2. DEPARTMENT OF PUBLIC
HEALTH DENTISTRY
SEMINAR
SALIVA
PRESENTED BY:-
Dr.AMRITA RASTOGI
M.D.S 1st YEAR
3. CONTENTS
INTRODUCTION
SALIVARY GLANDS
Development
Structure of terminal secretory units.
Classification Of Salivary Glands
Major Salivary glands
Minor Salivary glands
Nerve supply to salivary glands
• FORMATION OF SALIVA
• PROPERTIES OF SALIVA
• COMPOSTION OF SALIVA
4. • FUNCTIONS OF SALIVA
• REGULATION OF SALIVA
• CO-REALATION BETWEEN SALIVA AND DENTAL
CARIES
• SALIVA AS DIAGNOSITIC AID
• COLLECTION OF SALIVA
• SALIVA AND DENTAL PLAQUE
CLINICAL CONSIDERATION OF SALIVA
EFFECT OF DRUGS & CHEMICAL ON SALIVARY
SECRETION
CONCLUSION
REFERENCES
5. INTRODUCTION
The oral cavity is a moist environment; a film of fluid called
saliva constantly coats its inner surfaces and occupies the
space between the lining oral mucosa and teeth. Saliva is a
complex fluid, produced by the salivary glands, whose
important role is maintaining the wellbeing of mouth.
Human saliva consist of organic and inorganic
components and plays an essential role in mastication, in
bolus formation, acts as a lubricant in swallowing, helps in
speech production and protecting the mucosal surfaces of the
oral cavity from desiccation.
6. The enzymes found in saliva are essential in beginning the
process of digestion of dietary starches and fat.
Saliva circulating in mouth at any given time is termed
“whole saliva”.
Saliva reflects the physiological state of body including
emotional endocrinal nutrional and metabolic variations
also known as “THE BODY’S MIRROR”
7. According to Stedmen’s Dictionary
Saliva is a clear, tasteless, odourless slightly acidic (pH6.8),
viscid fluid, consisting of secretions from the parotid,
sublingual and submandibular salivary gland and the
mucous glands of the oral cavity.
• According to Webster Medical Dictionary
The watery tasteless liquid mixture of salivary & oral
mucous glands secretion that lubricates the chewing food ,
wets the oral wall & contains the enzyme ptyalin which
function in the pre-digestion of starch.
9. DEVELOPMENT
All salivary glands show a similar pattern of development.
MESENCHYME
ORAL
EPITHELIAL
BUDS
ECTODERMAL ENDODERMAL
PAROTID GLAND
AND MINOR
SALIVORY GLANDS
SUBMANDIBULAR
AND SUBLINGUAL
GLAND
10. The Primordia of the glands of humans appear during sixth
week . Primordium of sublingual glands appear after 7 to 8
weeks of fetal life.
The minor salivary glands begin their development during
the third month.
The epithelial bud grows into an extensively branched
system of cords of cell that are first solid but gradually
develop a lumen and become ducts.
The secretory portions develop later than the duct system
and forms by repeated branching and budding of the finer
cell cords and ducts.
11. Since salivary glands are formed from an initially solid core
of epithelial cells –for the proper functioning of the gland
the duct needs to undergo cavitations -to allow free access
between the saliva producing acini and oral cavity.- known
as Canilicular Stage.
12. STRUCTURE OF TERMINAL SECRETORY
UNITS
Salivary glands are made up of cells
which are arranged in small groups
around a central globular cavity called
acinus & alveolus.
The central cavity is continous with the
lumen of the duct.
The fine duct draining each acinus is
called the intercalated ducts.
Many intercalated ducts join together to
form intralobular ducts.
Two or more intralobular ducts join to
form interlobular ducts , which unite to
form the main duct of the gland.
The gland with this type of structure &
duct system is called racemose type.
Racemose means the bunch of grapes
13. CLASSIFICATION OF SALIVARY GLANDS
MAJOR
SALIVARY
GLANDS
Parotid
Gland
Submandibular
Gland
Sublingual
Gland
MINOR
SALIVARY
GLANDS
Lingual mucous
Lingual serous
Buccal glands
Labial glands
Palatal glands
(a)According to size and location
14. MAJOR SALIVARY GLANDS
PAROTID GLAND
Parotid gland is the largest salivary gland. It is irregular, wedged
shape and unilobular.
Parotid is 14-28 grams in weight and provides 60-65% of total
salivary volume.
Size averaging 5.8 cm ( cranio-caudal dimension),
3.4 cm (ventral-dorsal dimension).
Parotid gland
15. These glands are situated at the side of the face just below and in
front of the ear .
The main parotid duct – Stensens duct leaves mesial angle of
gland traverses over the massetter, pierces buccinator and enters
oral cavity buccal to maxillary 1st molar. Duct is about 35 to 40
mm long . Mainly Serous in secretion.
16. Submandibular Gland
Also called as Submaxillary
gland. Its irregular andWalnut
shaped.
It is 10-15gm in weight produce
20-30% of total salivary
volume.
Located in the submandibular
triangle of the neck, inferior &
lateral to mylohyoid muscle.
17. The posterior-superior portion of the gland curves up around the
posterior border of the mylohyoid and gives rise to Wharton’s
duct .Wharton’s duct passes forward along the superior surface of
the mylohyoid adjacent to the lingual nerve. It is 2-4mm in
diameter & about 5cm in length.
Wharton’s duct, opens at the side of frenulum of tongue by the
means of small opening on the papilla called Caruncula
Sublingualis
18. SUBLINGUAL GLAND
The sublingual glands are the
smallest of the major salivary
glands, produces 2-5% of the total
salivary volume.
Each is of the size and shape of an
almond .Weighs 3-4 gms.
Glands lie beneath mucosa of floor
of mouth, above mylohyoid muscle
, medial to mandible and lateral to
genioglossus, series of small ducts
19. The ducts of the sublingual glands are called Bartholin’s ducts.
In most cases, Bartholin’s ducts consists of 8-20 smaller ducts of
Rivinus. These ducts are short and small in diameter.
Open into oral cavity at the sublingual fold on either side of the
tongue
20. Minor Salivary Gland
The minor salivary glands are located beneath the epithelium in
almost all parts of the oral cavity. These glands usually consist of
several small groups of secretory units opening via short ducts
directly into mouth.
There are 600 to 1000 minor salivary glands lying in the oral
cavity and the oropharynx.
The minor salivary glands are classified according to their
anatomic location.
21. 1. Labial and Buccal Glands
Labial glands -- situated beneath the mucous membrane around
the orifices of mouth.They are circular in form, and about the size
of small peas; their ducts open by minute orifices upon the
mucous membrane.
Buccal glands– present between the mucous membrane and
buccinator muscle.
2. Glossopalatine Glands
The glossopalatine glands are pure mucous glands, they are
principally localized to the region of the isthmus in the
glossopalatine fold.
22. 3. Palatine Glands
They consist of several hundred glandular aggregates in the
lamina propria of the posterior region of the hard palate and in
the submucosa of the soft palate.The opening of the ducts on the
palatal mucosa are often large and easily recognized
4. Lingual Glands
The glands of the tongue are divided into several groups:
(a)The anterior lingual glands ( glands of BLANDIN AND NUHN )
Location – near the apex of tongue.
The anterior region of this glands are chiefly mucous in
character, whereas the posterior region is mixed.
.
23. (b) The posterior lingual mucous gland.
Location -- lateral and posterior to the vallate papillae and in
association with the lingual tonsil.
(c) The posterior lingual serous gland ( von Ebner’s glands)
Location -- between the muscle fibers of the tongue below the
vallate papillae.
24.
25. (b) According to the histochemical nature of secretory products.
• This type of gland is made up of serous cells
predominantly.
• These glands secrete thin & watery saliva .
• Parotid glands and lingual glands are serous glands.
SEROUS GLANDS
• This type of glands are made up of mucous cells mainly .
• These glands secrete thick & viscous saliva with more
mucin .
• Lingual mucous, buccal glands & palatal glands
belongs to this type.
MUCOUS GLANDS
• Mixed glands are made up of both serous and mucous
cells .
• Submandibular , sublingual & lacrimal glands are
mixed glands
MIXED GLANDS
26. Nerve supply to salivary glands
Salivary glands are under the control of autonomic
nervous system and receive efferent nerve fibres
from both parasympathetic and sympathetic
divisions of autonomic nervous system.
Parasympathetic fibers
The parasympathetic nerve fibers supplying the salivary glands
arise from the superior and the inferior salivatory nuclei,which
are situated in pons and medulla respectively.
27. Parasympathetic fibres to submandibular and sublingual
glands.
The parasympathetic preganglionic
fibers to submandibular & sublingual
glands arise from the superior
salivatory nucleus situated in pons .
After taking origin from this
nucleus,the preganglionic fibers pass
throgh nervous intermedius of
wrisberg, geniculate ganglion,the
motor fibers of facial nerve, chorda
tympani branch of facial nerve &
lingual branch trigeminal nerve &
finally reach the submaxillary
ganglion.
28. Parasympathetic fibres to parotid gland.
The parasympathetic preganglionic
fibres to parotid gland arises from
inferior salivatory nucleus situated in
the upper part of medulla oblongata.
From here , the fibres pass through
the tympanic branch of
glossopharyngeal nerve, tympanic
plexus & lesser petrosal nerve and
end in otic ganglion.
The postganglionic from otic
ganglion reach the parotid gland by
passing through the
auriculotemporal branch in
mandibular division of trigeminal
nerve
29. Sympathetic fibers
The sympathetic preganglionic fibres to salivary glands arise
from the lateral horns of first and second thoracic segments of
spinal cord.
The fibres leave the cord through the anterior nerve roots and end
in superior cervical ganglion of the sympathetic chain.
The postganglionic fibres from this ganglion are distributed to the
salivary glands along the nerve plexus around the arteries
supplying the glands
30. FORMATION OF SALIVA
( Mese et al., 2007, p. 711-713)
The secretory acinus produces the primary saliva, which is
isotonic with an ionic composition resembling that of plasma. In
the duct system, the primary saliva is then modified by selective
reabsorption of Na+ and Cl- (without water) and secretion of K+
and HCO3-.
Salivary secretion is a two-stage process:
Initial Formation stage involves acini to secrete a primary
secretion that contains ptyalin and/or mucus in a solution of
ions similar in plasma.
Modification stage is when the primary secretion flows
through the ducts and the ionic composition of saliva is
modified.
31. Initial Formation Stage:
Stimulation of the parasympathetic nerve, or mainly muscarinic
cholinergic receptors, initiates intracellular second messenger events
of acinar cells, the signal transduction system involves the release of
Ca2+ from intracellular stores. The increase in intracellular Ca2+
levels leads to the Cl– channels at the apical membrane to open and
an influx of Cl– into the lumen. Hence the change in
electronegativity by Cl– influx causes Na+ to diffuse across the
cation-permeable tight junction between acinar cells to preserve
electroneutrality within the lumen. The net influx of NaCl creates an
osmotic gradient across the acinus, which draws water from the
blood supply via a tight junction. Thus, saliva secreted in the lumen
(primary saliva) is an isotonic plasma-like fluid.
32. Modification Stage:
In the next step, the composition of primary saliva is modified in the duct
system. The intralobular ducts reabsorb Na+ and Cl– excluding water, and
make the final saliva hypotonic. Stimulation of the sympathetic nerve, or
ß-adrenergic receptors, causes exocytosis but less fluid secretion.
Activation of ß-adrenoceptors increases the intracellular cyclic adenosine
monophosphate (cAMP) level, which is the primary second messenger for
amylase secretion. cAMP is thought to activate protein kinase which may
regulate the process by which cells release the contents of their secretory
granules. This involves the fusion of the granule membrane with the
luminal plasma membraneof the secretory cell followed by rupture of the
fused membranes. The released contents of granules comprise a wide
variety of proteins which are unique to saliva and show biological
functions of particular importance to oral health.
(Reference from 6: Salivary Secretion, Taste and Hyposalivation)
33. PROPERTIES OF SALIVA
i) VOLUME:- 1000 to 1500 ml of saliva is secreted per day and ,
it is approximately about 1ml/minute . Contribution by each
major salivary gland is
34. ii) REACTION:- mixed saliva from all the glands is slightly
acidic with pH of 6.35 to 6.85.
iii) SPECIFIC GRAVITY:- it ranges between 1.002 to 1.012.
iv)TONICITY :- saliva is hypotonic to plasma.
36. Organic Substances
Enzymes
1-Amylases
Calcium metalloenzyme.
Hydrolyzes alpha (1-4)bonds of starches such as amylase and
amylopectin.
Several salivary isoenzymes.
Maltose is the major-end-product(20% is glucose).
Appears to have digestive function.
37. 2-Lactoferin
Iron-binding protein.
“Nutritional“ immunity (iron starvation).
Some microorganisms (e.g., E. coli) have adapted to this
mechanism by producing enterochelins.
bind iron more effectively than lactoferrin.
iron-rich enterochelins are then reabsorbed by bacteria.
Lactoferrin, with or without iron, can be degraded by some
bacterial proteases.
38. 3-Histatins
A group of small histatine-rich proteins
Potent inhibitors of Candida albicans growth
4-Cystatins
Are inhibitors of cystatine-proteases
Are ubiquitous in many body fluids
Considered to be protective against unwanted proteolysis
bacterial proteases
lysed leukocytes
May play inhibit proteases in periodontal tissues
Also have an effect on calcium phosphate precipitation
39. 5-Lingual lipase
Secreted by von ebners glands of tongue.
Involved in first phase of fat digestion.
Hydrolizes medium –to long –chain triglycerides.
Important in digestion of milk fat in new-born.
it is highly hydrophobic and readily enters fat globules.
6-STATHERINS
Calcium phosphate salts of dental enamel are soluble under
typical condition of ph and ionic strength.
Super saturation of calcium phosphates maintain enamel integrity.
40. Statherins prevent precipitation or crystallization of
supersaturated calcium phosphate in ductal saliva & oral fluid.
Produced by acinar cells.
Also an effective lubricant.
7-Proline Rich Proteins (PRPs)
Like statherins PRPs are also highly asymmetrical
Inhibitors of calcium phosphate crystal growth
Inhibition due to first 30 residues of negatively charged amino-terminal
end
Present in the initially formed enamel pellicle & in ‘mature’
pellicle.
41. 8-Mucins
Lacks precise folded structure of globular proteins
Asymmetrical molecule with open , randomly organized structure
Poly peptide backbone with CHO side chains
Side chains may end in negatively charged groups such as sialic
acid & bound sulphate
Hydrophillic , entraining water
Unique rheological properties
Two major mucins ( MG1 & MG2)
42. FUNCTION OF MUCIN
A) TISSUE CAPACITY
- protective coating about hard & soft tissues
- primary role in formation of acquired pellicle
- concentrates anti – microbial molecules at mucosal interface
B) LUBRICATION
- align themselves with direction of flow of saliva
- increase lubricating qualities
- film strength determines how effectively opposed moving
surface are kept apart
43. C) AGGRETION OF BACTERIAL CELLS
- bacterial adhere to mucins may result in surface attachment
- mucin coated bacteria may be unable to attach to surface
D) BACTERIAL ADHESION
- mucin oligosaccharides mimics those on mucosal cell surface
- react with bacterial adhesions , thereby blocking them
44. Inorganic Substances
1-SODIUM
Contributes to osmolarity of saliva(osmolarity is ½-3/4th of
blood).
Sodium concentration give diagnostic information relating
to the efficiency of ductal transport system.
2-CALCIUM
saliva is supesaturated with calcium and hence prevents
dissolution of enamel.
it also facilitates enamel mineralization.
45. 3-POTASSIUM
Contributes to osmolarity of saliva.
Potassium reaches saliva by active processes in both acini and
ducts.
Concentration falls immediately after stimulation and then
approximately constant.
4-BIOCARBONATE
Most important buffer in saliva [resist change in salivary Ph
when acid or alkali added].
Biocarbonates release weak carbonic acid when acid is added;this
is rapidly decomposed to H2O and CO2 which leaves the
solution resulting in complete removal of acids.
46. 5-CHLORINE
Contributes to osmolarity of saliva.
Increased flow rate leads to increased chloride reabsorption.
6-fluoride
fluoride is well known for its anti-caries property.
peak concentration of fluoride in gland saliva are observed some
30-60 minutes after ingestion of fluoride dose.
7-phosphorous
it is actively transported into saliva,probably mainly in the acini
but possibly also in the ducts
47. FUNCTIONs OF SALIVA
Saliva is very essential . Since it has many functions , its absence leads
to many inconveniences.
- preparation of food for swallowing
- appreciation of taste
- digestive function
- cleansing and protective functions
- role in speech
- excretory function
- regulation of body temperature
- regulation of water balance
48. 1)PREPARATION OF FOOD FOR SWALLOWING
When food enters the mouth , saliva moistens and dissolves it.
The mucous membrane of mouth is also moistened and masticated
food is rolled into a bolus.
The mucin of saliva lubricates the bolus and facilitates the
swallowing.
2)APPRECIATION OF TASTE
Taste is a chemical sensation. Saliva by its solvent action
dissolves the solid food substance , so that the dissolved
substances can stimulate the taste buds.The stimulated taste
buds recognize the taste.
49. 3)DIGESTIVE FUNCTION
Saliva has three digestive enzymes namely,salivary amylase,maltase,and
lingual lipase
SALIVARYAMYLASE
• salivary amylase is a carbohydrate splitting(amylolytic)enzyme.
• It acts on cooked or boiled starch and converts it into maltose ,major
part of it occurs in the stomach because,the food stays only for a short
time in the mouth.
• The optimum pH necessary for the activation salivary amylase is 6.
• The salivary amylase cannot act on cellulose.
MALTASE
• The enzyme maltase is present only in traces in human saliva.
• It converts maltose into glucose.
.
50. LINGUAL LIPASE
• The lingual lipase is secreted from serous glands situated on the
posterior aspect of tongue.
• It digest milk fats(pre-emulsified).
• It hydrolyses triglycerides into fatty acids.
51. 4)CLEANSING AND PROTECTIVE FUNCTION
• due to the constant secretion of saliva,the mouth and teeth are
rinsed and kept free from food debris,shed epithelial cells and
foreign particles.
• In this way,saliva prevents bacterial growth by removing
materials,which may serve as culture media for the bacterial
growth.
• the enzyme lysozyme of saliva kills some bacteria such as
staphylococcus,streptococcus,and brucella.
• mucin present in the saliva protects the mouth by lubricating the
mucous membrane of the mouth.
52. 5)ROLE IN SPEECH
By moistening and lubricating the soft parts of mouth and lips,saliva
helps in speech.
If the mouth is dry,articulation and pronunciation become difficult.
6) EXCRETORY FUNCTION
Many substances,both organic and inorganic,are excreted in
saliva.
It excretes substances like mercury,potassium iodide,lead and
thiocyanate.
Saliva also excretes some viruses such as those causing rabies
and mumps
In some pathological conditions, saliva exretes substances like
sugar in diabetes mellitus, calcium in hyperparathyroidism.
53. 7)REGULATION OF BODY TEMPERATURE
In dogs and cattle excessive dripping of saliva during panting
helps in loss of heat and regulation of body temperature.
However,in human being sweat glands play major role in the
temperature regulation and saliva does not play any role in this
function.
8)REGULATION OFWATER BALANCE
When the body water content decreases ,salivary secretion
also decreases.
This causes dryness of the mouth and induces thirst.
When the water is taken,it quenches the thirst and restores
the body water content.
54.
55. REGULATION OF SALIVARY SECRETION
Salivary secretion is regulated by nervous
mechanism & it is a reflex phenomenon.
Salivary reflexes are of two types:-
1)Unconditioned reflex
2)Conditioned reflex
56. 1)UNCONDITIONED REFLEX
Secretion of saliva when any substance is played in the mouth is
called the unconditioned reflex.
It is due to the stimulation of nerve endings in the mucuos
membrane of the oral cavity.
This reflexes is present since birth & hence it is also called
inborn reflex.
57. 2) CONDITIONED REFLEX
Secretion of saliva by the sight,smell,heaving or thought of food
is called conditioned reflex.
It is due to the impulses arising from the eyes,ear,etc.
It is an acquired reflex & needs previous experience.
58. CO-REALATION BETWEEN SALIVA AND
DENTAL CARIES
It is capable of regulating the pH of the oral cavity by
the help of its bicarbonate content as well as its
phosphate and amphoteric protein constituents.
Increase in secretion rate usually results in an
increase in pH and buffering capacity.
Because of its calcium and phosphate content it
helps to maintain the integrity of teeth.
Tooth dissolution is prevented or retarded and re-mineralization
is enhanced by the presence of
copious salivary flow.
59. The flow of saliva can reduce plaque accumulation
on the tooth surface.
The diffusion into plaque of salivary components
such as calcium, phosphate, hydroxyl and fluoride
ions enhances re-mineralization of early carious
lesions.
60. The carbonic acid-bicarbonate buffering system as
well as ammonia and urea constituents of the saliva
act as buffer
The total concentration of IgA in saliva may be
inversely related to caries experience.
Carbonic acid-bicarbonate
system
IgA
61. •Lysozyme, lactoperoxidase and lactoferrin in saliva have a
direct antibacterial action on plaque
•Salivary proteins could increase the thickness of the acquired
pellicle and so help to retard the movement of calcium and
phosphate ions out of enamel.
lactope
roxidas
lysozyme
e
62. CHEMICAL BENEFITS OF SALIVA STIMULATION
Stimulating the flow of saliva alters its composition. Dawes noted
that increasing the rate of salivary flow increases the
concentration of protein, sodium, chloride and bicarbonate and
decreases the concentration of magnesium and phosphorus.
Perhaps of greatest importance is the increase in the
concentration of bicarbonate, which increases progressively with
the duration of stimulation. The increased concentration of
bicarbonate diffuses into the plaque, neutralizes plaque acids,
increases the pH of the plaque and favors the remineralisation of
damaged enamel and dentin.
Increasing the rate of salivary flow increases the concentration of
protein, sodium, chloride and bicarbonate and decreases the
concentration of magnesium and phosphorus in saliva.
63. Salivary Flow Rate, Buffer Effect, and Dental Caries
Probably the most important caries-preventive functions of saliva
are the flushing and neutralizing effects, commonly referred to as
"salivary clearance" or "oral clearance capacity“ (Lagerlof and
Oliveby, 1994). In general, the higher the flow rate, the faster the
clearance (Miura et al., 1991) and the higher the buffer capacity
(Birkhed and Heintze, 1989).
Reduced salivary flow rate and the concomitant reduction of oral
defense systems may cause severe caries and mucosal
inflammations (Daniels et al., 1975; Van der Reijden et ah 1996).
Dental caries is probably the most common consequence of
hyposalivation (Brown et al, 1978; Scully, 1986).
64. Caries lesions develop rapidly and also on tooth surfaces that
areusually not susceptible to caries. Subjects with impaired saliva
flow rate often show high caries incidence (Papas et al., 1993;
Spak et al, 1994) or cariessusceptibility (Heintze et al).
65.
66. SALIVA - AS A DIAGNOSTIC AID
Human saliva performs a wide variety of biological functions that
are critical for the maintenance of the oral health.
Saliva, a multi constituent oral fluid, has high potential for the
surveillance of general health and diseases.
67. Why saliva?
Non – invasive
Limited training
No special equipment
Potentially valuable for children and
older patients
Cost effective
Eliminates the risk of infection
Easy, No pain, No needle prick, Fast
Screening of large population
No
Pain
68. What is a biomarker?
A biomarker is an objective measure that has been evaluated and
confirmed either as an indicator of physiologic health, a
pathogenic process, or a pharmacologic response to a therapeutic
intervention.
Biomarkers, whether produced by normal healthy individuals or
by individuals affected by specific systemic diseases, are tell -
tale molecules that could be used to monitor health status, disease
onset, treatment response and outcome.
69.
70. Classification of salivary biomarkers
Locally produced
proteins of host
and bacterial
origin (enzymes,
immunoglobulins
and cytokines)
Genetic ⁄ genomic
biomarkers such
as DNA and
mRNA of host
origin
Bacteria and
bacterial
products, ions,
steroid hormones
and volatile
compounds
Salivary proteomic, genomic and microbial
biomarkers for periodontal diagnosis
71.
72.
73. Salivary biomarkers have been used to examine the effect of
lifestyle factors, including smoking, on periodontal health.
Levels of salivary markers including prostaglandin E2,
lactoferrin, albumin, aspartate aminotransferase, lactate
dehydrogenase, alkaline phosphatase were significantly lower in
current smokers than in non-current smokers.
74.
75. Stress biomarkers in saliva.
Salivary α-amylase Chromogranin A
Salivary cortisol
Salivary – α amylase Chromogranin A
Biomarkers of acute stress and a-amylase is better.
Both salivary CgA and a-amylase are considered
biomarkers of the stress response by the sympatho–
adreno–medullary system, unlike cortisol, which is
considered a biomarker of stress response by the
Hypothalamic pituitary adrenal system.
76. Salivary cortisol
Its level in saliva is lower than that in blood.
Advantage of salivary over serum cortisol
measurement is the minimisation of stress from fear
of needles during collection, which may bias the
results.
77. Various other diagnosis
Candidiasis – Through the presence of candida spp in saliva
The presence of periodontal pathogenic bacteria can also be
diagnosed by this method - increasing the risk of cardiovascular
and cerebrovascular diseases.
Cystic fibrosis
Cystic fibrosis (CF) is a genetically transmitted disease of children
and young adults, which is considered a generalized exocrinopathy.
CF is the most common lethal autosomal-recessive disorder.
The abnormal secretions present in CF caused clinicians to explore
the usefulness of saliva for the diagnosis of the disease.
78. 21-Hydroxylase deficiency
an inherited disorder of steroidogenesis which leads to
congenital adrenal hyperplasia. In non-classic 21-hydroxylase
deficiency, a partial deficiency of the enzyme is
present.(Carlson et al., 1999).
In 21- hydroxylase deficiency, a strong correlation has been
found between 17- hydroxyprogesterone levels in saliva and
serum.
79. In some malignant diseases, markers can be detected in saliva,
such as the presence of protein p53 in patients with oral
squamous cell carcinoma.
Other biomarkers for OSCC:
M2BP
MRP14
CD59
Profilin
Catalase
80. The presence of the c- erb- 2 tumour marker in the saliva and
blood serum of breast cancer patients and its absence in healthy
women is a promising tool for the early detection of this disease.
In ovarian cancer too, the CA 125 marker can be detected in the
saliva with greater specificity and less sensitivity than in serum.
PCR detection of H. pylori in the saliva show high sensitivity.
The presence of antibodies to other infectious organisms such as
Borrelia burdogferi, shigella can also be detected in saliva.
Detection of hepatitis A and hepatitis B surface antigen in the
saliva has been used in epidemiological studies.
81. In neonates the presence of Ig A is an excellent marker of rota
virus infection
HIV antibody detection is as precise in saliva as in serum and is
both applicable in clinical and epidemiological studies.
Salivary and oral fluid test:
Orasure ( available in USA)
84. SUBMANDIBULR /SUBLINGUAL
Alternatively , for et al have
described a simpler method for the
collection of submandibular-sublingual.
After blocking the parotid saliva
secretion by placing a gauze pad at
the orifice of the parotid ducts.
Saliva can be collected from the floor
of the mouth with a micropipette.
85. MINOR GLANDS
Minor gland secretions can be
collected by micropipette,absorbent
filter paper or strips from the inner
surface of lips,palate,or buccal
mucosa and quantitated by weight
differences or using a Peritron
device.
86. SALIVA AND DENTAL PLAQUE
Whole saliva has long been known to contain large numbers of
bacteria. Little attention has been given to the question of why
bacteria are in saliva, when oral surfaces seem to provide a much
more favourable environment for growth.
Saliva exerts shearing forces as it flows. This might lead to passive
detachment of some microbes from biofilm surfaces. However, the
unstimulated velocity of the salivary film is low in most regions of
the mouth.
Biofilm bacteria play an active role in their transition to the
planktonic state. In several biofilm models, sessile bacteria produce
enzymes that promote their release into the fluid medium.
Similar mechanisms have been observed for biofilms of S.
mutans, the primary etiologic agent of dental caries .
87. CLINICAL CONSIDERATIONS OF SALIVA
1.HYPOSALIVATION
The reduction in the secretion of saliva is called hyposalivation. It is
of two types , namely
- Temporary
- Permanent
1) Temporary hyposalivation occurs in
i) emotional conditions like fear
ii) fever
iii) dehydration
2) Permanent hyposalivation occurs in
- sialolithiasis – obstruction of salivaary duct
- congenital absence or hypoplasia of salivary glands
- bell’s palsy – paralysis of facial nerve
88. Dry mouth (Xerostomia) – It is a frequent clinical
complaint A loss of salivary function or a reduction in the
volume of secreted saliva may lead to the sensation of oral
dryness. This occurs as a side effect of mediations taken by
the patient for other problems.
Many drug cause central or peripheral inhibition off salivary
secretion. Destruction is another common cause. Loss of gland
function occurs after radiation therapy for head and neck
cancer because the glands are included in the radiation field,
chemotherapy may also cause this condition. Temporary relief
is achieved by frequent sipping of water or artificial saliva .
89. SJOGREN’S SYNDROME
-Sjögren syndrome is a chronic autoimmune disorder
characterized by xerostomia (dry mouth), xerophthalmia (dry
eyes), and lymphocytic infiltration of the exocrine glands.
This triad is also known as the sicca complex. It is an autoimmune
disorder in which the immune cells destroy exocrine glands such
as lacrimal glands & sweat glands . It is named after HENRIK
SJOGREN who discovered it.
In some cases it causes dryness of skin , nose.
In severe condition the organs like kidneys ,lungs, liver ,
pancreas , thyroid , blood vessels & brain are affected
90. Age Changes –With age a generalized loss of gland
parenchymal tissue occurs.The lost salivary cells often are
replaced by adipose tissue.
Caries: a major problem of a reduced salivary flow is the
increased risk of caries as saliva normally washes away
acids. There may be an increase in recurrent decay on
coronal as well as root surfaces.
Incisal edges of interior teeth may also develop carious
lesions as well as recurrent lesions on the margins of
restorations.
91. Dental erosion: salivary gland hypofunction can cause
deficient remineralisation. ‘Low buffering capacity and flow
rate indicate a greater erosion risk and advice should be
given to the patient to minimise this.
This should include following acidic intake with a glass of
water to aid clearance and finishing each meal with a
neutral salivary stimulant, such as cheese, to promote
salivary flow.
Chewing sugar-free gum also stimulates production of
saliva.
92. Gingivitis: lack of saliva leads to retention of food particles
in the mouth, particularly interdentally and under dentures.
This may result in gingivitis and, in the long term,
periodontitis.
Oral ulceration: reduced saliva flow may result in
recurrent aphthous ulceration, pain, lichen planus, delayed
wound healing and secondary infection, such as candidiasis.
Mucositis: this is a painful condition where the mucous
membrane of the oral cavity becomes ulcerated and
inflamed. It increases susceptibility to fungal infections such as
candidiasis.
Mucositis can lead to dysphagia, dehydration and impaired
nutrition.
93. Swallowing: there are problems with too much saliva or
too little often accompanied by complaints of dysphagia.
Dysgeusia: distortion of taste may occur due to lack of
saliva as it ‘plays a critical role in taste function as a solvent
for food, a carrier of taste. eliciting molecules, and through
its composition.
This reduces enjoyment of eating. In addition, irradiation of
the head and neck area may damage or destroy taste buds or
salivary glands.
94. Glossitis: with salivary hypofunction,the tongue can appear
red, dry and raw, particularly on the dorsum, while the filiform
papillae may be lost.
Dentures: patients with hyposalivation often complain their
dentures lose retention and stability. This can cause problems
with speech, chewing, swallowing and nutritional intake.
It also increases the risk of candidal infections, ulceration,
gingivitis, aspiration pneumonia, bacteraemia, viral infections
and caries in the remaining teeth. Denture fixatives may be
required to retain the removable prosthesis.
95. Halitosis- Saliva gives rise to bad odours especially
during mouth breathing prolonged talking or hunger. Eating reduces
halitosis partly because it increases saliva flow and friction in the
mouth.
96. 2. HYPERSALIVATION
The excess secretion of saliva is known as hypersalivation . Hypersalivation
in pathological condition is known as ptyalism , sialorrhea , sialism or
sialosis.
Hypersalivation occurs in the following conditions :-
1) Decay of tooth or neoplasm of mouth or tongue due to continuous
irritation of nerve endings in the mouth
2) Disease of esophagus , stomach & intestine
3) Neurological disorder such as cerebral palsy & mental retardation
4) Cerebral stroke
5) Parkinsonism
6) Some psychological & psychiatric conditions
7) Nausea & vomiting
97. DROOLING
Uncontrolled flow of saliva outside the mouth is called drooling .
It is often called ptyalism.
Drooling occurs because of excess production of saliva in
association with inability to retain saliva within the mouth.
Drooling in small children is a normal part of development.
Teeth are coming in, they put everything in their little mouths,
and they haven’t developed the habit of keeping the lips together.
While child is teething ,their gums will produce excessive saliva.
98. The saliva which is produce during drooling is
designed to moisten and lubricate babys tender
gums.
Drooling serves to help make teething process
more bearable for child.
99. CHORDA TYMPANI SYNDROME
Chorda tympani syndrome is the condition characterized
by sweating while eating. During the regeneration of the
nerve fibers following trauma or surgical division , which
pass through chorda tympani branch of facial nerve may
deviate & join with the nerve fibers supplying sweat glands.
100. FREY'S SYNDROME
or GUSTATORY SWEATING also known
as Baillarger’s syndrome,
Dupuy’s syndrome,
Auriculotemporal syndrome or
Frey-Baillarger syndrome)
is a food related syndrome which can be congenital or
acquired specially after parotid surgery and can persist
for life.
The symptoms of Frey's syndrome are redness
and sweating on the cheek area adjacent to the ear. They
can appear when the affected person eats, sees, thinks
about or talks about certain kinds of food which produce
strong salivation.
101. PARALYTIC SECRETION OF SALIVA
- when the parasympathetic nerve to salivary gland is cut ,
salivary secretion increases for the first 3 weeks & later
diminishes; finally it stops at about 6th week. The increased
secretion of saliva after cutting the parasympathetic nerve fibers
is called paralytic secretion.
AUGMENTED SECRETION OF SALIVA
- if the nerve supplying salivary glands are stimulated
twice , the amount of saliva secreted by the second
stimulus is more than the amount secreted due to the
first stimulus.
- it is because , the first stimulus increases excitability of
acinar cells , so that when the second stimulus is applied
, the salivary secretion is augmented.
102. EFFECT OF DRUGS & CHEMICAL ON
SALIVARY SECRETION
1) Sympathomimetic drugs like adrenaline & ephedrine
stimulates salivary secretion
2) Parasympthomimetic drugs like acetylcholine ,
pilocarpine , muscarine & physostigmine increase the
salivary secretion
3) Histamine stimulates the secretion of saliva
4) Sympathetic depressants like ergotamine .
5) Parasympathetic depressants like atropine inhibit the
secretion of saliva
6) Anaesthetics like chloroform & ether stimulate the
reflex secretion of saliva . However , deep anaesthesia
decrease the secretion due to central inhibition.
103. CONCLUSION
Saliva has an important role in patient’s quality of life. Dental
professionals need to be aware of the problems that arise when
there is an overproduction or underproduction of saliva, and
also a change in its quality. It may be advantageous for dentists
to measure the salivary flow of patients on a regular basis to
see if any changes occur over time.
This knowledge enables early diagnosis, treatment and, if
possible, prevention of problems. Checking the patient’s
medical history regularly can identify conditions or
medications that can adversely influence saliva production.
104. REFERENCES
1.Orban’s oral histology
2.Tencate’s oral histology- 6TH Edition
3.Carranza’s clinical periodontology- 10 th edition
4.Eliaz Kaufman,Ira B.Lamster The diagmostic applications of
saliva – A review.Crit Rev Oral Biol Med 2009
5.Kaufman E,Lamster ib.Analysis of saliva for periodontal
diagnosis.A review J Clini Periodontol 2000
6.J.D.Rudney Saliva and dental plaque Adv Dent Res December
2000
7.Patricia Machperson The role of saliva in oral health and
disease.Dental nursing october 2013
105. 8.Textbook of medical physiology- guyton and hall 9th
edition
9.Concise medical physiology , chaudhuri , 2nd edition.
10.Human physiology by a.k.jain,1st edition
11.Essentials of medical physiology-k.
sembulingum,p.sembulingum,4th edition.
12.Oral medicine,burket’s-11th edition.
13.Saliva and oral health : the journal of american
dental association-may 2008
106. 14.Principal of anatomy and physiology- tortora-derrickson ,12th
edition.
15.CARIOLOGY-3rd edn-Ernest Newbrun
16.ESSENTIALS OF ORAL PHYSIOLOGY-Robert M Bradley
17.The physiology and biochemistry of the mouth-4th edn-G.Neil
Jenkins
18.APPLIED ORAL PHYSIOLOGY-2nd edn-Christopher L B
Lavelle
19.Textbook of Oral Pathology- Shafer,Hine & Levy
20.Saliva:its secretion,composition&functions.-British Dental
Journal 1992; 172:305
21.Saliva and Dental caries:Diagnostic tests for normal dental
practice;Larmas M .International Dental Journal ;1990August
42 (4):199-208
107. 22.Diagnostic Uses of saliva-Mandel I D.Journal of
Oral Pathology and Medicine March 1990:19(3);119-
25
23.Inherited risks for susceptibility to Dental Caries-
Journal of Dental Education Vol 65
24.Sturdevant’s art and science of operative dentistry.-
5th edn
25. The effect of saliva on dental caries George K.
Stookey, MSD, PhD
10.14219/jada.archive.2008.0347 2008;139(suppl
2):11S-17SJADA
