Saliva is a vital fluid that sustains life within the oral cavity. It is produced by the parotid, submandibular, and sublingual salivary glands as well as numerous minor salivary glands. Saliva contains water and electrolytes that are modified by the salivary ducts to produce a hypotonic fluid. Salivary secretion is regulated by the autonomic nervous system, with parasympathetic stimulation producing a copious watery secretion and sympathetic stimulation producing a less voluminous, thicker mucous saliva. The normal daily salivary flow is 1-1.5 liters, with unstimulated and stimulated flow rates being approximately 0.3 ml/

2. “SALIVA LACKS THE DRAMA OF
BLOOD, THE EMOTIONS OF
TEARS,AND THE SINCIERITY OF
SWEAT ,BUT STILL THE FACT IS THAT
IT IS THE VITAL ELEMENT WHICH
SUSTAINS LIFE WITHIN THE ORAL
CAVITY…..”
IDJ 1992- SALIVAAND ORAL HEALTH

4. 1. Brief about the salivary gland
2. Introduction
3. Formation of saliva
4. Salivary secretions
EMBRYOLOGY
HISTOLOGY
Properties
Types of saliva
Stimulated Unstimulated
ANATOMY

5. 5. Salivary flow rate
6. Composition of saliva
7. Factors affecting composition of saliva
8. Functions of saliva
Factors affecting unstimulated flow rate
Factors affecting stimulated flow rate

6. 9. Salivary collection
10. Saliva as diagnostic tool
11. Saliva in future
12. Summary and conclusion

7. Embryology
Histology
Anatomy
BRIEF ABOUT THE SALIVARY GLAND

8. Time of origin
Gland Location Intra uterine life
Parotid gland Corners of the stomatodaem 4-6th week
Submand. gland Floor of the mouth End of 6th wk
SubLingual gland Lateral to primordium 8th week
Minor glands Buccal Epithelium 12th week
EMBRYOLOGY

9. Stage 1& 2
Induction of oral epithelium by underlying mesenchyme
& Formation of bud and growth of epithelial cord
Epithelial bud

10. Stage 3 & 4
Initiation of branching in terminal parts of epithelial
cord & continuation of glandular Differentiation
and dichotomous branching of epithelial cord &
lobule formation

11. Stage 5 &6
Canalization of presumptive ducts and
cytodifferentiation

12. The terminal secretory units are composed of serous,
mucous and myoepthelial cells arranged into acini or
secretory tubules.
The secretions of these units are collected by the intercalated
ducts which empty into the striated ducts.
HISTOLOGY

13. Mucous cells
• The nucleus of the mucous cell is
oval or flattened in shape.
• The mitochondria and other
organelles are limited to this band.
• The golgi apparatus is large and
consist of several stacks of 10 to 12
saccules.
• The nucleus and a thin rim of
cytoplasm are compressed against
the base of the cell.
• The secretory products differ from
those of serous in two aspects
1. They serve mainly for lubrication and
protection of the oral tissues
2. The ratio of carbohydrate to protein
is greater.

14. • Found between basement membrane and basal plasma membrane
• They are also called a “basket cells”as their shape appears like
basket containing secretory cells.
Myoepithelial Cells
Functions
1. Support the secretory cells preventing over distention
as secretory products accumulate in cytoplasm.
2. Contracts and widens the diameter of intercalated duct.

15. Ducts
• The duct system of salivary
gland is formed by the
confluence of small ducts
into ones of progressively
larger caliber.
• Within a lobule the smallest
duct are the intercalated
ducts, they are thin branching
tubes of variable length that
connect the terminal
secretory unit to the next
larger duct, the striated duct.
• The striated duct continue to
join within the main
excretory duct.

16. Intercalated ducts - are lined by
single layer of low cuboid cells
with relatively empty appearing
cytoplasm.
 A few small secretory granules
may be found.
 These cells modify the saliva by
resorptive mechanism into
macromolecules like lysozyme
and lactoferin
Striated ducts - The striated ducts are lined by a layer of tall columnar
epithelial cells with large spherical centrally placed nuclei
A few short RER and a small golgi apparatus are found.
These ducts receive saliva from the intercalated ducts

17. Functions of salivary ducts
• The main function of the salivary gland is to convey
the primary saliva secreted by the terminal secretory
units to the oral cavity.
They actively modify the primary saliva by secretion
and reabsorption of electrolytes and secretion of
proteins.
The intercalated duct cells often contain secretory
granules in their apical cytoplasm and two of the
antibacterial proteins present in saliva, lysozyme and
lactoferrin have been localized to these ducts.

18. Parotid Gland
 Largest of all the salivary
glands
 Purely serous gland that
produce thin
watery amylase rich saliva
 Superficial portion lies in
front of
external ear & deeper
portion lies behind
the ramus of mandible
 Stensen's Duct-Opens out
adjacent to maxillary second
molar
GROSS
ANATOMY

19. Parotid Duct
At the anterior edge of the masseter muscle,
Stensen’s duct turns sharply medial and passes
through the buccinator muscle, buccal mucosa
and into the oral cavity opposite the maxillary
second molar.

20. Parotid fascia
Gland encapsulated by a fascial layer that is
continuous with the deep cervical fascia (DCF).
The stylomandibular ligament (portion of the
DCF) separates the parotid and submandibular
gland.
20

21. Parotid Lymphatics
Lymphatic drainage is to the superficial and
deep cervical nodes
Preauricular lymph nodes (LN) in the
superficial fascia drain the temporal scalp,
upper face, anterior pinna
LN within the gland drain the parotid gland,
nasopharynx, palate, middle ear and external
auditory meatus

22. VASCULAR SUPPLY TO THE PAROTID
GLAND
Arterial supply :Ext.Carotid Artery and its terminal branches
Venous supply: Ext.Jugular Vein

23. Submandibular gland
Located in the
submandibular triangle
of the neck, inferior &
lateral to mylohyoid
muscle.
The posterior-superior
portion of the gland
curves up around the
posterior border of the
mylohyoid and gives
rise to Wharton’s duct.

24. RELATIONS
 Inferior surface is covered by-
Skin
Platysma
Cervical branch of the facial nerve
Deep fascia
Facial vein
Submandibular lymph nodes
 Lateral surface is covered by-
Submandibular foosa
Insertion of the medial pterygoid
Facial artery

25. Submandibular duct
 2-4mm in diameter &
about 5cm in length.
 It opens into the floor of
the mouth through a
punctum
 The punctum is a
constricted portion of the
duct to limit retrograde
flow of bacteria-laden
oral fluids.

26.  Mixed gland (mainly
mucous)consisting of 1
main gland and several
smaller glands.
 It lies between the floor
of the mouth and the
mylohyoid muscle in
contact with the
sublingual fossa.
 Bartholin’s duct is the main secretory duct
opens close to the duct of submandibular
gland and 8-10 smaller duct opens separately
along with sublingual fold.

27. VASCULAR SUPPLY
• SUBMANDIBULAR GLAND
• Arterial:Facial Artery,Lingual Artery
• Venous: Common Facial Vein /Lingual Vein
• Lymphatic:Submandibular Lymph nodes
SUBLINGUAL
GLAND
Arterial:Lingual and
Submental Arteries
Venous: Lingual Vein

28. They are scattered and
distributed in groups beneath
the epithelium having very
small and narrow ducts.
Glands are present almost on all
parts of the oral cavity.
Labial and buccal glands
 Labial:- situated beneath
mucous membrane around
the orifice of mouth.
Mixed in nature (mainly
mucous).
 Buccal:- situated between
the mucous membrane and
buccinator muscle.
Mixed in nature (mainly
Minor salivary glands

29. Palatine glands-
 Purely mucous glands
 Made of several hundred glandular aggregates in the
lamina propria of the postero-lateral region of the
hard palate and in the submucosa of the soft palate
and uvula.
 Openings of the ducts on palatal mucosa are large
and can be seen easily.
Palatine
glands

30. Lingual glands
Anterior lingual glands (Glands of Blandin and
Nuhn)
Located near the apex of the tongue.
Anteriorly, glands are mucous while posteriorly mixed in
nature.
Ducts open on ventral surface of tongue near lingual
frenum.
 Posterior lingual mucous glands
 Located in the posterior part of tongue or posterior to sulcus
terminalis.
 Purely mucous in nature.
 Ducts opens on to the dorsal surface of the tongue.

31. Posterior lingual serous glands (Von Ebner’s glands)
 Located between the muscle fibers of the tongue below
the vallate papillae and at the rudimentary foliate papillae
on the sides of the tongue.
 Purely serous glands.
 Opens into the trough of vallate papilla.
Glossopalatine glands-
 Located in the region of the isthmus in the glossopalatine
folds but may extend from the posterior extension of
sublingual gland to the glands of the soft palate.
 Purely mucous glands.

32. WHAT IS SALIVA?
SALIVA ……(also referred to as spit, spittle or slobber)
 Saliva comes from a Greek word ‘SALIVON’
meaning – “In Life”.
 Saliva is one of our natural resources. As with
most resources, it is unappreciated until there
is a shortage.
 Neglected by dentists & ignored by physicians,
saliva is the least known & the least
appreciated of all body fluids.

33. • Saliva is a clear, alkaline somewhat viscid secretion
from the parotid, submandibular, sublingual and
smaller mucous glands the mouth.
• Saliva is a clear taste less, odourless, slightly
acidic, viscous fluid consisting of secretions from
the parotid, submandibular & mucous glands of oral
cavity.
Stedman’s Medical Dictionary
Dorland’s medical dictionary

34. The secretions of the major and minor salivary
glands together with the gingival crevicular fluid,
constitute the oral fluid or whole saliva, which
provides the chemical milieu of the teeth and oral
soft tissues.[ Neubrun ]
MINOR GLANDSMAJOR GLANDS
SALIVA
GCF
GCF
Ductal saliva is saliva flowing from individual gland
which is transparent like water.

35. SALIVA :
THE EARLY BEGINNINGS….
INDUCING SALIVATION : ONE OF THE
OLDEST TREATMENT MODALITY
CHEAPEST AND MOST EASILY
AVAILABLE ANTI-SEPTIC

36. Gland specific saliva Whole saliva
Stimulated saliva Resting saliva
Depending on origin
Depending on mode of collection

37. Neural control and formation of
saliva
• Saliva secretion is regulated by both sympathetic
and parasympathetic autonomic nerves.
• Parasympathetic Nerve stimulation produces a
profuse watery secretion while sympathetic
stimulation produce less voluminous, thick
mucous saliva.
• Primary neural regulator of salivary gland
function is the “parasympathetic nervous system.

38. NEURAL REGULATION OF SALIVARY SECREATION
SALIVARY GLAND
Parasympathetic
Nerve supply
More prevalent
Secretory
Contract M.E
cells
Vasodilation
Sympathetic Nerve
supply
Less prevalent
Trophic
Increase exocytosis
in certain cells
Vasoconstriction

39. PARASYMPATHETIC SYMPATHETIC
FLUID
SECRETION
MACROMOLECULE
SECRETION
Capillaries
Formation of Interstitial
fluid
ACINAR CELLS Taken up and modified
ISOTONIC
SECRETION
Polypeptides &
proteins are
synthesized &
released by
exocytosis
LUMEN OF
THE ACINI
INTERCALATED
DUCT
Active reuptake of
Na+ ions Passive
movement of Cl- ions
STRIATED
DUCT

40. Reabsorption of Bicarbonate HCO3
Produce hypotonic solution
Further reabsorption of
Na+ ions
secretion of K+ ions
HYPOTONIC SECRETION
EXCRETORY DUCT

41. Where do the salivary glands get the motive
force for secretion, from?
HYDROSTATIC PRESSURE
OF THE BLOOD
Increase blood supply increase salivary secretion
Hilton & lewis’ concept
Parasympathetic
stimulation
kallikrein
Bradykinin
Contraction of
M.E. cells
Vasodilation &
increase in blood
supply
Motive force
for secretion

42. Effect of nerve stimulation on the size of
glands and amount salivary secretion….
Symp stimulation increase in size of gland
Diet Hard Increase in Mastication Increase salivation
Soft Decrease in mastication Decrease salivation

43. During the regeneration of nerve fibers following
trauma or surgical division, some of the nerve fibers of
salivary gland, which pass through the chorda tympani
branch of facial nerve, may be misdirected and join
with the nerve fibers supplying the sweat glands.
So, when the food is taken in the mouth, salivary
secretion is associated with sweat secretion.
This is called the chorda tympani syndrome.
CHORDA TYMPANI SYNDROME

44. Physical characteristics
• Average Daily flow: 1-1.5 litres
• Normal pH : Slightly acidic(6.35-6.85)
• Specific gravity: 1.002-1.012
• Tonicity : Hypotonic to plasma
• Normal flow rate
Unstimulated: 0.2-0.3 ml/min
Stimulated : 1 – 2 ml/min
SALIVARY SECRETION

45. • Whole saliva can be of 2 types:
Unstimulated/basal/resting saliva
Stimulated saliva
• UNSTIMULATED/BASAL/RESTING SALIVA
• This is whole saliva that is continuously secreted under
resting conditions, without any exogenous stimulation.
• characterized by a slow flow of saliva
• keeps the mouth moist and lubricates the mucous
membranes
• primarily serves to maintain the integrity of oral tissues.

46. • STIMULATED SALIVA
• This is whole saliva secreted in response to
exogenous stimuli.
• - Contributes as much as 80% - 90% of the
average daily salivary production.
65%
20% 7 -
8%
<10% >50
%
summandibul
ar
parotid
Unstimulated flow
Stimulated flow
sublingual
Minor
glands

47. Salivary flow rate
• There is great variability in individual salivary flow
rates, and hence it is difficult to assess the status of a
patient’s salivary gland function from a single
measurement of salivary flow rate.
• A more reliable indicator would be the changes
observed in a patient’s salivary rate over time i.e.
recording a base reference value for a given patient and
comparing it with the values recorded later.

48. THRESHOLD VALUES FOR UNSTIMULATED AND STIMULATED WHOLE SALIVA (ml/min)
NORMAL LOW
Mean Range Range Hyposalivat
ion
UNSTIMUL
ATED
0.30 0.25 - 0.35 0.10 - 0.25  0.10
STIMULAT
ED
2.00 1.00 - 3.00 0.70 - 1.00  0.70

49. • Factors affecting stimulated saliva
Main factor
* Degree of
hydration
* Body position
* Exposure to light
* Previous
stimulation
* Carcadian
rhythms
* Carcannual
rhythms
* Drugs
Secondary
* Gender
* age
* Body weight
* Gland size
* Psychic effects
- thought/sight of
food, appetite,
mental stress,
functional
stimulation

50. • DEGREE OF HYDRATION
• This is potentially the most important
factor. When body water content is
reduced by 8% the salivary flow rate
decreases to virtually zero whereas
hyperhydration increases the salivary flow
rate.

51. • 2. BODY POSTURE
•
• Flow rate varies with position, with higher flow rate
on standing and lower flow rate when lying down.
• 3. EXPOSURE TO LIGHT
• Flow rate decreases by 30 – 40% when subjects are
either blindfolded or in the dark. However no such
differences exist between blind subjects and those
with sight.

52. • CIRCADIAN RHYTHM
• Flow rate peaks during the late afternoon and drops to
almost zero
• during sleep. This may influence the time of day at
which saliva is collected and the timing of oral
hygiene.
•
• 5. CIRCANNUAL RHYTHM
• A study carried out in Texas, on the parotid salivary
flow rate has shown a peak flow rate in winter and a
35% lower flow rate in summer.

53. • Factors affecting unstimulated saliva
• Nature of stimulus
• Gag reflex
• Vomiting
• Gland size
• Unilateral stimulation
• Food intake
mechanical
gustatory
olfactory

54. • 1. NATURE OF STIMULUS
• Mechanical
• The action of chewing in the absence of any taste will
itself stimulate salivation though, to a lesser degree than
that due to gustatory stimulation.
• Gustatory
• Of the four basic taste stimuli, sour stimuli (acid) is the
most potent followed by salt, bitter and sweet.
• eg. 5% citric acid, which stimulated a mean maximum
salivary flow rate of about 7 ml/min.
• Olfactory
• Olfactory stimuli and tobacco smoking have relatively
small effects in stimulating salivary flow.

55. 2. GAG REFLEX
• Mechanical stimulation of the fauces ( the gag reflex)
leads to increased salivation.
3. VOMITING
• Salivary flow is increased just prior to and during
vomiting.
4. GLAND SIZE
• Maximum stimulated flow rate from a single gland is
directly related to gland size. The unstimulated flow
rate, however, is independent of gland size.

56. • 5. UNILATERAL STIMULUS
• If a person habitually chews on one side of the mouth,
most of the saliva will be produced by the glands on that
side.
• 6. FOOD INTAKE
• Increased stimulated flow rates due to both mechanical
stimuli (chewing) and gustatory stimuli (taste).

57. XEROSTOMIA
defined as the dryness of mouth, which results from the
lack of salivary secretions from the salivary glands.
Causes:
• Aplasia of the salivary glands
• Atresia of the ducts
• X-ray radiation in the head and neck region
• Vitamin deficiency
• Sjogren’s syndrome
• Emotional stress
• Sialolithiasis
• Use of atropine or antihistaminics
• Pernicious or iron deficiency anemia
• Severe vomiting, dehydration, hemorrhage, sweating &
diarrhea
• Polyuria in diabetic patients
57

58. Clinical features:
· Soreness, burning and pain sensations in the
mouth.
· Atrophy of the tongue papilla with fissuring and
cracking.
· Increased caries activity, gingivitis, mucosal
ulcerations and
bleedings
· Difficulty in wearing dentures.
Treatment:
- Aimed at removing the cause of the disease.
- Use of artificial saliva

59. ARTIFICIAL SALIVA
The ingredients of the artificial saliva solution (as prepared by
the pharmacy of the College of Medicine, Munster Germany)
Filled up with distilled water to 1 Kg

60. Disadvantage:
• Poor taste
• Lacks wettability
• Cannot be selectively targeted to diff. parts of
oral site

61. Saliva stimulants
Natrol Dry Mouth Relief, utilizes as patented pharmaceutical
grade of anhydrous crystalline maltose (ACM) to stimulate saliva
production.
As its effect is to stimulate functional salivary glands, it is not
appropriate for patients whose salivary gland function has been
lost through radiological treatment.
It is formulated as lozenges, which dissolve in the mouth (three
times daily).
However in a clinical study of patients with Sjogren’s syndrome,
ACM was shown to increase secretion and improve patients
symptoms.

62. PTYALISM
Increased secretion of saliva more than 5ml/min.
Causes:
a. Physiologic causes:
1.Teething
2.Pregnancy
3.Physiologically by sight or
smell
of palatable food
b. Pathologic:
1.Epilepsy
2.Mental retardation
3.Ceribral injuries.
4.Rabies
5.Drugs: Cholinergic
Methyl choline
Pilocarpine
c. Other causes:
1.Ulcers in oral
cavity
2.Presence of foreign
body

63. COMPOSITION OF SALIVA: (mg/100ml)
RESTING STIMULATED
MEAN RANGE MEAN RANGE
WHOLE (MIXED)
Total solids 500 300-800 530 400-900
Ash 250 170-350
Proteins 220 140-640 280 170-420
Amino acids 4
Amylase 38 ?
Lysozyme 22 11 0.4-62
IgA 19
IgG 1.4
Organic constituents

64. Glucose 0.2
Citrate 1.0 1.0 0.5-3
Lactate Trace
Ammonia Trace
Urea 20 12-70 13 0.6-30
Uric acid 1.5 0.5-3 3 1-21
Creatinine 0.1 0.05-
0.2
? ?
Cholesterol 8 2.5-50

65. Sodium 15 0-20 60
Potassium 80 60-100 80
Thiocyanate-smoker 9 6-12 ?
Non-smokers 2 1-3 ?
Calcium 5.8 2.2-11.3 6
Phosphate (P) 16.8 6.1-71 12
Chloride 50 100
Fluoride (ppm) 0.028 0.015-
0.045
Inorganic constituents

66. ORGANIC CONSTITUENTS OF SALIVA
1) Proteins of saliva:
Amylase: secreted by acinar and intercalated
duct cells
Lysozyme: secreted by striated duct cells of
submandibular gland.
Glycoproteins:
 Formerly referred to as mucins

67. FUNCTIONS OF GLYCOPROTEINS
• Protection & lubrication
• Aggregation & clumping of bacteria
• Inhibit calculus formation
• Posses blood group antigens( A,B & O)
• Salivary agglutinins

68. Other polypeptide :
• STATHERIN - A phoshoprotein rich in tyrosine and
proline
• Inhibits hydroxyapatite crystal growth
• Prevents precepitation of calcium and
phosphate
• Decrease calculus formation.
• SIALIN – a tetrapeptide
• it is utilized by bacteria.
• Its alkaline end products regulate plaque P.H.
NITROGENOUS CONSTITUENTS

69. • GLUCOSE
• BLOOD GROUP SUBSTANCES
A, B & O
• VITAMINS
water soluble vitamins are present
• LIPIDS
cholesterol , cholesterol esters,
fatty acids ,glyserides & phospolipids.
• CORTICOSTEROIDS
cortisol & cotisone

70. ENZYMES OF THE SALIVA
Salivary amylase
Acid phosphatase
Esterases
Aldolases
Lysozyme
B-glucoronidase
Succinic dehydrogenase
Peroxidase
Carbonic anhydrase
Kallikrein
Lipase
OTHER PROTEINS • Citrates
• Lactates

71. ANTIBACTERIAL PROTEINS
• Lysozyme
• Sialoperoxidase / lactoperoxidase
• Lactoferrin
THE CELLS OF SALIVA
• Epithelial cells
• Leucocytes

72. INORGANIC CONSTITUENTS OF SALIVA
Becks & Wainright contribution
• Calcium & phosphate
Ca – 5.8mg/100ml (2.2-11.3mg%)
Po4 – 16.8mg/100ml (6.1-71.0mg%)
Key facts :
 Calcium content of sub mandibular saliva is double
that of parotid saliva
 Principal salivary Ca & Po4 salts:
Dicalcium phosphate dihydrate
Octa calcium phosphate
Tricalcium phosphate
Hydroxyapatite

73. CLINICAL SIGNIFICANCE
critical P.H.
calculus formation
Calcium
Complxed
with CO2
Bound to
glycoproteins
10% organic compounds
10% as pyrophosphate
6-24% as complexed
form bound to proteins
Phosphate

74. OTHER INORGANIC CONSTITUENTS
• Na: Trace increase with flow
• K: Depend upon flow rate of secretion.
• Cl: Decrease with salivary flow
• HCO3:Increase with increase secretion
• IODINE: salivary glands actively transport
iodine.
• FLUORIDE: Less than that of serum.
• THIOCYNATE: More Than In Serum
Level decrease with decrease flow
GASES : N2 O2 CO2 In Solution

75. HYDROGEN ION CONCENTRATION IN SALIVA
• P.H. of saliva is proportional to rate of
flow
• During eating the P.H. rises because of
increase in rate of flow.
• During sleep the P.H. falls because of
decreased flow rate.

76. FACTORS INFLUENCING COMPOSITION OF
SALIVARY
FLOW RATE:
Increase with concentration of proteins, Na K&
HCO3.
Decrease with phosphate and magnesium
falls.
DIFFERENTIAL GLAND CONTRIBUTIONS:
stimulated– Parotid produces more saliva.
Unstimulated– submandibular produces the
greatest flow.

77. NATURE OF THE STIMULUS:
Sour, salt, sweet are similar in electrolyte
composition but salt stimulates a higher
protein content and sugar stimulate high
amylase content in saliva.
INDIVIDUAL DIETRY CONSTITUENTS:
High carbohydrate diet – rich amylase
H0RMONES:
ACTH and cortisone– decrease in salivary
sodium.
EFFECT OF FATIGUE -- reduces flow

78. • Growth factors in saliva
 Salivary Epidermal GF ---------esophageal and
gastric integrity
Functions of EGF
• Healing of ulcers.
• Inhibition of acid activity.
• Mucosal protection from intra luminal injuries.
• may accelerate wound healing.

79. Function saliva

80. Saliva ---- A Diagnostic Boon…!!!!!!
• ‘The eyes may be the window to the soul,
but many scientists would say the mouth is
the window to the body’
What are biomarkers ??
• Biomarkers are defined as cellular, biochemical
and molecular characteristics by which
normal/abnormal processes can be recognized
and/or monitored.

81. • Saliva as a diagnostic fluid:-
• Advantages
1. It is safe, non-invasive and simple.
2. No needles and No sringing.
3. Home testing.
4. Can be used in blood dyscrasias
5. Greater compliance in patients (pedo)
6. Decreased chances of infectivity
7. Effective in screening the community
8. Cost of shipping & Storage tend to be lower
• Disadvantages
• Informative analytes are present in lower
amounts in saliva than in serum

82. • Saliva collection
Whole saliva collection
Ductal secretions collection
Parotid secretions collection
Sub mandibular & sub lingual secretions
collection

83. Measurement of stimulated whole saliva
To achieve reliable, standardised results, patient should be
given detailed instruction:
a. Patient should not eat or drink for at least 1 hr before.
b. Patient should not smoke or undergo heavy physical
stress
c. Patient should sit in a relaxed position in ordinary
chair, not on dental chair
d. 1 min. presampling period is recommended
e. 5 min. is fixed collection time
f. If microbiologic test are planned, sample collection
should be postponed for 2 weeks after course of
antibiotics.
g. If chemical analysis is planned samples containing
visible blood should be discarded.

84. • The patient is instructed to chew 1gm piece of parraffin for 1 min
to soften it and then to swallow or spit all saliva.
• Patient then chews softened bolus of paraffin for fixed time(5
min), spitting the saliva into graduated cylinder. The secretion
rate is calculated in mm/min
Measurement of unstimulated saliva
• It is impossible to sample true resting saliva
• Patient is instructed to sit in relaxed position, with elbows
resting on the knees and head lowered between
arms(coachman’ position)
• Even slight movement of tongue, cheeks, jaws lip is avoided
• Lips are only slightly apart and the patient allows saliva to drool
passively over the lower lip into measuring cylinder avoiding
actively spitting
.

85. • Measurement of saliva from major
salivary gland
• Parotid saliva is obtained from 2 chamber
Carlson-Crittenden collector
• Submandibular and sublingual gland
collected by plastic micropipette

86. PROCESSING & STORAGE
All procedures must be performed on ice:
(1)Divide the saliva samples into multiple 330μL samples
placed in cryotubes
at -80ºc.
Further processed for
• Protein analysis: Add protease inhibitors like
aprotinin(0.33µL).
• RNA analysis: Add 1.65µL of SUPERase inhibitor.
(2)Invert gently to mix.
(3)Store all fractions at -80ºc.

87. Salivary Biomarkers Possibilities of Use
• DNA - Standard genotyping
-Genetic information of the hosting human body
-Bacterial infection (oral microbes in the mouth)
-Diagnosing carcinomas of head & neck
-Forensics
• mRNA Information on transcription rates
• RNA Viral/bacterial identification
• Proteins - Genetic information
-Translational regulation
-Diagnosing periodontitis
-Detecting dental cavities
• Immunoglobulin Diagnosing viruses
• Metabolites Diagnosing periodontitis
87

88. SALIVARY DIAGNOSTICS IN ORAL SQUAMOUS
CELL CARCINOMA
1. Oral cancer biomarkers :--
2. Oncogenes (e.g. C-myc, c-Fos, C-Jun),
3. Anti-oncogenes (e.g. p53, p16), cytokines
4. Growth factors (e.g. VEGF, EGF and IGF),
5. Extracellular matrix-degrading proteinases
6. Hypoxia markers (HIF-α, CA-9),
7. Epithelial-mesenchymal transition markers
8. Epithelial tumor factors , cytokeratins , micro
RNA molecules and hypermethylation of
cancer-related genes (p16 and DAP-K)

89. Disease Salivary markers
Cystic fibrosis Increased electrolytes, uric acid and
total proteins
Coeliac
disease,
dermatitis
herpetiformis
Serum IgA, antigliadin antibody
Hydroxylase
deficiency
Increased 17 hydroxyprogesteron
Sjogrens
syndrome
Flow rate decreased, increased RF
H pylori Specific IgG antibody
Shigella
infection
Anti lipo - polysaccharide, antishiga
toxin antibody

90. Viral Disease Salivary markers
Hepatitis - A HAV antibody
Hepatitis – B
&C
HBV/HCV antibodies
Measles Antibody
Mumps Antibody
Rubella Antibody
Dengue Antidengue IgM
Parvovirus Antibody
HIV Anti HIV IgG Ab

91. POSSIBLE SALIVARY MARKERS FOR
PERIODONTAL DIAGNOSIS
 α – glucosidase
 β – glucosidase
 Alkaline Phosphatase
 Aminopeptidase
 β – galactosidase
 β – glucoronidase
 Collagenase
 Elastase
 Gelatinase
 kallikrein
 Lysozyme
 Myeloperoxidase
 Trypsin

92. A. a
B.Forsythus
P.Gingivalis
P.Intermedia
P . Micros
P .Nigrescens
C .Rectus
T .Denticola

93. Cystatins
EGF
Fibronectin
Lactoferrin
Platelet activating factors
VEGF

94. PEEP INTO THE FUTURE ……
Saliva seems to have a sphere of influence that
extends beyond the oral cavity….!!!
SALIVA AND THE HEART
“Kissing your cardiac woes away!”
‘Hirudin’

95. Immunoglobulins : IgA, IgG IgM sIgA
Host cells: PMNs
Ions : calcium
Hormone : cortisol
Volatile compounds :
Hydrogen sulfide
Methyl mercaptan
Pyridine
picolines

96. MOLECULAR PROBRS
IDENTIFYING TUMOUR MARKERS
IDENTIFYING THERAPIES
CELLULAR ONCOGENES
VIRAL PHENOTYPIC PROTEINS

98. Diagnostic Probes for Assessing Functional
Capacity of Salivary Epithelial Cells
ISOTOPIC PROBES FOR ION CHANNELS AND PROTEINS
Discrete molecular disturbances.
Future research – radionuclides coupled to
probes; Drayer et al., 1982)
Routine assessments of the status of key acinar
cell plasma membrane proteins possible both
in situ,during actual Function as well as with
biopsied material in vitro.

99. Summary
• Saliva continues to demonstrate that it is more
complex than generally perceived;
• A fluid often described as “99% water”, and
yet, capable of carrying out such wide ranges of
functions.
• It represents the first line of defense in the oral
cavity

100. • It protects the tissues against desiccation,
potential carcinogens and other physical irritants
and can encourage soft tissue repair.
• Saliva maintains an appropriate ecological
balance in the mouth.
• It is well adapted to protection against dental
caries.

101. • Its buffering capability, its ability to wash the
tooth surface, clear bacteria and to control
demineralization and mineralization; its
antibacterial activities and perhaps other
mechanisms all contribute to its essential role in
the health of teeth.
• From the dental professional’s perspective, it
often is the fluid to be excluded from the
operatory site for which untold hours are being
spent sponging, evacuating or damming, with
little regard to its value.

102. • So as dentists, the knowledge of normal
salivary composition, flow and function, is
extremely important on a daily basis when
treating patients.

103. Conclusion
• Saliva is now meeting the demand for
inexpensive, non-invasive and easy to use
diagnostic aids for oral and systemic diseases
and for assessing risk behaviours.
• With advances in microbiology, immunology
and biochemistry, salivary testing in clinical
and research settings is rapidly proving to be a
practical and reliable means of recognizing oral
signs of systemic illness and exposure to risk
factors.

104. • The components of saliva act as a “mirror of the
body’s health,”.
• The widespread use and growing acceptability
of saliva as a diagnostic tool is helping
individuals, researchers, health care
professionals and community health programs
to better detect and monitor disease and to
improve the general health of the public .
• And the challenge for exploiting the full
potential of saliva remains.