Faculty Bibliography

Biotechnological advances in rapid diagnostic testing of oral fluids such as saliva or oral transudate have led to the identification of a wide array of pathogens, enzymes, gene products and mutations, and other biomarkers. A new paradigm related to property rights likely will emerge with more information obtained from testing an individual patient or research participant; oral fluids may be a counterpart to blood. Traditionally, blood has been subjected to a large variety of diagnostic testing for both medical and legal purposes. Should oral fluid, like blood, also be granted comparable legal and ethical protections? Concerns about violation of privacy, including genetic discrimination, have emerged with rapid testing of saliva. The management of salivary biospecimens must include considerations of property rights and financial compensation; the right to privacy; and re-evaluation of informed consent. The challenges of obtaining informed consent for rapid oral diagnostic testing from culturally diverse populations must be addressed to promote overall public health and research. Testing must also be affordable and accessible. Strategies that incorporate rapid oral diagnostic testing into oral health care should reshape and align dentistry with medicine, promote public health, and advance research investigations. 2011 by Begell House, Inc

Major advances in the testing of oral fluid (e.g., saliva) may lead to the diagnosis and treatment of previously undiagnosed conditions and may enable dentists to manage oral disease more effectively. Such use of another body fluid, blood, is already well established. Blood is a complex tissue that has been extensively researched and is now used for a wide variety of diagnostic tests. It is also regarded as a form of property with ethical and legal dimensions. If saliva is to fulfill a similar role, it should perhaps be granted those same protections. This paper advances the concept that saliva should be considered a form of property, possibly within personal biological materials law. The emerging potential for the development of marketable products from oral fluids raises the issue of protecting the research participant's ethical and legal rights. In particular, violation of privacy and genetic discrimination may arise from the testing of salivary DNA. Respect for autonomy requires that the clinician inform a patient or research participant about his or her rights to property and privacy as these may pertain to oral fluid

OBJECTIVE: To determine the impact of highly active antiretroviral therapy (HAART) on salivary gland function in human immunodeficiency virus (HIV) positive women from the Women's Interagency HIV Study (WIHS). DESIGN: Longitudinal cohort study. SUBJECTS AND METHODS: A total of 668 HIV positive women from the WIHS cohort with an initial and at least one follow-up oral sub-study visit contributed 5358 visits. Salivary gland function was assessed based on a dry mouth questionnaire, whole unstimulated and stimulated salivary flow rates, salivary gland enlargement or tenderness and lack of saliva on palpation of the major salivary glands. MAIN OUTCOME MEASURES: Changes in unstimulated and stimulated flow rates at any given visit from that of the immediate prior visit (continuous variables). The development of self-reported dry mouth (present/absent), enlargement or tenderness of salivary glands (present/absent), and absence of secretion on palpation of the salivary glands were binary outcomes (yes/no). RESULTS: Protease Inhibitor (PI) based HAART was a significant risk factor for developing decreased unstimulated (P = 0.01) and stimulated (P = 0.0004) salivary flow rates as well as salivary gland enlargement (P = 0.006) as compared with non-PI based HAART. CONCLUSIONS: PI-based HAART therapy is a significant risk factor for developing reduced salivary flow rates and salivary gland enlargement in HIV positive patients