knowing of saliva and it's composition, functions& applied physiology is very important for practitioners for their general practice.

1. Presented by
Srinivas.T
I MDS
Dept of conservative dentistry and Endodontics

2.  CONTENTS
 Introduction
 Classification salivary glands
 Structure , Formation & secretion
 Reflex regulation of secretion
 Phases of secretion
 Classification of saliva
 Collection
 Composition
 Factors affecting composition

3.  Caries related components in saliva
 Buffering action
 Functions
 Applied physiology
 Role of saliva as a modifying factor in dental caries
 Artificial saliva
 Sialography

4.  Salivary gland tumors
 Isolation
 Recent advances in isolation in dentistry
 Conclusion
 References

5.  INTRODUCTION:
 The oral cavity is kept moist by a film of fluid called
saliva that coats the teeth and the mucosa.
 Saliva is a complex fluid, produced by the salivary
glands.
 The term whole saliva, mixed saliva, oral fluid are
commonly used.
 It is necessary for clinicians to have a good knowledge
concerning the norm of salivary flow and function.

6.  Based on their anatomical size
 Major and minor
 MAJOR
 - parotid gland
 - sub mandibular gland
 - sub lingual gland

8.  MINOR
 - buccal/labial
 - tonsillar (EBNER’S GLAND)
 -Molar or retromolar gland( CARMALT’S GLAND)
 -Anterior lingual glands
 -Posterior lingual glands (VON EBNER)
 NEWLY DISCOVERED SALIVARY GLAND
(TUBERIAL GLAND)

9.  STRUCTURE OF SALIVARY GLANDS:
 Salivary glands are made up of the cells which are
arranged in small groups called ACINUS
/ALVEOLUS/TERMINAL SECRETORY UNIT.
 These cells are arranged in small groups around a
central globular cavity which is continuous with the
lumen of the duct.
 The fine duct draining each acini is called
INTERCALATED DUCT.
 Many intercalated ducts join to form STRIATED
DUCTS / INTRALOBULAR DUCT.
 Two or more intralobular ducts join to form
INTERLOBULAR DUCTS, which unite to form main
duct of the gland.

11.  ACINI consist of pyramidal cells
- serous
- mucous
- mixed

12.  SEROUS CELLS

13.  Mucous cell

14.  SEROMUCOUS CELLS
 Funtional and structural characteristics of both serous
& mucus cells

15.  MYOEPITHELIAL CELLS
-FUNCTIONS
-Shorten & widen intercalated duct
-Accelerate out flow of saliva
-Support parenchyma

16.  PAROTID GLAND
 Largest of all salivary glands.
 Location Below external acoustic meatus, between
ramus of the mandible &sternocleidomastoid.
 WEIGHT: 20-30 gms in adult
 DUCT Stensen's duct

18.  Blood supply - branches of the external carotid artery as
they pass through the gland.
 Parasympathetic nerve supply from the glossopharyngeal
nerve.
 Sympathetic innervation to all

19.  SUBMANDIBULARGLAND
 LOCATION posterior part of the floor of the mouth
 WEIGHT:8- 10gms
 DUCT : Whartons duct
 Blood supply- from the facial and lingual arteries
 Parasympathetic nerve supply from facial nerve

20.  SUBLINGUALGLAND
 Smallest of the paired major glands.
 WEIGHT: 2-3 gms
 LOCATION: in the anterior part of the floor of the
mouth between the mucosa and the mylohyoid
muscle.
 DUCT: Secretions enter the mouth through ducts of
Rivinus, which opens into Bartholins duct.

23.  MINOR SALIVARYGLANDS
 Estimated to number between 600 to 1000. .
 Present in the submucosa throughout most of the oral
cavity.
 Not seen in gingiva and the anterior part of the hard
palate.
 Von ebners glands- located in tongue ,opens through
circumvallate papillae.

24.  FORMATION& SECRETION OF SALIVA
 The formation of saliva occurs in 2 stages.
 In the 1st stage cells of the secretary end pieces &
intercalated ducts produces primary saliva, which is an
isotonic fluid containing most of the organic component
and all of water that is secreted by the salivary gland.
 In the 2nd stage primary saliva is modified as it passes
through striated and excretory ducts, mainly by absorption
&secretion of electrolytes.
 The final saliva that reaches the oral cavity is hypotonic.

25.  Formed actively by movement of Na and CI-ions into
the lumen, creating an osmotic gradient which leads to
the passive movement of water.
 Before the fluid enters the duct, the Na* ion are
actively reabsorbed, CI ions move passively to
maintain electrical equilibrium.
 K* and bicarbonate ions are secreted.

26.  REFLEX REGULATION OF SALIVARY SECRETION
 Salivary secretion is regulated by nervous mechanism
& it is a reflex phenomenon.
 No hormonal or chemical mechanism is involved in
the regulation of secretion.
 Salivary reflexes are of 2 types:
 1) Unconditioned reflex
 2) Conditioned reflex

27.  UNCONDITIONEDREFLEX:
 When food is placed in mouth.
 Due to stimulation of nerve endings in the mucus
membrane of oral cavity it occurs.
 This reflex present since birth and hence is called
inborn reflex.

28.  CONDITIONEDREFLEX:
 Secretion of saliva by the sight, smell, hearing or
thought of food is called conditioned reflex.
 It is due to impulse arising from the eye, nose ,ear.
 It is an acquired reflex.

29.  PHASES OF SALIVARY SECRETION
 1) Cephelicphase- secretion of saliva before entering
of food into the mouth. It is caused by (conditioned
reflex) by mere sight or smell of the food.
 2) Buccalphase- secretion of saliva caused by
stimulation of buccal receptors by presence of food in
mouth (unconditioned).
 3) Oesophageal phase-stimulation of salivary glands
by the food passing through esophagus.

30.  4)Gastric phase- secretion of saliva by the presence of
food in the stomach, specially when irritating food is
present in stomach (eg- increased salivation before
vomiting).
 5) Intestinal phase- salivary secretion by presence
of irritating food in the upper intestine.

31.  CLASSIFICATION OF SALIVA
 Gland specific saliva
 Whole saliva

32.  COLLECTION OF SALIVA
 1)Gland specific saliva:
 a )Parotidgland:
 - Saliva is collected using Carlson-Crittenden
collectors.
 - Collectors are placed over Stensen duct orifice &are
held in place with gentle suction.
 b) Submandibular & sublingualgland:
 -An aspirating device is used or alginate-held collector
called segregator is used.

33.  2 )Whole saliva collection: It includes 4 methods:
a) Draining
b) Suction
c) Spitting
d) Sponge(Absorbent)

34.  WATER – 99%
 ORGANIC SUBSTANCES
 INORGANIC SUBSTANCES

35.  ORGANIC
 Proteins
 salivary-Amylase
 IgA
 Lysozyme
 Lingual lipase
 Other polypeptide
 kalikerin

36.  Other organic compounds
 1.Urea
 2 Glucose
 З Vitamins
 4 Free amino acids

37.  INORGANIC
-Na
-Bicarbonate
-Calcium
-CL
-Flouride
-phosphate
-K
-Thiocynate

38.  FACTORS INFLUENCING THE COMPOSITION
-EFFECTS ON FLOW RATE
-EFFECTS ON AGE
-EFFECTS ON DRUGS
-EFFECTS ON CIRCADIAN RYTHM

39.  FACTORS INFLUENCING THE COMPOSITION
 Effect of flow rate:
 High flow rates There is less time for reabsorption and
secretion so the concentration of ions changes with
increase flow rate & contains:
 -high sodium ion.
 -high chloride ion.
 -low biocarbonate ion.
 -low potassium ion.

40.  Low flow rate
 -there is more time for reabsorption and secretion so
the modified saliva under resting condition contains
 -low sodium
 -low chloride
 -high bicarbonate
 -high potassium

41.  Effect of age:
-In old age, submandibular and minor salivary gland
flow rate are decreased ‚but parotid salivary flow does
not seem to be affected because they appear to have a
substantial secretory reserve.
-As age advances there is decreased production of
saliva and this is mainly due to loss of salivary gland
parenchymal tissue.

42. Effect of circadian rhythm:
-Lowest flow rate of saliva are observed in the early
hours of morning with high flow rates in the
afternoon.
Effect of drugs:
-Many classes of drugs, particularly those that have
anticholinergic action (antidepressants,
antihistaminics etc), may cause reduction in SF

43.  Saliva contain numerous substances which have an
effect on dental caries.
 Concentration of these substances vary from person
to person.
 For ex: salivary urea level is high in patients with
chronic renal failure.
 So, such patients may have little caries in spite of
having high plaque scores.

44.  Another example is salivary glucose which may be
high in diabetic patient.
 Such patient have been shown to develop more caries.

45.  Solutions containing both weak acids and their salts
are referred to a s 'buffer solutions'.
 These solutions have the capacity of resisting changes
of pH where either acids or alkalies are added to them.
 The buffer capacity of human saliva is regulated by two
buffer systems:
1) The carbonic acid / bicarbonate system.
2) Phosphate system.

47.  FUNCTIONS OF SALIVA:
DIGESTION
 DILUENT AND COOLING EFFECT
 MOISTENING,
 CLEANSING AND
 ANTIBACTERIAL FUNCTION

48.  4)LUBRICATION FOR
MASTICATION,SWALLOWING AND SPEECH.
 5 )SALIVA AS A SOLVENT:
• The sensation of taste is produced only by
substances in solution.
• Thus saliva helps in taste perception.

49.  7 )EXCRETORYFUNCTION:
-Several substances like lead, mercury iodides,
alkaloids like morphine, urea, uric acid, ammonia are
excreted in the saliva.
.

50.  HYPOSALIVATION
 HYPERSALIVATION
 XERSTOMIA
 MUMPS
 SJOGERN’S SYNDROME
 DROOLING OF SALIVA

51.  1 )HYPOSALIVATION
• The reduction in secretion of the saliva is called
hyposalivation.
-There are two types
a) Temporary
b) Permanent
Temporary hyposalivation occurs in:
a. emotional condition like fear
b. fever
c. dehydration.

52.  • Permanent hyposalivation occurs in:
a. Sailolithiasis -obstruction of salivary duct.
b. congenital absence or hypoplasia of salivary glands.
c. Bell's palsy.

53.  2 .HYPERSALIVATION
The excess secretion of saliva is known as
hypersalivation
The physiological condition when hypersalivation
occurs is pregnancy.
Hypersalivation in pathological condition is called
PTYALISM
SIALORRHEA
SIALISM
SIALOSIS.

54.  It occurs in the following conditions:
 a) neoplasm of mouth or tongue.
 b)Disease of esophagus , stomach and intestine.
 c) Cerebral stroke.
 d) Parkinsonism.
 e) Psychiatric condition.
 f) Nausea and vomiting.

55.  XEROSTOMIA:
 Also called as dry mouth / cotton mouth.
 It is due to hypo salivation or absence of salivary
secretion (aptyalism).
 It causes difficulty in mastication, swallowing
&speech.
 It also leads to halitosis (bad breath).
 Causes: - Trauma to salivary gland / duct -
Dehydration - Radiotherapy - Shock

56.  MUMPS

58.  4 )DROOLING:
 Uncontrolled flow of saliva outside the mouth.
 It occurs because of excess production of saliva in
association with inability to retain saliva within
mouth.
 It occurs in the following condition: -
-Tonsillitis
- Peritonsillar abcess
- Teeth eruption in children.

60.  ROLE OF SALIVA AS A MODIFYING FACTOR
IN DENTAL CARIES:
• Saliva is well known to have specific protective
effects against dental caries. Properties of saliva that
protect teeth against caries are:
1) Dilution &clearance of dietary sugar.
2) Neutralization and buffering of acids in plaque.
3) Supply of ions for remineralization.
4) Antiplaque and antimicrobial factors.

61.  Artificial saliva
• They are useful agents for the palliative treatment of
xerostomia.
-They are divided into 2 groups: •
1)Carboxymethycellulose {CMC} based .
2)Mucin based.

62.  SIALOGRAPHY:
-It is the radiographic visualization of the salivary
gland following retrograde instillation of soluble
contrast material into the ducts.
-
- Sialograph of Sjogren's syndrome -> cherry blossom /
branch less fruit laden tree appearance.
-Sialograph of sialorchitis Sausage string appearance.

63.  BENIGN
 MALIGNANT

64.  NON-NEOPLASTIC DISORDERS
DEVELOPMENTAL ANOMALIES
1.Aplasia
2.Hypoplasia
3.Aberrant salivary gland
4.Atresia
5.Accessoray ducts
6.lingual mandibular salivary gland depression

65.  REACTIVE LEISIONS
1)Mucous retention cyst
2)Mucous extravasation cyst
3)Sialolithiasis
4)Chronic slerosing sialometaplasia

66.  INFECTIVE LEISIONS
1)Bacterial
-Acute
-Chronic
-Recurrent
2)Viral
-Mumps
3)Immune mediated
-Milkuliz’s disease
-sjogern’s syndrome

67.  NEOPLASTIC DISORDERS
EPITHELIAL TISSUE NEOPLASAMS
1)Adenomas
-pleomorphic adenoma
-Monomorphic adenoma
-Adenolymphoma
2)Other types
-mucoepidermoid carcinoma
-Adenoid cystic carcinoma
-Adenocarcinoma

68.  CONNECTIVE TISSUE NEOPLASMS
1)Fibroma
2)Fibrosarcoma
3)Lipoma
4)Hemangioma
5)Lymphoma

70.  Pleomorphic Adenoma (PA)
 Is the most common benign tumor
 They are more common between the 40s and 50s
 Referred as mixed tumor :the tumor has three
components: an epithelial, myoepithelial cell, and
mesenchymal components.

71.  Warthin's Tumor
 Vast majority found in the parotid, with bilateral
involvement in 4% to 6% of the cases
 It occurs in Old age
 Associated with cigarette smoking and radiation
 The clinical presentation is that of a doughy painless
mass often found in the tail of the parotid

72.  Mucoepidermoid Carcinoma
 Is the most common malignant salivary gland tumor.
 This tumor makes up 10% of major gland tumors
(mostly parotid) and 20% of minor gland tumors
(mostly palatal). (Mean age is 45 years.)

73.  Adenoid cystic carcinoma
 Third most common intraoral salivary gland
malignancy a mean age of 53 years.
 Clinical features : low-growing, nonulcerated masses,
with an associated chronic dull pain. And it can be
faster growth rate and higher rate of distant
metastasis.

74.  Operative dentistry can not be
expressed properly unless the
moisture in the mouth is properly
controlled

75.  The goals of operative field isolation are
 Moisture control
 Retraction
 Harm prevention

76.  Materials can be used
 1.RubberDam
 2. Cotton rolls & cellulose wafers
 3. Throat shields
 4. High volume evacuators & saliva
 5. Mirror & evacuator tip retractor
 6. Mouth props
 7. Air Water syringe
 8. Cheek retractor
 9. Drugs

78.  I. NEWER ADVANCES IN RUBBER DAM
a) Derma dam (Ultradent Products. Inc, USA)
b) Flexi dam (Coltène/Whaledent)

79. II. Newer advances in rubber dam clamp
a) Clamp with long guard extension
b) Tiger clamp
c) S-G (Silker-Glickman) clamp
d) Super clamp
e) Gold coloured clamp

80. III Newer advances in rubber dam frames
a) Articulated frame
b) safe T frame
IV Recent alternatives to Rubber Dam
a) insti dam
b) Handi dam
c) Dry dam

81.  The components of saliva acts as a mirror of body
health. knowledge of normal salivary composition ,
flow and functions is extremely important on daily
basis when treating the patients. it makes to
preservation and maintenance of oral and systemic
health.

82.  PURKIT’S oral pathology
 SHAFER’S Text book of oral pathology
 Text book of GROSSMAN’S
 IOSR Journal of Dental and Medical Sciences (IOSR-
JDMS)