof snel afgebroken.

  • In speeksel van patiënten met ernstige epilepsie treedt een snelle afbraak op van beschermende speekselfactoren, onder andere van mucinen; gingivale overgroei door fenytoïne leidt tot verslechterde mondhygiëne en omgekeerd leidt de slechte mondhygiëne tot verdere gingivale overgroei.

  • Bij patiënten met multipele sclerose is in ongestimuleerd totaalspeeksel een geringe daling te zien van de S-IgA-afgifte per minuut. Speeksel is tot op heden niet als diagnosticum te gebruiken voor multipele sclerose.

  • Graft-versus-hostziekte gaat gepaard met milde tot ernstige hyposialie, terwijl de concentratie in speeksel van lysozym en van Na+ is toegenomen; de concentratie van S-IgA en van fosfaat is afgenomen.

  • Door parodontale ontstekingen zijn serumcomponenten, waaronder albumine, verhoogd in speeksel aanwezig; ook is er een verhoging van microbiële hydrolytische enzymen in mondvloeistof; opmerkelijk is de positieve correlatie tussen parodontitis en cystatinen in klierspeeksels.

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Copyright information

© Bohn Stafleu van Loghum, onderdeel van Springer Uitgeverij 2008

Authors and Affiliations

  1. 1.Sectie Orale BiochemieAcademisch Centrum Tandheelkunde Amsterdam (ACTA), Vrije Universiteit en Universiteit van AmsterdamAmsterdam

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