This document provides information about saliva, including its classification, structure, formation, secretion, composition, and functions. Saliva is produced by major and minor salivary glands and contains over 99% water. It also contains organic compounds like enzymes, proteins, vitamins, and inorganic electrolytes. Saliva plays an important role in lubrication, digestion, buffering, and protecting oral health. Its composition and secretion are influenced by neural and reflex mechanisms in the body.

1. SALIVA
DEPT. OF CONSERVATIVE DENTISTRY
& ENDODONTICS
1

2. CONTENTS
 Introduction
 Classification salivary glands
 Structure
 Formation & secretion
 Reflex regulation of secretion
 Phases of secretion
 Classification of saliva
 Collection
 Composition
 Factors affecting composition
2

3.  Caries related components in saliva
 Buffering action
 Functions
 Applied physiology
 Saliva & risk of developing caries
 Role of saliva as a modifying factor in dental caries
 Artificial saliva
 Sialography
3

4. INTRODUCTION:
 The oral cavity is kept moist by a film of fluid called saliva
that coats the teeth and the mucosa.
 Saliva is a complex fluid, produced by the salivary glands.
 The term whole saliva, mixed saliva , oral fluid are
commonly used.
 Saliva is critical to the preservation and maintenance of oral
health, yet it receives little attention until quantity or quality is
diminshed.
 It is necessary for clinicians to have a good knowledge
concerning the norm of salivary flow and function. 4

5. 5

6. SALIVARY GLANDS
Based on their
anatomical size
 Major Salivary Glands
- Parotid gland
- Submandibular gland
- Sublingual gland
3
6

7. Minor Salivary Glands
 Buccal / Labial
 Palatine
 Tonsillar (WEBER’S GLAND)
 Molar or Retromolar gland
(CARMALT’S GLAND)
 Anterior lingual glands
(BLANDIN-NUHN)
 Posterior lingual glands
(VON-EBNER)
7

8.  Salivary glands are made up of the cells which are arranged
in small groups called ACINUS /ALVEOLUS/TERMINAL
SECRETORY UNIT.
 These cells are arranged in small groups around a central
globular cavity which is continuous with the lumen of the duct.
 The fine duct draining each acini is called INTERCALATED
DUCT.
 Many intercalated ducts join to form STRIATED DUCTS /
INTRALOBULAR DUCT.
 Two or more intralobular ducts join to form INTERLOBULAR
DUCTS, which unite to form main duct of the gland.
STRUCTURE OF SALIVARY GLANDS:
8

9. 9

10.  Acini consists of Pyramidal cells:
 Serous
 Mucous
 Seromucous
Parotid Purely serous
Sub mandibular Mixed, with serous units predominating
Sub lingual Mixed, with mucus units predominating
10

11. Buccal / Labial Mixed
Palatine & Glossopalatine Purely mucous
Glands of Blandin & Nuhn Chiefly Mucous
Von Ebner glands Purely serous
11

12. SEROUS CELLS
 Pyramidal in shape
 Nucleus is spherical
 Thin & watery saliva.
MUCOUS CELL
 Pyramidal in shape
 Nucleus is flattened.
 Thick & viscous saliva.
12

13. SEROMUCOUS CELLS
 Functional and structural characteristics of both serous &
mucus cells.
13

14. MYOEPITHELIAL CELLS:
 Closely related to secretory & intercalated duct cells.
FUNCTIONS:
 Shorten & widen intercalated duct.
 Accelerate outflow of saliva.
 Support parenchyma.
14

15. DEMILUNE:
 Combination of serous & mucus unit in which mucus cells are
capped by several serous cells.
15

16.  Largest of all salivary glands.
 LOCATION: Below external acoustic meatus, between ramus
of the mandible & sternocleidomastoid.
 WEIGHT: 20-30 gms in adult
 DUCT: Stensen’s duct
PAROTID GLAND
16

17.  Intimately associated with peripheral branches of the facial
nerve.
 Parotid capsule is an investing layer of the deep cervical
fascia forms a capsule for the gland
 Blood supply - branches of the external carotid artery as
they pass through the gland.
 Parasympathetic nerve supply from the glossopharyngeal
nerve.
 Sympathetic innervation to all salivary glands by fibers
from superior cervical ganglion
17

18.  A part of gland often detached which lies bw zygomatic
arch & parotid duct ka accessory parotid G or pars
acessoria or socia parotidis.
18

19.  LOCATION: posterior part of the floor of the mouth
 WEIGHT : 8 – 10 gms
 DUCT: Whartons duct
 Blood supply- from the facial and lingual arteries
 Parasympathetic nerve supply from facial nerve
SUBMANDIBULAR GLAND
19

20.  Smallest of the paired major glands.
 WEIGHT: 2-3 gms
 LOCATION: in the anterior part of the floor of the mouth
between the mucosa and the mylohyoid muscle.
 DUCT: Secretions enter the mouth through ducts of
Rivinus , which opens into Bartholins duct .
SUBLINGUAL GLAND
20

21.  Blood supply - from the sublingual and submental arteries
 Parasympathetic innervation from facial nerve.
PAROTID Stensons duct Opens near maxillary 2nd
molar in the buccal
mucosa
SUBMANDIBULAR Whartons duct Opens at the side of lingual
frenum
(caruncula sublingualis)
SUBLINGUAL a) Bartholins duct
b) Several minor ducts
a) Opens near sub
mandibular duct
b) Open along the sub
lingual fold
independently 21

22. 22

23.  Estimated to number between 600 to 1000.
 Small, discrete aggregates.
 Present in the submucosa throughout most of the oral
cavity.
 Not seen in gingiva and the anterior part of the hard
palate.
 Von ebners glands- located in tongue ,opens through
circumvallate papillae.
MINOR SALIVARY GLANDS
23

24. FORMATION & SECRETION OF SALIVA
 The formation of saliva occurs in 2 stages.
 In the 1st stage cells of the secretary end pieces &
intercalated ducts produces primary saliva, which is an
isotonic fluid containing most of the organic component and
all of water that is secreted by the salivary gland.
 In the 2nd stage primary saliva is modified as it passes
through striated and excretory ducts, mainly by absorption
& secretion of electrolytes.
 The final saliva that reaches the oral cavity is hypotonic.
24

25.  Formed actively by movement of Na+ and Cl- ions into the
lumen, creating an osmotic gradient which leads to the
passive movement of water.
 Before the fluid enters the duct, the Na+ ion are actively
reabsorbed, Cl- ions move passively to maintain electrical
equilibrium.
 K+ and bicarbonate ions are secreted.
Some proteins electrolytes
Na+ Cl- resorbed
K+ secreted
Hypotonic
final saliva
into mouth
Most proteins
Water &
electrolytes
Isotonic
primary saliva
25

26.  The macromolecules components like amylase, mucous,
glycoproteins are formed in acinar cells by endoplasmic
reticulum .
 These are processed into Golgi apparatus and exported
from the cells by exocytosis.
SALIVARY SECRETION
 Salivary secretion are controlled by both parasympathetic &
sympathetic stimuli.
 It is secreted in response to neurotransmitter stimuli.
26

27. Sympathetic Parasympathetic
Neurotransmitter release
activates receptor (a or b) on the external surface of cell
membrane
This activates an intermediate ‘G’ protein
which in turn activates a regulating enzymes (phospholipase
/adenyl cyclase) on the inner cytoplasmic surface of the cell.
27

28. Phospholipase C Adenyl Cyclase Pathway
leading to the secretion of leads to exocytosis of
water and electrolytes. secretory protein
Neurotransmitter substances are:
 Nor-adrenalin (from sympathetic supply)
 Acetyl choline
 Substance P (from parasympathetic supply).
 Vasointestinal peptide
28

29. NOTE:
 S.G are under the control of ANS & receive fibre from both
parasympathetic & sympathetic division.
 Parasympathetic nerve fibre arise from superior & inferior
salivatory nucleus , situated in pons & medulla respectively.
 Sympathetic fibre arises from 1st & 2nd thorasic segments of
spinal cord through anterior nerve root.
Fibres end in superior cervical ganglion.
Post ganglionic fibres from this ganglion are distributed to
salivary glands.
29

30. 30

31. 31

32. REFLEX REGULATION OF SALIVARY
SECRETION
 Salivary secretion is regulated by nervous mechanism & it is a reflex
phenomenon.
 No hormonal or chemical mechanism is involved in the regulation of
secretion.
 Salivary reflexes are of 2 types:
1) Unconditioned reflex
2) Conditioned reflex
UNCONDITIONED REFLEX:
 When food is placed in mouth.
 Due to stimulation of nerve endings in the mucus membrane of oral
cavity.
 This reflex present since birth and hence is called inborn reflex.
32

33. CONDITIONED REFLEX:
 Secretion of saliva by the sight , smell, hearing or thought of
food is called conditioned reflex.
 It is due to impulse arising from the eye, nose ,ear.
 It is an acquired reflex.
33

34. PHASES OF SALIVARY SECRETION
1) Cephelic phase- refers to secretion of saliva before entering of
food into the mouth.
 It is caused by conditioned reflex by mere sight or smell of the
food.
2) Buccal phase- refers to secretion of saliva caused by
stimulation of buccal receptors by presence of food in mouth
(unconditioned).
3) Oesophageal phase-refers to stimulation of salivary glands by
the food passing through oesophagus.
4) Gastric phase-refers to secretion of saliva by the presence of
food in the stomach , specially when irritating food is present in
stomach (eg- increased salivation before vomiting).
5) Intestinal phase- refers to salivary secretion by presence of
irritating food in the upper intestine. 34

35.  Gland specific
 Whole saliva
Depending on collection
 Stimulated
 Unstimulated (Resting)
CLASSIFICATION OF SALIVA
35

36.  Is considered to be mainly protective .
 The normal resting or unstimulated secretion rate in adults is
between 0.3 and 0.5 ml/minute.
 Most of the resting saliva is produced by the submandibular gland.
 The factors affecting unstimulated saliva flow rate are degree of
hydration
- body position
- exposure to light
- previous stimulation
- circadian rhythms and drugs.
 Less important factors are age, body weight ,psychic effects, and
functional stimulation.
RESTING SALIVA
36

37.  Stimulated saliva is secreted in response to either
masticatory or gustatory stimulation.
 The normal stimulated secretion rate in adults is 1-2
ml/minute.
 In normal conditions the parotid glands produce 50 per
cent of the stimulated saliva.
STIMULATED SALIVA
37

38. 1) Gland specific saliva:
a) Parotid gland:
 Saliva is collected using Carlson-Crittenden collectors.
 Collectors are placed over Stensen duct orifice & are held in
place with gentle suction.
b) Submandibular & sublingual gland:
 An aspirating device is used or alginate-held collector called
segregator is used.
COLLECTION OF SALIVA
38

39. 2) Whole saliva collection:
It includes 4 methods:
a) Draining
b) Suction
c) Spitting are most commonly used
d) Sponge(Absorbent)
SPITTING METHOD:
 The patient is allowed to accumulate saliva in mouth & then
expectorate into a preweighed tube. [once/min for 5-15 min].
SPONGE METHOD:
 It uses a preweighed gauze sponge that is placed in the
patient’s mouth for a set amount of time. 39

40.  Salivary flow rates can be calculated from the individual major
glands or from mixed sample of oral fluids i.e whole saliva.
 FR are determined gravimetrically in mL/min/gland.
 Estimation of salivary flow rate is known as Sialometry.
 Salivary flow rate
Unstimulated < 0.1 mL/min are considered as
Stimulated < 0.7 mL/min abnormally low
40

41. COMPOSITION OF SALIVA
● Water - 99.5%
● Organic substances
● Inorganic substances
41

42. ORGANIC
Proteins
 -Amylase
 Maltase
 Lingual lipase
 Immunoglobulin
NON IMMUNOLOGIC
PROTEIN
 Antibacterial Protein
1. Lysozymes
2. Lactoferrin
3. Sialoperoxidase
 Glycoprotein(MG1 and
MG2)
 Agglutinin
 Other polypeptide
1. Proline rich protein
2. Statherins
3. Cystatins
4. Histatins
 Von Ebner’s gland protein
 Secretory leucocyte
proteinase inhibitor
 Chitinase
 Calprotectin
 chromogranin
42

43. Other organic compounds
1. Urea
2. Glucose
3. Vitamins
4. Free amino acids
1. Urea (12-20 mg /100 ml)
 Hydrolyzed by bacteria with the release of Ammonia.
 Rise in pH.
2. Glucose (0.5- 1 mg/ 100ml)
 Too low for bacterial growth.
 Increase in D.M. 43

44. 3.Vitamins
 Water soluble vitamins
4. Free Amino acids- (Below 0.1 mg/100 ml)
 Too low to provide nutrient source for bacterial
growth
44

45. INORGANIC
 Na
 Bicarbonate
 Calcium
 Cl
 Fluoride
 Phosphate
 K
 Thiocynate
45

46. CELLS
 Epithelial cells
 Leucocytes
 Polymorphs
 Lymphocyte
 Monocyte
 Bacteria
 Facultative
 Obligatory
 Yeast and Protozoa
 Amoeba salivaris
GASES
 Oxygen
 Nitrogen
 CO2
46

47. SALIVARY AMYLASE:
 It’s a carbohydrate splitting enzyme (amylolytic).
 Acts in cooked / boiled starch & converts it into dextrin & maltose.
 It cannot act on cellulose.
 Hydrolyses  1:4 glycosidic bond.
 Though ,starch digestion starts in the mouth, major part of it occurs in the lower GIT
because, food stays only for a short time in the mouth.
 Luminal phase (oral cavity)
 Initial digestion by salivary -amylase
 Second phase (upper small intestine)
 Pancreatic amylase
 Cl required as co-factor.
47

48. SALIVARY LIPASE
 Secreted by Von Ebner’s gland.
 Initiation of digestion of fats.
 Synergy with pancreatic lipase.
MALTASE
 Present only in traces in human.
 Convert maltose into glucose.
48

49. IMMUNOGLOBULIN
 IgG (1.5 mg/ 100 ml)
 IgM (0.2 mg/ ml)—From crevicular fluid
 IgA is the predominant immunoglobulin (20 mg/100 ml) and
comprises of 90% of total parotid IgA.
 IgA has 3 main functions:
- Binding to specific bacterial antigen.
- Affects specific enzymes essential for bacterial
metabolism.
- Inhibition of bacterial colonization. 49

50. ANTIBACTERIAL PROTEINS
LYSOZYMES
 Attacks the cell wall component— lysis.
 The antibacterial effect has been shown to be exerted
against mutans streptococci.
 It is present in newborn babies at levels equal to those of
adults, suggesting a pre-eruptive antimicrobial function.
 It is positively charged and binds to salivary ions of
various types, including bicarbonate, fluoride etc. 50

51. Lysozyme + Anions in saliva
hydrolysis of glycosidic bonds in the polysaccharide
component of the wall
destabilizes the wall
autolysis
 Gram-negative bacteria are more resistant to this enzyme
due to the protective function of their external
lipopolysaccharide layer.
51

52.  LACTOFERRIN – Iron-binding protein
Remove free iron from saliva
Depletion of iron supply for bacteria that require it for
metabolism.
 This bacteriostatic effect is lost if the lactoferrin molecule is
saturated with iron, a factor that should be taken into
account in areas where the drinking water is rich in iron.
52

53. PEROXIDASE / SIALOPEROXIDASE
 This system inhibits growth and acid production of a variety
of micro-organisms, including streptococcus, lactobacilli,
fungi and enteric bacteria.
53

54. salivary thiocyanate ions(SCN)
H2O2
Peroxidase or sialoperoxidase
(serves as a catalyst)
Hypothiocyanite
Potent antibacterial substance
As H2O2 is consumed
proteins and cells are protected
from its toxic and oxidant effects.
54

55. GLYCOPROTEIN (MUCINS)
 Lubricant.
 Aids in mastication, speech, swallowing by lubrication.
 Protective barrier against excessive wear.
 Types — MG1 & MG2.
PROPERTIES:
• solubility
• viscosity
• Strong adhesiveness
• Antibacterial action by selective adhesion & clearance of
microbes.
55

56. MG1
 High molecular-wt
 Binds tightly to tooth
surface.
 High in caries
susceptible patients
MG2
 Low molecular wt
 Binds to enamel but
displaces easily.
 High in caries resistant
cases.
56

57. AGGLUTININ
 These are glycoproteins that have the capacity to interact
with unattached bacteria, resulting in clumping of bacteria
into large aggregates that are more easily flushed away by
saliva and swallowed.
 Extremely sticky properties.
VON EBNER’S GLAND PROTEIN (VEGH)
 Known as tear specific pre albumin (TSPA).
 Antiviral agent.
57

58. PROLINE-RICH PROTEINS & STATHERIN
 Inhibit the
- Spontaneous precipitation of calcium phosphate salts &
- The growth of hydroxyapatite crystals on the tooth
surface
Preventing the formation of salivary and dental calculus
58

59. CYSTATINS
 The cystatins are also related to acquired film formation
and to hydroxyapatite crystal equilibrium.
 Due to its proteinase inhibiting properties, it is suggested
that they act in controlling proteolytic activity.
59

60.  Group of histidine rich proteins that show antimicrobial activity
against
1) Some strains of Streptococcus mutans
2) Inhibit hemoagglutination of the periopathogen
P.gingivallis.
 Several histatins are present, most common types in saliva are
histatin 1, 3 and 5.
 Kills C.Albican in yeast form and mycelial form.
HISTATINS:
60

61.  The bactericidal and fungicidal effects occur through the union
of positively loaded histatins with the biological membranes
resulting in the destruction of their architecture and altering
their permeability.
 Other function attributed to these peptides is of histamine
release by the mastocytes, suggesting a role in oral
inflammation.
61

62.  Na, K, Cl, Bicarbonate — Constituents for
osmolarity
 Bicarbonate— Main buffering ion
 F — Elevated by external influences
 Thiocynate - Antibacterial
 Cal. And Phosphate
1. Free form
2. Bound to protein
3. Soluble complexes with carbonate,
lactate
INORGANIC CONSTITUENT
62

63. FACTORS INFLUENCING THE COMPOSITION
1) Effect of flow rate:
63
High flow rates
 There is less time for
reabsorption and secretion
so the concentration of
ions changes with
increase flow rate &
contains:
 high sodium ion.
 high chloride ion.
 low biocarbonate ion.
 low potassium ion.
Low flow rate
 There is more time for
reabsorption and
secretion so the modified
saliva under resting
condition contains:
 low sodium
 low chloride
 high biocarbonate
 high potassium

64. 2) Effect of duration of stimulation:
As stimulation is maintained, flow rates fall slightly and
protein content is reduced, presumably because the stores
of secretory material in the acinar cells are not quickly
replenished.
3) Effect of diet:
 High CHO diet causes
- A rise in amylase content.
- Also reduces the buffering capacity of saliva
 Increased protein intake causes increased buffering
capacity. 64

65. 4) Effect of age:
 In old age, submandibular and minor salivary gland flow rate
are decreased ,but parotid salivary flow does not seem to be
affected because they appear to have a substantial secretory
reserve.
 As age advances there is decreased production of saliva and
this is mainly due to loss of salivary gland parenchymal tissue.
 The lost cells are replaced by adipose tissue cells.
 The resting salivary secretion is in the normal range, the
volume of saliva produced during stimulated condition is less
than normal. 65

66. 5) Effect of circadian rhythm:
 Lowest flow rate of saliva are observed in the early hours of
morning with high flow rates in the afternoon.
6) Effect of hormones and drugs:
 ACTH and cortisone causes lowering of salivary sodium,
but little changes in potassium levels.
 Many classes of drugs, particularly those that have
anticholinergic action (antidepressants, antihistaminics etc),
may cause reduction in SF.
66

67. CARIES RELATED
COMPONENTS IN SALIVA
 Saliva contain numerous substances which have an effect on
dental caries.
 Concentration of these substances vary from person to
person.
 For ex: salivary urea level is high in patients with chronic
renal failure.
 This high urea level will lead to binding of hydrogen ions & a
more alkaline saliva pH.
 So, such patients may have little caries in spite of having
high plaque scores.
67

68.  Another example is salivary glucose which may be high in
diabetic patient.
 Such patient have been shown to develop more caries.
 Other substance may be ion coming from food stuff &
geochemically via drinking water.
 One such ion named F, has an important role against caries.
68

69. BUFFERING POWER OF SALIVA:
 Solutions containing both weak acids and their salts are
referred to as ‘buffer solutions’.
 These solutions have the capacity of resisting changes of pH
where either acids or alkalies are added to them.
 The buffer capacity of human saliva is regulated by three
buffer systems:
1) The carbonic acid / bicarbonate system.
2) Phosphate system.
3)The proteins – mucin.
69

70.  In stimulated saliva it is largely due to the bicarbonate ion
which provides 85% of the total buffering capacity of about
10m-equiv/liter.
 As the salivary flow increases during a meal the concentration
of bicarbonate also increases , thus increasing the buffering
capacity of saliva.
70

71. CARBONIC ACID/BICARBONATE SYSTEM
 It is based on the equilibrium
H2CO3  HCO3
-+H+
 When an acid is added, the bicarbonate releases the weak
carbonic acid.
 Carbonic acid is readily decomposed into H2O and CO2
which leaves the solution.
 In contrast to most buffers, the net result is therefore not an
accumulation of a weaker acid , but a complete removal of
acid.
 This change of phase for CO2 from dissolved states to gas
phase for which the term “phase buffering” is used .
71

72. PHOSPHATE BUFFER SYSTEM
 This system functions basically by the same general
principle as the HCO3
- system except for the fact that no
phase change is involved.
 At physiological pH, the system operates according to the
following equilibrium.
H2PO4
-  HPO4
2-+H+
 Thus the two buffer system described act together to keep
the salivary pH above 6.
72

73. SALIVARY PROTEINS
 These do not have any significant buffering action at pH
values involved in the oral cavity.
NOTE:
 It is possible that cigarette smoking may influence the
salivary buffer capacity.
 In a comparison of smokers and non-smokers the buffer
capacity was significantly lower in smokers.
 Reason for an impaired salivary buffer capacity in smokers
are not readily apparent.
73

74. IMPORTANCE:
 The buffering action of saliva helps to keep the pH of the
oral fluids within a range , optimum for activity of salivary
amylase.
 pH of oral fluids is also critical for survival of the bacterial
flora of the mouth and influences the development of dental
caries.
74

75. FUNCTIONS OF SALIVA
75

76. FUNCTIONS OF SALIVA:
1) Digestion of polysaccharides
 Salivary amylase acts on the polysaccharides starch, dextrin
and to some extent on glycogen.
 But due to rapid ingestion of food digestion of starch
continues in the stomach.
2) Diluent and cooling effect
 Saliva dilutes the effect of acidic solutions or spicy foods.
 Hot foods and drinks may be cooled in the mouth before
they are swallowed. 76

77. 3) MOISTENING, CLEANSING AND ANTIBACTERIAL
FUNCTION:
a) Saliva keeps the oral and pharyngeal mucosa moist.
 This helps in speech & swallowing.
b) Saliva helps to maintain oral hygiene.
 When salivation is suppressed (as during fever, post-
operatively or as seen in mouth breathers), oral mucosa dry
up. Dried mucosa sheds epithelium which harbours bacteria.
c) Saliva also has antibacterial activity. Its bacteriostatic
properties are due to the presence of lysozyme and related
antibacterial substance such as leukocytes and opsonins.77

78. 4) LUBRICATION FOR MASTICATION, SWALLOWING AND
SPEECH.
5) SALIVA AS A SOLVENT:
 The sensation of taste is produced only by substances in
solution.
 Thus saliva helps in taste perception.
6) ROLE IN THIRST MECHANISMS :
 Mucosa of mouth and pharynx dry up when salivary secretion is
suppressed.
 This persistent dryness results in constant stimulation of afferent
nerves of the mouth and evokes sensation of thirst.
 Thus, salivation plays an important role in maintenance of water
balance of body.
78

79. 7) EXCRETORY FUNCTION:
 Several substances like lead, mercury iodides, alkaloids
like morphine, urea, uric acid, ammonia are excreted in the
saliva.
 The excretion of these substances by salivary gland has
promoted its test to be used for medicolegal purposes.
79

80. APPLIED PHYSIOLOGY:
1) HYPOSALIVATION
 The reduction in secretion of the saliva is called hyposalivation.
 There are two types
a) Temporary
b) Permanent
 Temporary hyposalivation occurs in:
a. emotional condition like fear
b. fever
c. dehydration.
 Permanent hyposalivation occurs in:
a. Sailolithiasis –obstruction of salivary duct.
b.congenital absence or hypoplasia of salivary glands.
c. Bell’s palsy.
80

81. 2. HYPERSALIVATION
 The excess secretion of saliva is known as hypersalivation.
 The physiological condition when hypersalivation occurs is pregnancy.
 Hypersalivation in pathological condition is called PTYALISM /
SIALORRHEA / SIALISM / SIALOSIS.
 It occurs in the following conditions:
a) Tooth decay , neoplasm of mouth or tongue.(d/t continuous
irritation of nerve endings in the mouth.)
b)Disease of oesophagus , stomach and intestine.
c) Cerebral stroke.
d) Parkinsonism.
e) Psychiatric condition.
f) Nausea and vomiting. 81

82. 3) XEROSTOMIA:
 Also called as dry mouth / pasties / cotton mouth.
 It is due to hypo salivation or absence of salivary secretion
(aptyalism).
 It causes difficulty in mastication, swallowing & speech.
 It also leads to halitosis (bad breath).
 Causes:
- Trauma to salivary gland / duct
- Dehydration
- Radiotherapy
- Shock 82

83. 4) DROOLING:
 Uncontrolled flow of saliva outside the mouth.
 It occurs because of excess production of saliva in
association with inability to retain saliva within mouth.
 It occurs in the following condition:
- Tonsillitis
- Peritonsillar abcess
- Teeth erruption in children.
- Difficulty in swallowing.
83

84. 5. CHORDA TYMPANI SYNDROME
 During the regeneration of nerve fibers following trauma or
surgical division , some of the nerve fibers of the salivary
glands which passes through chorda tympani branch of
facial nerve joins with the nerve fibers supplying sweat
glands.
 So ,when the food is taken in the mouth, salivary secretion
is associated with sweat secretion.
84

85. 6. PARALYTIC SECRETION OF SALIVA:
 When the parasympathetic nerve to salivary gland is cut,
salivary secretion increases for 3 weeks and later decreases
and then stops at 6th week.
 This increased secretion of saliva after cutting
parasympathetic nerve fibre is called paralytic secretion.
 This is because increased release of adrenaline after
denervation.
 Salivary acinar cells are hypersensitive to adrenaline.
 P.S does not occur after cutting the sympathetic nerve fibres
to salivary glands.
85

86. Primary Sjogren’s syndrome /
SICCA COMPLEX
- Dry mouth
- Dry eye
Secondary Sjogren’s syndrome
- Dry mouth
- Dry eye
-Connective tissue disorder
like SLE, scleroderma ,polyartritis
nodosa & polymyositis
Mikulicz Syndrome
Chronic bilateral lacrimal gland
enlargment associated with
enlargement of salivary gland.
7.
86

87. Sialoadenosis / Sialosis
NON- INFLAMMATORY , non-
neoplastic enlargement of salivary
gland
Sialdenitis INFLAMMATION of salivary GLANDS.
Sialorchitis
INFLAMMATION of salivary gland DUCT.
Sialolithiasis
Occurance of STONES in salivary gland
& its ducts.
Sialadenoma Papiloma of salivary gland.
Sialorrhea Increased salivation
Sialogogue
Drugs that increase salivation
-Parasympathomimetics
- Cholinergic
Antisialogogue
Drugs that decrease salivation
-Anticholinergic
-Antihistaminic
87

88. SALIVA & RISK OF DEVELOPING
CARIES LESION:
 In general, caries can develop in all individuals regardless of
their saliva flow & composition.
 Thus, from a physiological point of view no one has saliva that
would make them resistant to caries.
 However, there are notable difference in caries between
individuals, some of which can be explained by saliva.
 For ex: patients with
salivary gland hypofunction
radiation therapy to head & neck region have increased.
sjogren’s syndrome caries activity 88

89.  Thus, knowledge about the salivary status of a given patient
is a valuable tool in identifying patient at risk.
 This will further help in prognosis & treatment planning.
89

90. ROLE OF SALIVA AS A MODIFYING FACTOR IN DENTAL
CARIES:
 Saliva is well known to have specific protective effects
against dental caries. Properties of saliva that protect teeth
against caries are:
1) Dilution & clearance of dietary sugar.
2) Neutralization and buffering of acids in plaque.
3) Supply of ions for remineralization.
4) Antiplaque and antimicrobial factors.
90

91.  Salivary substitutes/Artificial saliva
 They are useful agents for the palliative treatment of
xerostomia.
 They are divided into 2 groups:
Carboxymethycellulose {CMC} based .
Mucin based.
CMC
CMC is used to impart lubrication and viscosity.
Salts are added to mimic the electrolyte content of saliva.
Calcium, Phosphate,Flouride ions are added to provide
remineralisation potential.
91

92. MUCINS
 Mucin is derived from porcine gastric tissues or bovine
submaxillary glands.
 Mucin based salivary substitutes are known to have the
lowest contact angle and the best wetting properties on the
denture base and the oral mucosa.
 Their rheological properties are more comparable to that of
natural saliva.
 Available in forms of sprays and lozenges.
92

93. SIALOGRAPHY:
 It is the radiographic visualization of the salivary gland
following retrograde instillation of soluble contrast material into
the ducts.
 It is the recommended method for evaluating intrinsic &
acquired abnormalities of ductal dystem.
 Reason being it provides the clearest visualization of
branching ducts & acinar end pieces.
 Sialograph of Sjogren’s syndrome cherry blossom /
branch less fruit laden tree appearance.
 Sialograph of sialorchitis Sausage string appearance.93

94. REFRENCES:
 A text book of oral pathology: William G.Shafer
 Cariology - Newbrun
 Medical Physiology- Guyton
 Burket’s Oral Medicine
 Saliva composition and functions: A comprehensive review.
Journal of contemporary dental practice 2008:9(3)
94

95. 95