saliva - body's mirror

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Good morning

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SALIVA

Presented by PRAVEEN KUMAR GALI

P.G STUDENT DEPARTMENT OF CONSERVATIVE DENTISTRY

& ENDODONTICS

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SEMINAR DETAILS

• Title: SALIVA• Total slides: 179• Textslides : 117• Illustrations:64 • Time for presentation: 45 minutes approx.

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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

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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.

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• 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

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CONTENTS1. Introduction 2. Development3. Anatomy and Histology Of Salivary Glands4. Formation And Secretion5. Composition Of Saliva6. Factors effecting composition 7. Properties And Functions 8. Methods Of Collecting Saliva9. Analysis Of Saliva (Salivary Biomarkers)10.Clinical Considerations In Dentistry & salivary disorders 11.Saliva As Storage Medium12.Journal References13.Conclusion

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INTRODUCTION

‘Salvindo’

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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 edition

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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 edition

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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 EDITION

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Stages in development Pre bud

Initial bud

Pseudo glandular

Canalicular

Terminal bud


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PAROTID GLAND

•Largest of all glands

•Average Wt - 25gm

•Located in the preauricular region and along the posterior surface of the mandible.


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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


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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


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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.


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SUBMANDIBULAR GLANDS

Large superficial and small deeper part continuous with each other around the posterior border of mylohyoid.

Superficial Part Situated in the digastric triangleWedged b/w body of mandible and mylohyoid.


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SUBMANDIBULAR DUCT

Also called as Wharton's duct5 cm longEmerges at the anterior end of deep part of the

gland.Opens in the floor of mouth at the side of frenulum

of tongue.


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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.


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Duct of Rivinus

•8-20 ducts

•Most of them open directly into the floor of mouth•Few of them join the submandibular duct.


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Minor salivary glands • Located beneath the epithelium in almost all parts of the oral cavityLabialBuccal or molar glands Palatal glandsLingual 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

MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION

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Based on secretions

•Parotid •Lingual serous

Serous •Lingual mucus•Buccal and palatal

Mucus

•Submandibular •Sublingual and labial glands

Mixed MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION

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HISTOLOGY OF GLANDS

ACINI

serous

mucous

myoepithelial

SECRETORY UNIT

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SEROUS CELLS

•Acini - spherical.

•8-12 cells .

•Cells - pyramidal

•The spherical nucleus is located in the basal region of the cell.


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Membrane bound ribosome

Cisternal space of RER

Golgi apparatus(Carbohydrate addition,post transitional modification)

Packed into secretory granules

SECRETION OF SALIVARY PROTEINS


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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.

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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

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synthesis

Storage

Secretion of protein

N - linked Glyco protein

Serous cells

mucin

Lubricate

Microbial barrier

O – linked Glyco protein

Mucous cells

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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.


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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 )

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STRIATED DUCTS

•Largest portion of ductal system •Located within lobules•Contain kallikrein•Synthesize secretory glycoproteins


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EXCREATORY DUCTS

•Located in connective tissue septa•Larger in diameter then striated duct .


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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.


05/01/2023 38The salivary gland fluid secretion mechanism The Journal of Medical Investigation Vol. 56 2009.ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION

05/01/2023 39ORAL HISTOLOGY AND EMBRYOLOGY– ORBAN’S. 12TH EDITION

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Control of salivary secretion

Afferent pathway

Central pathway

Efferent pathway


05/01/2023 41MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION

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Afferent pathway

Resting flow

Psychic flow

Unconditional reflexes


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Resting flow

Circadian variation

Light and arousal

Hydration

Exercise and stress

• morning• night

• Bright • Dark

• Hydrated • Dehydrated


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Psychic flow

• Anticipation of food or sight of food• Awareness of saliva in mouth • IVAN PAVLOV


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Unconditioned reflexes

Mastication

Gustatory stimuli

Others


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Central control

• Superior salivatory nucleuspons

• Inferior salivatory nucleusmedulla


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Efferent pathway

Parasympathetic

Sympathetic


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Parasympathetic fibers

Nucleus salivatorius superior• Submandibular & sublingual glands

Nucleus salivatorius inferior • Parotid gland


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Parasympathetic fibers to submandibular and sub lingual glands


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Parasympathetic fibers to parotid gland


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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


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Parasympathetic

Sympathetic

Profuse saliva

Watery

Less organic content

Dialate blood vessels

AcetylcholineLess saliva

Thick and mucoid

Vasoconstriction

Noradrenaline

More organic content


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Composition of saliva

SALIVA

99.5%water

Solids 0.5%

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solids

Organic substances

0.2%

Inorganic substances

0.3%

GasesSmall

fraction

1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition

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Organic substances

Enzy

mes

Amylase maltaseLingual lipaselysozymephosphataseCarbonic anhydraseKallikreinAcid phospahatasePeroxidaseLactoferrin

othe

rsproteinsBlood group antigensAmino acids Non protein nitrogenous substances(Urea,uric acis,creatinine ,xanthine,and hypoxanthine)Hormones Water soluble vitamins


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Inorganic substances

• sodium• calcium• potassium• bicarbonate• bromide• chloride• fluoride• Phosphate


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Gases

Oxygen1ml/100ml

Nitrogen2.5ml/100ml

Co2

5ml/100ml


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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


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Amylases

• abundant salivary enzyme (50 % of proteins )• 80 % - parotid• Hydrolyzes starches →maltose, maltotriose,

dextrins

•Anti bacterial•Digestion

•Tissue coating1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition

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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


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Statherins

• By acinar cells• Both Parotid and submandibular glands• prevent precipitation or crystallization of

supersaturated calcium phosphate in ductal saliva and oral fluid


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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 coating Basic

• Anti viral • lubricationGlycosylated


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Lysozyme ( LZ ) • Oral LZ is derived from 1. major and minor salivary glands2. phagocytic cells3. gingival crevicular fluid (GCF) • Is an antibacterial enzyme.• The mean concentration in whole saliva resting is 2.2mg/100ml stimulated-11mg/100ml.

63

ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85

number 2.

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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)


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Lactoferrin

• Iron binding glycoprotein secreted by serous cells

• High affinity for iron • Bacteriostsatic, cidal, fungal, antiviral and anti

inflammatory


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Histatins

• A group of small histidine-rich proteins• Potent inhibitors of Candida albicans growth• Wound healing


number 2.

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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.


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Cystatins

• Are inhibitors of cysteine-proteases • Protective against unwanted proteolysis

(bacterial proteases, lysed leukocytes) • Inhibit proteases in periodontal tissues


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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


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Agglutinins

• Interact with unattached bacteria• Cause clumping of bacteria into large

aggregates which are easily flushed by saliva


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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


number 2.

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Blood group substances

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


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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.


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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.


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Amino acids

• 9 types in parotid• 12 in submandibular • 18 in whole saliva at low concentration of

about 0.1mg /100ml


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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


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Inorganic contentscations

Sodium

Potassium

Calcium

Magnesium

anions

Chloride

Bicarbonate

Phosphate

Trace elememnts of halides

Less sodium andHigher potasium than ECF


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Element Concentration mE/lit Details

Sodium 10 to 100 Flow dependant

Potassium 8.20 Independent of flow1.5 to 4 times plasma conc.

Calcium 3 Ionic or bound formColloidal calcium phosphate

Magnesium 0.6 Trace

Chloride 15 to 25 Less conc. Than plasma

Bicarbonate 5 to 60 Osmolarity Buffering


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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.

CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION

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Factors affecting

composition

Flow rate

Hormones

Fatigue

Plasma concentration

Diet Nature of stimulus

Duration of

stimulus

Circadian rhythm

Differential contributions

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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.


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• 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.


number 2.

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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 - 1.52. Submandibular - 3.43. Sublingual - 3.4


number 2.

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Volume

Total volume – 500-750ml/daySubmandibular – 60%Parotid – 30%Sublingual 3-5%Minor salivary glands – 7%

In Sleep• Parotid - 0%• Submandibular - 72%• Sublingual - 8%

Resting stageSubmandibular – 72%Parotid – 21%Sublingual -1-2%Minor salivary glands – 7%

Acidic stimulationSubmandibular – 46%Parotid – 45%Sublingual – 1.5%

Mechanical stimulationParotid – 58%Submandibular – 33%

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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



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Buffering capacity of saliva

Carbonic acid / bicarbonate system

Phosphate system

Protein system (mucin)



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Carbonic acid / bicarbonate system

H+HCO3-H2CO3



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Phosphate buffer system

HPO42- H+H2PO4

-

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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


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Plaque mineralization and calculus formation

• Salivary calcium and phosphate are the source of minerals

• statherin and proline-rich proteins inhibit precipetation


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Saliva and Dental Caries

Static

Antebacterial

SupersaturationCa ,phosphate

Substrates for pellicle

Dynamic

Buffering

Clearance

Supersaturation Of HCO3


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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


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WHOLE SALIVA

SALIVARY 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.

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Parotid saliva

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


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Submandibular saliva

• Cannulation• Segregator device • Wolfe appartatus• Suction


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Minor salivary glands

• Labial and buccal saliva • Palatine saliva Pipette Filtration paper Impression of palate Individual collection prosthesis


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Salivary diagnostics


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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


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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.”


http://www.google.co.in/imgres?imgurl=http://biomarker.cdc.go.kr/biomarker/biomarkerimg/1SH2x500.jpg&imgrefurl=http://biomarker.cdc.go.kr/biomarker/biomarker/index.jsp&usg=__sj8yCW5pcMIL5mlzOmWZTlIoaWY=&h=500&w=500&sz=66&hl=en&start=7&zoom=1&tbnid=OqEPuIOafRDKkM:&tbnh=130&tbnw=130&ei=gD-1T7beM83OrQejrLj3Cw&prev=/search?q=biomarker&hl=en&sa=X&qscrl=1&nord=1&rlz=1T4ADSA_enIN451&biw=1366&bih=653&tbm=isch&prmd=imvnsb&itbs=1

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Biomarker

Monitor progression / recurrence

Detect disease

Stage disease

Treatment efficacy

Response to treatment


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Salivary genomicsor

salivary proteomicsor

salivomics


05/01/2023 105SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION

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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

SALIVARY BIOMARKERS

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Autoimmune diseases Sjögren's syndrome

• A low resting flow rate and abnormally low stimulated flow rate of whole saliva

• Elevated levels of 1. Rheumatoid factor2. Antinuclear antibody3. Anti-ss-a4. Anti-ss-b antibody .


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Bone turnover markers


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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.

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Diabetic markers

For type II diabetes • KRAS• EGFR• PSMB2



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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



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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)


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Drug monitoring

• Phenytoin

• Lithium

• Primidone

• Methadone

• Ethosuximide

• Cyclosporine

• Carbamazipine

• Marijuana

• Theophylline

• Cocaine

• Caffeine

• Alcohol


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Forensic evidence

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


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Genetic disordersCystic 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


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VIRAL DISEASES

•the salivary glands and serum – Ig •Secretory IgA (sIgA) - main specific immune defense mechanism in saliva. •Antibodies against viruses and viral components



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


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• 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.


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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 .


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•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.


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Stress biomarkers in saliva

• Salivary α-amylase• Chromogranin A• Salivary cortisol


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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.


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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.


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


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Lab now analyser with nano bio chip elements

UCLA mobile analyser

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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

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Isolation

1. Rubber Dam2. Cotton rolls & cellulose wafers3. Throat shields4. High volume evacuators & saliva ejector5. Mirror & evacuator tip retractor6. Mouth props7. Air Water syringe8. Cheek retractor9. Drugs

STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION

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Rubber Dam Isolation


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• 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

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• It is used to remove water and saliva with high suction speed.

• Also helps in retracting the soft tissues.

High volume evacuators & saliva ejector


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Hygroformic saliva ejector

Pulp dent dental products manual – isolation

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• 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


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Svedopter

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• Anti sialogogues • Local anaesthetics

Drugs


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Anti sialogogues

Methantheline bromide

• Banthine • 50 mg 1 hour

before

Propantheline bromide

• Pro banthine • 15 mg 1 hour

before

ClonidineHydrochloride

• Anti hypertensive

• 0.5 mg 1 hour before

Anti cholinergics Act by inhibiting myoepithelial cells

DENTAL PHARMACOLOGY BY K.D TRIPATI 6TH EDITION

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Interactions with dental materials

While restoring • GIC• AMALGAM• Composites

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SALIVA AS ELECTROLYTE

• May cause wet corrosion

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Chances of getting infected

• Potential infections are 1. Hepatitis B2. Respiratory infections 3. Conjuctivitis 4. Herpes infections 5. HIV

OSHA GUIDELINES

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DO s and DON’T s

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Aberrations in flow

• Hyposalivation,xerostomia and Aptyalism• Hyper salivation• Drooling• Chordatymapani syndrome• Paralytic secretion • Augmented secretion


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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.

Dyspahgia diagnosis and treatment by Ekberg 1st edition

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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)


• Antacid• Antianxiety• Anticholinergic• Anticonvulsant• Antidepressant• Antiemetic• Antihistamine• Antihypertensive• Antiparkinsonian• Antipsychotic

Factors that Affect Salivary FlowMedications

•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

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• Ageing• Decreased mastication• Salivary gland tumors and neoplasms


• 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


• 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


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


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Treatment

1. Preventive therapy.

2. Symptomatic treatment.

3. Local/Topical salivary stimulation

4. Systemic salivary stimulation

5. Specific disease therapies


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Preventive therapy

• Topical fluoride therapy • Remineralising solutions


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Topical fluorides

• Sodium fluoride • Stannous fluoride • APF • Amine fluorides • Fluoridated mouth rinses

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Remineralization

• CPP-ACFP (GC TOOTH MOUSSE PLUS)• BETA TRICALCIUM PHOSPHATE (CLINPRO)• NOVA MIN (BIO ACTIVE GLASS)• PRONAMEL • ENAMELON • XYLITOL

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Symptomatic treatment


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XEROSTOMIA: Management Treatment of Xerostomia-Associated Problems


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Topical stimulation

• Topical lozenges • Sugarless gums • Gentle massage • Sour foods • Mild electric discharge • Artificial saliva


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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


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• Commercially available:– Orabalance– Dry mouth – XERO – Lube– Salivart– Optimoist– Oralub


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Systemic salivary stimulation

• Anetholetrithione • Bromhexine mucolytics

• Pilocarpine hydrochloride (5 to 7.5 mg TID)

• Cevimeline hydrochloride (30 mg TID)

parasympathomimetics

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Recent approaches • Acupuncture may increase parasympathetic

activity, causing a release in neuropeptide, stimulating salivary flow and secretions.

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• 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

Management of Xerostomia Related to Radiotherapy for Head and Neck Cancer; journal of oncology ;December 2005 By Shannon T. Kahn

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Restorative considerations

• Fluoride releasing materials preferred • Restorations are more prone to surface

deterioration • Permanent restorations are preferred• Frequent topical fluoride application


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Hypersalivation

• Excess secretion • Physiological in pregnancy • Pathological - sialorrhoea/sialism/sialosis


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• Deacy of tooth • Neoplasm of oral cavity • GIT imbalance• Cerebral palsy and mental retardation• Cerebral stroke • Parkinsonism• Nausea and vomiting


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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

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Drooling/ptyalism

• Uncontrolled & outside mouth • Excess production and inability to retain • Occurs in 1. Children during teeth eruption 2. Upper respiratory tract infection3. Difficulty in swallowing 4. Tonsillitis5. Quincy


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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


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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


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Augmented secretion

• Double stimulation • First stimulation increases excitability • Second stimulation augments salivary

secretion


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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

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Journal references

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Effect of artificial saliva contamination on adhesion of dental restorative materialsKisaki 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.

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

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Salivary Cells in Patients with Dental Amalgamand Composite Resin Material Restorations

Irena Kasacka, Joanna ŁapińskaPolish 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.

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Effect of salivary contamination at different steps of the bonding process on the micro leakage around Class V restorationsCristiane 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.

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Correlation between Dental Caries and SalivaryAlbumin 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.

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Potential areas for research

• Dental materials that can sustain moisture contamination without compramising in mechanical properties function

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CONCLUSION

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Thank you…

saliva - body's mirror

Health & Medicine

Transcript of saliva - body's mirror