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The leukocyte count in saliva
Oral THE
LEUKOCYTE
Medicine COUNT
IN SALIVA
P. E. B. CALONIUS, DR. ODONT., HF.LSINKI,
FINLAND
T
HE leukocyte count of the blood and the cerebrospinal fluid has proved to be of important clinical value. Even in the constantly secreted tears2 or the urine, the leukocyte count may furnish valuable hints. In diseases of the oral cavity, it is not easy to follow an inflammatory process by means of laboratory methods. Attention has heretofore been paid to the number of bacteria in the saliva and to their quality, rather than to the leukocyte count of the saliva. The object of the present work was to study the leukocyte count of the saliva of persons with sound or filled teeth, with inflammatory states of the mouth, and with edentulous mouths. With regard to the “normal” leukocyte count of the saliva, the following figures have been stated in the literature: According to Laquer,3 2,000 cells in 1 c.mm. of saliva. According to Stephens and Jones,” in 50 per cent of the material 25 cells in 1 c.mm. and in 50 per cent 500 to 1000 cells in 1 c.mm. According to Petzold,4 200 to 700 cells in 1 cmm. According to Venzin,6 300 to 700 cells in 1 c.mm. The leukocyte count fluctuates daily,l and all kinds of stimuli, such as the sensation of hunger,4 heat, iodoform, sodium chloride solution and quinine,6 effect changes in the leukocyte count. It is known that the leukocyte count increases in pathologic states. In gingivitis, for instance, the leukocyte count may increase to nearly 4,000 cells in 1 c.mm.6 No parallel exists between the counts of blood and saliva.5 The following method was employed in the determination of the leukocyte count: The saliva sample was collected in a glass during a period of about five to 10 minutes. The sample (0.5 to 2 CC.) was stirred with a glass rod; 0.1 CC. was drawn into a capillary pipette and transferred into 1 C.C. of diluting fluid.* The The solution was agitated for ten to sixty minutes in an automatic mixer. counting was performed in a Fuchs-Rosenthal counting chamber, and the numThe mean value of deterber of leukocytes per 1 c.mm. saliva was determined. minations was accepted. The count was performed one-half to three hours after the sample had been taken.
From the Institute of Dentistry. University of Helsinki, and Department of serology and Bacteriology. *Diluting fluid: 20 CL aqua destillata, to which some chlorophyll powder was added with & platinum loop.
43
0. S.. 0. M., & 0. P. January, 1958
CALONIUS
4-l
The oral cavity, tonsils, and dentition of the experimental subjects were carefully examincd with a mirror, under good lighting. The alveolar gingiva was palpated with t.he fingers in order t,o detect purulent gingival pockets and bleeding, since frequently only palpat,ion reveals a chronic purulent pocket. 10,000
: 6 6 .
4 . 2 . 1,000 * 8 6 . 4 . T t
2 *
.
loo . 6 . 6 . 4 -
2 10 . 6 6 . 4 .
2
o And . *
Fig. L-Leukocyte
- LNkOCyt.3 detenlnation wlthln one-halt to three hours of sampling. - The samplea were left to 0tand r0r twp
day6 prior
to detarmln.tlon.
count of the saliva of the experimental subjects, c.mm. of saliva (logarithmic scale).
in number
of cells per 1
Particular attention was paid to local reddening of the mucous membrane. The detailed dental status was not recorded. No roentgenograms of teeth or jaws were taken. Group 1, clinically healthy mouths with sound or filled teeth, contained eighteen subjects (eleven woman and seven men) of ages varying between 22
Volume Number
LEUKOCYTE
1I I
COUNT
IN
SALIVA
45
and 26 years. Group 2, inflamed and carious mouths, consisted of thirteen subjects; their age, sex, clinical findings, and count of leukocytes in saliva are given. The third group, clinically healthy toothless mouths, comprised twentyfive subjects (eighteen women and seven men) aged 33 to 78 years.* From three subjects, two of them having healthy mouths with filled teeth and one having an inflamed mouth with filled teeth, the leukocyte count was determined at one-hour intervals for eight to twelve hours. The results are shown graphically in Fig. 1 and in Table I. TABLE
I.
LEUKOCYTE
EXPERIMENTALSUBJECT, AQE,ANDSEX 1. K.K.,40 year,male
COUNT
OF THE
SALIVA
IN CLINICALLY
LEUKOCYTECOUNT OFTHESALIVA CELLSINlC.MM.
4,812
INFLAMED
MOUTHS
CLINICALOBSERVATIONS
Marked
gingivitis,
swollen
papillae,
caries,
tartar
2. K. P., 50 years, female
4,323
Gingivitis in upper and lower papillae, caries, tartar
3. V. E., 20 years, male
5,912
Strong local inflammation vae (region 6+, 7+)
4. E. K., 18 years, male
11,896
Suppurating
fistula
jaw,
swollen
of the alveolar
gingi-
at 2+, no gingivitis
2,209
Marked
6. J. K., 20 years, male
1,127
Slight
7. T.H.,20
2,756
Slight localized gingivitis, alveolar gingivae.
readily
bleeding
1,606
Slight localized cisor region
gingivitis
in
upper
in-
9. E. R., 27 years, male
1,848
Slight localized cisor region
gingivitis
in the
in-
10. A. N., 23 years, female
1,320
Reddening
11. A.V.,23
1,133
No gingivitis or caries, pharyngeal clearly reddened. Irritation of when swallowing
5. V.V.,22
8. I.P.,
years,male
years,male
26 years,male
years, female
gingivitis,
caries
localized gingivitis, fistula at 6+
observed
caries, cicatrized
the
labially
in the tonsils
12. L. V., 19 years, male
861
Very slight reddening of alveolar labially at the lower incisor.
13. M. K., 20 years, malt
770
Slight reddening of alveolar at lower incisors, caries
arches the throat gingivae
gingivae
labially
Discussion of the Results Significant differences in leukocyte count are observed between the three groups. In the clinically healthy mouths with teeth, the leukocyte count varied between 110 and 1,364 cells per 1 c.mm. In the group of inflamed and carious mouths the count varied in the range 770 to 11,896 cells per 1 c.mm. The lowest values, 770 and 861 cells per 1 c.mm., count
*This was
group made
includes two days
seven after
cases, marked in Fig. the sample was taken.
1 with
an
asterisk,
whose
leukocyte
CALONIUS
46
0. s., 0. M., & 0. P. January.1958
occurred in cases where very slight reddening of the gingival border was obThe highest leukocyte count occurred served labially from the lower incisors. in a case where the sole detectable pathologic process was a suppurating fistula leading to the root (Jf a maxillary second incisor. The toothless subjects showed the lowest leukocyte counts, 3. to 143 cells per 1 c.mm. VcnzinG had already found that wearers of prostheses who had, at the same time, well-restored residual t,eeth presented a lower leukocyte count than mouths with all t,eeth present. The leukocyte count of the saliva might have significance in the assessment of pathologic processes. summary The number of leukocytes in the saliva has been counted for healthy persons and \vithout teeth and for persons with an inflammatory process in the rc>giori of 11~ oral cavity. In the toothless, healthy mouth the leukocyte count is considerably lower (1 to 143 cells per 1 cmm.) than in the healthy mouth with teeth (110 to the count increased 1,364 cells per 1 cmm.) ; in mouths with inflammation, quite remarkably (770 to 11,896 cells per 1 c.mm.). The differences cannot be attributed to daily variations. with
I wish to express my sincere gratitude to Prof. K. 0. Renkonen, M.D., and Prof. J. Kivim’iki, M.D., for their advise and their interest in my work. Miss A. Peltola has per(Pol. Sci.), has prepared the formed the leukocyte counts and Mr. J. Kihlberg, M.A. Cordial thanks ate due them for their valuable logarithmic~ I c:prt~s(~ntatiol~ of the results. help.
References 1. Comroe, B. I. : Salivary Changes in Systemic Disease,, Dental Cosmos 76: 563-569, 1934. tiber die Eigenschaften der menschbchen Triinenfliissigkeit, Dissertation, 2. Junnola, K.: Ann. med. cxpcr. ct biol. Fcnniae, 31, Supp. 1, 1953. 3. Layuer, F.: iiber die Natur und Herkunft der Speichelk~rperchen und ihre Beziehungen zu den Zellen des Blutes, Frankfurt. Ztschr. Path. 11: 79-104, 1912. 4. Petzold, R.: fiber Herkunft und Bedeutung der Speichelkcrperchen. Odontologica, Base& 1952, Benno Schwabe. Sub5. Stephens, D. J., and Jones, E.: Leucocytes in the Saliva in Normal and Abnormal jects, Proc. Sot. Rxper. Riol. & Med. 31: 879-880, 1934. 6. Venzin, B.: iiber den Einfluss der Salzpaste Selgin auf die Speichelkarperchen Odontologica, Basel, 1953, Renno Schwabe. BULEVARDI 5.
LEUKOCYTE
Medicine COUNT
IN SALIVA
P. E. B. CALONIUS, DR. ODONT., HF.LSINKI,
FINLAND
T
HE leukocyte count of the blood and the cerebrospinal fluid has proved to be of important clinical value. Even in the constantly secreted tears2 or the urine, the leukocyte count may furnish valuable hints. In diseases of the oral cavity, it is not easy to follow an inflammatory process by means of laboratory methods. Attention has heretofore been paid to the number of bacteria in the saliva and to their quality, rather than to the leukocyte count of the saliva. The object of the present work was to study the leukocyte count of the saliva of persons with sound or filled teeth, with inflammatory states of the mouth, and with edentulous mouths. With regard to the “normal” leukocyte count of the saliva, the following figures have been stated in the literature: According to Laquer,3 2,000 cells in 1 c.mm. of saliva. According to Stephens and Jones,” in 50 per cent of the material 25 cells in 1 c.mm. and in 50 per cent 500 to 1000 cells in 1 c.mm. According to Petzold,4 200 to 700 cells in 1 cmm. According to Venzin,6 300 to 700 cells in 1 c.mm. The leukocyte count fluctuates daily,l and all kinds of stimuli, such as the sensation of hunger,4 heat, iodoform, sodium chloride solution and quinine,6 effect changes in the leukocyte count. It is known that the leukocyte count increases in pathologic states. In gingivitis, for instance, the leukocyte count may increase to nearly 4,000 cells in 1 c.mm.6 No parallel exists between the counts of blood and saliva.5 The following method was employed in the determination of the leukocyte count: The saliva sample was collected in a glass during a period of about five to 10 minutes. The sample (0.5 to 2 CC.) was stirred with a glass rod; 0.1 CC. was drawn into a capillary pipette and transferred into 1 C.C. of diluting fluid.* The The solution was agitated for ten to sixty minutes in an automatic mixer. counting was performed in a Fuchs-Rosenthal counting chamber, and the numThe mean value of deterber of leukocytes per 1 c.mm. saliva was determined. minations was accepted. The count was performed one-half to three hours after the sample had been taken.
From the Institute of Dentistry. University of Helsinki, and Department of serology and Bacteriology. *Diluting fluid: 20 CL aqua destillata, to which some chlorophyll powder was added with & platinum loop.
43
0. S.. 0. M., & 0. P. January, 1958
CALONIUS
4-l
The oral cavity, tonsils, and dentition of the experimental subjects were carefully examincd with a mirror, under good lighting. The alveolar gingiva was palpated with t.he fingers in order t,o detect purulent gingival pockets and bleeding, since frequently only palpat,ion reveals a chronic purulent pocket. 10,000
: 6 6 .
4 . 2 . 1,000 * 8 6 . 4 . T t
2 *
.
loo . 6 . 6 . 4 -
2 10 . 6 6 . 4 .
2
o And . *
Fig. L-Leukocyte
- LNkOCyt.3 detenlnation wlthln one-halt to three hours of sampling. - The samplea were left to 0tand r0r twp
day6 prior
to detarmln.tlon.
count of the saliva of the experimental subjects, c.mm. of saliva (logarithmic scale).
in number
of cells per 1
Particular attention was paid to local reddening of the mucous membrane. The detailed dental status was not recorded. No roentgenograms of teeth or jaws were taken. Group 1, clinically healthy mouths with sound or filled teeth, contained eighteen subjects (eleven woman and seven men) of ages varying between 22
Volume Number
LEUKOCYTE
1I I
COUNT
IN
SALIVA
45
and 26 years. Group 2, inflamed and carious mouths, consisted of thirteen subjects; their age, sex, clinical findings, and count of leukocytes in saliva are given. The third group, clinically healthy toothless mouths, comprised twentyfive subjects (eighteen women and seven men) aged 33 to 78 years.* From three subjects, two of them having healthy mouths with filled teeth and one having an inflamed mouth with filled teeth, the leukocyte count was determined at one-hour intervals for eight to twelve hours. The results are shown graphically in Fig. 1 and in Table I. TABLE
I.
LEUKOCYTE
EXPERIMENTALSUBJECT, AQE,ANDSEX 1. K.K.,40 year,male
COUNT
OF THE
SALIVA
IN CLINICALLY
LEUKOCYTECOUNT OFTHESALIVA CELLSINlC.MM.
4,812
INFLAMED
MOUTHS
CLINICALOBSERVATIONS
Marked
gingivitis,
swollen
papillae,
caries,
tartar
2. K. P., 50 years, female
4,323
Gingivitis in upper and lower papillae, caries, tartar
3. V. E., 20 years, male
5,912
Strong local inflammation vae (region 6+, 7+)
4. E. K., 18 years, male
11,896
Suppurating
fistula
jaw,
swollen
of the alveolar
gingi-
at 2+, no gingivitis
2,209
Marked
6. J. K., 20 years, male
1,127
Slight
7. T.H.,20
2,756
Slight localized gingivitis, alveolar gingivae.
readily
bleeding
1,606
Slight localized cisor region
gingivitis
in
upper
in-
9. E. R., 27 years, male
1,848
Slight localized cisor region
gingivitis
in the
in-
10. A. N., 23 years, female
1,320
Reddening
11. A.V.,23
1,133
No gingivitis or caries, pharyngeal clearly reddened. Irritation of when swallowing
5. V.V.,22
8. I.P.,
years,male
years,male
26 years,male
years, female
gingivitis,
caries
localized gingivitis, fistula at 6+
observed
caries, cicatrized
the
labially
in the tonsils
12. L. V., 19 years, male
861
Very slight reddening of alveolar labially at the lower incisor.
13. M. K., 20 years, malt
770
Slight reddening of alveolar at lower incisors, caries
arches the throat gingivae
gingivae
labially
Discussion of the Results Significant differences in leukocyte count are observed between the three groups. In the clinically healthy mouths with teeth, the leukocyte count varied between 110 and 1,364 cells per 1 c.mm. In the group of inflamed and carious mouths the count varied in the range 770 to 11,896 cells per 1 c.mm. The lowest values, 770 and 861 cells per 1 c.mm., count
*This was
group made
includes two days
seven after
cases, marked in Fig. the sample was taken.
1 with
an
asterisk,
whose
leukocyte
CALONIUS
46
0. s., 0. M., & 0. P. January.1958
occurred in cases where very slight reddening of the gingival border was obThe highest leukocyte count occurred served labially from the lower incisors. in a case where the sole detectable pathologic process was a suppurating fistula leading to the root (Jf a maxillary second incisor. The toothless subjects showed the lowest leukocyte counts, 3. to 143 cells per 1 c.mm. VcnzinG had already found that wearers of prostheses who had, at the same time, well-restored residual t,eeth presented a lower leukocyte count than mouths with all t,eeth present. The leukocyte count of the saliva might have significance in the assessment of pathologic processes. summary The number of leukocytes in the saliva has been counted for healthy persons and \vithout teeth and for persons with an inflammatory process in the rc>giori of 11~ oral cavity. In the toothless, healthy mouth the leukocyte count is considerably lower (1 to 143 cells per 1 cmm.) than in the healthy mouth with teeth (110 to the count increased 1,364 cells per 1 cmm.) ; in mouths with inflammation, quite remarkably (770 to 11,896 cells per 1 c.mm.). The differences cannot be attributed to daily variations. with
I wish to express my sincere gratitude to Prof. K. 0. Renkonen, M.D., and Prof. J. Kivim’iki, M.D., for their advise and their interest in my work. Miss A. Peltola has per(Pol. Sci.), has prepared the formed the leukocyte counts and Mr. J. Kihlberg, M.A. Cordial thanks ate due them for their valuable logarithmic~ I c:prt~s(~ntatiol~ of the results. help.
References 1. Comroe, B. I. : Salivary Changes in Systemic Disease,, Dental Cosmos 76: 563-569, 1934. tiber die Eigenschaften der menschbchen Triinenfliissigkeit, Dissertation, 2. Junnola, K.: Ann. med. cxpcr. ct biol. Fcnniae, 31, Supp. 1, 1953. 3. Layuer, F.: iiber die Natur und Herkunft der Speichelk~rperchen und ihre Beziehungen zu den Zellen des Blutes, Frankfurt. Ztschr. Path. 11: 79-104, 1912. 4. Petzold, R.: fiber Herkunft und Bedeutung der Speichelkcrperchen. Odontologica, Base& 1952, Benno Schwabe. Sub5. Stephens, D. J., and Jones, E.: Leucocytes in the Saliva in Normal and Abnormal jects, Proc. Sot. Rxper. Riol. & Med. 31: 879-880, 1934. 6. Venzin, B.: iiber den Einfluss der Salzpaste Selgin auf die Speichelkarperchen Odontologica, Basel, 1953, Renno Schwabe. BULEVARDI 5.