This Presentation includes systematic compilation of the anatomy, physiology, biochemistry and pathology related to saliva and salivary glands. it also mentions about the role of saliva in dentistry. Any additions or mistakes are welcome! Please do leave your comments and let me know if the presentations has helped you! The presentation is available on request. Mail me at apurvathampi@gmail.com

1. “YOU NEVER MISS
WATER… UNTIL THE
WELL RUNS DRY.....”
5/8/2016 1

2. SALIVA
P R E S E N T E D B Y :
A P U R V A T H A M P I
1 S T Y E A R P G ,
D E P A R T M E N T O F P R O S T H O D O N T I C S5/8/2016 2

3. CONTENTS
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3
Embryology
The development of salivary
glands
Histology
The cell structure of salivary
glands
Anatomy
The anatomical structure of
the salivary glands, its nerve
and blood supply
Biochemistry
The composition of saliva
Physiology
The flow of saliva, factors
affecting it, and the functions
of saliva
Clinical significance
The collection of saliva and
the saliva function tests
Applied aspects saliva in
dentistry
Pathology
The pathologies of the
salivary gland, hyper and
hypo secretion of saliva

4. 5/8/2016
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5. INTRODUCTION
• Watery and frothy in consistency – produced in humans and most
animals
• Produced and secreted from the salivary glands
• Contains a highly complex mixture of substances
• Unique biomarkers that reflect oral and systemic health
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THE WATERY ,SLIGHTLY ALKALINE FLUID SECRETED INTO THE MOUTH BY
SALIVARY GLANDS AND MUCOUS MEMBRANE THAT LINES THE MOUTH
(British Medical Association)
Sreebny, Leo M. : Saliva in health and disease: an apptraisal
and update: IDJ (2000)50; 140-161

6. HISTORY
• Ancient records have proved the use of “Rice Tests” as a means of
proving innocence or guilt.
• Traditional Chinese doctors used the thickness and smell of saliva as
diagnostic tools to assess the health of the patient
– Over secretion of saliva – heart burn / cold stimulation of the stomach
– Sweet saliva – spleen malfunctions
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Sreebny, Leo M. : Saliva in health and disease: an apptraisal
and update: IDJ (2000)50; 140-161

7. CLASSIFICATION OF SALIVARY GLANDS
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Major
Parotid
Submandibular
Sublingual
Minor
Labial / buccal
Anterior
Palatine
Glossopalatine
Von – ebner’sOrban's oral histology and embryology 10th ed

8. 5/8/2016
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CLASSIFICATION OF SALIVARY GLANDS
Mucous
Serous
Mixed
• Labial & Buccal Glands
• Glossopalatine
• Palatine
• Posterior tongue
• Submandibular &
Sublingual
• Anterior tongue
• Parotid
• Glands of Von Ebner
BASED ON TYPE OF SALIVA SECRETED
Orban's oral histology and embryology 10th ed

9. EMBRYOLOGY
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10. DEVELOPMENT OF THE SALIVARY GLANDS
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Glands Origin Intrauterine life
Parotid Corners of the
stomodeum
6th week
Submandibular Floor of the mouth End of 6th week
Sublingual Lateral to
submandibular
primordium
8th week
Minor salivary Buccal epithelium 12th week
Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

11. STAGES IN FORMATION OF SALIVARY
GLAND DUCTS
1. Bud formation
2. Cord growth
3. Branching of cords
4. Lobule formation
5. Canalization of cords
6. Cytodifferentiation
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

12. STAGE 1 – BUD FORMATION
• 6th week of IUL – cells initiates low level synthesis of
salivary secretory proteins
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

13. STAGE 2 – CORD GROWTH
• Formation of stalk - Primary end bud
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

14. STAGE 3 – BRANCHING OF CORDS
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

15. STAGE 4 – LOBULE FORMATION
• Arborized pattern – glandular enlargement
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

16. STAGE 5 – CANALIZATION OF CORDS
• First in distal ends of main cord & in branch cords then in proximal part
of main cord
• Finally in central portion of main cord
5/8/2016
16Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

17. STAGE 6 - CYTOFIFFERENTIATION
• Secretary cell differentiation
• Epithelial mesenchymal interactions
5/8/2016
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Tucker A.S, salivary gland development, cell developmental
biology : 18 (2007) 237-244

18. HISTOLOGY
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19. HISTOLOGY OF SALIVARY GLANDS
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• Terminal units – Acini
• Made up of epithelial secretory cells –
serous and mucus
• Arranged in a spherical or tubular shape
• Mucous acini have larger lumen than
serous acini
• Secretory end piece – tubular configuration
Orban's oral histology and embryology 10th ed

20. SEROUS CELLS
• Pyramidal with broad base – typical of protein secreting cell
• Spherical nucleus placed at the basal region
• Apical cytoplasm – accumulation of secretory granules (1 mm
diameter)
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ZYMOGEN (Formed by glycolated protiens)
Orban's oral histology and embryology 10th ed

21. MUCOUS CELLS
• Apex appears empty except for thin strands of cytoplasm – trabecular
network
• Nucleus is oval or flattened in shape – above the basal membrane
5/8/2016
21Orban's oral histology and embryology 10th ed

22. MYOEPITHELIAL CELLS
• Closely related to secretory and intercalated duct cells.
• Stellate or spider-like – flattened nucleus
• Long branching process – fusiform shape
• “basket cells” – basket cradling secretory unit
• Similar to smooth muscle
5/8/2016
22Orban's oral histology and embryology 10th ed

23. DUCTS
• Consists of hollow tubes
• Initially connected with acinus – gradually
– with other ducts
• Grow larger from inner to outer portion of the gland
• Actively participates in the production of saliva
• Small ducts – intercalated ducts, large ducts – striated ducts
• Excretory – interlobular ducts – increase in size, increased amount of
connective tissue
5/8/2016
23Orban's oral histology and embryology 10th ed

24. ANATOMY
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25. PAROTID
GLAND
• Largest salivary gland
• Provides 60 – 65% of
total salivary volume
• Purely serous
secretions
• Pyramidal in shape –
covered by a capusule
• Located in the groove
between mastoid
process and angle of
mandible
5/8/2016 25Burketts oral medicine diagnosis and treatment planning
10th edition

26. B OR DERS OF
P A R OTI D GL A ND
Superiorly : lower border
of the zygomatic arch
Posteriorly : anterior
border of the
sternocleidomastoid
muscle
Anteriorly : posterior
border of the masseter
muscle
5/8/2016 26Burketts oral medicine diagnosis and treatment planning
10th edition

27. A NA T OMY OF
P A R OTI D GL A ND
Nerve supply :
• Parasympathetic :
auriculotemporal nerve
• Sympathetic : plexus
around the ECA
• Sensory : auriculo
temporal nerve
Blood supply : external
carotid artery and its
branches
5/8/2016 27Burketts oral medicine diagnosis and treatment planning
10th edition

28. The parotid duct
(Stenson’s duct)
opens into the buccal
mucosa at the upper
second molar region
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29. SUBMANDIBULAR
GLAND
• Large salivary gland
• Anterior part of
digastric triangle
• Mixed secretions –
serous + mucous
5/8/2016 29Burketts oral medicine diagnosis and treatment planning
10th edition

30. B OR DERS OF
S UB MA ND I B ULAR
GL A ND
• Lateral surface :
• Submandibular fossa
• Insertion of medial
pterygoid
• Facial artery
• Medial surface
• Anterior : mylohyoid
• Middle : hyoglossus,
styloglossus, lingual
nerve
• Posterior : styloglossus,
stylohyoid ligament,
wall of pharynx
5/8/2016 30Burketts oral medicine diagnosis and treatment planning
10th edition

31. A NA T OMY OF
S UB MA ND I B ULAR
GL A ND
• Nerve supply: branches from
the submandibular ganglion
• Blood supply: facial artery
• Venous drainage: facial and
lingual veins
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32. Submandibular duct
opens on the floor of the
mouth, on the summit od
the sublingual papillae, at
the side of the frenulum
of the tongue – Warthin’s
duct
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33. SUBLINGUAL
GLAND
• Smallest salivary gland
• Almond shaped
• Mixed secretions – serous
+ mucous
5/8/2016 33Burketts oral medicine diagnosis and treatment planning
10th edition

34. 6-8 sublingual ducts
open into the floor of
the mouth
Main duct –
Bartholin’s duct
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35. MINOR SALIVARY GLANDS
• Located beneath the epithelium
• Consist of several small groups of secretory cells
• Lack a distinct capsule
• 600-1000 minor salivary glands
• Classified based on anatomic location
• Not present in gingiva, antr. raphae, antr 2/3rd of dorsum of tongue
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Labial
glands
Glosspalatin
e glands
Palatine
glands
Lingual
glands
Von Ebner’s
glands
Burketts oral medicine diagnosis and treatment planning
10th edition

36. LABIAL/BUCCAL
GLANDS
• Glands of lips and cheek
• Mixed type
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GLOSSOPALATINE
GLANDS
• Posterior extension of
sublingual gland to glands of
soft palate
• Pure mucous
Burketts oral medicine diagnosis and treatment planning
10th edition

37. PALATINE
GLANDS
• Posterolateral regions of the
hard palate and the
submucosa of soft palate and
uvula
• Pure mucous
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LINGUAL
GLANDS
• Antr linual – apex of tongue
(Glands of Blandin and Nuhn)
– mucous
• Postr lingual – postr to
circumvallate papillae, tonsil –
mucous
Burketts oral medicine diagnosis and treatment planning
10th edition

38. VON EBNER’S GLANDS
• Posterior lingual serous glands
• Secretions wash out the troughs of the papillae
• Play a role in taste reception
• Studies suggest – digestive and protective function
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Burketts oral medicine diagnosis and treatment planning
10th edition

39. BIOCHEMISTRY
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40. COMPOSITION OF SALIVA
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Water
99%
Others
1%
Primary Composition of saliva
Water Others
Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels,
Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

41. COMPONENTS OF SALIVA (CONTD…)
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Organic
protiens
Salivary amylase immunoglubulins
Protiens synthesized
within glands
glycoprotiens
lipids Blood group
Antigen A,B
Hormones
Parathyroid
Growth factor
carbohydrates
Glucose
hexosamine
• Alpha amylase
• Kallikrien
• Dextranases
• Alpha phosphtase
• lipase
• IgA
• IgM
• IgG
• Factor VII
• Factor VIII
• Factor IX
• Platelet factor
• MG1,MG2
• Protien rich
glycoprotiens
Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels,
Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

42. 5/8/2016
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inorganic
sodium potassium calcium phosphorus chloride bicarbonate
Cells :
• Yeast
• Bacteria
• Protozoa
• Polymorphonuclear lymphocytes(PMNL)
• Desquamated epithelial cells
Gases:
• Oxygen
• Nitrogen
• carbondioxide
Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels,
Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

43. PROPERTIES OF SALIVA
• Ph : 5-8
• Specific gravity : 1.0024 – 1.0061
• Freezing point : 0.07 – 0.34 degree Celsius
• Velocity : 0.8 – 8 mm/minute
• Flow rate : 0.3 ml/min when unstimulated and 1.5-2 ml/min when
stimulated
5/8/2016
43Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels,
Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

44. PHYSIOLOGY
5/8/2016 44

45. FUNCTIONS OF SALIVA
• Digestive
• Protective
• Taste
• Excretion
• Water balance
• Oral hygiene
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46. DIGESTIVE FUNCTION
• -Amylase (ptyalin)
– It is a calcium dependent digestive enzyme
– It is activated by Cl.
– It acts on cooked starch
– Optimum pH= 6.8
– It is inactive below pH 4
• Lingual lipase
– Von ebner gland
– It is responsible for the first phase of fat digestion.
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47. Bolus formation
• Moistening of food (Water)
• Mucin – It is a lubricating material, makes food slippery, facilitates
swallowing
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48. PROTECTIVE FUNCTIONS
• Lubrication properties
– Coating of tissue( Mucin)
– Lubricatory film- resistance to friction
– Prevent desiccation
• Maintenance of mucous membrane
– Salivary mucins
• Tissue hydration
• Control of permeability
• Protective against proteolytic enzymes formed in
inflammation and ulceration
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49. Soft tissue repair
• Nerve growth factor
Wound
• Epidermal growth factor healing
• Speeds up the coagulation properties.
• Dilutes anti-thrombin factor in traumatic area
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50. Debridement/Lavage
• Physical flow of saliva – removal of bacteria
and food debris .
Aggregation
• IgA system- Inhibit bacterial attachment
• Mucin – aggregation of bacterial cells.
• Macromolecules- compete for attachment site
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51. Direct antimicrobial
• Enzymes:
– Lactoferrin
– Lysozyme
– Human Salivary peroxidase , Myeloperoxidases.
– IgA system
– Chitinase.
• Peptides:
– Histidine rich peptide-(histatin-5)
Growth inhibitory, Bactericidal.
– B- defensins.
– Calprotectin
– Chromogranin A
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52. DEFENDER OF THE ORAL CAVITY:
Mucins & Agglutinins
Cystatin
Von Ebner Gland Protein(VEGP)
Tissue inhibitors of metalloproteinase(TIMPS
Extra parotid glycoprotein
Secretary leucocyte proteinase inhibitor(SLPI)

53. 8. Gingival crevicular fluid
– IgG
– Lysozyme, Lactoferrin (liberated from phagocytic cells)
– PMNs - Phagocytosis

54. 9. Maintenance of pH (Buffer)
• Bicarbonate
– Main buffering ion
–Unstimulated saliva--- Less bicarbonate
–Flow rate Bicarbonate
–Pass through the plaque—Acid neutralization

55. 9. Maintenance of tooth integrity
– Enamel pellicle
– Increased surface hardness, Resistance to caries
– Decreased permeability
– Regulation of ionic environment in plaque, oral cavity
PRP, Statherin:
• Subsurface lesion remineralization
• Inhibition of calculus
• Maintains Ca- phosphate supersaturation in
saliva

56. 10. Antifungal activity
Histatin peptide
11. Epidermal growth factor
–Maintenance of oro - esophageal and
gastric tissue integrity
–Healing of ulcers
–Stimulation of DNA synthesis

57. 12. Hormonal function
• Parotin-deposition of Ca on tooth
• Nerve growth factor- growth of sympathetic
ganglia.
13. Excretory function
Drugs- Route of elimination

58. 5/8/2016 58

59. MECHANISM OF SALIVARY SECRETION
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Acinar cells
K+ and HCO3-
by active process
Along with Cl- for
electrical neutrality
Simultaneous secretion of
water into acinar lumen
Primary isotonic
saliva
Salivary duct cells –
Rich blood suply
Actively reabsorb Na+ and Cl-
And transfer K+ and HCO3-
Into saliva
Impermeable to water
Final Hypotonic
saliva
Salivary secretion can be defined as a unidirectional movement of fluid electrolytres
and macromolecules into saliva in response to appropriate stimulation
Glandular mechanism of secretions : Chpt 2, Mechanism of
salivary secretion : Pete M Smith

60. MECHANISM OF SALIVARY SECRETION
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Two stage salivary gland secretion model.
In stage 1:
• Acinar cell secrete a NaCl-rich fluid
called primary saliva - isotonic
In stage 2:
• The primary saliva - modified - passage
along the ductal tree (reabsorbing NaCl
and secreting KHCO3).
• Ductal epithelium - poorly permeable to
H2O
• Final saliva - hypotonic.
Glandular mechanism of secretions : Chpt 2, Mechanism of
salivary secretion : Pete M Smith

61. CONTROL OF SALIVARY SECRETION
PARASYMPATHETIC STIMULATION SYMPATHETIC STIMULATION
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Increased by parasympathetic and parasympathetic activity
Release of proteolytic enzyme –
kallikrien
Alpha 2 globulins
Into the interstitial fluid
bradikynin Vasodilation of blood vessels
Stimulates secretion from acini
Release of saliva rich in
Organic substances + mucus
(process similar to parasympathetic
stimulation takes place)
Submandibular and sublingual glands
Glandular mechanism of secretions : Chpt 2, Mechanism of
salivary secretion : Pete M Smith

62. FACTORS AFFECTING SALIVARY FLOW
RATE
Diurnal variation
• Protein concentrations tend to be high in the afternoon
• Sodium and chloride concentrations are high in the early hours of the
morning
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63. • Potassium high in the afternoon
• Calcium and phosphate concentrations appear to remain stable
during the day
• Calcium concentration increases in the night
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64. Duration of stimulus
If the salivary glands are stimulated for longer than 3 minutes, the
concentration of many components is reduced , although after a short period
, bicarbonate, calcium and protein concentrations begin to rise again
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65. Dietary factors
Functional salivary glandular activity is influenced by mechanical or
gustatory factors
Plasma concentrations
Amino acid, calcium, glucose, urea are correlated with those in plasma
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66. Hormonal influences
• Aldosterone – increased sodium reabsorption in the striated ducts
• Antidiuretic hormone – water reabsorption by the striated duct cells
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67. 5/8/2016
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68. ROLE OF SALIVA
IN DIAGNOSIS
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69. COLLECTION OF SALIVA
STIMULATED
• Expectoration every 30-60 seconds
– Gustatory- Acids
– Mechanical- Chewing Paraffin
wax, rubber band
UNSTIMULATED
• Draining method
• Spitting method
• Suction method
• Swab method
5/8/2016 69
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

70. SALIVA FUNCTION TEST
SIMPLE SCREENING TESTS
• Sialometry
• Visual inspection of saliva
• pH and buffering capacity
• Dip stick tests
OTHER TESTS
• Carlson Crittenden collector
(parotid gland)
• Peristron (minor salivary glands)
5/8/2016 70
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

71. SALIVA IN ONCOLOGIC DIAGNOSIS
• Saliva used in the diagnosis of many malignancies
(mutation of tumour suppressor - gene p53 – malignancy – 50%)
– Spino-cellular carcinoma
– Breast cancer
– Blood cancer (level of neutrophils)
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SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

72. SALIVA IN CARDIOVASCULAR DISEASES
• Salivary amylase as a protien biomarker
• Primary function – break down sugars
• Studies show that there is an increased production of salivary amylase
during high stress
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SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

73. SALIVA IN DIAGNOSTIC TESTING OF
DRUGS
• Previously used – urine
• Salivary glands – highly vascular – easy cross over of drugs from blood
to saliva
• Level of drugs remain in saliva for a number of hours after intake
• Egs : Amphetamines, Barbiturates, Benzodiazepines, Marijuana, Cocaine,
Heroin, NIcotine
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SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

74. SALIVA IN DIAGNOSIS OF INFECTIOUS
DISEASES
• Bacterial :
– Mycobacterium tuberculosis – high levels in saliva in acute stages
• Viral :
– HIV : ELISA + Western blot tests – higher chances for accurate results with saliva
(studies also suggest levels of HIV will be lower in saliva than in blood)
5/8/2016
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SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac
Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

75. PATHOLOGY
5/8/2016 75

76. SALIVARY GLAND DISORDERS
Developmental
disorders
Functional disorders
Obstructive
disorders
Inflammatory/
infectious disorders
Immunological
disorders
Neoplastic disorders
Asymptomatic
enlargement
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• Burkett's Oral medicine diagnosis and treatment planning 10th ed
• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz

77. DEVELOPMETAL DISORDERS
• Abberancy
• Aplasia
• Hypoplasia
• Hyperplasia
• Atresia
• Accessory Ducts
• Diverticuli
• Congenital fistula
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• Burkett's Oral medicine diagnosis and treatment planning 10th ed
• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz

78. FUNCTIONAL DISORDERS
• Sialorrhoea
• Xerostomia
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79. OBSTRUCTIVE DISORDERS
• Sialolithiasis
• Mucous plug
• Stricture & Stenosis
• Foreign bodies
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80. ASYMPTOMATIC ENLARGEMENT
• Sialosis;
• Allergy
• Malnutrition & Alcohol related
5/8/2016
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81. INFLAMMATORY/ INFECTIOUS
DISORDERS
• Bacterial
• Viral
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82. AUTOIMMUNE DISORDERS
• Sjogren’s syndrome
• Mikulicz’s disease
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83. NEOPLASMS
• Benign
– Warthin’s tumor
– Pleomorphic adenoma
• Malignant
– Malignant Pleomorphic
Adenoma
– Adenoid Cystic Carcinoma
– Mucoepidermoid
Carcinoma
– Acinic cell tumor
– Adenocarcinoma;
– Squamous Cell Carcinoma
5/8/2016 83

84. SIALORROHEA
5/8/2016
84
Etiology
Acute
inflammation
of oral cavity
Oral
cancer
teething
Patients with
neurological
disorders
Decreased
swallowing
frequency

85. SIALORRHEA (CONTD…)
• TREATMENT
– Drugs : Anti-histamine (xerostomia inducing)
(Pilocarpin, Cevimeline cause increased salivation)
– Temporary injection of botulinum toxin into parotid gland
– Surgery : Mandibular duct diversion
• ANTISIALOGOGUES
– They are parasympathetic or cholinergic blocking agents include atropine and its
related alkaloids obtained from the plant.
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86. XEROSTOMIA
ETIOLOGY
• Aplasia or hypoplasia of the
gland
• Surgical excision of the gland
• Post menopausal period
• Uncontrolled diabetes mellitus
• Dehydration
• Primary aldosteronism
• Alcoholism
• Malnutrition
• Sialolithiasis
• Mumps
• Sjogrens syndrome
• Vitamin deficency
• Fear,anxiety,over
excitemen
5/8/2016 86

87. Causes of long standing xerostomia
5/8/2016
87
Iatrogenic
Drugs
Local radiation
Chemotherapy
Diseases
Diabetic mellitus
Cystic fibrosis
Primary biliary cirrhosis
Hepatitis c virus infection
HIV

88. 5/8/2016
88
Preventive therapy
Symptomatic treatment
Salivary stimulation
T
r
e
a
t
m
e
n
t
XEROSTOMIA (CONTD…)

89. PREVENTIVE THERAPY
Topical fluorides
Maintain meticulous oral hygiene
Remineralising solutions
5/8/2016
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90. SYMPTOMATIC TREATMENT
water
Increasing humidity of the environment
Oral rinses and gels
Salivary substitutes
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91. SALIVARY STIMULATION
• Local or topical stimulation
– Chewing – sour and sweet tastes
– Electrical stimulation
• Systemic stimulation
– Bromhexine (Mucolytic agent)
– Anetoletrithione (mucolytic agent)
– Pilocarpin (Parasympathomimetic
drug)
5/8/2016 91
PILOCARPIN :
• functions as a muscarinic cholinergici
• Side effects – sweating, hot flashes, urinary frequency, diarrhea,
blurred vision
• Dosage: 5.0-7.5 mg 3-4 times daily
• Contraindicated : pulmonary disease, CVS diseases, glaucoma,
urethral reflux

92. CLINICAL
ASPECTS
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93. ROLE OF SALIVA IN PROSTHODONTICS
• Denture retention (maxillary denture more than mandibular)
• Difficulty in impression making if saliva too mucous
Atropine sulfate – prior to impression making
• Denture stomatitis (due to lack of salivary mucins)
• Alteration in taste perception due to denture
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Blahova Zora et al: Physical factors in retention of complete
dentures. J Prosthet Dent 1971; 25: 230-235.

94. Denture retention – physical agent
• Cohesion
• Adhesion
• Surface tension
• Capillary attraction
• Atmospheric pressure
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Blahova Zora et al: Physical factors in retention of complete
dentures. J Prosthet Dent 1971; 25: 230-235.

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COHESION
• Molecular attraction between
two similar surfaces in close
contact.
• It occurs in the layer of saliva
between the denture base and
mucosa.
ADHESION
• Physical molecular attraction of
unlike surfaces in close contact.
• It acts when saliva wets and sticks
to the basal surfaces of dentures
Blahova Zora et al: Physical factors in retention of complete
dentures. J Prosthet Dent 1971; 25: 230-235.

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SURFACE TENSION
• Resistance to separation by the
film of liquid between two well
adapted surfaces.
• It is found in the thin film of saliva
between the denture base and
the mucosa of basal seat.
CAPILLARY ATTRACTION
• Force that causes the surface of
liquid to become elevated or
depressed when it is in contact
with a solid.
• On close adaptation of the
denture, the space filled with a thin
film of saliva acts like a capillary
tube and helps retain the denture.
Blahova Zora et al: Physical factors in retention of complete
dentures. J Prosthet Dent 1971; 25: 230-235.

97. DISTRIBUTION OF SALIVA OVER A
DENTURE
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Complete coverage of denture
and mucous membrane
• No meniscus – hence no
retention
Coverage of mucous
membrane and partial
coverage of denture
• Produces a meniscus –
retentive force exists
Coverage of basal tissue
denture surface
• Meniscus present – hence
considerable retentive force
present
Blahova Zora et al: Physical factors in retention of complete
dentures. J Prosthet Dent 1971; 25: 230-235.

98. ROLE OF SALIVA IN PERIODONTAL
DIAGNOSIS
• Saliva used to identify the onset of certain diseases
• Biomarkers – small molecules – monitor disease onset, treatment
response and outcome
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Biomarkers
Specific
SystemicNon-
specific
Gianobelle William V., Saliva as a diagnostic tool for
periodontal disease - current state and trends : Periodontal
2000 : 50m 2009, 52-64

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Gianobelle William V., Saliva as a diagnostic tool for
periodontal disease - current state and trends : Periodontal
2000 : 50m 2009, 52-64

100. CONCLUSION
The components of saliva act as a mirror of the body’s health. With
emerging trends in microbiology, immunology and biochemistry, salivary
testing for clinical & research purposes ,is proving to be a practical and
reliable method of recognizing a number of diseases . As a consequence
these advances in technology are not confined to oral health
characteristics but may be used to measure features of overall health.
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101. BIBLIOGRAPHY
• Orban's oral histology and embryology 10th ed
• Burketts oral medicine diagnosis and treatment planning 10th edition
• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz
• Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ
(2000)50; 140-161
• Tucker A.S, salivary gland development, cell developmental biology : 18 (2007)
237-244
• Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids
:Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit.
Rev. Oral Biol. Med. 1995; 6; 161
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102. • Glandular mechanism of secretions : Chpt 2, Mechanism of salivary
secretion : Peter M Smith
• Saliva as a diagnostic medium ; Biomed Pap Med Fac Univ Palacky
Olomouc Czech Repub. 2009, 153(2):103–110.
• Blahova Zora et al: Physical factors in retention of complete dentures. J
Prosthet Dent 1971; 25: 230-235
• Gianobelle William V., Saliva as a diagnostic tool for periodontal disease -
current state and trends : Periodontal 2000 : 50m 2009, 52-64
5/8/2016
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THANK YOU
AND
HAVE A PLEASANT DAY!!!

104. SALIVA IN DENTAL CARIES
• Saliva plays an important role in reduction of caries by its buffering,
clearance, antibacterial and antibody actions.
• Xerostomia is usually associated with increased caries. This is due to:-
• pH
• buffering capacity
• clearance of food
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105. SALIVA IN FORENSICS
• Saliva is deposited usually through bitemarks.
• It can also be retrieved from cigarette butts, postage stamps, envelopes,
clothes and skin.
OTHER TESTS INCLUDE:
• Fluorescence detection method
• Chemical method
• Thiocynate test
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Initially – detect the presence of alpha-amylase enzyme ( Phadebas – chemical reagent)
Later – the molecule on the whole could be detected
Lateral flow Immunochromatographic strip test, rapid stain identification – Confirmation.

106. XEROSTOMIA – A COMPLICATION OF
ANTIHYPERTENSIVES
• Identify the drug
• Decrease dosage or change the drug
• Artificial salivary stimulants
• Chewing or electrical stimulation
• Sialogogues
– Cholinergic drugs
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107. CONTRAINDICATIONS OF ATROPINE
• Glaucoma
(atropine is used commonly for the dilation of pupils)
• Pyloric stenosis
• Prostate enlargement
• Substitute : Propantheline bromide
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108. MODIFIED SCHIRMER’S TEST
• Variation of schirmer’s test used for the eye
• Caliberated Whatman 41 filter paper
• Stripis placed on the floor of the mouth – absorbed by the filter paper
• After 5 mins – wetted length is measured (in mm)
• rate of saliva secretion is measured in mm/5min
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