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Saliva in dentistry

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This Presentation includes systematic compilation of the anatomy, physiology, biochemistry and pathology related to saliva and salivary glands. it also mentions about the role of saliva in dentistry. Any additions or mistakes are welcome!
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Saliva in dentistry

  1. 1. “YOU NEVER MISS WATER… UNTIL THE WELL RUNS DRY.....” 5/8/2016 1
  2. 2. SALIVA P R E S E N T E D B Y : A P U R V A T H A M P I 1 S T Y E A R P G , D E P A R T M E N T O F P R O S T H O D O N T I C S5/8/2016 2
  3. 3. CONTENTS 5/8/2016 3 Embryology The development of salivary glands Histology The cell structure of salivary glands Anatomy The anatomical structure of the salivary glands, its nerve and blood supply Biochemistry The composition of saliva Physiology The flow of saliva, factors affecting it, and the functions of saliva Clinical significance The collection of saliva and the saliva function tests Applied aspects saliva in dentistry Pathology The pathologies of the salivary gland, hyper and hypo secretion of saliva
  4. 4. 5/8/2016 4
  5. 5. INTRODUCTION • Watery and frothy in consistency – produced in humans and most animals • Produced and secreted from the salivary glands • Contains a highly complex mixture of substances • Unique biomarkers that reflect oral and systemic health 5/8/2016 5 THE WATERY ,SLIGHTLY ALKALINE FLUID SECRETED INTO THE MOUTH BY SALIVARY GLANDS AND MUCOUS MEMBRANE THAT LINES THE MOUTH (British Medical Association) Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ (2000)50; 140-161
  6. 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 the patient – Over secretion of saliva – heart burn / cold stimulation of the stomach – Sweet saliva – spleen malfunctions 5/8/2016 6 Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ (2000)50; 140-161
  7. 7. CLASSIFICATION OF SALIVARY GLANDS 5/8/2016 7 Major Parotid Submandibular Sublingual Minor Labial / buccal Anterior Palatine Glossopalatine Von – ebner’sOrban's oral histology and embryology 10th ed
  8. 8. 5/8/2016 8 CLASSIFICATION OF SALIVARY GLANDS Mucous Serous Mixed • Labial & Buccal Glands • Glossopalatine • Palatine • Posterior tongue • Submandibular & Sublingual • Anterior tongue • Parotid • Glands of Von Ebner BASED ON TYPE OF SALIVA SECRETED Orban's oral histology and embryology 10th ed
  9. 9. EMBRYOLOGY 5/8/2016 9
  10. 10. DEVELOPMENT OF THE SALIVARY GLANDS 5/8/2016 10 Glands Origin Intrauterine life Parotid Corners of the stomodeum 6th week Submandibular Floor of the mouth End of 6th week Sublingual Lateral to submandibular primordium 8th week Minor salivary Buccal epithelium 12th week Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  11. 11. STAGES IN FORMATION OF SALIVARY GLAND DUCTS 1. Bud formation 2. Cord growth 3. Branching of cords 4. Lobule formation 5. Canalization of cords 6. Cytodifferentiation 5/8/2016 11 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  12. 12. STAGE 1 – BUD FORMATION • 6th week of IUL – cells initiates low level synthesis of salivary secretory proteins 5/8/2016 12 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  13. 13. STAGE 2 – CORD GROWTH • Formation of stalk - Primary end bud 5/8/2016 13 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  14. 14. STAGE 3 – BRANCHING OF CORDS 5/8/2016 14 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  15. 15. STAGE 4 – LOBULE FORMATION • Arborized pattern – glandular enlargement 5/8/2016 15 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  16. 16. STAGE 5 – CANALIZATION OF CORDS • First in distal ends of main cord & in branch cords then in proximal part of main cord • Finally in central portion of main cord 5/8/2016 16Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  17. 17. STAGE 6 - CYTOFIFFERENTIATION • Secretary cell differentiation • Epithelial mesenchymal interactions 5/8/2016 17 Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244
  18. 18. HISTOLOGY 5/8/2016 18
  19. 19. HISTOLOGY OF SALIVARY GLANDS 5/8/2016 19 • Terminal units – Acini • Made up of epithelial secretory cells – serous and mucus • Arranged in a spherical or tubular shape • Mucous acini have larger lumen than serous acini • Secretory end piece – tubular configuration Orban's oral histology and embryology 10th ed
  20. 20. SEROUS CELLS • Pyramidal with broad base – typical of protein secreting cell • Spherical nucleus placed at the basal region • Apical cytoplasm – accumulation of secretory granules (1 mm diameter) 5/8/2016 20 ZYMOGEN (Formed by glycolated protiens) Orban's oral histology and embryology 10th ed
  21. 21. MUCOUS CELLS • Apex appears empty except for thin strands of cytoplasm – trabecular network • Nucleus is oval or flattened in shape – above the basal membrane 5/8/2016 21Orban's oral histology and embryology 10th ed
  22. 22. MYOEPITHELIAL CELLS • Closely related to secretory and intercalated duct cells. • Stellate or spider-like – flattened nucleus • Long branching process – fusiform shape • “basket cells” – basket cradling secretory unit • Similar to smooth muscle 5/8/2016 22Orban's oral histology and embryology 10th ed
  23. 23. DUCTS • Consists of hollow tubes • Initially connected with acinus – gradually – with other ducts • Grow larger from inner to outer portion of the gland • Actively participates in the production of saliva • Small ducts – intercalated ducts, large ducts – striated ducts • Excretory – interlobular ducts – increase in size, increased amount of connective tissue 5/8/2016 23Orban's oral histology and embryology 10th ed
  24. 24. ANATOMY 5/8/2016 24
  25. 25. PAROTID GLAND • Largest salivary gland • Provides 60 – 65% of total salivary volume • Purely serous secretions • Pyramidal in shape – covered by a capusule • Located in the groove between mastoid process and angle of mandible 5/8/2016 25Burketts oral medicine diagnosis and treatment planning 10th edition
  26. 26. B OR DERS OF P A R OTI D GL A ND Superiorly : lower border of the zygomatic arch Posteriorly : anterior border of the sternocleidomastoid muscle Anteriorly : posterior border of the masseter muscle 5/8/2016 26Burketts oral medicine diagnosis and treatment planning 10th edition
  27. 27. A NA T OMY OF P A R OTI D GL A ND Nerve supply : • Parasympathetic : auriculotemporal nerve • Sympathetic : plexus around the ECA • Sensory : auriculo temporal nerve Blood supply : external carotid artery and its branches 5/8/2016 27Burketts oral medicine diagnosis and treatment planning 10th edition
  28. 28. The parotid duct (Stenson’s duct) opens into the buccal mucosa at the upper second molar region 5/8/2016 28
  29. 29. SUBMANDIBULAR GLAND • Large salivary gland • Anterior part of digastric triangle • Mixed secretions – serous + mucous 5/8/2016 29Burketts oral medicine diagnosis and treatment planning 10th edition
  30. 30. B OR DERS OF S UB MA ND I B ULAR GL A ND • Lateral surface : • Submandibular fossa • Insertion of medial pterygoid • Facial artery • Medial surface • Anterior : mylohyoid • Middle : hyoglossus, styloglossus, lingual nerve • Posterior : styloglossus, stylohyoid ligament, wall of pharynx 5/8/2016 30Burketts oral medicine diagnosis and treatment planning 10th edition
  31. 31. A NA T OMY OF S UB MA ND I B ULAR GL A ND • Nerve supply: branches from the submandibular ganglion • Blood supply: facial artery • Venous drainage: facial and lingual veins 5/8/2016 31
  32. 32. Submandibular duct opens on the floor of the mouth, on the summit od the sublingual papillae, at the side of the frenulum of the tongue – Warthin’s duct 5/8/2016 32
  33. 33. SUBLINGUAL GLAND • Smallest salivary gland • Almond shaped • Mixed secretions – serous + mucous 5/8/2016 33Burketts oral medicine diagnosis and treatment planning 10th edition
  34. 34. 6-8 sublingual ducts open into the floor of the mouth Main duct – Bartholin’s duct 5/8/2016 34
  35. 35. MINOR SALIVARY GLANDS • Located beneath the epithelium • Consist of several small groups of secretory cells • Lack a distinct capsule • 600-1000 minor salivary glands • Classified based on anatomic location • Not present in gingiva, antr. raphae, antr 2/3rd of dorsum of tongue 5/8/2016 35 Labial glands Glosspalatin e glands Palatine glands Lingual glands Von Ebner’s glands Burketts oral medicine diagnosis and treatment planning 10th edition
  36. 36. LABIAL/BUCCAL GLANDS • Glands of lips and cheek • Mixed type 5/8/2016 36 GLOSSOPALATINE GLANDS • Posterior extension of sublingual gland to glands of soft palate • Pure mucous Burketts oral medicine diagnosis and treatment planning 10th edition
  37. 37. PALATINE GLANDS • Posterolateral regions of the hard palate and the submucosa of soft palate and uvula • Pure mucous 5/8/2016 37 LINGUAL GLANDS • Antr linual – apex of tongue (Glands of Blandin and Nuhn) – mucous • Postr lingual – postr to circumvallate papillae, tonsil – mucous Burketts oral medicine diagnosis and treatment planning 10th edition
  38. 38. VON EBNER’S GLANDS • Posterior lingual serous glands • Secretions wash out the troughs of the papillae • Play a role in taste reception • Studies suggest – digestive and protective function 5/8/2016 38 Burketts oral medicine diagnosis and treatment planning 10th edition
  39. 39. BIOCHEMISTRY 5/8/2016 39
  40. 40. COMPOSITION OF SALIVA 5/8/2016 40 Water 99% Others 1% Primary Composition of saliva Water Others Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161
  41. 41. COMPONENTS OF SALIVA (CONTD…) 5/8/2016 41 Organic protiens Salivary amylase immunoglubulins Protiens synthesized within glands glycoprotiens lipids Blood group Antigen A,B Hormones Parathyroid Growth factor carbohydrates Glucose hexosamine • Alpha amylase • Kallikrien • Dextranases • Alpha phosphtase • lipase • IgA • IgM • IgG • Factor VII • Factor VIII • Factor IX • Platelet factor • MG1,MG2 • Protien rich glycoprotiens Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161
  42. 42. 5/8/2016 42 inorganic sodium potassium calcium phosphorus chloride bicarbonate Cells : • Yeast • Bacteria • Protozoa • Polymorphonuclear lymphocytes(PMNL) • Desquamated epithelial cells Gases: • Oxygen • Nitrogen • carbondioxide Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161
  43. 43. PROPERTIES OF SALIVA • Ph : 5-8 • Specific gravity : 1.0024 – 1.0061 • Freezing point : 0.07 – 0.34 degree Celsius • Velocity : 0.8 – 8 mm/minute • Flow rate : 0.3 ml/min when unstimulated and 1.5-2 ml/min when stimulated 5/8/2016 43Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161
  44. 44. PHYSIOLOGY 5/8/2016 44
  45. 45. FUNCTIONS OF SALIVA • Digestive • Protective • Taste • Excretion • Water balance • Oral hygiene 5/8/2016 45
  46. 46. DIGESTIVE FUNCTION • -Amylase (ptyalin) – It is a calcium dependent digestive enzyme – It is activated by Cl. – It acts on cooked starch – Optimum pH= 6.8 – It is inactive below pH 4 • Lingual lipase – Von ebner gland – It is responsible for the first phase of fat digestion. 5/8/2016 46
  47. 47. Bolus formation • Moistening of food (Water) • Mucin – It is a lubricating material, makes food slippery, facilitates swallowing 5/8/2016 47
  48. 48. PROTECTIVE FUNCTIONS • Lubrication properties – Coating of tissue( Mucin) – Lubricatory film- resistance to friction – Prevent desiccation • Maintenance of mucous membrane – Salivary mucins • Tissue hydration • Control of permeability • Protective against proteolytic enzymes formed in inflammation and ulceration 5/8/2016 48
  49. 49. Soft tissue repair • Nerve growth factor Wound • Epidermal growth factor healing • Speeds up the coagulation properties. • Dilutes anti-thrombin factor in traumatic area 5/8/2016 49
  50. 50. Debridement/Lavage • Physical flow of saliva – removal of bacteria and food debris . Aggregation • IgA system- Inhibit bacterial attachment • Mucin – aggregation of bacterial cells. • Macromolecules- compete for attachment site 5/8/2016 50
  51. 51. Direct antimicrobial • Enzymes: – Lactoferrin – Lysozyme – Human Salivary peroxidase , Myeloperoxidases. – IgA system – Chitinase. • Peptides: – Histidine rich peptide-(histatin-5) Growth inhibitory, Bactericidal. – B- defensins. – Calprotectin – Chromogranin A 5/8/2016 51
  52. 52. DEFENDER OF THE ORAL CAVITY: Mucins & Agglutinins Cystatin Von Ebner Gland Protein(VEGP) Tissue inhibitors of metalloproteinase(TIMPS Extra parotid glycoprotein Secretary leucocyte proteinase inhibitor(SLPI)
  53. 53. 8. Gingival crevicular fluid – IgG – Lysozyme, Lactoferrin (liberated from phagocytic cells) – PMNs - Phagocytosis
  54. 54. 9. Maintenance of pH (Buffer) • Bicarbonate – Main buffering ion –Unstimulated saliva--- Less bicarbonate –Flow rate Bicarbonate –Pass through the plaque—Acid neutralization
  55. 55. 9. Maintenance of tooth integrity – Enamel pellicle – Increased surface hardness, Resistance to caries – Decreased permeability – Regulation of ionic environment in plaque, oral cavity PRP, Statherin: • Subsurface lesion remineralization • Inhibition of calculus • Maintains Ca- phosphate supersaturation in saliva
  56. 56. 10. Antifungal activity Histatin peptide 11. Epidermal growth factor –Maintenance of oro - esophageal and gastric tissue integrity –Healing of ulcers –Stimulation of DNA synthesis
  57. 57. 12. Hormonal function • Parotin-deposition of Ca on tooth • Nerve growth factor- growth of sympathetic ganglia. 13. Excretory function Drugs- Route of elimination
  58. 58. 5/8/2016 58
  59. 59. MECHANISM OF SALIVARY SECRETION 5/8/2016 59 Acinar cells K+ and HCO3- by active process Along with Cl- for electrical neutrality Simultaneous secretion of water into acinar lumen Primary isotonic saliva Salivary duct cells – Rich blood suply Actively reabsorb Na+ and Cl- And transfer K+ and HCO3- Into saliva Impermeable to water Final Hypotonic saliva Salivary secretion can be defined as a unidirectional movement of fluid electrolytres and macromolecules into saliva in response to appropriate stimulation Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Pete M Smith
  60. 60. MECHANISM OF SALIVARY SECRETION 5/8/2016 60 Two stage salivary gland secretion model. In stage 1: • Acinar cell secrete a NaCl-rich fluid called primary saliva - isotonic In stage 2: • The primary saliva - modified - passage along the ductal tree (reabsorbing NaCl and secreting KHCO3). • Ductal epithelium - poorly permeable to H2O • Final saliva - hypotonic. Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Pete M Smith
  61. 61. CONTROL OF SALIVARY SECRETION PARASYMPATHETIC STIMULATION SYMPATHETIC STIMULATION 5/8/2016 61 Increased by parasympathetic and parasympathetic activity Release of proteolytic enzyme – kallikrien Alpha 2 globulins Into the interstitial fluid bradikynin Vasodilation of blood vessels Stimulates secretion from acini Release of saliva rich in Organic substances + mucus (process similar to parasympathetic stimulation takes place) Submandibular and sublingual glands Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Pete M Smith
  62. 62. FACTORS AFFECTING SALIVARY FLOW RATE Diurnal variation • Protein concentrations tend to be high in the afternoon • Sodium and chloride concentrations are high in the early hours of the morning 5/8/2016 62
  63. 63. • Potassium high in the afternoon • Calcium and phosphate concentrations appear to remain stable during the day • Calcium concentration increases in the night 5/8/2016 63
  64. 64. Duration of stimulus If the salivary glands are stimulated for longer than 3 minutes, the concentration of many components is reduced , although after a short period , bicarbonate, calcium and protein concentrations begin to rise again 5/8/2016 64
  65. 65. Dietary factors Functional salivary glandular activity is influenced by mechanical or gustatory factors Plasma concentrations Amino acid, calcium, glucose, urea are correlated with those in plasma 5/8/2016 65
  66. 66. Hormonal influences • Aldosterone – increased sodium reabsorption in the striated ducts • Antidiuretic hormone – water reabsorption by the striated duct cells 5/8/2016 66
  67. 67. 5/8/2016 67
  68. 68. ROLE OF SALIVA IN DIAGNOSIS 5/8/2016 68
  69. 69. COLLECTION OF SALIVA STIMULATED • Expectoration every 30-60 seconds – Gustatory- Acids – Mechanical- Chewing Paraffin wax, rubber band UNSTIMULATED • Draining method • Spitting method • Suction method • Swab method 5/8/2016 69 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  70. 70. SALIVA FUNCTION TEST SIMPLE SCREENING TESTS • Sialometry • Visual inspection of saliva • pH and buffering capacity • Dip stick tests OTHER TESTS • Carlson Crittenden collector (parotid gland) • Peristron (minor salivary glands) 5/8/2016 70 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  71. 71. SALIVA IN ONCOLOGIC DIAGNOSIS • Saliva used in the diagnosis of many malignancies (mutation of tumour suppressor - gene p53 – malignancy – 50%) – Spino-cellular carcinoma – Breast cancer – Blood cancer (level of neutrophils) 5/8/2016 71 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  72. 72. SALIVA IN CARDIOVASCULAR DISEASES • Salivary amylase as a protien biomarker • Primary function – break down sugars • Studies show that there is an increased production of salivary amylase during high stress 5/8/2016 72 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  73. 73. SALIVA IN DIAGNOSTIC TESTING OF DRUGS • Previously used – urine • Salivary glands – highly vascular – easy cross over of drugs from blood to saliva • Level of drugs remain in saliva for a number of hours after intake • Egs : Amphetamines, Barbiturates, Benzodiazepines, Marijuana, Cocaine, Heroin, NIcotine 5/8/2016 73 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  74. 74. SALIVA IN DIAGNOSIS OF INFECTIOUS DISEASES • Bacterial : – Mycobacterium tuberculosis – high levels in saliva in acute stages • Viral : – HIV : ELISA + Western blot tests – higher chances for accurate results with saliva (studies also suggest levels of HIV will be lower in saliva than in blood) 5/8/2016 74 SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.
  75. 75. PATHOLOGY 5/8/2016 75
  76. 76. SALIVARY GLAND DISORDERS Developmental disorders Functional disorders Obstructive disorders Inflammatory/ infectious disorders Immunological disorders Neoplastic disorders Asymptomatic enlargement 5/8/2016 76 • Burkett's Oral medicine diagnosis and treatment planning 10th ed • Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz
  77. 77. DEVELOPMETAL DISORDERS • Abberancy • Aplasia • Hypoplasia • Hyperplasia • Atresia • Accessory Ducts • Diverticuli • Congenital fistula 5/8/2016 77 • Burkett's Oral medicine diagnosis and treatment planning 10th ed • Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz
  78. 78. FUNCTIONAL DISORDERS • Sialorrhoea • Xerostomia 5/8/2016 78
  79. 79. OBSTRUCTIVE DISORDERS • Sialolithiasis • Mucous plug • Stricture & Stenosis • Foreign bodies 5/8/2016 79
  80. 80. ASYMPTOMATIC ENLARGEMENT • Sialosis; • Allergy • Malnutrition & Alcohol related 5/8/2016 80
  81. 81. INFLAMMATORY/ INFECTIOUS DISORDERS • Bacterial • Viral 5/8/2016 81
  82. 82. AUTOIMMUNE DISORDERS • Sjogren’s syndrome • Mikulicz’s disease 5/8/2016 82
  83. 83. NEOPLASMS • Benign – Warthin’s tumor – Pleomorphic adenoma • Malignant – Malignant Pleomorphic Adenoma – Adenoid Cystic Carcinoma – Mucoepidermoid Carcinoma – Acinic cell tumor – Adenocarcinoma; – Squamous Cell Carcinoma 5/8/2016 83
  84. 84. SIALORROHEA 5/8/2016 84 Etiology Acute inflammation of oral cavity Oral cancer teething Patients with neurological disorders Decreased swallowing frequency
  85. 85. SIALORRHEA (CONTD…) • TREATMENT – Drugs : Anti-histamine (xerostomia inducing) (Pilocarpin, Cevimeline cause increased salivation) – Temporary injection of botulinum toxin into parotid gland – Surgery : Mandibular duct diversion • ANTISIALOGOGUES – They are parasympathetic or cholinergic blocking agents include atropine and its related alkaloids obtained from the plant. 5/8/2016 85
  86. 86. XEROSTOMIA ETIOLOGY • Aplasia or hypoplasia of the gland • Surgical excision of the gland • Post menopausal period • Uncontrolled diabetes mellitus • Dehydration • Primary aldosteronism • Alcoholism • Malnutrition • Sialolithiasis • Mumps • Sjogrens syndrome • Vitamin deficency • Fear,anxiety,over excitemen 5/8/2016 86
  87. 87. Causes of long standing xerostomia 5/8/2016 87 Iatrogenic Drugs Local radiation Chemotherapy Diseases Diabetic mellitus Cystic fibrosis Primary biliary cirrhosis Hepatitis c virus infection HIV
  88. 88. 5/8/2016 88 Preventive therapy Symptomatic treatment Salivary stimulation T r e a t m e n t XEROSTOMIA (CONTD…)
  89. 89. PREVENTIVE THERAPY Topical fluorides Maintain meticulous oral hygiene Remineralising solutions 5/8/2016 89
  90. 90. SYMPTOMATIC TREATMENT water Increasing humidity of the environment Oral rinses and gels Salivary substitutes 5/8/2016 90
  91. 91. SALIVARY STIMULATION • Local or topical stimulation – Chewing – sour and sweet tastes – Electrical stimulation • Systemic stimulation – Bromhexine (Mucolytic agent) – Anetoletrithione (mucolytic agent) – Pilocarpin (Parasympathomimetic drug) 5/8/2016 91 PILOCARPIN : • functions as a muscarinic cholinergici • Side effects – sweating, hot flashes, urinary frequency, diarrhea, blurred vision • Dosage: 5.0-7.5 mg 3-4 times daily • Contraindicated : pulmonary disease, CVS diseases, glaucoma, urethral reflux
  92. 92. CLINICAL ASPECTS 5/8/2016 92
  93. 93. ROLE OF SALIVA IN PROSTHODONTICS • Denture retention (maxillary denture more than mandibular) • Difficulty in impression making if saliva too mucous Atropine sulfate – prior to impression making • Denture stomatitis (due to lack of salivary mucins) • Alteration in taste perception due to denture 5/8/2016 93 Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235.
  94. 94. Denture retention – physical agent • Cohesion • Adhesion • Surface tension • Capillary attraction • Atmospheric pressure 5/8/2016 94 Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235.
  95. 95. 5/8/2016 95 COHESION • Molecular attraction between two similar surfaces in close contact. • It occurs in the layer of saliva between the denture base and mucosa. ADHESION • Physical molecular attraction of unlike surfaces in close contact. • It acts when saliva wets and sticks to the basal surfaces of dentures Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235.
  96. 96. 5/8/2016 96 SURFACE TENSION • Resistance to separation by the film of liquid between two well adapted surfaces. • It is found in the thin film of saliva between the denture base and the mucosa of basal seat. CAPILLARY ATTRACTION • Force that causes the surface of liquid to become elevated or depressed when it is in contact with a solid. • On close adaptation of the denture, the space filled with a thin film of saliva acts like a capillary tube and helps retain the denture. Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235.
  97. 97. DISTRIBUTION OF SALIVA OVER A DENTURE 5/8/2016 97 Complete coverage of denture and mucous membrane • No meniscus – hence no retention Coverage of mucous membrane and partial coverage of denture • Produces a meniscus – retentive force exists Coverage of basal tissue denture surface • Meniscus present – hence considerable retentive force present Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235.
  98. 98. ROLE OF SALIVA IN PERIODONTAL DIAGNOSIS • Saliva used to identify the onset of certain diseases • Biomarkers – small molecules – monitor disease onset, treatment response and outcome 5/8/2016 98 Biomarkers Specific SystemicNon- specific Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009, 52-64
  99. 99. 5/8/2016 99 Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009, 52-64
  100. 100. CONCLUSION The components of saliva act as a mirror of the body’s health. With emerging trends in microbiology, immunology and biochemistry, salivary testing for clinical & research purposes ,is proving to be a practical and reliable method of recognizing a number of diseases . As a consequence these advances in technology are not confined to oral health characteristics but may be used to measure features of overall health. 5/8/2016 100
  101. 101. BIBLIOGRAPHY • Orban's oral histology and embryology 10th ed • Burketts oral medicine diagnosis and treatment planning 10th edition • Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz • Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ (2000)50; 140-161 • Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244 • Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161 5/8/2016 101
  102. 102. • Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Peter M Smith • Saliva as a diagnostic medium ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110. • Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235 • Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009, 52-64 5/8/2016 102
  103. 103. 5/8/2016 103 THANK YOU AND HAVE A PLEASANT DAY!!!
  104. 104. SALIVA IN DENTAL CARIES • Saliva plays an important role in reduction of caries by its buffering, clearance, antibacterial and antibody actions. • Xerostomia is usually associated with increased caries. This is due to:- • pH • buffering capacity • clearance of food 5/8/2016 104
  105. 105. SALIVA IN FORENSICS • Saliva is deposited usually through bitemarks. • It can also be retrieved from cigarette butts, postage stamps, envelopes, clothes and skin. OTHER TESTS INCLUDE: • Fluorescence detection method • Chemical method • Thiocynate test 5/8/2016 105 Initially – detect the presence of alpha-amylase enzyme ( Phadebas – chemical reagent) Later – the molecule on the whole could be detected Lateral flow Immunochromatographic strip test, rapid stain identification – Confirmation.
  106. 106. XEROSTOMIA – A COMPLICATION OF ANTIHYPERTENSIVES • Identify the drug • Decrease dosage or change the drug • Artificial salivary stimulants • Chewing or electrical stimulation • Sialogogues – Cholinergic drugs 5/8/2016 106
  107. 107. CONTRAINDICATIONS OF ATROPINE • Glaucoma (atropine is used commonly for the dilation of pupils) • Pyloric stenosis • Prostate enlargement • Substitute : Propantheline bromide 5/8/2016 107
  108. 108. MODIFIED SCHIRMER’S TEST • Variation of schirmer’s test used for the eye • Caliberated Whatman 41 filter paper • Stripis placed on the floor of the mouth – absorbed by the filter paper • After 5 mins – wetted length is measured (in mm) • rate of saliva secretion is measured in mm/5min 5/8/2016 108

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