saliva in dentistry
TRANSCRIPT
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“YOU NEVER MISS WATER… UNTIL THE WELL RUNS DRY. . . . . ”
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SALIVAP R E S E N T E D BY :
A P U R V A T H A M P I1 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 S
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CONTENTSEmbryology
The development of salivary glands
HistologyThe cell structure of salivary glands
AnatomyThe anatomical structure of the
salivary glands, its nerve and blood
supply
BiochemistryThe composition of
saliva
PhysiologyThe 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
PathologyThe pathologies of the salivary gland,
hyper and hypo secretion of saliva
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Saliva lacks the Drama of Blood, the Sincerity of Sweat,
the Emotional Appeal of Tears and the Intimacy of GCF
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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
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
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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
Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ
(2000)50; 140-161
05/02/2023
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CLASSIFICATION OF SALIVARY GLANDS
Major Parotid
Submandibular
Sublingual
Minor Labial / buccal
Anterior
Palatine
Glossopalatine
Von – ebner’sOrban's oral histology and embryology 10th
ed
05/02/2023
8
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
05/02/2023 9
EMBRYOLOGY
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DEVELOPMENT OF THE SALIVARY GLANDS
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 weekTucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGES IN FORMATION OF SALIVARY GLAND DUCTS
1. Bud formation2. Cord growth3. Branching of cords4. Lobule formation5. Canalization of cords6. Cytodifferentiation
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGE 1 – BUD FORMATION• 6th week of IUL – cells initiates low level synthesis of salivary secretory proteins
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGE 2 – CORD GROWTH
• Formation of stalk - Primary end bud
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGE 3 – BRANCHING OF CORDS
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGE 4 – LOBULE FORMATION• Arborized pattern – glandular enlargement
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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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
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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STAGE 6 - CYTOFIFFERENTIATION• Secretary cell differentiation• Epithelial mesenchymal interactions
Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
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HISTOLOGY
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HISTOLOGY OF SALIVARY GLANDS
• 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
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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)ZYMOGEN (Formed by glycolated protiens)
Orban's oral histology and embryology 10th ed
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MUCOUS CELLS• Apex appears empty except for thin strands of cytoplasm –
trabecular network• Nucleus is oval or flattened in shape – above the basal
membrane
Orban's oral histology and embryology 10th ed
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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
Orban's oral histology and embryology 10th ed
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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
Orban's oral histology and embryology 10th ed
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ANATOMY
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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
Burketts oral medicine diagnosis and treatment planning 10th edition
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BORDERS OF PAROTID GLAND
Superiorly : lower border of the zygomatic archPosteriorly : anterior border of the sternocleidomastoid muscleAnteriorly : posterior border of the masseter muscle
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ANATOMY OF PAROTID GLAND
Nerve supply : • Parasympathetic :
auriculotemporal nerve
• Sympathetic : plexus around the ECA
• Sensory : auriculo temporal nerve
Blood supply : external carotid artery and its branchesBurketts oral medicine diagnosis and
treatment planning 10th edition
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The parotid duct (Stenson’s duct) opens into the buccal mucosa at the upper second molar region
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SUBMANDIBULAR GLAND
• Large salivary gland• Anterior part of
digastric triangle• Mixed secretions –
serous + mucous
Burketts oral medicine diagnosis and treatment planning 10th edition
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BORDERS OF SUBMANDIBULAR GLAND
• 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
Burketts oral medicine diagnosis and treatment planning 10th edition
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ANATOMY OF SUBMANDIBULAR GLAND• Nerve supply:
branches from the submandibular ganglion
• Blood supply: facial artery
• Venous drainage: facial and lingual veins
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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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SUBLINGUAL GLAND
• Smallest salivary gland
• Almond shaped• Mixed secretions –
serous + mucous
Burketts oral medicine diagnosis and treatment planning 10th edition
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6-8 sublingual ducts open into the floor of the mouthMain duct – Bartholin’s duct
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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
tongueLabial glands
Glosspalatine glands
Palatine glands
Lingual glands
Von Ebner’s glands
Burketts oral medicine diagnosis and treatment planning 10th edition
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LABIAL/BUCCAL GLANDS• Glands of lips and cheek• Mixed type
GLOSSOPALATINE GLANDS• Posterior extension of
sublingual gland to glands of soft palate
• Pure mucous
Burketts oral medicine diagnosis and treatment planning 10th edition
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PALATINE GLANDS• Posterolateral regions of
the hard palate and the submucosa of soft palate and uvula
• Pure mucous
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
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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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BIOCHEMISTRY
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COMPOSITION OF SALIVA
Water99%
Others1%
Primary Composition of saliva
Water OthersBiochemical 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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COMPONENTS OF SALIVA (CONTD…)
Organic
protiens
Salivary amylase
immunoglubulins
Protiens synthesized
within glandsglycoprotiens
lipids Blood group
Antigen A,B
Hormones
ParathyroidGrowth factor
carbohydrates
Glucosehexosamine
• 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
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inorganic
sodium potassium calcium phosphor
us 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
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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
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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PHYSIOLOGY
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FUNCTIONS OF SALIVA• Digestive
• Protective
• Taste
• Excretion
• Water balance
• Oral hygiene
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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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Bolus formation• Moistening of food (Water)• Mucin – It is a lubricating material, makes food slippery,
facilitates swallowing
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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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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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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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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
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)
8. Gingival crevicular fluid– IgG– Lysozyme, Lactoferrin (liberated from phagocytic
cells)– PMNs - Phagocytosis
9. Maintenance of pH (Buffer)• Bicarbonate
– Main buffering ion
–Unstimulated saliva--- Less bicarbonate–Flow rate Bicarbonate–Pass through the plaque—Acid
neutralization
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
10. Antifungal activityHistatin peptide
11. Epidermal growth factor
–Maintenance of oro - esophageal and gastric tissue integrity
–Healing of ulcers–Stimulation of DNA synthesis
12. Hormonal function• Parotin-deposition of Ca on tooth• Nerve growth factor- growth of sympathetic ganglia.
13. Excretory functionDrugs- Route of elimination
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MECHANISM OF SALIVARY SECRETION
Acinar cells K+ and HCO3- by active process
Along with Cl- forelectrical 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
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MECHANISM OF SALIVARY SECRETIONTwo 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
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CONTROL OF SALIVARY SECRETION
PARASYMPATHETIC STIMULATION SYMPATHETIC STIMULATION
Increased by parasympathetic and parasympathetic activity
Release of proteolytic enzyme – kallikrien
Alpha 2 globulinsInto 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
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FACTORS AFFECTING SALIVARY FLOW RATEDiurnal 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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• 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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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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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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Hormonal influences
• Aldosterone – increased sodium reabsorption in the striated ducts
• Antidiuretic hormone – water reabsorption by the striated duct cells
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ROLE OF SALIVA IN DIAGNOSIS
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COLLECTION OF SALIVASTIMULATED
• Expectoration every 30-60 seconds
– Gustatory- Acids– Mechanical- Chewing
Paraffin wax, rubber band
UNSTIMULATED
• Draining method
• Spitting method
• Suction method
• Swab method
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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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)
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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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)
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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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
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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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
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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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)
SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech
Repub. 2009, 153(2):103–110.
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PATHOLOGY
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SALIVARY GLAND DISORDERS
Developmental
disordersFunctional disorders
Obstructive disorders
Inflammatory/ infectious
disorders
Immunological
disordersNeoplastic disorders
Asymptomatic
enlargement
• Burkett's Oral medicine diagnosis and treatment planning 10th ed
• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz
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DEVELOPMETAL DISORDERS• Abberancy• Aplasia• Hypoplasia• Hyperplasia• Atresia• Accessory Ducts • Diverticuli• Congenital fistula
• Burkett's Oral medicine diagnosis and treatment planning 10th ed
• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz
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FUNCTIONAL DISORDERS
• Sialorrhoea• Xerostomia
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OBSTRUCTIVE DISORDERS
• Sialolithiasis• Mucous plug• Stricture & Stenosis • Foreign bodies
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ASYMPTOMATIC ENLARGEMENT• Sialosis;• Allergy• Malnutrition & Alcohol related
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INFLAMMATORY/ INFECTIOUS DISORDERS• Bacterial• Viral
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AUTOIMMUNE DISORDERS
• Sjogren’s syndrome• Mikulicz’s disease
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NEOPLASMS
• Benign– Warthin’s tumor– Pleomorphic adenoma
• Malignant– Malignant Pleomorphic
Adenoma– Adenoid Cystic Carcinoma– Mucoepidermoid Carcinoma– Acinic cell tumor– Adenocarcinoma;– Squamous Cell Carcinoma
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SIALORROHEA
Etiology
Acute inflamma
tion of oral
cavity
Oral canc
er
teething
Patients with
neurological
disorders
Decreased
swallowing
frequency
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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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XEROSTOMIAETIOLOGY• 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
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Causes of long standing xerostomia
IatrogenicDrugsLocal radiationChemotherapy
DiseasesDiabetic mellitusCystic fibrosisPrimary biliary cirrhosisHepatitis c virus infectionHIV
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Preventive therapy
Symptomatic treatmentSalivary
stimulation
Treatment
XEROSTOMIA (CONTD…)
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PREVENTIVE THERAPY
Topical fluorides
Maintain meticulous oral hygiene
Remineralising solutions
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SYMPTOMATIC TREATMENT
waterIncreasing humidity of the environmentOral rinses and gels
Salivary substitutes
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SALIVARY STIMULATION
• Local or topical stimulation– Chewing – sour and sweet tastes– Electrical stimulation
• Systemic stimulation– Bromhexine (Mucolytic agent)– Anetoletrithione (mucolytic
agent)– Pilocarpin (Parasympathomimetic
drug)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
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CLINICAL ASPECTS
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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
Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet
Dent 1971; 25: 230-235.
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Denture retention – physical agent• Cohesion• Adhesion• Surface tension• Capillary attraction• Atmospheric pressure
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.
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DISTRIBUTION OF SALIVA OVER A DENTURE
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.
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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
Biomarkers
Specific
Systemic
Non- speci
ficGianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009,
52-64
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99Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009,
52-64
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CONCLUSIONThe 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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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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• 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
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THANK YOU AND
HAVE A PLEASANT DAY!!!
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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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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
Initially – detect the presence of alpha-amylase enzyme ( Phadebas – chemical reagent)Later – the molecule on the whole could be detectedLateral flow Immunochromatographic strip test, rapid stain identification – Confirmation.
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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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CONTRAINDICATIONS OF ATROPINE• Glaucoma(atropine is used commonly for the dilation of pupils)• Pyloric stenosis• Prostate enlargement• Substitute : Propantheline bromide
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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