This document provides an overview of saliva, the salivary glands, and salivary gland disorders. It defines saliva and describes the anatomy and histology of the major and minor salivary glands. The regulation of salivary secretion, composition of saliva, and functions of saliva are discussed. Methods of collecting and screening saliva are presented, as are common salivary gland disorders and considerations for their management.
2. Contents:
1.INTRODUCTION
2.ANATOMY OF SALIVARY GLANDS
3.REGULATION OF SALIVARY SECRETION
4.COMPOSITION
5.FUNCTION
6.PROPERTIES OF SALIVA
7.METHODS OF COLLECTION AND SCREENING
8.SALIVARY GLAND DISORDERS
9.XEROSTOMIA AND ITS MANAGEMENT
10.PROSTHODONTIC CONSIDERATIONS
3. 1. INTRODUCTION
DEFINITION – Saliva is a complex mixture of fluid contributed from the major
and minor salivary glands, the minor accessory glands and gingival crevicular
fluid.
or Saliva is clear, slightly acidic mucoserous exocrine secretion.
It is normally referred to as whole saliva, when referring to the fluid in the
mouth, as against ‘duct saliva’ which is present in individual glands.
The several sources of whole saliva complicate its composition, as its
composition from different sources vary.
4. 2.SALIVARY GLANDS
MAJOR SALIVARY GLANDS:
1. PAROTID GLAND
2. SUBMANDIBULAR/ SUBMAXILLARY GLAND
3. SUBLINGUAL/ LINGUAL GLAND
MINOR SALIVARY GLANDS:
1. ANTERIOR LINGUAL SALIVARY GLANDS
2. BUCCAL, LABIAL, LINGUAL AND PALATAL GLANDS
3. GLANDS (OF VON EBNOR)
9. SUBMANDIBULAR GLAND
MACROSCOPIC ANATOMY Irregular walnut shape, larger superficial part
(body) in contact with skin
Smaller deep process
TYPE OF SECRETION Mixed secretions, 20-25% of salivary volume
DUCT Whartons duct, 2inches long and tortuous passes
through sublingual gland and genioglossus
muscle to open at summit of sublingual caruncle
besides frenum.
STRUCTURES PASSING THROUGH Lingual nerve
RELATIONS Medially – mylohyoid muscle
Laterally – mandibular body
BLOOD SUPPLY Branches of facial and lingual arteries
Venous drainage- submental vein
NERVE SUPPLY Parasympathetic innervation – Chorda tympani
br of facial nerve, Submandibular ganglion
11. SUBLINGUAL GLAND
MACROSCOPIC ANATOMY Smallest major salivary gland, almond shaped,
imm. beneath the oral mucosa lining the floor of
mouth raising a small fold on either sides
TYPE OF SECRETION Mucus secretion
DUCT Bartholins duct, series of ducts projecting above
mucosa - ducts of Rivinus
STRUCTURES PASSING THROUGH Whartons duct, lingual nerve
RELATIONS Anteriorly – Genioglossus
Laterally – Body of mandible
BLOOD SUPPLY Sublingual and submental arteries,
Submental veins – int jugular vein
NERVE SUPPLY Parasympathetic innervation – Chorda tympani br
of facial nerve, Submandibular ganglion
13. MINOR SALIVARY GLANDS
Glands of Von Ebner – Small glands whose ducts open
into sulci of circumvallate papillae. (serous)
Anterior lingual glands- Irregular shaped, on either
sides on frenulum on undersurface of tongue with
several ducts piercing through overlying mucosa.
Lingual, buccal, labial and palatal glands – These
glandular aggregates are scattered over the tongue
surface, in the lips, cheeks and palatal mucosa.
14. HISTOLOGOLICAL FEATURES
ACINUS Rounded secretory unit
Myoepithelial cells Contractile function. They help in expelling secretions from the lumen of acini and facilitate the
movement of saliva in salivary ducts
Serous acini Secrete protein in isotonic watery fluid
Mucus acini Secrete mucin, a lubricant
Mixed acini A serous acinus forms a demilune around the mucus acini
Intercalated ducts Low cuboidal cells surrounded by myoepithelial cells, secretory units merge into them
Striated ducts Folded basal membrane enables active transport of substances out of the duct. Water resorption, and ion
secretion takes place, to make saliva hypotonic.
Inter-lobular duct
(excretory duct)
The striated ducts lead into interlobular (excretory) ducts, lined by tall columnar epithelium.
Lobules
(Connective tissue septa)
Each lobule contains numerous secretory units, or acini.
19. NORMAL SALIVARY FUNCTION
The Salivary glands are innervated along the parasympathetic
gustatory pathway.
Gustatory centers are stimulated in the brain
Release of ACTH which acts on muscarinic receptors on salivary
gland cells
Triggers release of intracellular Ca ions from endoplasmic
reticulum
Ca activates transmembrane Na-K pump, increases intraductal
conc. Of Na ions
20. Ca activates transmembrane Na-K pump, increases intraductal conc.
Of Na ions
An ionic gradient then pulls the Cl- ions from the ductules
which in turn creates an osmotic gradient
results in the secretion of fluid from the cells.
23. DRUGS INCREASING SALIVARY SECRETION
1.Sympathomimetic drugs like Adrenaline, ephedrine
2.Parasympathomimetic drugs like Acetylcholine, pilocarpine, muscarine and
physostigmine
3.Histamine
24. DRUGS DECREASING SALIVARY SECRETION
1.Sympathetic depressants like Ergotamine, Dibenamine
2.Parasympathetic depressants like Atropine, scopolamine.
25. COMPOSITION OF SALIVA
SALIVA
SOLIDS 0.5%
Organic
Proteins
Ig A, Ig M
β- globulin
Albumin,
Histatins
Proline rich
proteins
Blood group
antigens
Free amino acids
Mucoproteins
Glycoproteins
Enzymes
Amylase
Maltase
Lingual lipase
Lysozyme
Phosphatase
Sialoperoxidase
Kallikrein
Carbonic anhydrase
Others
Hormone like substances
growth factors
Carbohydrates
Lipids
Nitrogenous compounds
Lactoferrin
Inorganic
Na+
Ca
PO4
HCO
3
Br
Cl
F
P
Gases
Oxygen
Carbondioxide
Nitrogen
WATER 99.5%
26. SALIVARY PROTEINS
COMPONENT FUNCTION
Ig A, IgM
• Inhibition of bacterial colonization by agglutination
• Binds with specific bacterial antigens involved with cellular adherence
• Affecting specific enzymes essential for bacterial metabolism
Β globulin • Antibacterial action
Albumin • Used to assess integrity of mucosal function in the mouth
Histatin • Anti-microbial action
Proline rich proteins • Inhibits precipitation of Ca phosphate from saliva
Blood group antigen
Free amino acids
Mucoproteins
• Proline rich proteins, glycine and glutamic acid
• Contribute to enamel pellicle
Glycoproteins
• Galactose, mannose, hexose, fructose
• Contribute to enamel pellicle
27. SALIVARY ENZYMES
COMPONENT FUNCTION
Amylase • Breaks down starch from food, into maltose a smaller
carbohydrate.
• concentration of α-amylase in saliva is high and may
constitute as much as 30-40% of the total protein in whole
saliva.
Maltase Converts maltose into glucose
Lingual Lipase Breaks down fatty acids
Lysozyme Present in high concentration in saliva,
Defensive function
Sialoperoxidase a potent antibacterial
Alkaline phosphatase Metabolic processes, raised in inflammation.
Kallikrein Causes vasodilation to supply actively to secreting glands
Carbonic anhydrase Buffering agent
28. OTHER SUBSTANCES
COMPONENT FUNCTION
Hormone like substances
• ADH, Aldosterone, Testosterone
Regulation of water balance
1. Nerve growth factor
2. Fibroblast growth factor
3. Epidermal growth factor
• Affects growth and development of sympathetic nerve fibres
• a potent regulator of wound healing
• Enhances healing of ulcers and plays a protective
role in mucosal protection
Carbohydrates
(Glucose, fructose, hexose etc)
bacterial adsorption and plaque aggregation
Lipids
(Di and triglycerides, cholesterol,
phospholipids and cortisone)
bacterial adsorption and plaque aggregation
Nitrogenous compounds -
Urea, Uric acid etc
Excretion
Lactoferrin Iron binding protein. It takes up iron thereby reducing iron availability for
bacterial growth
Parotin Facilitates calcium and helps maintain serum Ca level, facilitates connective
tissue growth
29. FUNCTIONS OF SALIVA
DIGESTION LUBRICATION WATER BALANCE
DILUTION AND
CLEARANCE
NEUTRALIZATION/
BUFFERING
EXCRETORY
FUNCTION
SATURATION AND
REMINERALIZATION
ANTIBACTERIAL
EFFECTS
TISSUE REPAIR
MAINTENANCE OF
TOOTH INTEGRITY
PLAQUE AND
PELLICLE
FORMATION
30. FUNCTIONS OF SALIVA
1.DIGESTION- Amylase is the main digestive enzymes critical ph of 6-8,
inactive in stomach because of acidic pH.
2.LUBRICATION- of hard and soft oral surfaces for speech, mastication
,swallowing and for general health and comfort.
3.WATER BALANCE- Vomitting or Hyperapnoea may result in dehydration with
loss of water through oral cavity.
4.DILUTION AND CLEARANCE- Water causes dilution of substances into mouth
and subsequent removal by spitting/swallowing. Solids are first dissolved so
that they can be tasted and cleared.
5.NEUTRALIZATION/BUFFERING- Saliva is alkaline and an effective buffer.
Protects oral cavity from acids from food and plaque. Principal constituent
responsible for this is HCO3, it reduces the cariogenic potential of food.
6.EXCRETORY FUNCTION-Excretory route for several blood components like
urea, uric acid, ammonia and thiocynate.
31. 7.SATURATION AND REMINERALIZATION – Saliva is supersaturated with respect
to tooth mineral which is responsible for remineralization phase of caries
process.
In addition, presence of proline rich proteins and statherins is a major factor
for preventing excess calcification in the mouth.
8.ANTIBACTERIAL EFFECTS –
A. IMMUNOGLOBULINS : IgA, IgG, IgM.
B.NON SPECIFIC ANTIBACTERIAL PROTEINS : Sialoperoxidase, Lactoferrin,
lysozyme etc
9.PLAQUE AND PELLICLE FORMATION- Both plaque and pellicle matrix contain
protein from saliva.
10.MAINTENANCE OF TOOTH INTEGRITY.
11.TISSUE REPAIR – A variety of growth factors and trefoil proteins are present
in small quantities, these promote tissue growth, differentiation and healing.
Taste sensation -The salivary flow initially formed inside the acini is
isotonic with respect to plasma. However, as it runs through the network of
ducts, it becomes hypotonic.The hypotonicity of saliva (low levels of glucose,
sodium, chloride, and urea) and its capacity to provide the dissolution of
substances allows the gustatory buds to perceive different flavours.
32. PROPERTIES OF SALIVA
1.Total amount - 500 ml - 1.5 liters/24 hours
2.Consistency - Slightly cloudy because of cells and mucin
3.Reaction - pH 6.02 - 7.05 (slightly acidic)
4.Specific gravity - 1.002 – 1.012
5.Gases - Oxygen, Nitrogen, Carbondioxide
6.Property of Spinnbarkeit
33. FACTORS INFLUENCING COMPOSITION
Flow rate
• As it increases, conc. Of proteins, Na, Ca and HCO3 increases while levels of PO4 and Mg++ fall.
Differential gland contributions
• In unstimulated whole saliva, parotid contributes only 20% of fluid volume whereas in stimulated
saliva they become prominent
Circadian rhythm
• Variations in concentration maybe seen. Eg Ca+ and PO4- are low in mornings
Duration of stimulus
• At constant flow rate, composition may change with duration.
Nature of stimulus
• Salt stimulates higher protein content, while sugar stimulates high amylase content
Diet
• increase F levels in people drinking fluoridated water
Pathological conditions
• D.M shows increased amount of glucose
34. FACTORS AFFECTING SALIVARY FLOW RATE-
1.Resting unstimulated flow is 0.1-0.2ml/ min upto 0.4ml/ min (Edgar WM)
Stimulated flow less than 7ml/ min (Edgar WM)
Salivary hypofunction – unstimulated salivary flow < 0.1ml/ min
Circadian rhythm – Less at night, more in morning
Less in summer, more in winter
2.Conditioned reflex – mouth watering on anticipation of food, handling by dental
instruments, taking unpleasant substances, medications etc
3.Unconditioned reflex – Mastication, taste, nausea, vomiting etc
4.Hormonal influence – ADH, Aldosterone, testosterone and thyroxine influence
salivary flow.
35. METHODS OF COLLECTION OF SALIVA
1.SIALOMETRY
2.PASSIVE DROOL METHOD
3.SALIVARY ORAL SWAB (SOS) METHOD
METHODS OF SCREENING OF SALIVARY GLANDS :
1.SALIVARY SCINTIGRAPHY
2.SIALOGRAPHY
3.BIOPSY OF GLAND
36. INSTRUCTIONS TO PATIENTS PRIOR
COLLECTION-
Avoid alcohol for 12 hours before sample collection
Avoid dairy products 20 minutes before collection
Avoid major meals 1 hour before sample collection
Avoid foods high in sugar or acidity or high in caffeine immediately before
collection as they may compromise the assay by lowering pH and increase
bacterial growth.
Rinse mouth to clear food residue and wait at least 10 minutes prior to
collection to avoid sample dilution.
Cut plastic drinking straws into 2 inch/ 5cm pieces.
37. PASSIVE DROOL
Highly recommended, cost effective and approved for use with almost all
analytes.
Use of polypropylene vials recommended to avoid contamination and the vials
must be able to withstand temperatures as much as -80°C.
A –80 °C freezer can preserve saliva for a long time. Recent evidence from
Speicher suggests a note of caution: salivary DNA with no stabilizing solution,
stored at –80° for 14 months with no freeze-thaw cycles, is partially or
completely degraded.
38. INSTRUCTIONS TO PATIENTS-
Allow saliva to pool in the mouth.
With head tilted forward patients should drool down the saliva through the
straw into the vial.
Repeat as often as necessary
1ml (excluding foam) is often adequate for most tests.
39. 2.SIALOMETRIC ORAL SWAB (SOS)
In patients not willing/ unable to drool into the vial.
Excellent alternative to passive drool acc. to its ease of use.
It also filters mucus from the sample and allows for better immunoassay
results
42. METHODS OF SCREENING/TESTING GLAND FUNCTION
1. SIALOGRAPHY is the radiographic examination of the
salivary glands.
It is used to assess salivary gland stones and masses.
43. SALIVARY SCINTIGRAPHY
2. Salivary scintigraphy (gland scan)
Gamma scintillation camera
Used in assessing salivary gland function
Assessed by the pattern of uptake and secretion
of a radioactive tracer, technetium 99
Also used to evaluate swellings due to
inflammation or obstruction
44. SALIVARY GLAND BIOPSY
A salivary gland biopsy involves the removal of cells or small pieces
of tissue from one or more salivary glands
To determine :
1. Abnormal lumps or swellings in the gland
2. Blockages of ducts
3. If tumor present and is to be removed
4. Autoimmune diseases like Sjogrens syndrome
45. ROLE OF SALIVA IN COMPLETE DENTURE
PROSTHODONTICS
Retention for a denture is its resistance to removal in a direction opposite to that of its
insertion.
For achieve retention –
1) Negative atmospheric pressure between denture and mucosa covered by the denture.
2) Good border seal and intimate tissue contact
3) Good neuromuscular control and function
4) Gravity
5) Saliva and its physical properties
46. SALIVA AND ITS PHYSICAL PROPERTIES
Saliva plays a very important role in physical factors affecting denture retention.
They are:
1. Adhesion
2. Cohesion
3. Interfacial surface tension
4. Capillarity
5. Atmospheric pressure
47. PHYSICAL PROPERTIES OF SALIVA
PROPERTY FEATURE
ADHESION
Physical attraction between
two unlike molecules for
each other
It acts when saliva sticks to and wets the basal surface of the dentures & at
the same time to the mucous membrane of the basal seat
COHESION
Physical attraction
between two like
molecules for each other
Occurs between layer of saliva and the denture base and mucosa, in order
to be effective thin film of saliva is essential
INTERFACIAL SURFACE
TENSION
Phenomenon that maintains
the surface continuity of a
fluid
Is the resistance to separation posed by a film of liquid between two well
adapted surfaces. Found in the thin film of saliva – similar in its action to
cohesion and to capillary attraction
48.
49. PHYSICAL PROPERTIES OF SALIVA
PROPERTY FEATURE
CAPILLARITY
Is a force that causes the surface of a liquid to become
elevated or depressed when it is in contact with a solid
ATMOSPHERIC PRESSURE
The atmospheric pressure acts as a retentive force when
dislodging forces are applied to the denture.
VISCOSITY
It is the resistance experienced by one part pf liquid in moving
over another part.
50. GALVANISM
In the mouth with saliva as an electrolyte, the continuous renewal of saliva
prevents equilibrium and thereby maintains the electrolytic action, so that
part of the metal gradually goes into solution – causing corrosion.
Corrosion occurs more in alloys
The electric current arising in the mouth and causing corrosion is primarily
responsible for discoloration of metal restorations.
51. SALIVARY GLAND DISORDERS
DISORDER FEATURES
Hypersalivation/Ptyalism/
Sialorrhea
• Pregnancy, Severe oral injuries, Psychic tension
Hyposalivation (Xerostomia) • Gland dysfunction leading to decreased salivary output
Sjogren’s syndrome • Chronic autoimmune disease affecting glands, tear glands, sweat and oil
glands
Salivary gland cysts and
tumors
• Cysts due to injury, infection, stones
• Pleomorphic adenoma, Warthin’s tumor, malignant tumors
Sialolithiasis • Tiny stones in glands
• Due to deposition calcium and phosphate
Sialadenitis • Painful infection of glands
• Common in elderly but can affect infants also
Salivary gland enlargement • Due to viral infections like mumps, flu, CMV etc.
Sialadenosis • Painless swelling of glands without a known cause, usually parotid
affected
52. SIALORRHEA/ HYPERSALIVATION
It is a state of hypersalivation often experienced by the patient due to
hyperfunction of the glands.
Causes –
Pregnancy
Irritation of mucosa
New denture
Severe oral ulcerations/injuries
Psychic stress
53. FEATURES
Thick Ropy Saliva
Causes :
1. Dietary imbalance or inadequacy
2. Heavy mucous secretion from gland
3. Pregnancy
4. Diseases like Digestive tract irritation, Parkinsonism, Epilepsy, Apthous ulcer, Herpes infection etc
5. Prosthetic appliance -
54. PROBLEMS ENCOUNTERED
Complicates impression by forming voids on surface while it sets
Causes patient to gag during impression making and denture delivery
Any thickening of the interposed salivary film by excessive mucin destroys
the intimacy of the contacting surface, thereby reducing friction and
causing skidding
55. SIALORRHEA/ HYPERSALIVATION
Treatment –
Vitamins, mineral supplements and dietary improvements.
Palatal surface should be wiped free of saliva before impression making
Massaging glands to empty
IMPRESSION MAKING -
Mouth irrigated with an astringent, mouth washed prior to investing impression material.
Fast setting impression material is used.
Anti-sialagogues administered immediately or 1 to 2 days before treatment
56. XEROSTOMIA (DRY MOUTH, PASTIES, COTTON MOUTH)
It is the condition of dry mouth resulting from reduced or absent salivary flow
Subjective feeling of oral dryness
Symptom, not a disease
Common complaint among older adults and according to a study, 30% of population
aged above 65+ years experience this disorder. (Ship 2002)
59. SIGNS AND SYMPTOMS
Dry mouth
Dysgeusia
Increased need to drink water while swallowing/eating dry crumbly food.
Increased susceptibility to pdl disease
Reduced denture retention and generalized denture intolerance
Decreased buffering capacity with risk of opportunistic infections
60. SIGNS AND SYMPTOMS
The oral mucosa appears thin, pale, loose its shine and glittering quality and
feel dry
A tongue blade may adhere to oral tissues
Increased dental caries,
Presence of oral infections like candidiasis, fissuring or lobulation of dorsum
of tongue
Swelling of salivary glands sometimes
61. NON ORAL SYMPTOMS
NON ORAL SYMPTOMS –
Blurred vision, ocular dryness
Itching and burning of sensation of the eyes
Dryness of skin
62. CLINICAL DIAGNOSIS
Medical history, H/o radiation, chemotherapy, oral infections questionnaire.
Dry mouth questionnaire
Sialography, salivary scintigraphy, gland biopsy.
4 reliable predictors of gland hypofunction –
1. Dryness of lips,
2. Buccal mucosa,
3. Absence of saliva production during gland palpation and
4. increased DMFT index score.
Dugal R. Xerostomia: Dental implications and management. Ann Essences dent. 2010 Jul 13;3:137-
40.
63. CLINICAL DIAGNOSIS
Salivary flow and consistency will vary with
each patient.
Some abnormal findings must be noted such as
frothy saliva or thick ropy saliva
Gauze should be used to dry the floor of the
mouth and visually asses the flow from the
Wharton’s duct orifice and other ducts of both
the sublingual and submandibular glands
65. PREVENTION
Frequent dental examinations
Before radiation : Radiation stents
Intensity modulated irradiation therapy (IMRT)
Amifostine protects salivary gland damage
Higher fungal infections : soak in Nystatin powder
Milking the salivary glands : Massaging, suckling on candies
Medicine modifications : With fewer anti-cholinergic effects
66. THERAPEUTIC IRRADIATION
Sensation of oral dryness occurs early in the course of radiation. It has been shown that 24 hrs after
administration of only 2.25 Gy (225Rads) there is already a 50% decrease in flow of the parotid
saliva.
When exposure exceeds 50Gy (5000Rads) the reduction in flow is profound & the decrease
salivation is more than 90%.
Glands in the decreasing order of sensitivity – Parotid, submandibular, sublingual and the minor
glands
68. MEDICATIONS
Pilocarpine –
Cholinergic, non specific muscarinic agonist,
Dosage – 5-10mg/day upto 3 times a day
Contraindications – Asthma, glaucoma, Gall bladder disease
Side effect – GIT upset
Cevimiline –
Acts on 2 specific muscarinic receptors, longer duration of action
Indications – Autoimmune xerostomia
Side effect – Cardiorespiratory complications
69. Johnson J T et al on oral pilocarpine for post-irradiation xerostomia in
patients with head and neck cancer. (New Eng J Med 1993; 329: 390-395)
44% of patients reported improved salivation while on a dose of 5.0 mg of
Pilocarpine thrice a day.
70. ARTIFICIAL SALIVARY SUBSTITUTES
Carboxy methylcellulose – lubrication
Animal mucins – to increase viscosity
Parabens - inhibit bacterial growth
Sugar free agents - xylitol, sorbitol
Mineral salts - simulate electrolyte content
Fluoride - remineralization
Trade names: salivart (spray), mouthkote (spray), oral balance (gel).
The oral mucous and the intaglio surface of prosthesis can be sprayed throughout the day with
artificial saliva
72. Epstein et al did a double-blind crossover trial of Oral Balance gel and Biotene
toothpaste versus placebo in patients with xerostomia following radiation
therapy. Oral Oncol 1999; 35: 132-137
Compared use of Oralbalance gel and Biotene toothpaste against control
group of carboxymethylcellulose gel and commercial toothpaste
They found that patients using Oralbalance and Biotene reported these two
products to be more effective than the controls
73. RESTORATIVE CONSIDERATIONS
Early diagnosis of the condition
Caries intervention
3-6 month recalls
Concentrated fluoride varnish
Conservative cavity preparation
74. PROSTHODONTIC CONSIDERATIONS
Relation with complete dentures –
Extension of denture base:
Stensons duct- it is rare for a maxillary denture to cause obstruction to this
duct.
Whartons duct-extension of the lingual flange in this region can lead to
obstruction – patient complains of swelling under the tongue while eating.
Sublingual- it is rare for a denture to cause any significant obstruction.
75. PROSTHODONTIC CONSIDERATIONS
1. Complete Dentures :
Procedures - aim at optimizing retention and stability
Use dentures with metal bases (Hybrid dentures)
Use of soft liners to improve comfort
Use of denture adhesives to augment retention
76. Frequent recall in pts more prone to candida infections
Elastomeric impression materials preferred
Implant supported overdentures are preferred
In the patients susceptible to mucosal ulcerations & fungal infections --
Minimize denture use at times when decreased salivary flow is noted
77. To prevent sticking of lips and cheek, apply petroleum jelly to denture
surface
Restrict diet to moist food
Limit denture use to short periods
Artificial saliva reservoirs to simulate secretion
79. PROSTHODONTIC CONSIDERATIONS
2. Fixed Partial Dentures –
In dry environment, fixed non-tissue bearing prosthesis are preferred where indicated
FPDs should have full coverage retainers and easily cleaned pontics and connectors
Margins of retainers should be supragingival
Dugal R. Xerostomia: Dental implications and management. Ann Essences dent. 2010 Jul 13;3:137-40.
80. PROSTHODONTIC CONSIDERATIONS
3. Removable Partial Dentures –
Health of residual teeth and periodontal tissues should be assessed.
Use of gingivally approaching clasp to be avoided
Tooth supported denture with minimal tissue coverage
Metal denture bases are preferred
Dugal R. Xerostomia: Dental implications and management. Ann Essences dent. 2010 Jul 13;3:137-40.
81. SALIVA AS A DIAGNOSTIC TOOL
Salivary testing is becoming more common as clinicians have begun to
appreciate its advantages & investigators defined its worth.
Salivary levels of drugs can be detected following therapeutic
medications.
Saliva drug testing kits are commercially available. Included in these are
the tests for alcohol, cocaine ,HLA typing, HIV1 ,HIV2 ,DNA, etc
Salivary cortisol is an indicator of hypothalamic pituitary adrenal axis
function- used to quantify the human stress & to determine the effect
of treatment on it.
82. SALIVA AS A DIAGNOSTIC TOOL
To detect antibodies-hepatitis A, rubella virus, etc
To diagnose systemic disease after salivary gland dysfunction- Sjogrens
syndrome, Alzheimers disease, Cystic fibrosis,etc.
Forensic odontology
Salivary pH assessment using telemetry:
Device called telemetry system is incorporated in the denture which has a
radiosensitive diode, oscillator, pH sensor, and a computer analyzer.
Editor's Notes
Salivary secretion is controlled by various fibres of A.N.S., As to the parasympathetic innervation, the parotid gland is governed by inferior salivatory nucleus in the medulla via the Glossopharyngeal nerve.
Stimulation of Parasymp fibres cause secretion of large quantity of watery saliva bcuz Parasymp fibres activate the acinar cells and cause vasodilation of the glands.
Originate in Superior sal. nuc. In Pons, pre-gang fibres run through N V W, Geniculate ganglion ,motor fibres of facial nerve and chorda tympani br of facial nerve, and lingual branch of trigeminal nerve and finally reach the Submandibular ganglion.
Sympathetic fibres cause vasoconstriction by noradrenaline
ADHESION – Wetting characteristics btwn saliva and denture base will determine the effectiveness of adhesion of saliva to denture, WATERY saliva is quite effective, Thick ropy saliva will build up and pushes the denture out of position, its bcuz hydraulic pressure produced by thick saliva which may overpower adhesion.
CAPILLARITY – The space filled with THIN film of saliva acts as a capillary tube and helps to retain the denture
ATM PRESSURE - Developed with the proper extension of the denture into the vestibule.
VISCOSITY – Varies greatly, stimulated has much less viscosity than unstimulated. For a given V value, high retention values result when a denture is subjected to high forces of mastication of short duration,, Conversely , small forces over a long duration may dislodge the denture. Its because theres little time for flow of saliva to occur when force is applied suddenly.
Electric soluble potential, dissolution of ions, state of equilibrium, cycle goes on due to renewal and therefore corrosion
Excess salivation occurs during new denture delivery as it acts as a foreign body
ASTRINGENT – precipitate protein but not penetrate the cells, only affecting superficial layer. They toughen the surface by making it more mechanically stronger and decrease exudation.
ANTI SIALOGOUGES - ATROPINE, METHANTHININE, SCOPOLAMINE
Appliance may obstruct the palatal glands due to excessive pressure exerted by denture on palatal mucosa and over a long period degeneration of gland may occur.
Overextended lingual flange – Whartons duct is long and tortous, may get compressed along the crevice or its openingby mandibular lingual flange. Pt co swelling developing undr mandible.
Sugar free chewing gums containing fluoride may be useful in these patients. The effect of fluoride on tooth substance is prolonged due to low saliva flow rate and subsequently, reduced oral clearance. During meals, the patients should be advised to sip water when eating and swallowing.. If present, oral candidiasis should be treated with:-Topical application of miconazole (2%) ointment or gel.-Nystatin ointment or oral suspension-Systemic treatment with fluconazole, ketaconazole or itraconazole should be reserved for refractory cases and Immuno-compromised patients
Pharmacological sialogogues : may also stimulate an increase in salivary secretion. These drugs are cholinergic agonists that stimulate muscarinic receptors. Symptoms of oral dryness may be alleviated by the use of mouth gels, oral sprays or artificial saliva
Saliva lubricates the denture thereby making it more compatible with the lips cheek and tongue movements
, In xerostomia, cheek and lips stick to the denture in and uncomfortable manner and cause extreme discomfort and makes it more susceptible to functional irritation from denture movement.
NO ZOE/ IMPRESSION COMPOUND AS IT LEADS TO MORE IRRITATION
Intra oral salivary reservoir in the hollowed lingual flange of mandibular, Basal plate of maxillary denture
RESULTS are poor due to difficulty in cleaning of denture and refilling of reservoir
