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Development & growth of salivary glands /certified fixed orthodontic courses by Indian dental academy


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  • 1.
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  • 3. CONTENTS 1.introduction. 2. Key words. 3.development &growth of salivary glands. 4. Classification & structure of human salivary glands. 5.secretion of saliva. 6.saliva composition. of salivary components. 8. Functions of saliva. 9. Diseases with alteration in salivary secretion. A. hypo secretion/ xerostomia. b.hyper /sialorrhea. 10.applied diagnostic imaging of salivary glands. 11.saliva – as diagnostic aid. considerations. (orthodontic , prosthodontic ,endodontic) 13.conclusion. 14. References.
  • 4. INTRODUCTION     Saliva- which protects our mouth. “Saliva is kind of like a car wash”-a constant cleaning mechanism.said DIAZ ARNOLD. Saliva is something you probably consider disgusting ,not beneficial. You probably don’t even think about it much at all, but if it disappears ,you wish you had your saliva back. “people with dry mouth often wake up in middle of the night b’se their mouth is uncomfortably dry”-CIDNEY MAREK THOMPSON.
  • 5. Chronology of defining salivary components  Beginning in 1950’s whole saliva evaluated.(anti microbial properties, role in microbial attachment,mineralization,taste, lubrication.)  Secretions of major salivary glands (parotid,submandibular, sublingual.)  In 1970’s individual components isolated & biochemically characterized.  In mid 1980’s beginning to map functional domains. (peptide synthesis, & recombinant approaches.)
  • 6. KEY WORDS. 1.Saliva. 2. Salivon. 3.XEROSTOMIA. 4. SJOGREN’S SYNDROME. 5. SIALLOHRIA 6. SIALOGRAPHY. 7. Sialogogues. 8. Anti sialogogues. 9. Stimulated flow & unstimulated flow.
  • 7. Development&growth of salivary glands.  During fetal life each salivary gland is formed at a specific location in the oral cavity through the growth of a bud of oral epithelium into the underlying mesenchyme 1.parotid & submandibular_ 6th wk. 2.sublingual -7-8th wk. 3. Minor salivary glands-3rd month
  • 8. STAGES OF DEVELOPMENT. Stage 1 ;- formation induction of oral epithelium by underlying Mesenchyme . Stage 2 ;- formation &growth of the epithelial cord.
  • 9. Stage 3. Initiation of branching in terminal parts of the epithelial cord & continuation of glandular differentiation . Stage 4. Repetitive branching of the epithelial cord &lobule formation. Stage 5 ;-canalization of presumptive ducts.
  • 10. Stage 6. ;- cytodifferentiation . Acinar cells Terminal bulb cells Myoepithelial cells Duct cells.
  • 11. Studies of embryonic salivary glands.  Factor which influence growth of the gland- is mesenchyme.  The growth of epithelium depends on mesenchyme.  Experiments on rat.  Effect of addition of drug cytochalasin B .
  • 12. FUNCTIONAL INNERVATION. Which is essential to proper growth & maintenance of salivary gland structure. Sympathetic denervation_atrophy of glands to hypertrophy of glands. Parasympathetic denervation –30% loss of glandular wt in 2-3 wks. Of developing rat – prevents attainment of adult size.
  • 13. Importance of physiologic activity. 1. Feeding liqvid diet. 2.increasing bulk of food. Repeated amputation of incisors , Apparently acting through superior cervical Ganglion, also causes enlargement of salivar Glands. Treatment of mice & rat with isoproterenol. 1injection of isoprotererenol_causes rapid complete Discharge of stored secretory products &stimulation of protien synthesis 20-30hr’s after injection _ increase in D.N.A.synthesis.&a wave of mito Occur.
  • 14. Daily injections _ cellular hypertrophy. hyperplasia. The synthesis of certain protiens is enhanced, While that of others reduced. Several new protiens are synthesised by the Enlarged glands.
  • 15. Salivary gland changes in aged. It was shown qvantitatively & clearly by morphogenic analysis that human Salivary glands show a relatively linear reduction in proportional volume represented by acinar cells. the decrease is larger in submandibular gland 37% than for parotid gland 32% . A C I N A R V O l 60 50 40 parotid sub mandibular 30 20 Minor salivary glands in young & aged 10 0 16-35 36-55 56-75 >75 age
  • 16. Classification of salivary glands. They have been classified based on 1.the size & location. 2.the histochemical nature of secretary products. 1 .Based on size Major salivary glands. Minor salivary glands. 2. Based ON NATURE 1.SEROUS 2.MUCOUS 3.MIXED.
  • 17. MAJOR SALIVARY GLANDS  THE largest of glands are the 3 bilaterally paired major salivary glands.  They are located extra orally & their secretions reach mouth by variably long ducts.  THEY ARE _1.parotid gland.  2.submandibular gland.  3.sublingual gland.
  • 18. HISTOLOGY. Each of major salivary glands has a secretory portion & a duct portion. 1. Secretory portion 1. Serous cells. 2. Mucous cells. 3. Myoepithelial cells. 2. Duct portions ;- smallest intercalated ducts. straighted ducts. intra lobular ducts. Inter lobular ducts intra lobar ducts& principal duct. inter lobar ducts.
  • 19. PAROTID GLAND. LOCATION_ superficial portion lying in front of the external ear Deeper part filling the retro mandibular fossa. EXCRETARY DUCT:STENSON’S DUCT opens into oral cavity –buccal mucosa opposite 2nd molar. .
  • 20. Histology Serous glands may have a dense central core. The intercalated ducts of the parotid are long & branching. The pale staining striated ducts are numerou And stand out conspicuously against more Densely striated acini. Nature of secretion ;- pure serous. in infant few mucous units are found.
  • 21. Sub mandibular gland LOCATIONit is located in the sub mandibular triangle behind & below The free border of mylohyiod musle ,with a small extension lying Above the mylohyoid.
  • 22. EXCRETORY DUCT_ warthon’s duct Opens –carancula sub lingualis. NATURE OF SECRETION _ mixed gland. HISTOLOGY _ The mucous terminal portions are capped by demilunes of serous cells The serous granules exhibit avariable structure. Intercalated ducts are shorter , striated ducts are longer.
  • 23. Sublingual gland. LOCATION_ between floor of the mouth & the mylohyiod muscle. Excretory duct – Bartholin’s duct. Opens _with or near submandibular duct. NATURE OF SECRETION – MIXED GLAND.
  • 24. Histology The mucous cells are arranged in tubular pattern Serous demilunes may present at blind ends of tubules. The intercalated ducts are poorly developed.
  • 25. Minor salivary glands. Located beneath the epithelium in almost all parts of the oral cavity They are of different types . PALATA 1.labial&buccal glands. GLANDS 2.glossopalatine glands. 3.palatine glands. 4.lingual glands. 1.LABIAL&BUCCAL GLANDS. . - glands of lips & cheeks. - mixed. -consists of mucous tubules with serous demilunes. Lingual glands.
  • 26. GLOSSOPALATINE GLANDS. _ localized to the region of the isthmus in the glossopalatine fold.but may extend from the posterior Extension of the sublingual glands of soft palate. - pure mucous. Palatine glands. They consists of several hundred glandular aggregates in the Lamina propria of the postero lateral regionof the hardpalat & in the submucosa of soft palate& uvula. LINGUAL GLANDS. divided into several groups. 1.Anterior lingual glands. (glands of blandin& nuhn.) 2.posterior lingual mucous glands.
  • 27. Control of salivary secretion. Two types. 1. Spontaneous secretion. 2.secretion after a stimulus. 1.SPONTANEOS SECRETION-; continuous with out known stimulus. 2. AFTER A STIMULUS. Food when placed on tongue , or smell, or even thought of Palatal food causes secretion. this is due to reflex- called salivary reflex. two types. 1. Conditioned. 2. Unconditioned.
  • 28. parotid Superior salivary Nucleus auriculotemporal Otic Inferior salivary nucleus ganglion Sublingual gland Chorda tympani Sub mandibular ganglion Sub mandibular gland.
  • 29. MECHANISM OF SECRETION Satiety. stress Parasympathetic Nervous system Sympathetic Nervous system acetylcholine Nor epinephrine. i.p 3 D.A.G C AMP + _ SALIVARY SECRETION
  • 30. 1. CHORDATYMPANI SALIVARY GLANDS. kallikrein Salivation. Globules of local intestinal fluid. Bradykinin.(vasodilator) Vasodilation. 2. Parasympathetic stimulation V.I.P. vasodilation Neurotrasmitter at the end of parasympathetic ganglionic nerve ending – acetylcholine. Inhibited by atropine reducing salivary
  • 31. PARALYTIC SECRETION-; demonstrated by CIAUDE BERNARD. IN 1864. Chorda tympani cut in an animal submaxillary gland increases in size. secret thin scanty juice. remains same level for about 3 wks then tapers off & Disappears completely in around 6th wk. Probably cutting of chordatympani results in hypersensitivityof th end piece cells towards sympathetic stimulation.
  • 32. Mechanism of saliva formation. Saliva is formed as a result of primary acinar secretion. Followed by it’s modification in ducts of salivary glands. primary saliva- organic secondary - inorganic.
  • 34. The most important function of salivary glands is to secrete Saliva. The total volume of saliva secreted by humans – 1-2 lts /day. With out stimulation – 0.5 ml / min . In presence of food – 8ml/min. About 60% - submandibular gland. 30% -parotids. 5% -sub linguals. 7% - minor salivary glands. Water accounts for 99 % or more of saliva. Ph - 6.4 –7.4 SALIVA- contains 1. Inorganic factors. 2. Organic factors
  • 35. Inorganic factors Major –Na+,k+,cl- &Hco3 -. The levels of these ions is variable depending on type of Stimulation. & rate of salivary flow. Human saliva always hypotonic to plasma. Na+, cl- are less that of plasma.but k+ & Hco3 – are higher. At low flow rates - acidic in nature. as Na +, cl- are actively reabsorbed. At high flow rates – basic as rich in Hco3 -& k+ and also in N a+ & cl -
  • 36. ORGANIC FACTORS. These include 1. Large carbohydrate rich glycoproteins or mucins 2.antibacterial substances. 3. A group of proteins Certain serum substitutes- albumin , blood clotting factors,(8,9,10,pta ) b-2 macroglobulins, immunoglobulins (ig a, ig g, ig m ) Various enzymes – major - parotid amylase. others include lysozyme, lactoferin, myeloperoxidase, lactoperoxidase, b- glucoronidase, chondriotin sulfotase,catalase , Peroxidase, collagenase etc. Salivary enzymes which inc. in conc. In periodontal disease – hyaluronidase, lipase. Organic molecules in saliva include cyclic amp & it’s binding protei
  • 37. Anti proteases – cathepsin which inhibit cysteine protease. anti leucoproteases - inhibt elastase. T I M P – tissue inhibitor of matrix metalloproteases. Histatins Statherins Lysozyme Proline-rich proteins Carbonic anhydrases Amylases Peroxidases Lactoferrin Mucin 2 (MG2) sIgA Mucin 1 (MG1) 1 10 100 1000 Size (kDa) 10000
  • 38. Flow rate in aged. 250 200 Acinar cells are only cell type capable of transporting fluid. 85-90% secreted proteins found in saliva. The reduction in acinar cell mass would diminish salivary gland performance. However this is not observed in citric acid stimulated parotid flow rate in Healthy individuals. EXPLANATION;it has been postulated that young adults have a substantial secretoary Reserve capacity( excess acinar tissue.) which can be utilised later in life. normal secretory function can be achieved as long as there is no further Stress on the system. When conc of amylase & siga are Compared at different ages. 150 amylase S IGA 100 50 0 20-39 40-59 -60-84
  • 39. Effect of skylab on chemical composition of saliva. there were no changes in cl-, albumin, or ig g conc. There were slight decrease in total protein coinciding with moderate Saliva flow. Rate inc. after every flight. dec. in Na+ &lysozyme. Inc. in Mg+, Ig A. journal of dental residency –1997 oct. 56-vol.
  • 40. Properties of saliva  Multifunctionality  Redundancy  Amphi functionality  complexing
  • 41. Multifunctionality. Amylase,cysatine, Carbonic anhydrase, Histatine, mucins, Peroxidases. cystatine, Anti bacterial buffering Histatines. Amylase, mucines, Anti viral digestion Salivary families mucine Anti fungal mlneralization Tissue histatine coating P R PS,statherins Cystatine Histatine Lubrication & viscosity Amylase, cystatine, mucines, lipase Mucins, statherins PRPS Statherin
  • 42. Redundancy. Saliva has built in redundancy in regarding to protective functions. EXAMPLE - many salivary molecules can inhibit the ppt of capo4 Salts. Strong inhibitors such as statherin acidic PRPS. Moderate inhibitors such as histatine , cystatines. Weak inhibitors such as mucins , amylases.
  • 43. Amphifunctionality A molecule may have both protective &dentrimental properties. -“’A DOUBLE EDGED SWORD. -It may depend on molecule location or site of occurrence. -EXAMPLEAMYLASES -IN SOLUTION-they facilitate clearance of Streptococus viridens. adsorbed to tooth surface , they promote adherence of these Bacteria ,digest starch to dietary maltose & produce acid. STATHERINS & ACID PRP S – at enamel surface –mineralization by inhibiting primary & Secondary capo4 salts. when adsorbed on enamel surface – they promote attachment of cariogenic Bacteria.
  • 44. Complexing. Functinal relationship exist bt. Different molecules in saliva. TWO types of complexes (covalent&non covalent. - homotypic. - heterotypic. EXAMPLE – MUCIN. HOMOTYPE- lubrication & viscoelastic. heterotypic - s iga ,lysozyme, cystatines complex of these antimicrobials At tissue interfaces.
  • 45. Functions of saliva. 1.DIGESTION;principle digestive enzyme – AMYLASE. amylase 1. carbohydrates glucose+maltose. 2.lingual lipase. digestion of lipids, hydrolizes tryglyserides to monoglycerides, diglycerides , fattyacids. 2.LUBRICATION. mucous glycoproteins.
  • 46. 3.REMINERALIZATION OF TOOTH ENAMEL. protect the teeth by means of cleansing &buffering action & control Of ca+ & po4 – conc in saliva & around teeth. salivary proteins called proline rich proteins b’se their high content of aminoacid proline, statherin, a small tyrosine rich protein inhibit the ppt Of capo4 from saliva. Statherin & certain proline rich proteins bind to tooth surface forming Acqvired enamel pellicle. results localized supersaturatoin of ca & po4 ions promotion pf remineralisation.
  • 47. 4.PROTECTION ;several small substances that are capable of inhibiting the growth of the microorganisms & possibly preventing infection are found in saliva. 1. High molecular weight salivary glycoproteins. 2. The secretion of peroxidase by the acinar cells thiocyanate secreted by duct system establishes a bactericidal system in saliva. 3. IMMUNOGLOBULINS ;- an important group of defensive substances in Saliva . predominant immunoglobulin found is IGA. STRUCTURE OF IGA ;it consists of dimer of two iga molecules and a protein called j – chain additional glycoprotein called secretory component. secretory component increases resistance of iga molecule to denaturation Or proteolysis in oral cavity.
  • 48. IgA inhibits oral strepto cocci attachment. GIBBONS&colleagues suggested antibodies in secretions may impair The ability of bcteria to attach to mucosal surface&dental surface. 5. ENZYMES. targets viillonella sps LYSOZYME. actinobaciilus Actinomycetumcomitens THIOCYANATE LACTOPEROXIDASE SYSTEM. Prevents lysine& glutamic a cid. bactericidal to lactobacillus &streptococcus. LACTOFERRIN actinobacillus sps. Myeloperoxidase - inhibits attachment of actinomyces to hydroxy Apetite. 4.BUFFERING ACTION. Important saliva buffer - bicarbonate – carbonic acid system. 5.CLOTTING MECHANISM. Clotting factors – 8, 9 ,10, PTA, & Hageman factor. Hasten blood coagulation & protect wounds from bacterial investigation.
  • 49. 7. Role in periodontal pathology. Saliva exerts a major influence on plaque initiation,maturation& Metabolism. Saliva contains all forms leucocytes imp -PMNS. Living pmns are –OROGRANULOCYTES. migration –orogranulocyte migratory rate. rate of migration correlated to sverity of gingival inflammation. 8. OTHER FUNCTIONS. Parotin - 1.promote growth of mesenchymal tissues 2. Lower ca levels in rabbits . 3. Stimulation calcification of rat incisor dentin. 4. Bone marrow temperature with an increases circulating leucocyte 2.thermoregulation in mammals lacking sweat glands. 3. In some reptiles & amphibians the homologous venom glands produce A variety of toxic substances.
  • 50. The distribution of oral mucosal ph value in healthy saliva secretions. Aim ;- to qvantify mucosal ph in several sites in oral cavity & Correlate these measurements to salivary flow rates. RESULTS;mean ph pf all sites 6.78+or – 0.04 palate 7.34+or – 0.3 floor of mouth 6.5 + or – 0.3 buccal mucosa 6.28 + or – 0.36 tongue 6.8 = or – 0.26 The palate has lowest regional blood flow which has significant effect On ph values. 7.4 7.2 CONCLUSIONS;7 6.8 future diagnostic tool in G I disorders 6.6 To explore drug delivery & absorption 6.4 6.2 Via the oral mucosa. 6 5.8 floor of Oral diseases head & mouth sciences vol 12 number 4 july 2006. palate buccal tongue mucosa ph
  • 51. Diseases. Decrease or absence of salivary flow -- xerostmia increase in salivary flow --- siallohrea. XEROSTOMIA-; it is the subjective feeling of dryness of the mouth. prevalence --- 14-46 %. more in females by 5- 12 %. CAUSES;1. Salivary gland aplasia. 2. damage to salivary gland. 1. Auto immune diseases a. sjogren’s syndrome. b. s l .e c. scleroderma. d. chronic sarcoidosis. e. graft vs host reaction.
  • 52. 2. Radiation therapy to head & neck. 3. Surgery. 4. H.I.v. 5. Hepatitis c infection. 6. Vitamin deficiency. 3. Interference with neural function;psychological disorders. that effect c n s ( alzhemers disease.) truma , paralysis of facial nerve. 4. Water loss/ dehydration. 5. Drugs. Caries incidence in sjogrens syndrome. 6. Others ;- acute infections , diabetes. COMPLICATIONS;1inc. Freqvency of dental caries . 2. Inc tendency towards candidal infections. Candidiasis.
  • 53. Gingivitis dysarthria Dysphagia dysguisia burning tongue. oral mucosal sorenes cracked lips Salivary gland enlargement. bad breath. Oesophagitis. Aggravated acid reflux. Oral mucosa in elderly with xerostomia. Treatment 1. Elimination or reduction of selected drugs. 2. A change in manner they are taken. 3. Substances which increase saliva. SIALOGOGUES. DRUGS OR OTHER agents that increase flow of saliva. a. mechanical stimulants. w
  • 54. c. Chemical stimulants;d. Electrical stimulation. 4. Freqvent sips of water. 5. Oral hygeine. salivary interleukin –6 & tumor necrosis factor in patient with drug induced xerostomia. We wanted to find out whether drugs themselves influence salivary glands which would result in altered cytokinins or whether xerostomia itself of different causes leads to changes in salivary cytokinin levels. RESULT;- no significant difference in salivary il 6 & t n f bt patients with drug induced xerostomia when compared to healthy controls. oral diseases head & neck sciences vol 12 number 5 sept 2oo6.
  • 55. An investigation into use of pilocarpine as a sialogogue in pts with radiation induced xerostomia. 5 mg pilocarpine HCL 3 times daily for 3 months is given to patients who had undergone radiation therapy. RESULT all the patients taking pilocarpine with base salivary flow rate > 0 ml/ min demonstrated improvement in stumulated & unstimulated salivary flow rates. candida counts decreased. salivary substitutes used can be aqueous ionic solutions carboxymethyl cellulose preparations, mucin containing sol, glycoprotein containing agents , enzyme containing gel. the main problem associated with these are short duration of action objectionable taste. Australian dental journal 2002 vol 47 issue 4.
  • 56. The effect of electro stimulation on parotid flow;the purpose of study is to asses the effectiveness of Transcutaneous nerve stimulation (TENS) as a means of stimulation of salivary function in healthy adult subjects . study design ;- 22 healthy subjects were taken. the TENS electrode pads were placed on skin overlying parotid glands. results ;- 15 - inc. in salivary flow. 5 no inc. 2 dec. the mean unstimulated flow 0.02418 mi/ min the mean stimulated flow - 0.04946 ml/min. Journal of oral surg, oral med, oral path, endodontology. march 2005 vol.99, no3.
  • 57. Hypersalivation / sialorrhoea. Increase in salivary flow. Excess saliva may be due to 1. Actual increase in the production of saliva. 2. Drooling of saliva due to dysfunction of swallowing mechanism (decreased clearance of saliva.) 1. Increase production of saliva. May be seen due to – herpetic stomatitis irritation by dentures, pregnancy, cholinergic drugs – clozapine ,pilocarpine, ketamine. toxins – mercury, copper, organophosphate, arsenic, excessive starch intake , g I reflux disease, liver disease, serotonin syndrome, oral infections.
  • 58. Decreased clearance of saliva ;1.Infections – tonsilitis. Retropharangeal & peritonsillary abscess, mumps. 2. Jaw fracture or dislocation. 3.radiation therapy 4. Cns disorders ;- myesthenia gravis , parkinsons disease, rabies, bulbar paralysis, facial nerve palsy , hypoglossal nerve palsy. Clozapine induced hypersalivation ;it is unclear whether clozapine increases salivation through it’s muscaranic m4 receptors activation / blockade of alfa –2 adrenoceptors, or by causing a distortion in swallowing reflux. TREATMENT;1. Increased production of saliva ;1. Chewing gum. 2. Reducing dosage of drugs causing hypersalivation . 3. Antisialogogues – drugs which decrease salivation. - anti cholinergcs , atropine sulfate, scopalamine, glycopyrolate etc.
  • 59. Treatment of drooling of saliva ;1. Oral motor therapy. 2. Behavioural modification via biofeedback. 3. Orofacial regulation therapy. 4. Surgical ;- neurectomy. 5. Injection of botulinum toxin .
  • 60. Applied diagnostic imaging of salivary glands. These include 1. Plain film radiography. 2. Intraoral radiography. 3. Extra oral radiography ---- panoramic radiography 4. Sialography 5. Scintigraphy 6. Computed tomography. 7. Magnetic resonance imaging. plain film radiography ;provide sufficient information to preclude the use of more sophisticated &expensive imaging techniqves. Intra oral radiography ;sialoliths imaged with 1. Cross sectional mandibular occlusal projection. 2. Periapical radiography.
  • 61. Occlusal projection. Panoramic projection;- Periapical radiographs Sterioscopic panoramic plain film projection Note the laminated appearance of sialolith in submandibular gland.
  • 62. Conventional sialography ;first performed in 1902. it is a radiographic technique where in a radiographic contrast agent is infused into the ductal system of a salivary gland; sol used --lipid soluble ethidol non lipid soluble - snographin vol 0.2 – 1.5 ml these iodine containing agents render the ductal system radioopaque ductal system appears ---tree limbs. SIALOGRAM.
  • 63. Computed TOMOGRAPHY. useful in assesing acute inflamatory process& abscess as well as cysts mucocels & neoplasia. It displays both soft tissues hard tissues as well as minute differences. Magnetic resonance imaging. Provides better images of soft tissues than ct The margins of salivary gland images , internal structures & regional extension of the lesion into adjacent tissues or spaces,as occurs with some Lesions of the deep lobe of the parotid.
  • 64. Scintigraphy;-(nuclear medicine, positron emission computed tomography) It provide a functional study of salivary glands taking advantage of selective conc of specific radio pharmaceuticals in the glands. When TC- 99 pertechnetate is injected I. v. it is conc. In & excreted by glandular structures. Demonstrates retention of isotope in the right parotid gland. Ultrasonography;The primary applicationof ultrasonography is to differentiate solid masses from cystic ones.
  • 65. Saliva ---- as a diagnostic aid . Saliva is replacing most of the blood tests as 1. It is easy to collect. 2. Sample collection can be repeated easily. 3. Qvantity of sample collected can be more. 1. In detecting dental caries. caries activity tests are performed using saliva samples 1. To determine the need &extent of preventive measures. 2. To identify high risk groups &indiiduals. 3. To serve as an index of the succses of the therapeutic measures. 1. Lactobacillus colony test introduced by HADLEY in 1933 popularized by JAY. sample collection ;- immediately after rising patient chews a small piece of paraffin the saliva accumulates is collected in a container. media ;- 20 ml of liqvified agar.
  • 66. Interpretation. Lacto bacillus count No of organisms Degree of caries activity 0-1000 1000-5000 5000-10,000 >10,000 Little or none Slight Moderate marked 2. Calorimetric snyder test. it measures the ability of salivary micro organisms to form organic aids From a carbohydrate medium. At 37oc 24 hrs 48 hrs 72 hrs Glucose agar if yellow if yellow if yellow + marked caries definite limited Bromocresol green if green if green if green + 0.2 cc of saliva. continue continue caries inactive.
  • 67. 3.The swab test. Developed by GRAINGER. The oral flora is sampled by swabbing buccal surfaces of the teeth & incubated. Ph 4.1 &>4.1 - marked caries activity Ph 4.2 - 4.4 - active. ph 4.5 – 4.6 - slightly active ph 4.6 - & over – caries active. 4. Streptococcus mutans level in saliva . Streptococcus mutans > 10 5 / ml of saliva unacceptable. 5.salivary buffer capacity. The amount of 0.5 hcl reqvired to bring the saliva to ph 5 is measured. < 0. 45 ml of hcl – low buffer capacity. > 0.45 ml of hcl – high buffer capacity. 6. Enamel solubility test. Powdered enamel + glucose soluble ca ( measures degree of susceptability )
  • 68. Salivary reductase test. Measures activity of reductase enzyme. Alban’s test ;Media bactopeptane 20 gms dextrose – 20 gms nacl - 5 gms agar – 16 gms bromocresol green – 0.02 gms INTER PRETATION ;no colour change - Beginning of colour change --- + ½ --- ++ ¾ --- +++ Total --- ++++
  • 69. Immunological &molecular detection of HIV in saliva & comparision with Blood testing. although HIV infection is usvally detected serologically by the presence of specific antibodies a sample & reliable saliva based test for detecting the virus may prove to be very useful in large population screening. Almost all HIV carriers studied had oral health problem & most periodontal Disease. . : based on these data , the use of saliva samples for detection of HIV antibodies seems to be qvite reliable. European journal of oral sciences june 2006 , vol 114 , number 3. Saliva can be used in pregnancy tests.
  • 70. Dental considerations. orthodontic considerations. 1. BONDING ;bonding is done before placing bracket on the tooth. Saliva contamination should be avoided while doing this procedure. control of field of operation is done by 1. Direct methods 1.using fluid absorbing materials 1. Cotton rolls. 2. Gauze 3. Absorbent paper pads / wafers. 2.fluid evacuation eqvipment ;1. Saliva ejector 2. High –speed devices ( vacu rinse) 3. Svedopter.
  • 71. 2. Indirect methods ;a. patient position. b. local anesthesia. 3. Chemical methods. a. anti sialogogues. b. anti anxiety drugs. c. muscle relaxants. 4. Rubber dam application ;-
  • 72. 2. Orofacial regulation therapy to control drooling of saliva. A functional appliance employed according to the principles of CASTELLO MORALES. It consists of acrylic palatal plate with vestibular & lingual stimulators. vestibular stimulator – stimulate lip seal. lingual stimulator -- induces sucking & subseqvently tongue retrusion. very useful in pts hypotonic peri oral musculature. protruding tongue as seen in down’s syndrome.& moebius syndrome. Journal of oral surg, oral med, oral path, endo. june –2006 vol 101 , no 3 3. Over extension of removable appliance. extension on to palate causes excessive salivation & gauging sensation. 4. In maxillary expansion. ( used in the beginning of max expansion ) baseplate with hickary wood expands when gets wet with saliva.
  • 73. 5. In preventing dental caries.  When the pt is undergoing orthodontic treatment saliva helps in maintaining oral hygeine, prevents caries helping in tooth remineralization.
  • 74. Prosthodontic considerations. Saliva classified based on qvality 1. Thick mucous saliva 2. Thin serous saliva Based on qvantity 1. Normal 2. Excessive 3. Xerostomia. Denture retention ;Retention may be defined as the ability of a denture at rest to resist forces displacing it at right angles away from the denture bearing surface & for a complete denture is a function of the physiologic properties of saliva. STEPHAN’S LAW ;- ¾ n a 2 t ( 1/h1 2 – 1/h2 2) n - viscocity of liqvid . a. area of palate t – time of force application.
  • 75. h1 initial plate separation h2 – final plate separation. greater the viscosity of saliva -- better the retention. this principle utilized in preparation of denture adhesives. the glycoproteins & proteoglycons dissolved in saliva not only increse the Viscosity but provide it with pseudoelastic properties. LAPLACE FORMULA ;p” – p’ = s.t ( 1/r1 – 1/r2 ) this relationship was adopted by BARBEREL to express the difference bt the pressure in saliva film separating a denture from it’s supporting tissue & pressure in mouth. Saliva flow in aged. ;Although degenerative changes seen in salivary glands with age it is not reflected in salivary flow .
  • 76. In case of hyposalivation artificial saliva is substituted retention is dramatic . B’se some of the ingredients which are added to improve lubrication qvalities. ( ex ;- na carboxy methyl cellulose , poly ethyl methoxide ) lack of lubrication by saliva makes mandibular denture bearing area sore due to constant friction with slightly mobile denture & the persistant Pain. large but less extensive red painful areas beneath the mandibular denture may be conseqvence of a thin friable mucosa or insufficient saliva. if the friable mucosa is associated with insufficient saliva & a silicone liner Is prescribed the increase in coeff . Of friction bt the liner & dry mucosa makes problem worst.
  • 77. Endodontic considerations. 1. Clinical evaluation of teeth. should be done in moist state of teeth & saturated with saliva before & after procedures like 1. Shade selection in composite filling 2. Microabrasion technique in bleaching. 2. Use of urea in bleaching ;urea occurs naturally in the body is produced by salivary glands & present in saliva urea is used in bleaching kits to 1. Stabilise h2o2 . 2. Elevate ph of solution . 3. Enhance other properties – anticariogenic saliva stimulation wound healing. 3. As a storing media ;- to store avulsed tooth before replantation. 4. Isolation of saliva.
  • 78. conclusion “unfortunately there is no real substitute for saliva.’’
  • 79. References Text book references ;1.orban’s oral histology & embryology -10th edition 2. Text book of oral pathology - shafer – 4th edition 3. Oral radiology principles & practice - white & phoroah – 5 th edition 4. Text book of medical physiology -- guyton -- 10th edition. 5. Color atlas & text of dental care of elderly. - john . R. drummond. james .p. newton 1995 publication. 6. Oral development & histology - james . K. avery –3 rd edition.
  • 80. JOURNAL REFERENCES ;1.journal of dental residency - october 1997 volume 56 . 2. Oral diseases head & neck sciences - july 2006, vol 12, no 4. 3. Critical reviews in oral biology & medicine – march 2002 vol 13 , issue 2. 4. Australian dental journal 2002 vol 47 , issue 4. 5. Journal of oral med , oral surg, oral path, endodontology, march 2005, vol 99, no 3 . 6. European journal of oral sciences june 2006, vol 114, no 3. 7. Oral diseases head & neck sciences – sept 2006, vol 12, no5. 8. Journal of oral surg, oral med, oral path, endodontology jan 2006, vol 101, no 3.
  • 81.