saliva - body's mirror

SALIVA
Presented by
PRAVEEN KUMAR GALI
P.G STUDENT
DEPARTMENT OF CONSERVATIVE DENTISTRY
&
ENDODONTICS
8/27/2015 2

SEMINAR DETAILS
• Title: SALIVA
• Total slides: 179
• Textslides : 117
• Illustrations:64
• Time for presentation: 45 minutes approx.
8/27/2015 3

TEXTBOOK REFERENCES
1. Concise Medical Physiology – Choudhary. 7th Edition
2. Human Physiology By A.K. JAIN 5th Edition
3. Medical Physiology By Sembulingam 4th Edition
4. ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12th
Edition
5. Text Book Of Oral Pathology – William G. Shafers. 6th Edition
6. Salivary Diagnostics By David T Wong 1st Edition
7. Dental Materials By S.Mahalaxmi 1st Edition
8. Sturdervant’s Art And Science Of Operative Dentistry 5th
Edition
9. Human Antomy By B.D Chaurasia 4th Edition
10. Dental Pharmacology By K.D Tripati 6th Edition
11. Dyspahgia diagnosis and treatment by Ekberg 1st edition
8/27/2015 4

JOURNAL REFERENCES
• British dental journal 1992, 172 : 305 – Saliva : its selection, composition
and functions by W.H. Edgar.
• Badruddin et al storage medium for avulsed teeth Indian Journal of
Multidisciplinary Dentistry, Vol. 3, Issue 3, May-July 2013.
• The salivary gland fluid secretion mechanism
The Journal of Medical Investigation Vol. 56 2009.
• Salivary Diagnostics: An Insight Indian Journal of Dental Sciences.
December 2011 Issue:5, Vol.:3.
8/27/2015 5

• A review of saliva: Normal composition,flow, and function
JPD volume 85 number 2.
• Health benefits of saliva: a review
Michael W.J. Dodds Journal of Dentistry (2005) 33, 223–233
• Management of Xerostomia Related to Radiotherapy for Head and Neck
Cancer; journal of oncology ;December 2005 By Shannon T. Kahn
8/27/2015 6

CONTENTS
1. Introduction
2. Development
3. Anatomy and Histology Of Salivary Glands
4. Formation And Secretion
5. Composition Of Saliva
6. Factors effecting composition
7. Properties And Functions
8. Methods Of Collecting Saliva
9. Analysis Of Saliva (Salivary Biomarkers)
10.Clinical Considerations In Dentistry & salivary disorders
11.Saliva As Storage Medium
12.Journal References
13.Conclusion
8/27/2015 7

INTRODUCTION
8/27/2015 8
‘Salvindo’

Definition
“Saliva is a clean, tasteless, odorless slightly
acidic viscous fluid, consisting of secretions
from the parotid, sublingual, sub mandibular
salivary glands and the mucous glands of oral
cavity”
HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition8/27/2015 9

Types of salivary glands
• Salivary glands can be divided into Major and minor
salivary glands.
• Major – There are their pair of major glands namely:
– Parotid.
– Sub Mandibular
– Sub lingual
• Minor – These are distributed in mucosa and sub
mucosa of the oral cavity namely:
– Labial and Buccal glands.
– Glossopalatine glands.
– Palatine glands.
– Lingual glands.
Human antomy by B.D chaurasia 4th edition8/27/2015 10

DEVELOPMENT
• Similar pattern
• They originate from oral epithelial buds invading
the underlying Mesenchyme.
• ECTODERMAL in parotid and minor salivary
gland
• ENDODERMAL in sub Mandibular and
Sublingual glands.
• PRIMORDIA – 6th week
(sublingual glands- 7-8 weeks)
The minor salivary glands - third month.
ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION8/27/2015 11

Stages in development
Pre bud
Initial bud
Pseudo glandular
Canalicular
Terminal bud
8/27/2015 12
ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION

PAROTID GLAND
•Largest of all glands
•Average Wt - 25gm
•Located in the preauricular region and along the
posterior surface of the mandible.
148/27/2015 Human antomy by B.D chaurasia 4th edition

 Divided by the facial nerve into a superficial lobe
and a deep lobe.
 The superficial lobe
 Overlying the lateral surface of the masseter,
 Part of the gland lateral to the facial nerve.
 The deep lobe
 Medial to the facial nerve
 Located between the mastoid process and the ramus
of the mandible

PAROTID DUCT
•Ductus parotideus; Stensen’s duct
•5 cm in length
•Anterior border of the gland
•Runs anteriorly and downwards on the masseter b/w the
upper and lower buccal branches of facial N.
At the anterior border of masseter it pierces
•Buccal pad of fat
•Buccopharyngeal fascia
•Buccinator Muscle

 Because of oblique course of duct
through buccinator inflation of duct is
prevented during blowing.
 It opens into the vestibule of mouth
opposite to the 2nd upper molar.

SUBMANDIBULAR GLANDS
Large superficial and small deeper part continuous
with each other around the posterior border of
mylohyoid.
Superficial Part Situated in the digastric triangle
Wedged b/w body of mandible and mylohyoid.

SUBMANDIBULAR DUCT
Also called as Wharton's duct
5 cm long
Emerges at the anterior end of deep part of the
gland.
Opens in the floor of mouth at the side of frenulum
of tongue.

SUBLINGUAL SALIVARY GLAND
Smallest of the three glands
3-4 gm
Lies beneath the oral mucosa in
contact with the sublingual fossa
on lingual aspect of mandible.

Duct of Rivinus
•8-20 ducts
•Most of them open directly into the floor of mouth
•Few of them join the submandibular duct.

Minor salivary glands
• Located beneath the epithelium in almost all parts of
the oral cavity
Labial
Buccal or molar glands
Palatal glands
Lingual mucus / tip and margins of tongue
Lingual serous / circumvallate and foliate glands
•Small groups of secretory units
•Opening is via short ducts directly into the mouth .
•They lack connective tissue capsule
248/27/2015
MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION

Based on secretions
• Parotid
• Lingual serousSerous
• Lingual mucus
• Buccal and palatalMucus
• Submandibular
• Sublingual and labial glandsMixed
8/27/2015 25

HISTOLOGY OF GLANDS
ACINI
serous
mucous
myoepithelial
SECRETORY UNIT8/27/2015 26

SEROUS CELLS
•Acini - spherical.
•8-12 cells .
•Cells - pyramidal
•The spherical nucleus is located in the basal region of
the cell.
288/27/2015

29
Membrane bound ribosome
Cisternal space of RER
Golgi apparatus
(Carbohydrate addition,post
transitional modification)
Packed into secretory
granules
SECRETION OF SALIVARY PROTEINS
8/27/2015

MUCOUS CELLS
•Polyhedral & contain mucinogen granules.
•Little or no enzymatic activity.
•Lubrication and protection of the oral
tissues.
•The ratio of carbohydrate to protein is
greater.
•Larger amounts of sialic acid and
sulphated sugar.
308/27/2015

31
Single droplet discharged
Fused with apical plasma
membrane
Plasma membane seperates
droplets from lumen
Membrane may remain intact or
dissolved after discharging droplet
SECRETION OF MUCOUS DROPLET
8/27/2015

32
synthesis
Storage
Secretion of
protein
N - linked
Glyco protein
Serous
cells
mucin
Lubricate
Microbial
barrier
O – linked
Glyco protein
Mucous
cells
8/27/2015

Myoepithelial cells
– Related to the secretory and intercalated duct cells
– Between the basal lamina and the basal membranes of
parenchymal cells.
– Contractile function, helping to expel secretions form the
luminal space of the secretory units and ducts.
8/27/2015 33

INTERCALATED DUCTS
•The small ducts
•Thin branching tubes
•Variable length
•Connect to the terminal secretory units to the next
larger ducts.
•Primary saliva passes first thorough intercalated
ducts.
•Contain secretory granules in their apical cytoplasm
(Lysozyme or lactoferritine may be localized ) 348/27/2015

STRIATED DUCTS
•Largest portion of ductal system
•Located within lobules
•Contain kallikrein
•Synthesize secretory glycoproteins
358/27/2015

EXCREATORY DUCTS
•Located in connective tissue septa
•Larger in diameter then striated duct .
368/27/2015

FORMATION AND SECRETION OF SALIVA
Fluid and electrolyte secretion is two step procedure.
• 1st step : Occures In acinar cells (primary saliva)
• 2nd step : Occurs In salivary ducts.
378/27/2015

8/27/2015 38The salivary gland fluid secretion mechanism The Journal of Medical Investigation Vol. 56 2009.

8/27/2015 39
ORAL HISTOLOGY AND EMBRYOLOGY– ORBAN’S. 12TH EDITION

Control of salivary secretion
Afferent pathway
Central pathway
Efferent pathway
8/27/2015 40

8/27/2015 41

Afferent pathway
Resting flow
Psychic flow
Unconditional
reflexes
8/27/2015 42

Resting flow
Circadian variation
Light and arousal
Hydration
Exercise and stress
• morning
• night
• Bright
• Dark
• Hydrated
• Dehydrated
8/27/2015 43

Psychic flow
• Anticipation of food or sight of food
• Awareness of saliva in mouth
• IVAN PAVLOV
8/27/2015 44

Unconditioned reflexes
Mastication
Gustatory stimuli
Others
8/27/2015 45

Central control
•Superior
salivatory nucleuspons
•Inferior salivatory
nucleusmedulla
8/27/2015 46

Efferent pathway
Parasympathetic
Sympathetic
8/27/2015 47

Parasympathetic fibers
Nucleus salivatorius superior
•Submandibular & sublingual glands
Nucleus salivatorius inferior
•Parotid gland
8/27/2015 48

Parasympathetic fibers to
submandibular and sub lingual glands
8/27/2015 49

Parasympathetic fibers to parotid gland
8/27/2015 50

Sympathetic fibers
Pre ganglionic fibers from Lateral horns of
First and second thoracic segments of spinal cord
Anterior nerve roots
Superior cervical ganglion in sympathetic chain
Post ganglionic nerve fibers– glands
8/27/2015 51

Profuse saliva
Watery
Less organic content
Dialate blood vessels
Less saliva
Thick and mucoid
Vasoconstriction
More organic content
8/27/2015 52

Composition of saliva
SALIVA
99.5%
water
Solids
0.5%
8/27/2015 53

solids
Organic
substances
0.2%
Inorganic
substances
0.3%
Gases
Small
fraction
8/27/2015 54
1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition

Organic substancesEnzymes
Amylase
maltase
Lingual lipase
lysozyme
phosphatase
Carbonic anhydrase
Kallikrein
Acid phospahatase
Peroxidase
Lactoferrin
others
proteins
Blood group antigens
Amino acids
Non protein nitrogenous
substances
(Urea,uric acis,creatinine
,xanthine,and hypoxanthine)
Hormones
Water soluble vitamins
8/27/2015 55

Inorganic substances
• sodium
• calcium
• potassium
• bicarbonate
• bromide
• chloride
• fluoride
• Phosphate
8/27/2015 56

Gases
Oxygen
1ml/100ml
Nitrogen
2.5ml/100ml
Co2
5ml/100ml
8/27/2015 57

Glycoprotein Mucin
• Tissue coating
• Protective coating about hard and soft tissues
• Formation of acquired pellicle
• Concentrates anti-microbial molecules
• Lubrication
• Forms a moist mucosal environment
8/27/2015 58

Amylases
• abundant salivary enzyme (50 % of proteins )
• 80 % - parotid
• Hydrolyzes starches →maltose, maltotriose,
dextrins
•Anti bacterial
•Digestion
•Tissue coating
8/27/2015 59

Lingual Lipase
• von Ebner’s glands of tongue
• Fat to medium or long chained triglycerides
(1st phase )
• Increase the efficacy of pancreatic polypeptide
• digestion of milk fat in new-born
8/27/2015 60ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION

Statherins
• By acinar cells
• Both Parotid and submandibular glands
• prevent precipitation or crystallization of
supersaturated calcium phosphate in ductal
saliva and oral fluid

Proline-rich Proteins (PRPs)
• Inhibitors of calcium phosphate crystal growth
• Present in the initially formed enamel pellicle
and in “mature” pellicles
• Lubricaion
• Mineralization
• Tissue coating
Acidic
• Binding of tannins
• Tissue coatingBasic
• Anti viral
• lubricationGlycosylated
8/27/2015 62

Lysozyme ( LZ )
• Oral LZ is derived from
1. major and minor salivary glands
2. phagocytic cells
3. gingival crevicular fluid (GCF)
• Is an antibacterial enzyme.
• The mean concentration in whole saliva
resting is 2.2mg/100ml
stimulated-11mg/100ml.
8/27/2015
63
A review of saliva: Normal composition,flow, and function JPD volume 85
number 2.

Lysozyme ( LZ )
Anti-microbial activity by:
• Inhibition of bacterial adhesion to tooth
surfaces
• Inhibition of glucose uptake and acid
production
• Muramidase activity (lysis of peptidoglycan
layer)

Lactoferrin
• Iron binding glycoprotein secreted by serous
cells
• High affinity for iron
• Bacteriostsatic, cidal, fungal, antiviral and anti
inflammatory

Histatins
• A group of small histidine-rich proteins
• Potent inhibitors of Candida albicans growth
• Wound healing
8/27/2015 66
number 2.

Kallikrein
• It splits beta-globulin into bradykinin
• Bradykinin passes back into the gland and into
B.V.’s thus causing functional vasodilatation to
supply an actively secreting gland.

Cystatins
• Are inhibitors of cysteine-proteases
• Protective against unwanted proteolysis
(bacterial proteases, lysed leukocytes)
• Inhibit proteases in periodontal tissues

Salivary peroxidase systems
• Antimicrobial
• protection of host proteins and cells from
toxicity of H2O2
• Sialoperoxidase (SP, salivary peroxidase)
Myeloperoxidase (MP),thiocyanate systems
• From leukocytes entering via gingival crevice

Agglutinins
• Interact with unattached bacteria
• Cause clumping of bacteria into large
aggregates which are easily flushed by saliva

IMMUNOGLOBULINS
• Secretory Ig A - inhibit adhesion – 90%
• Ig G – enhance phagocytosis
• Ig M - enhance phagocytosis
• IgA has 3 main functions:
– Inhibition of bacterial colonization.
– Binding to specific bacterial antigen.
– Affects specific enzymes essential for bacterial
metabolism
8/27/2015 71
number 2.

Blood group substances
• Blood group antigens are also present in saliva
• Ag A and AgB.

Hormones
• “Parotin” and a “nerve growth factor”.
• Parotin – facilitates calcification and helps to
maintain serum calcium levels.
• Nerve Growth Factor (NGF) – affects growth
and development of symphathetic nerve
fibres.

Carbohydrates
• Has glucose at a concentration of
0.5-1mg/100ml (parotid).
• In submandibular – glucose, hexose, fructose
with small amounts of hexosamine and sialic
acid.

Amino acids
• 9 types in parotid
• 12 in submandibular
• 18 in whole saliva at low concentration of
about 0.1mg /100ml

Lipids
• Small amount of diglycerides, triglycerides,
cholesterol and cholesterol esters,
phospholipids, corticosteroids.
• Play a role in salivary protein binding ,bacterial
absorption to apatite, and plaque microbial
aggregation

Inorganic contents
cations
Sodium
Potassium
Calcium
Magnesium
anions
Chloride
Bicarbonate
Phosphate
Trace
elememnts
of halides
Less sodium and
Higher potasium than ECF

Element Concentration mE/lit Details
Sodium 10 to 100 Flow dependant
Potassium 8.20 Independent of flow
1.5 to 4 times plasma conc.
Calcium 3 Ionic or bound form
Colloidal calcium
phosphate
Magnesium 0.6 Trace
Chloride 15 to 25 Less conc. Than plasma
Bicarbonate 5 to 60 Osmolarity
Buffering

FACTORS AFFECTING COMPOSITION
• Altered as the saliva passes in the duct system,
mainly due to re absorption of sodium chloride and
secretion of potassium and inorganic phosphates.
8/27/2015 79CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION

Factors
affecting
composition
Flow rate
Hormones
Fatigue
Plasma
concentration
Diet
Nature of
stimulus
Duration
of
stimulus
Circadian
rhythm
Differential
contributions
8/27/2015 80

PROPERTIES OF SALIVA
• Daily secretory volume 500-7500ml
• Consistency slightly cloudy and viscous
• Saliva is acidic in nature usually.
• Saliva is colourless opalscent fluid.
• Specific gravity is 1.002 to 1.012
• Saliva is usually hypotonic but approaches
isotonicity when flow rates are high.
• It is rarely hypertonic.

• pH  5 to 8 & Mean pH  6.4
– pH becomes alkaline with high flow rates.
– Bacterial action may also alter the pH of saliva.
• Freezing point – 0.07-0.34°C
• Osmotic pressure – ½ -3/4 of blood (1400milli osmol/L)
• Flow rate – 0.02ml / min. – At rest
7ml / min. – In stimulated saliva.
• Velocity – 0.8-8mm/min.
– Lowest velocity films occurred on facial surfaces of upper
incisors
– Highest velocity occurred on lingual surfaces of teeth.
8/27/2015 82
number 2.

VISCOSITY-‘SPINN BARKEIT
PHENOMENA’
• Viscosity depends on their glycoprotein content as
described by Gottschalk 1961.
• non-newtonian.
• viscoelastic properties.
• Ability to draw out a thread of saliva is typical of a
viscoelastic fluid and is known “Spinn Barkeit”.
• The relative viscosity of the three main secretions after
acetic acid stimulation were found by Schneyer (1955).
1. Parotid - 1.5
2. Submandibular - 3.4
3. Sublingual - 3.4
8/27/2015 83
number 2.

Volume
Total volume – 500-750ml/day
Submandibular – 60%
Parotid – 30%
Sublingual 3-5%
Minor salivary glands – 7%
In Sleep
• Parotid - 0%
• Submandibular - 72%
• Sublingual - 8%
Resting stage
Parotid – 21%
Sublingual -1-2%
Minor salivary glands – 7%
Acidic stimulation
Parotid – 45%
Sublingual – 1.5%
Mechanical stimulation
Parotid – 58%
8/27/2015 84

Functions of saliva
Digestion of
polysaccharides
Diluent and cooling
effect
Moistening , cleansing
and tooth integrity
Anti microbial function
Lubrication and wound
healing
Buffering
As a solvent and taste
Thirst mechanisms
Excretory
Middle ear pressure
adjustment

Buffering capacity of saliva
Carbonic acid / bicarbonate system
Phosphate system
Protein system (mucin)

Carbonic acid / bicarbonate system
H+HCO3
-
H2CO3

Phosphate buffer system
HPO4
2- H+H2PO4
-
8/27/2015 88

Pellicle and plaque deposition
• Both pellicle and plaque matrix contain
protein predominantly derived from saliva.
• Pellicle formation is a physico-chemical
process
• Plaque formation involves incorporation of
salivary proteins
8/27/2015 89

Plaque mineralization and calculus
formation
• Salivary calcium and phosphate are the source
of minerals
• statherin and proline-rich proteins inhibit
precipetation
8/27/2015 91

Saliva and Dental Caries
Static
Antebacterial
Supersaturation
Ca ,phosphate
Substrates for
pellicle
Dynamic
Buffering
Clearance
Supersaturation
Of HCO3
8/27/2015 92

Critical pH
• “The pH at which any particular saliva ceases
to be saturated with calcium and phosphate is
referred to as ‘ critical pH ’
• It is usually 5.5
• High salivary calcium and phosphate –
Remineralization
• Low calcium , phosphate – Demineralization
8/27/2015 93

WHOLE SALIVA
8/27/2015 96SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
Whole saliva collection method:
Resting saliva
• Draining method.
• Spitting method.
• Suction method.
• Swab method.
Stimulated saliva
• Masticatory method.
• Gustatory method.

Parotid saliva
• Lashley cup
• Cannulation
• Personalized plastic cup
• Snail collector

Submandibular saliva
• Cannulation
• Segregator device
• Wolfe appartatus
• Suction

Minor salivary glands
• Labial and buccal saliva
• Palatine saliva
 Pipette
 Filtration paper
 Impression of palate
 Individual collection prosthesis

Salivary diagnostics

Why saliva???
• Non – invasive
• Limited training
• No costly equipment foe
collection
• Potentially valuable for children
and older patients
• Cost effective
• Eliminates the risk of infection
• Easy, No pain, No needle prick,
Fast
• Screening of large population
No Pain
1018/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION

What is a biomarker???
“A biomarker is an objective measure that has
been evaluated and confirmed either as an
indicator of physiologic health, a pathogenic
process, or a pharmacologic response to a
therapeutic intervention.”

Biomarker
Monitor
progression
/ recurrence
Detect
disease
Stage
disease
Treatment
efficacy
Response to
treatment

Salivary genomics
or
salivary proteomics
or
salivomics

AUTO IMMUNE
DISEASES BONE
TURNOVER
MARKERS
Systemic disorders
DENTAL CARIES AND
PERIODONTAL
DISEASES
DRUG LEVEL
MONITORING
FORENSIC EVIDENCE AND
SUBSTANCE ABUSE
GENETIC
DISORDERS
INFECTIONS
OCCUPATIONAL AND
ENVIRONMENTAL
MEDICINE
PSYCHOLOGICAL
STRESS
RENAL
DISEASES
MALIGNANCY
DISEASES OF
ADRENAL
CORTEX
8/27/2015 106

Autoimmune diseases
Sjögren's syndrome
• A low resting flow rate and abnormally low
stimulated flow rate of whole saliva
• Elevated levels of
1. Rheumatoid factor
2. Antinuclear antibody
3. Anti-ss-a
4. Anti-ss-b antibody .

Bone turnover markers

Cardio vascular markers
• CRP and MMP-9 with intima–media thickness
• LTB4 and PGE2 with arterial stiffness
• lysozyme with hypertension.
Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December
2011 Issue:5, Vol.:3.

Diabetic markers
For type II diabetes
• KRAS
• EGFR
• PSMB2
2011 Issue:5, Vol.:3.

Biomarkers for caries risk assessment
• The Levels of Salivary Mutans Streptococci
and Lactobacilli
• Salivary Flow Rate
• Salivary pH and Buffer Capacity
• Salivary Proteins(MUC7,PRPs)
• alpha-defensins HNP1-3 in children
• sIgA levels
2011 Issue:5, Vol.:3.

Periodontal disease
• IL 1,2,4,10
• MMP 1, MMP 8
• PGE2
• ICTP
• TNF
• fibronectin degrading enzymes
• IgA2
• Epidermal growth factor (EGF)
• Vascular endothelial growth factor (VEGF)

Drug monitoring
• Phenytoin
• Lithium
• Primidone
• Methadone
• Ethosuximide
• Cyclosporine
• Carbamazipine
• Marijuana
• Theophylline
• Cocaine
• Caffeine
• Alcohol

Forensic evidence
• High levels of salivary amylase
• Desquamated cells
• Same proteins as blood and urine

Genetic disorders
Cystic fibrosis
•The submandibular saliva contains more lipid
•The levels of neutral lipids, phospholipids, and glycolipids are
elevated.
•The altered physico-chemical properties of saliva in this disease.
•Elevations in electrolytes (sodium, chloride, calcium, and
phosphorus), urea and uric acid, and total protein

VIRAL DISEASES
•the salivary glands and serum – Ig
•Secretory IgA (sIgA) - main specific immune defense
mechanism in saliva.
•Antibodies against viruses and viral components
2011 Issue:5, Vol.:3.

•Acute (HAV) & (HBV) -IgM antibodies in saliva.
• The ratio of IgM to IgG
•Determining immunization and detecting infection
with measles, mumps, and rubella.

• sIgA best marker for ROTAVIRUS in infants
•The shedding of herpesviruses in saliva
•PCR-based identification in HSV-1 reactivation in
patients with Bell's palsy.

HIV
•Diagnosis of infection is equivalent to serum in
accuracy
•Antibody to HIV in whole saliva of infected
individuals, which was detected by ELISA and
Westernblot assay, correlated with serum antibody
levels .

•95% sensitivity
•100% specificity when compared to serum
diagnostics
•Salivary IgA levels to HIV decline as infected
patients become symptomatic
•A prognostic indicator for the progression of HIV
infection.

Stress biomarkers in saliva
• Salivary α-amylase
• Chromogranin A
• Salivary cortisol

MALIGNANCY
•early detection.
• p53
•Inactivation of p53 suppressor through mutations and
gene leads to malignancy
•Elevated levels of salivary defensin-1in oral SCC.
•salivary defensin-1 levels and serum levels of SCC-
related antigen.

The Monitoring of Hormone Levels
•Lipid solubility and steroid hormones
•Salivary cortisol levels in cushing's syndrome and
addison's disease
•Monitoring the hormone response to physical
exercise and the effect of accelerating stress.

•Salivary aldosterone levels with serum aldosterone
levels
•Increased salivary aldosterone levels with primary
aldosteronism.
•Salivary insulin

Lab now analyser with nano bio chip elements
8/27/2015 125

Clinical considerations in
restorative dentistry and endodontics
• Isolation
• Interactions with dental materials
• Chance of infection
• Aberrations in salivary flow and management
• Age changes
• Saliva as a storage medium for avulsed tooth
8/27/2015 126

Isolation
1. Rubber Dam
2. Cotton rolls & cellulose wafers
3. Throat shields
4. High volume evacuators & saliva ejector
5. Mirror & evacuator tip retractor
6. Mouth props
7. Air Water syringe
8. Cheek retractor
9. Drugs
8/27/2015 127STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION

Rubber Dam Isolation

• Cotton rolls, gauze & cellulose wafers
absorbents are helpful for short period of
isolation of the teeth especially where rubber
dam application is not possible.
• Usually placed in Buccal & lingual sulcus
specially where salivary gland ducts exit, to as
to absorb saliva.
Cotton rolls
8/27/2015 129

• It is used to remove water and saliva with high
suction speed.
• Also helps in retracting the soft tissues.
High volume evacuators & saliva
ejector

Hygroformic saliva ejector
8/27/2015 131Pulp dent dental products manual – isolation

• By air water syringe an air blast can be useful
to dry tooth and soft tissue during
examination or used during procedure.
Air water syringe

• Anti sialogogues
• Local anaesthetics
Drugs

Anti sialogogues
Methantheline
bromide
• Banthine
• 50 mg 1 hour
before
Propantheline
bromide
• Pro banthine
• 15 mg 1 hour
before
Clonidine
Hydrochloride
• Anti
hypertensive
• 0.5 mg 1 hour
before
Anti cholinergics
Act by inhibiting myoepithelial cells
8/27/2015 135DENTAL PHARMACOLOGY BY K.D TRIPATI 6TH EDITION

Interactions with dental materials
While restoring
• GIC
• AMALGAM
• Composites
8/27/2015 136

SALIVA AS ELECTROLYTE
• May cause wet corrosion
8/27/2015 137

Chances of getting infected
• Potential infections are
1. Hepatitis B
2. Respiratory infections
3. Conjuctivitis
4. Herpes infections
5. HIV
8/27/2015 138OSHA GUIDELINES

DO s and DON’T s
8/27/2015 139

Aberrations in flow
• Hyposalivation,xerostomia and Aptyalism
• Hyper salivation
• Drooling
• Chordatymapani syndrome
• Paralytic secretion
• Augmented secretion
8/27/2015 141

Xerostomia
• Xerostomia (dry mouth) is the subjective feeling of oral
dryness.
• It is generally accompanied by salivary gland
hypofunction and a severe reduction is the secretion of
unstimulated (resting) whole saliva.
8/27/2015 142Dyspahgia diagnosis and treatment by Ekberg 1st edition

Etiology
• Autoimmune disease (Sjogren’s syndrome, lupus)
• Systemic diseases (diabetes, asthma, kidney
malfunction, sarcoidosis, HIV)
• Stress/anxiety/depression
• Radiation therapy to the head and neck
– 30 Gy = glandular fibrosis (gland can still produce
some saliva)
– 60-70 Gy = glandular destruction (gland can no
longer produce saliva)
8/27/2015 143Dyspahgia diagnosis and treatment by Ekberg 1st edition

• Antacid
• Antianxiety
• Anticholinergic
• Anticonvulsant
• Antidepressant
• Antiemetic
• Antihistamine
• Antihypertensive
• Antiparkinsonian
• Antipsychotic
Factors that Affect Salivary Flow
Medications
•Cholesterol reducing
•Decongestant
•Diet pills
•Diuretic
•Hormonal replacement therapy
•Muscle relaxant
•Narcotic analgesic
•Sedative
•Bronchodilator
Over 400 Medications Can Produce the Side Effect of Xerostomia
144Dyspahgia diagnosis and treatment by Ekberg 1st edition

• Ageing
• Decreased mastication
• Salivary gland tumors and neoplasms
8/27/2015 145
Dyspahgia diagnosis and treatment by Ekberg 1st edition

• Viscous saliva
• Sticky saliva
• Difficulty speaking
• Difficulty swallowing
• Halitosis
• Altered taste
• Complaint of dryness
• Complaint of burning mouth, lips, or tongue
• Altered sense of smell
XEROSTOMIA
Symptoms
146

• Increased caries
• Food sticking to the oral structures
• Frothy saliva
• Gingivitis
• Absence of saliva
• Cracking and fissuring of the tongue
• Ulceration of oral mucosa
• No pooling of saliva in the floor of the mouth
• Recurrent candidal infections
• A toothbrush, mouth mirror, or instrument that
sticks to the soft tissues
• Poorly fitting prostheses
XEROSTOMIA: signs
147

ORAL SYSTEMIC
Saliva: decrease in amount, foamy, viscous
Ropy (increase in spinnbarkeit)
Lips: dry, cracked, fissured (chelosis)
Tongue: Burning (glossopyrosis), pain
(glossodynia)
Cheeks: dry
Salivary glands: Swelling, pain
Thirst: frequent ingestion of fluids
especially while eating: keep water at
bedside
Mastication: difficulty with eating dry
foods; difficulty with the use of a denture,
difficulty with swallowing (dysphagia)
speech difficulty (dysphonia),
Taste abnormality (dysgeusia)
Throat: dryness, hoarseness, persistent dry
cough
Nose: dryness, frequent crust formation,
decrease in olfactory acuity.
Eyes: dryness, burning, itching gritty sensation,
feeling that the lids stick together, blurred
vision, sensitivity to light.
Skin: dryness, butterfly rash, vasculitis.
Joints: Arthritis, pain, swelling, stiffness
GI tract: constipation.
Vagina: dryness, burning, itching history of
recurrent fungal infections, dyspareunia.
General symptoms: fatigue, weakness,
generalized aching, weight loss, depression.
148

Treatment
1. Preventive therapy.
2. Symptomatic treatment.
3. Local/Topical salivary stimulation
4. Systemic salivary stimulation
5. Specific disease therapies
8/27/2015 149

Preventive therapy
• Topical fluoride therapy
• Remineralising solutions
8/27/2015 150

Topical fluorides
• Sodium fluoride
• Stannous fluoride
• APF
• Amine fluorides
• Fluoridated mouth rinses
8/27/2015 151

Remineralization
• CPP-ACFP (GC TOOTH MOUSSE PLUS)
• BETA TRICALCIUM PHOSPHATE (CLINPRO)
• NOVA MIN (BIO ACTIVE GLASS)
• PRONAMEL
• ENAMELON
• XYLITOL
8/27/2015 152

Symptomatic treatment
8/27/2015 153

XEROSTOMIA: Management
Treatment of Xerostomia-Associated Problems
1548/27/2015

Topical stimulation
• Topical lozenges
• Sugarless gums
• Gentle massage
• Sour foods
• Mild electric discharge
• Artificial saliva
8/27/2015 155

Artificial saliva components
• Xanthan gum
• Sodium carboxymethylcellulose
• Potassium chloride
• Sodium chloride
• Magnesium chloride
• Calcium chloride
• Di-potassium hydrogen orthophosphate
• Potassium di-hydrogen orthophosphate
• Sodium fluoride
• Sorbitol
• Methyl p-hydroxybenzoate
• Spirit of lemon
8/27/2015 156

• Commercially available:
– Orabalance
– Dry mouth
– XERO – Lube
– Salivart
– Optimoist
– Oralub
8/27/2015 157

Systemic salivary stimulation
• Anetholetrithione
• Bromhexine
mucolytics
• Pilocarpine hydrochloride
(5 to 7.5 mg TID)
• Cevimeline hydrochloride
(30 mg TID)
parasympatho
mimetics
8/27/2015 158

Recent approaches
• Acupuncture may increase parasympathetic
activity, causing a release in neuropeptide,
stimulating salivary flow and secretions.
8/27/2015 159

• The daily ingestion of 2,000 units of gamma-
linoleic acid (found in evening primrose oil) for
at least 6 weeks may increase parotid and
submandibular salivary flow
8/27/2015 161
Management of Xerostomia Related to Radiotherapy for Head
and Neck Cancer; journal of oncology ;December 2005 By
Shannon T. Kahn

Restorative considerations
• Fluoride releasing materials preferred
• Restorations are more prone to surface
deterioration
• Permanent restorations are preferred
• Frequent topical fluoride application
8/27/2015 162

Hypersalivation
• Excess secretion
• Physiological in pregnancy
• Pathological - sialorrhoea/sialism/sialosis
8/27/2015 163

• Deacy of tooth
• Neoplasm of oral cavity
• GIT imbalance
• Cerebral palsy and mental retardation
• Cerebral stroke
• Parkinsonism
• Nausea and vomiting
8/27/2015 164

Management at dental office
Name of drug Dosage in milligrams
30 min before procedure
Atropine (atronex , atrover ) 0.4 to 1.5
Scopalamine (belloid ,
buscopan etc)
0.3 to 0.6
Hyoscyamine (levcin , levbid ) 0.125 to 0.75
Methantheline 50 to 100
Propantheline (pro banthine ) 15 to 30
Glycopyrrolate (robinul) 1 to 2
Blocking or inhibiting
acetyl choline action
Salivary inhibition
at a low dose
8/27/2015 165DENTAL PHARMACOLOGY BY K.D TRIPATI 6TH EDITION

Drooling/ptyalism
• Uncontrolled & outside mouth
• Excess production and inability to retain
• Occurs in
1. Children during teeth eruption
2. Upper respiratory tract infection
3. Difficulty in swallowing
4. Tonsillitis
5. Quincy
8/27/2015 166

Chorda tympani syndrome
• Sweating while eating
• Nerve fibers supplying salivary gland in
relation to chordatympani while regenerating
may join those fibres supplying sweat glands
• Salivary secretion associated with sweat
secretion
8/27/2015 167

Paralytic secretion
• Increased secretion after cutting
parasympathetic nerve fibers
• Due to release of large amounts of adrenaline
from supra renal glands
• Acinar cells are hypersensitive to adrenaline
8/27/2015 168

Augmented secretion
• Double stimulation
• First stimulation increases excitability
• Second stimulation augments salivary
secretion
8/27/2015 169

Saliva as a storage medium
• For not more than one hour
• Its osmolality (60-70 mOsm/kg) is much lower
than the physiologic
• Can damage pdl
• chance of infection
• More readily available
• Better than tap water or dry state
Badruddin et al storage medium for avulsed teeth
Indian Journal of Multidisciplinary Dentistry, Vol. 3, Issue 3, May-July 2013
8/27/2015 170

Journal references
8/27/2015 171

Effect of artificial saliva contamination on adhesion of dental
restorative materials
Kisaki SHIMAZU et al
(Dental Materials Journal 2014; 33(4): 545–550)
• The purpose of this study was to evaluate the
effects of artificial saliva contamination on
three restorative materials, namely, a glass
ionomer cement (GIC), a resin-modified GIC
(RMGIC), and a composite resin (CR)
• The dentin bond strength for CR was
significantly lower after artificial saliva
contamination.
8/27/2015 172

• artificial saliva contamination did not affect
the shear bond strengths of GIC and RMGIC or
their degrees of microleakage.
8/27/2015 173

Salivary Cells in Patients with Dental Amalgam
and Composite Resin Material Restorations
Irena Kasacka, Joanna Łapińska
Polish J. of Environ. Stud. Vol. 19, No. 6 (2010), 1223-1227
• The aim of our study was to compare the
composition and morphological activity of sali-
vary cells in patients with amalgam and
composite material restorations.
• Significant morphological changes were observed
in the salivary smears in patients with amalgam
restorations
• There was a slight difference in salivary cells in
patients with composite restorations in compar-
ison to the control group.
8/27/2015 174

Effect of salivary contamination at different steps of the bonding process on the
micro leakage around Class V restorations
Cristiane Becher Rosa et al.
Braz J Oral Sci. October-December 2007 - Vol. 6 - Number 23
• This study aimed to investigate the influence
of the moment of salivary contamination
during the bonding procedure (before or after
acid conditioning) on the micro leakage
around composite resin restorations
• salivary contamination after acid etching
increases the micro leakage around composite
resin restorations, especially at dentin
margins.
8/27/2015 175

Correlation between Dental Caries and Salivary
Albumin in Adult Indian Population– An In Vivo Study
Mithra N. Hegde et al.
British Journal of Medicine & Medical Research 4(25): 4238-4244, 2014
• To analyze the relationship between
dental caries, albumin in young adults
between the age group of 20 to 30
years
• there is an increase in the levels of caries with
decrease in the levels of albumin. Serum
albumin levels were also found to be
decreased in caries prone individuals, hence
showing a significant correlation between
serum and salivary albumin levels.
8/27/2015 176

Potential areas for research
• Dental materials that can sustain moisture
contamination without compramising in
mechanical properties function
8/27/2015 177

saliva - body's mirror

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie saliva - body's mirror

Ähnlich wie saliva - body's mirror (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

saliva - body's mirror