importance of saliva is often neglected by clinicians and practitioners but is one of the most important body fluids not only in dentistry perceptive but also in regard to medical diagnosis. in dentistry it plays a special role specially in complete denture patients

1. SALIVA
D R . B H U P E N D R A R I Z A L
J R 1
D E PA R T M E N T O F
P R O S T H O D O N T I C S

2. CONTENTS
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3. - M A N D E L ( 1 9 9 0 )
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4. INTRODUCTION
• Saliva is most valuable oral fluid that is often taken for
granted. It is critical for the preservation and
maintenance of oral health, yet it receives little
attention until quality or quantity is diminished.
• Saliva is largely an unheralded, unsung and ignored
secretion.
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5. Is saliva important ?
• There’s an old axiom which states “you never miss the water
till the well runs dry”. (How true this is, especially for saliva.
)The fact is, a world without saliva is a world without
pleasure….like living with a drought…..
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6. HISTORY
• Ancient records have proved the use of ‘rice tests’ as a means
of proving innocence or guilt.
• Traditional Chinese doctors used the thickness and smell of
saliva as diagnostic tools to assess the health of a patient.
• Value of saliva mentioned even in cosmology of antient Egypt.
• Even in the New Testament in the Holy Bible.
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7. DEFINITION
SALIVA
• ‘The watery, slightly alkaline fluid secreted into the
mouth by salivary glands and mucous membrane that
lines the mouth” – British Medical Association
OR
• An extracellular fluid produced and secreted into the
mouth by the salivary glands that aids in the digestion
of food.
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8. SOURCES
• Saliva is a clear and slightly alkaline
mucoserous exocrine secretion.
•When referring to the fluid normally present in
the mouth the term “whole saliva” is commonly
used, as distinct from “duct saliva” which is that
flowing from the individual glands.
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9. Secretions enter into the oral cavity by way of:
• Parotid – Stenson's duct- orifice in the cheek above
the molar teeth.
• Submandibular gland - Wharton’s duct - lingual side
of the mandible in the submandibular fossa.
• Sublingual gland - ducts of Rivinus - sublingual fold
in the floor of the mouth.
• Accessory salivary glands - through individual ducts
at their respective locations.
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10. CLASSIFICATION OF SALIVARY GLAND
MAJOR
PAROTID
SUBLINGUAL
SUBMANDIBULAR
MINOR
LABIAL/BUCCAL
PALATINE
LINGUAL
GLOSSOPALATINE
VON EBNER’S
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11. CLASSIFICATION BASED ON SALIVARY SECRETION
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MUCOUS
• LABIAL/BUCCAL
• GLOSSOPALATINE
• PALATINE
• POSTERIOR TONGUE
SEROUS • PAROTID
• VON EBNER’S
MIXED
• SUBMANDIBULAR
• SUBLINGUAL
• ANTERIOR TONGUE
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12. PAROTID GL AND
• Largest salivary gland
• Shape – resembles an
inverted, three sided
pyramid
• Weight – 20 to 30gm
each
• Location – in front of the
ears & behind the ramus
Secretory duct – via
“Stenson's” duct - opposite
to the upper second molar12Dr.Bhupendra

13. S U B M A N D I B U L A R
G L A N D
• 2nd largest salivary gland
• Shape & size – roughly J
shaped & about the size of a
walnut
• Weight – 8 to 10gm each
• Location – posterior part of
the floor of the mouth,
tucked up against the
medial aspect of the body of
mandible
• Secretory duct – Wharton’s
duct - underneath the
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14. S U B L I N G UA L
G L A N D
• Smallest of the three
major glands
• Almond shaped
• Weight – 2 to 3gm each
• Location – subjacent to
mucosa of floor of the
mouth.
• Secretory duct – 6-8 small
ducts opens in the floor
of the mouth(ducts of
“Rivinus”)
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15. MINOR SALIVARY GLANDS
• Located beneath the epithelium and consists of
several small group of secretory cells.
• Lack a distinct capsule.
• 600-1000 minor salivary gland.
• Classified based on their anatomical location and not
present on gingivae, ant raphe and ant 2/3rd of
dorsum of tongue.
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16. L ABIAL / BUCCAL GL ANDS
• Gland on lips and cheeks.
• Mixed type
GLOSSOPAL ATINE GL ANDS
• Principally localized in the
region of isthmus in
glossopalatine fold.
• Pure mucous gland
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17. PAL ATINE GL AND
• Posterior region of hard
palate and submucosa of
soft palate
LINGUAL GL AND
• Anterior lingual – near the tip
of tongue ( glands of Blandin
and Nuhn) – mucous
• Posterior lingual – posterior to
circumvallate papillae - mucous
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18. VON EBNER’S GLAND
• Posterior lingual serous glands.
• Secretions wash out the troughs of
papillae.
• Plays a role in taste perceptions.
• Studies suggest- digestive and
protective function.
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19. DEVELOPMENT OF SALIVARY GLAND
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20. MECHANISM OF SECRETION
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Stage 1
• Acinar cells secrete a NaCl rich fluid
called primary saliva – isotonic
Stage 2
• The primary saliva – modified –
passed along the ductal tree
(reabsorbing NaCl and secreting K
,HCO3
• Final saliva - hypotonic Dr.Bhupendra

21. NERVOUS REGULATION OF SALIVARY
SECRETION
• Nerve system that controls saliva production - AUTONOMIC
NERVOUS SYSTEM
• Controlled by two different type of nerves-
• Sympathetic
• Parasympathetic
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22. 22Dr.Bhupendra

23. • PARASYMPATHETIC NERVE
SUPPLY
• Most active during the day, while
eating .
• Creates more watery, or serous
saliva predominantly by Parotid
gland & partly by the
Submandibular gland.
• SYMPATHETIC NERVE SUPPLY
• Produces predominantly thicker,
mucous saliva mainly by the
Sublingual Gland & partly by
the Submandibular Gland
• Present in certain situations like
fear, stress or anger
• This is also the case during
hard physical exercise .
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24. COMPOSITION OF SALIVA
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• 99% water - inorganic
0.2-0.4%,organic 0.3-
0.6%.
• Saliva is therefore
important in the balance
of total body water.
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25. 25Dr.Bhupendra
Cortisol, Estrogen,
Testosterone

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27. PROPERTIES OF SALIVA
• pH : 6.2 – 7.4
• Specific Gravity : 1.0024 -1.0061
• Freezing point : 0.07 – 0.34 ̊C
• Velocity : 0.8-8 mm/min
• Flow rate : 0.3ml/min when unstimulated and 1.5-2ml/min
when stimulated.
• Total volume of saliva secreted by humans daily : 750 – 1000
ml approximately
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29. FACTOR AFFECTING FLOW OF SALIVA
Individual Hydration :
When the body water content is reduced by
8%, SF virtually diminishes to zero, whereas
hyperhydration causes an increase in SF
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Diurnal variation/ Circadian cycle :
The concentration of total proteins attains its
peak at the end of the afternoon, while the
peak production levels of sodium and
chloride occur at the beginning of the
morning.
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30. Body Posture, Lighting, and Smoking
• Patients kept standing up or lying down
present higher and lower SF,
than seated patients.
• There is a decrease of 30% to 40% in SF
of people that are blindfolded or in the
dark.
• Olfactory stimulation and smoking
a temporary increase in unstimulated SF.
• Men that smoke present significantly
higher stimulated SF than non-smoking
men.
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31. Medications
• Many classes of drugs, particularly those
that have anticholinergic action
(antidepressants, anxiolytics,
antipsychotics, antihistaminic, and
antihypertensives)
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Gustatory Stimulation
• The action of chewing something
tasteless itself stimulates salivation
but to a lesser degree than the tasty
stimulation caused by citric acid.
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32. FUNCTIONS OF SALIVA
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• 1. Digestion
• 2. Protection
• 3. Buffering
• 4. Antimicrobial action
• 5. Taste
• 6. Maintenance of tooth integrity
• 7. Tissue repair
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34. Digestive function
• The moistening and lubricating action of saliva allows the
formation and swallowing of the food bolus.
• Salivary amylase and lipase are primary enzymes contained
saliva that begin the digestive process in the oral cavity itself.
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35. 35
1.α- Amylase (ptyalin)
• Acts on cooked starch
• Optimum pH = 6.8
• Inactive below pH 4
2.Lingual lipase
• Von Ebner gland
• Responsible for the first phase of fat
digestion.
3.Bolus formation
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36. Protective function
• Salivary mucins and other glycoproteins
provide lubrication.
• Mucins form a barrier against noxious
stimuli, microbial toxins and minor trauma.
• Salivary proteins protect the tooth
surface.
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37. Antimicrobial Action
• Saliva contains a spectrum of proteins which possess
antimicrobial properties such as
o lysozyme,
o lactoferrin,
o peroxidase,
o immunoglobulins
• Some salivary proteins and peptides are also known to
exhibit antiviral activity and antifungal activity. histatins &
cystatins.
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38. Buffering (maintenance of ph)
•The resting ph of saliva is 6 to 7.
•Bicarbonate - buffering action
•Protects the teeth from demineralization and subsequent
dental caries.
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39. Maintenance of Tooth Integrity
• Salivary proteins such as
• Statherin
• Proline rich proteins
• Sialin
• The presence of fluoride ions in saliva also helps in the
remineralization of the initial carious lesion.
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40. • Tissue Repair
• A variety of growth factors and biologically active peptides
present in the saliva which aid in tissue repair and
Nerve growth factor
Wound healing
Epidermal growth factor
• Speeds up coagulation process
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41. Taste
• The saliva produced by the minor salivary glands present in the
vicinity of circumvallate papillae contains proteins that are
to bind to the taste substances and present them to the taste
receptor.
• Saliva also aids in preserving the health of the taste receptor sites
protecting them from mechanical and chemical stress or bacterial
infection.
• Solubilizes food substances so that they can be sensed by taste
receptors located in the taste buds.
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42. CLINICAL CONSIDERATION
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43. HYPOSALIVATION
• Reduction in the secretion of saliva
• Temporary :
o emotional situations like fear, anxiety
o Fever
o Dehydration
• Permanent :
o Sialolithiasis – obstruction of salivary duct
o Aplasia/ hypoplasia of the salivary glands
o Bell’s palsy – paralysis of facial nerve
• Age
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44. DRY MOUTH (XEROSTOMIA)
• A loss of salivary function or a
reduction in the volume of secreted
saliva may lead to sensation of oral
dryness.
• Xerostomia is rarely a solitary
symptom. Accompanying it is a wide
variety of other oral and non oral
complaints.
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45. • Causes-
1.Diseases affecting the salivary gland
* Sjogren’s syndrome
* HIV/AIDS
* Diabetes
2. Drugs with anticholinergic actions
3. Radiation therapy of head and neck.
4. Alcoholism
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46. SIGNS AND SYMPTOMS
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48. 48Dr.Bhupendra

49. 1. SYMPTOMATIC TREATMENT:
2. ADDRESS UNDERLYING CAUSE:
Physician consultation
Alter drug dosages
Substitute medication causing xerostomia
Control of systemic disorder
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50. 3.STIMULATE RESIDUAL GLAND FUNCTION:
Sugarless gums (xylitol / sorbitol) and candies
Cholinergic agonists :
Pilocarpine: 5mg tid up to 90 days
Cevimeline: 30mg tid up to 6 weeks
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51. 4. SALIVA SUBSTITUTES :
• Palliative Measures that can alleviate the xerostomia by moistening &
lubricating oral cavity.
• Commercial Salivary Substitute like
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52. 5. ENCOURAGE ORAL HYDRATION:
Humidifiers, especially during sleep
6. OPTIMIZING ORAL HYGIENE :
Antimicrobial mouthwashes(alcohol-free)
Biotène Dry Mouth Toothpaste contains salivary enzymes
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53. PROSTHODONTIC MANAGEMENT
In Fixed Partial Denture
• 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.
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54. • In removable partial denture
• Health of residual teeth and periodontal tissues.
• Use of gingivally approaching clasp avoided.
• Tooth supported denture with minimal tissue coverage.
• Metal denture bases are preferred.
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55. In complete denture
• Procedures -aim at optimizing retention and stability.
• Use dentures with metal bases.
• Use of soft liners to improve comfort.
• Use of denture adhesives to augment retention.
• Frequent recall – As more prone to candida infections.
• Fabrication of intra oral artificial salivary reservoirs.
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56. HYPERSALIVATION
• Excess secretion of saliva – ptyalism ,
sialorrhea, sialism or sialosis
• Conditions :
o Neoplasms of the mouth or tongue
o Neurological disorders : cerebral palsy ,
cerebral stroke
o Parkinsonism
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57. SIALORRHEA
• Excessive salivation often experienced by the
individual and experienced by the individual &
noticed by the operator.
• Causes :
• Acute inflammation of oral cavity
• Teething
• Patients with neurological disorder
• Oral cancer
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58. MANAGEMENT :
• Drugs like anti-histamine and anti-sialogogeus.
• Temporary injection of botulinum toxin into the
parotid gland.
• Surgery like mandibular duct diversion.
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59. PROSTHODONTIC MANAGEMENT
In Removable partial denture
• Anti sialagogues administered 1to 2 days before treatment.
• Impression making: mouth irrigated with an astringent.
• Mouth washed prior to investing impression material.
• Fast setting impression material is used.
• Patient’s mouth should be packed with 4x4 inch gauze that
has been folded to form an absorptive strip.
• “ Tandem” impression technique.
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60. • Cleaning the alginate impression:
• Failure to remove saliva from the impression will result in an
inaccurate cast
• Thin, serous saliva to be washed under cool tap water. If
running tap water is not effective, the saliva can be removed
using a soft camel hair brush and a mild detergent.
• Thick, ropy saliva- a thin layer of dental stone be sprinkled
the surface of the impression
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61. Control of Saliva during Impression for Fixed Partial Denture
• When an impression is made or a restoration is cemented,
great degree of dryness is required
• Achieved by using-
• Rubber dam, high-volume vacuum, saliva ejector, anti-
sialagogues. Methantheline bromide (banthine) and
propantheline bromide (pro-banthine).
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62. PROSTHODONTIC CONSIDERATIONS
• From the prosthodontists point of view, salivary glands are of great
importance both anatomically and physiologically.
Extension of denture base:
• Stenson's duct - it is rare for a maxillary denture to cause
obstruction to this duct.
• Wharton’s 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. 62Dr.Bhupendra

63. Amount of saliva
• If a mouth is dry . Retention of the denture –affected+
increased potential for soreness.
• Excess saliva- complicates denture construction- impression
making.
• When new dentures are first inserted increased salivation
due to temporary increase in salivary flow is a natural
response to foreign object & in time will subside. Patients
need assurance about this.
• Deglutition will be necessary to evacuate the excess -
not to rinse and spit as this – unsettling of the denture bases.
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64. Consistency
• Best to work with a serous type of saliva.
• Presence of thick saliva may create a problem for maxillary
complete denture retention.
• In an effort to alleviate this problem, a cupids bow can be
scribed on the master cast .
• Thick saliva also complicates impression making by forming
voids in the impression surface while the impression sets.
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65. ROLE OF SALIVA IN DENTURE RETENTION
• Saliva is considered as a major factor in evaluating the
physical influences that contribute to the denture retention .
• The physical forces in which saliva is involved are:
• Adhesion
• Cohesion
• Interfacial surface tension
• Capillary attraction
• Peripheral seal
• Viscosity of saliva & surface tension.
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66. 1. ADHESION
• Physical molecular attraction of
unlike surfaces in close contact.
• It acts when saliva wets and stick
to the basal surface of denture
and mucous membrane of the
basal seat.
• The amount of retention
provided by adhesion is directly
proportional to the area covered66Dr.Bhupendra

67. 2. COHESION
• Molecular attraction between
two similar surfaces in close
contact.
• It occurs in the layer of saliva
between the denture base and
the mucosa.
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68. 3. INTERFACIAL SURFACE TENSION
• Resistance to separation possessed by the
film of liquid between two well adapted
surfaces.
• Found in the thin film of saliva between
denture base and the mucosa.
• The cohesive forces result in the formation
of a concave meniscus at the surface of
saliva in the border region of the denture.
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69. 4.CAPILLARY ATTRACTION
• Forces that causes the surface of
liquid to become elevated or
depressed when it is in contact
with a solid.
• On close adaptation of a denture,
the space filled with a thin film of
saliva acts like a capillary tube
and helps retain the denture.
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70. 5.PERIPHERAL SEAL
• Developed with the proper
extension of the denture into the
vestibule.
• Denture border merging against
the mucosal border assembled by
a thin film of saliva provides
border seal as it prevents ingress
of air , thus enabling the denture
to be in their position.
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71. CONCLUSION
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• The components of saliva act as a mirror of the body’s health.
• The multi factorial role of salivary components continue to represent a
focused area of dental research.
• The knowledge of normal salivary composition, flow & function is
extremely important on a daily basis when treating patients.
• Dental health professionals spend untold hours removing this precious
natural resource to perform therapy, with little regard to its value until
flow is significantly reduced.
• Whether saliva occurs in quantities large or small , recognition should
be given to the many contributions it makes to the preservation &
maintenance of oral & systemic health.
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72. REFRENCES
Essentials of complete denture prosthodontics 3rd edition –Sheldon Winkler
B.D Chaurasia’s Human Anatomy for dental students
Orban,s oral histology and embryology 10th edition
Burkett;’s Oral Medicine diagnosis and treatment planning 10th edition
Sreebny, Leo M; Saliva in health and disease: IDJ (2000)50;140-161
Tucker A.S; salivary gland development and cell developmental biology;18(2007)237-244
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73. Kasayuki .K, Taizo .H. Role of saliva in retention of maxillary complete denture. J Prosthet Dent. 1978;40(2):131-136.
Blahova Z, Neuman M. Physical factors in retention of complete dentures. J Prosthet Dent. 1971; 25(1): 230-235.
Edgerton M, Tabak LA, Levine MJ. Saliva: A significant factor in removable prosthodontic treatment. J Prosthet Dent. 1987; 57(1):
57-66.
Winkler S, Ortman H.R, Michael T.R. improving retention of complete dentures. J Prosthet Dent. 1975;34(1):11-15.
PROSTHODONTIC MANAGEMENT OF GAGGING : A REVIEW
Biochemical composition of human saliva in relation to other mucosal fluids:Leon C.P.Menno C.I Veerman, Arie V Nieuw;Crit Rev Oral
Biol.Med1995;6;161
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