Role of Saliva in Dentistry

Presented by:
Dr. Kanchan Sahwal
IInd Yr MDS
Dept. Of Prosthodontics, RDC, Loni
ROLE OF SALIVA
19 June 2017
1

Content
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 Introduction
 Glands
 Physiology
 Formation of Saliva
 Composition of Saliva
 Secretion of Saliva
 Factors affecting the
composition
 Function of Saliva
 Test for detection of
Saliva
 Xerostomia
 Sjögren's Syndrome
 Excess Salivation
 Aging and Saliva
 Role of Saliva
 Complete Denture
 Artificial Saliva
 Fixed Prosthesis
 Implant
 Salivary Biomarkers
 Review of Literature
 Conclusion
 Reference

Introduction
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 Saliva is a clear, slightly acidic mucoserous
exocrine secretion.
 It is a complex mix of fluids from major and minor
salivary glands and from gingival crevicular fluid
(GCF), which also contains oral bacteria,
desquamated epithelial cells and food debris.
 Secretion: 0.3ml/min at rest
1.5-2 ml/min when stimulated
 pH 6.4 – 7.4
 Volume: 750 – 1000ml/day
Orban’s Oral Histology & Embryology

Glands
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4 Gray’s anatomy 40th edition

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Parotid
• In front of the
external ear
• Largest,
Pyramidal,
Lobulated
• Stensen’s duct
• 20%
contribution of
daily output
(50%)
• Serous
Submandibular
• Posterior border
of mylohyoid
• Walnut size
• Wharton’s duct
• 65%
• Predominantly
serous
Sublingual
• On the
mylohyoid
• Almond size
• Bartholin’s
Duct
• 7-8%
• Predominan
tly mucous
Gray’s anatomy 40th edition

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Minor Salivary Glands
1. Labial - Mixed
2. Buccal - Mixed
3. Palatoglossal -
Mucous
4. Palatal - Mucous
5. Lingual
a. Anterior –
Mucous
b. Posterior –
Mucous
c. Deep – Serous
Gray’s anatomy 40th edition

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 Types of cell in salivary gland
 Acinar cell – First secretion of saliva takes place
 Duct cell
 Intercalated – First to connect. No function
 Striated – Electrolyte regulation (Na)
 Excretory – Na resorption and secreting K
 Myoepthelial cell – Causing “squeezing out” action
under neural control.
Formation of Saliva
A review of saliva: normal composition, flow, and function. Sue Humprey. JPD

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Primary and Secondary
secretion
 From the acinar cells and then
it is modified in the duct.
 Na, Cl ions in lumen causing
osmotic gradient for the
movement of the saliva.
 Before secretion, Na is
reabsorbed, Cl is passively
moved, K and HCO3 ions are
secreted.
 The macromolecules like
amylase, mucous glycoprotein
are formed in ER and is
secreted by exocytosis.
Saliva: Its Secretion, composition and functions. W. M. Edgar. BDJ

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Signal Transduction
 Stimulated nerve for the ↑sed salivary flow is by
neurotransmitter.
 These include noradrenaline (sympathetic) and
acetylcholine, substance P and vasointestinal
polypeptide (parasymphathetics).
 Two pathways : Phospholipase C and Adenyl
Cyclase.

Secretion of Saliva
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 The glands have neural control but is influenced by
hormones.
 Controlled by Autonomic Nervous System
 Sympathetic – Amylase and Vasoconstrictor
 Parasympathetic – Watery, Secretomotor and
Vasodialator

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 Resting flow:
Slow flow of saliva which keeps the mouth moist and
lubricates the mucous membranes. The majority of the
time, is very important for the health and well being of the
oral cavity.

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 Circannual: Low during summer, peak during
winter.
 Circadian variation: Affect the flow and also the
components.
 Circadian Daily flow rate: Peaks at approximately
5pm with a minimum flow during the night. It is
independent of eating and sleeping behavior.
 Light and arousal: The effect of usual input in
maintaining a state of arousal. Saliva flow in much
reduced during sleep.
 Dehydration: Loss of 8% body water. Presenting
thirst.

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 Psychic Flow
A mouth watering sensation is a sensation of sudden
flow of saliva into the mouth

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 Unconditional reflexes: Associated with feeding;
masticatory movement and especially taste.
 Mastication: Detect the presence of a bolus and its
mastication and stimulate the salivary nuclei to
increase the parasympathetic secretomotor
discharge.
 Gustatory stimuli: Sour stimuli are more effective,
followed by sweet, salt and bitter. Most foods also
elicit olfactory stimuli as well.
 Other stimuli: Salivation as well as nausea
frequently occur just before vomiting, perhaps as an
attempt to dilute or neutralized the irritant which is
giving rise to nausea.
 Hypersalivation (ptyalism) is also described in
pregnancy, but the physiologic basis is unclear

Composition of Saliva
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Organic Components
• Mucins
• PRP & other Polypeptide
• Amylase
• Lipase
• Sialoperoxidase
• Lysozyme
• Lactoferrin
• Salivary IgA
• Histatins
• Statherin
• Blood group substances,
sugars, steroid hormones,
amino acids, ammonia, urea.
Inorganic Components
• Calcium
• Phosphate, Urea &
Bicarbonate
• Fluoride
• Thiocyanate
• Sodium, Potassium,
Chloride
• Lead, Cadmium, Copper

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Organic Components
 Mucin: Coating the food. Aggregation of micro-
organism and formation of plaque. The properties of
high solubility, viscosity, elasticity and adhesiveness.
Types MG1, MG2.
 PRP and Other polypeptide: PRP’s and Sialherrin
bind to hydroxyapatite crystals and prevent calculus
formation in the duct and on the teeth. Sialin regulates
the pH by formation of end products.
 Amylase and Lipase: Starch and fat digestion.
 Sialoperoxidase: It forms a potent antibacterial by
the H2O2 released by the bacteria as an oxidant.

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 Lysozyme: Antibacterial action by lysic attack to the
cell wall of the bacteria.
 Lactoferrin: Removes free iron from the saliva and
depletes the supply of the bacteria. Also have
bacteriostatic & bactericidal effect.
 Salivary IgA: Prevent the cohesion of bacteria to the
tissue and teeth. Antiviral action (rhinovirus,
poliovirus, HIV).
 Histatin: Secreted by parotid has antifungal action
(C. albicans).
 Statherin: Inhibits super saturation of saliva &
calculus formation.
 Blood group substances, sugars, steroid hormones,
amino acids, ammonia.
1992; 172: 305

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Inorganic Components
 Calcium: Antisolubility factor (also Phosphate) for
modulating the demineralization and remineralization.
 Phosphate, Urea and Bicarbonate : Modulate pH
and buffering action.
 Fluoride: Formation of fluorapatite
 Thiocyanate: Antibacterial effect with
Sialoperoxidase
Saliva: Its Secretion, composition and functions. W. M. Edgar. BDJ 1992; 172:
305

Factors Influencing the composition
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 Flow rate: With the ↑se in flow rate there is
decreases in ductal fluid(bicarbonate, Phosphate,
Mg) except bicarbonate.
 Differential gland contribution: Parotid contains
lower level of Ca then submandibular gland. During
stimulated flow the parotid contribution increases from
10% to 50%. Therefore the Ca levels in whole saliva
decreases.
 Circadian rhythm: Ca & Phosphate levels are low in
morning.
 Duration of stimulus: Variation in composition with
the duration in stimulation.
 Nature of stimulus: Salt stimulates high protein
content and sugar stimulates high amylase content.
The effect is insignificant.

Function of Saliva
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1. Digestion
 Salivary amylase initiates the digestion of starch,
Lipase for fat digestion.
2. Lubrication
 Speech, Mastication, Swallowing, Oral health and
comfort.
 It removes the debris by transporting it to the
oropharynx.
 Lubricates and moistens the moving tissue (important
for denture wearers).
 The viscosity is non-newtonian. It has visco-elastic
properties know as Spinnbarkeit.

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3. Dilution and Clearance
 Water content dilutes the bolus and clearance is by
swallowing or spitting.
 Debris Clearance depends of the movement of the
film (0.8-8 mm/min).
4. Neutralization and buffering
 Saliva is alkaline. So it prevents the acid attack form
the food and plaque.
 Bicarbonate in stimulated saliva, Proteins and
phosphates in unstimulated saliva.

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5. Saturation
 Saliva is supersaturated with tooth mineral, If not so
the teeth would dissolve in saliva. This supersaturated
solution helps for the and remineralization.
6. Antibacterial effects
 IgA – aggregation of bacteria and preventing their
adhesion,
 IgG – Bacterial lysis.
 Sialoperoxidase, Lactoferrin, Lysozyme, Thiocyanate,
Histatin, Amylase (in bronchial and urogenital
secretion).
 Nutritional Immunity, Clumping process (also mucin).

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7. Pellicle and Plaque Formation
 High molecular highly glycosylated mucin
(MG1)contribute to pellicle formation. It protects the
teeth from the chemical and mechanical insult
(plaque, carcinogens in smoking, mouth breathing).
 MG2 binds to enamel and is easily displaceable.
 Selective bacterial growth of non-cariogenic micro-
flora.
8. Taste Perception
 Tasting capabilities depend when proteins and gustin
bind to zinc.
Saliva: Its Secretion, composition and functions. W. M. Edgar. BDJ 1992; 172:
305

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9. Tooth Integrity
 High levels of calcium and phosphate contribute for
the maturation and remineralization of tooth.
 Statherin stabilizes the Ca and PO4 level, initiate
pellicle formation with in turn protects the tooth wear.
 During remineralization formation of fluorapatite
crystals which is stronger and caries resistant then
the enamel.

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10. Mucous membrane integrity
 Mucins acts as the “natural proofing” for keeping the
tissue hydrated and preventing sudden osmotic
change.
 Also helps in soft tissue repair as it contains
(Epidermal growth factor) EGF which speeds
epidermal regeneration of mid-dermal skin injuries.
 Also called as “licking one’s wound”.
 EGF is present in parotid and submandibular
secretions.
 Studies on effect of EGF on oral wound healing are
not yet approved.
The role of saliva in maintaining oral homeostasis. I. Mandel. JADA

19 June 2017
26 Annual review.: The secretion, components and properties of
saliva. Guy Carpenter. 2013. 4. 267-276

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 Saliva was also used by the ancient judicial
community in its service to the public.
 The accused was asked to chew a handful of
rice; if fear it inhibited the secretory function that
he could not form a bolus.
The functions of saliva. I. Mandel. JDR 1987;66:623-627.

TEST
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1. Visual examination for hydration
2. Visual Examination for viscosity: It should be clear &
watery consistency. Stringy, frothy, bubbly
appearance suggest ↓water.
3. Testing pH of unstimulated saliva flow
Saliva: A powerful diagnostic tool for minimal intervention dentistry.
Ranganath et al. J of contemporary dental practise.2012;

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4. Testing flow of stimulated saliva (Quantity)
5. Testing buffering capacity of stimulated saliva
(Quality)
6. String Beading Test
Saliva: A powerful diagnostic tool for minimal intervention dentistry.
Ranganath et al. J of contemporary dental practise.2012;

 In greek it means dry + mouth.
 Atrophy of cells lining the intermediate ducts and
decrease salivary flow rate (due to drugs or
systemic illness).
 ↓Ptyalin content and ↑Mucin content = More
viscous and ropy saliva. (9:1)
Xerostomia (Asialorrhea)
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Essentials of complete denture prosthodontics. Sheldon Winkler. 3rd edition.
Anticholinergic: Atropine,
scopolamine
Diabetes mellitus Menopause
Antidepressants:
Amitryptyline, Nortryptyline
Diabetes
insipidus
X-ray radiation
Antipsychotics: Benztropine,
Phenothiazine
Nephritis Vitamin
deficiencies
Antihypertensive: Clonidine Pernicious
anemia
↓ SGH

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Clinical Feature:
 Burning of oral tissue and
tongue, Fissuring of tongue,
Cracking of lips, Halitosis.
 Dry, rough, sticky mouth,
Hoarse voice. (difficulty in
taking)
 Mouth sore due to denture
always.
 Sipping fluids frequently to
avoid tongue sticking to the
roof or side of the mouth.
1989;119:298-304.

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Clinical Feature:
 Difficulty in eating and sometime
impossible.
 Fillings falling out of mouth.
 Teeth are crumbling away.
 Reduced BMI, skin fold
thickness.
 Interrupted sleep to sip water
1989;119:298-304.
th

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 Careful cleansing of the mouth before
sleep as the salivary flow rate is
reduced.
 Use of sugarless chewing gums
(xylitol, sorbitol) with acidic or sweet
taste to stimulate the desired flow.
 Home fluoride treatment for caries
management.
 As loss of taste acuity is present
avoiding of spices and flavors as
tongue is often painful.

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MANAGEMENT of Xerostomia Denture patient
 Frequent mouth rinse and good hygiene to prevent
candidiasis.
 Denture usage for short period of time.
 Coating the denture surface with artificial salivary
substitute.
 Nutritious diet/soft and moist food.
 Lowering the dosage or changing the drug..
 Pilocarpine HCl 5mg dose(10 drops of a 10% solution) if
the glandular function is present
 Sour hard candy as a Sialogogues.
 Nutrional deficiency: Nicotinamide 250-400mg 3times a
day - 2 weeks.

Sjögren’s Syndrome
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 Chronic inflammatory autoimmune disorder at any
age.
 Primary and Secondary SS.
 Often said as old people do not cry with tears, “they
cry inside”.
Clinical feature:
 Dry, gritty, sore, burning eyes. Sensitivity to sun/tear
 Recurrent eye and mouth infections.
 Difficulty in speaking, chewing and swallowing.
Increased dental decay. Altered taste/smell. Cracked
tongue or lips
 Dry nasal passage and throat, dry cough,
Prosthodontic treatment for edentulous patient. Zarb. 13th edition

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Diagnosis:
 History, complaints.
 Oral examination and symptoms.
 It takes 5 to 9 years for SS to be diagnosed.
Investigation:
 Flow rate test, Sialography, etc.
Management
 Symptomatic Rx (Ocular lubricants with Rx of
Xerostomia.)

Excess Salivation
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 Associated with parkinson’s disease,
Down’s syndrome, autism, cerebral
palsy.
 The denture acts as a foreign body in
mouth and as sialogogues thereby
stimulating salivary flow.
 Diagnosis: Ropy, Thick saliva causes
↑in hydrostatic pressure anterior to
PPS resulting in the downward
dislodgement force on the denture base.
 Management: To prevent this the
CUPID BOW fine line can be scribed on
the master cast anterior to the cluster of
palatal mucous gland as it contains the
thick mucus to provide seal.

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Other causes:
1. Incorrect centric jaw relation registrations
2. Excessive vertical dimension
3. Overextension of denture borders
4. Pain and excessive pressure upon the oral mucosa
5. Pressure upon nerves and their terminal
ramifications
6. Excessive stimulation of the salivary glands by the
dentures acting as a foreign body
7. Excessive thickness of the dentures restricting the
tongue in its static state, as well as in function
8. The patient’s anxiety about possible failure of the
dentures.
Troubleshooting in complete denture prosthesis part IX. Joseph Landa. JPD.1961;

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Management:
 Atropine sulfate (0.4-1.6mg
orally)
Sublingual: 1-2 drops of 0.5%
solution, every four to six
hours (Hyson et al. Sublingual atropine
for sialorrhea secondary to parkinsonism:
a pilot study . Mov Disord. 2002; 17 (6):
1318-20)
 Reassurance
Troubleshooting in complete denture prosthesis part IX. Joseph Landa. JPD.1961;

Aging and Saliva
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 The fat and fibrovascular
tissue increased as the
acini decreased.
 Functional parenchyma are
replaced by C.T. & fat. It
helps in diagnosis of
Sjögren’s Syndrome.
 The flow rates are less in
healthy women than in
healthy men.
 The healthy elderly have
sufficient salivary capacity
but require extra
Special care in Dentistry. Arjan Vissink et al.1996; 16:95-103

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 So if the elderly pt. come with the complaint of
oral dryness the diagnosis can be Sjögren’s
syndrome, Use of drugs, Head and neck
radiotherapy.

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 Use of drugs like: anti-arrhythmics, diuretics, anti-
depressants, anti-hypertensives.

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 No significant age changes in the organic and
inorganic components of the saliva.
 MG1, MG2, Salivary IgA show some reduction as
increasing age and might result in mucosal
inflammation process.
AGE
CHANGE

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Denture Retention: The resistance in the movement of a
denture away from the tissue foundation especially
in a vertical direction (GPT – 9).
1. Adhesion
2. Cohesion, Surface Tension, Viscosity
3. Atmospheric Pressure
4. Shape and Weight of the denture
5. Contact between polished surface and lips and
cheeks
6. Material
7. Occlusion
8. Articulation
Saliva and denture retention. Ostlund. JPD 1960; 10: 658-
Role of Saliva in Complete
Denture

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1. Adhesion : Physical attraction of molecules to
substance or molecular attraction existing between
the surfaces of the bodies in contact. (GPT-9).
Between saliva and denture, saliva and the tissue
surface. Force is 10-6cm per 0.000001cm. The
thickness of saliva when denture is placed is
0.1mm
2. Cohesion, Surface Tension, Viscosity: Act or state of
sticking together tightly. (GPT-9). Cohesion is
negligible force as compared to adhesion.
Physical Factors in retention of Complete Denture. JPD 1971;

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 Surface Tension: It is the tension maintained at the
surface of the liquid. Surface tension of the saliva is
less then that of water. Therefore, the viscosity is in
proportion to the surface tension.
 Viscosity: Cedervarn in 1950 said viscosity is
important factor for the retention but couldn’t
demonstrate.
The retention is only provided in the initial phase as
later the volume increases from the glands.

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3. Atmospheric Pressure: While dislodging, the pressure
difference inside the denture with surrounding
atmosphere (outside the denture).
 Capillary attraction: Ability of the liquid to flow in
narrow space. It does not act on the surface, it require
two bases to act. Therefore, it is a force whose
magnitude is the difference of the attraction of the
exterior atmosphere and the saliva under the denture.

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4. Shape and Weight of the denture
5. Contact between polished surface and lips and
cheeks
6. Material
7. Occlusion and Articulation
Saliva and denture retention. Ostlund. JPD 1960; 10: 658-

Artificial Saliva
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 Intrinsic (medication)
 Extrinsic (Topical)
Artificial saliva: present and future. Levine et al. J. Dent Res.1987;66:693-698.
Carboxymethylcellulose Lubrication and viscosity
Animal Mucin Emulsion of food,
Swallowing,
Distribution of substitute
Xylitol or Sorbitol Sweetener
High surface tension
Mineral salts To mimic electrolyte
Fluorides Remineralization
Preservatives
a) Methyl p-hydroxybenzoate
b) KSCN + H2O2 →
Hypothiocyanate
Preservative

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TECHNIQUE OF CONSTRUCTING RESERVOIRS
(Maxillary)
1. Contour the external palatal surface of wax with
functional movements of the tongue (as in
swallowing, speech, and mastication) in trial
denture.
2. Complete waxing of the denture, invest it, and boil
out the wax.
3. Construct a chrome-cobalt palatal plate only on the
palatal.
4. The metal palate is 0.45 mm thick at the centre and
1mm thick where it joins the acrylic base.
6. Drill two holes and fill it with the reservoir and glue to
the cast.
7. Pack and Cure.
Artificial saliva reservoirs. Vissinik et al. JPD 1984;52:710-715.

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TECHNIQUE OF CONSTRUCTING RESERVOIRS
(Mandibular)
1. Before the mandibular denture is constructed, make
a block of acrylic resin posterior teeth that slide into
a metal track. To aid retention in the acrylic resin,
four strips of stainless steel are spot-welded to the
outside of each track.
2. The acrylic resin section is waxed as needed,
invested, boiled out, and a silicon mold made.
3. Pack the mold with a tooth-colored acrylic resin and
cure.
4. Construct the mandibular denture with an accepted
technique.
5. The prefabricated posterior teeth and the metal track
are used in the wax trial denture. Complete the
denture waxing, invest it, and boil out the wax.

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6. Replace a 1.5 mm thickness of wax in the upper half of
the mold. Keep the opening of the track free of wax.
7. Replace all of the wax in the lower half of the mold.
8. Invest each half of the flask with a second
complementary half of the flask.
9. At the end of the curing process the mandibular denture
consists of two parts.
10. Mount both parts in an articulator and fix them together
with self-curing acrylic resin.
11. The reservoir will pass from one arch to other.
12. Drill saliva escape hole low on lingual surface of midline.

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PALATAL PROSTHESIS FOR DENTULOUS PATIENTS
1. Make a shellac baseplate. Add wax on the external
baseplate.
2. Place four clasps for retention of the prosthesis.
3. Invest the maxillary cast with the waxed baseplate
and dewax.
4. Make a chrome-cobalt metal base on a duplicate
cast.
5. Complete the fabrication as described for maxillary
dentures.

Sialogogues
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LOCAL SYSTEMIC
1% malic acid
Sugar free chewing gum
Pilocarpine (Isopto Carpine,
Salagen)
5mg, PO, T.i.d.
3 months
Saliva substitute –
Carboxymethylcellulose/
Hydroethylcellulose
Mucin spray
Cevimeline (Evoxac)
30mg, PO, T.i.d.
6 weeks
Saliva stimulants – Gel,
Mouthwash, Toothpaste
(OTC)
Diagnosis and management of xerostomia and hyposalivation.
Alessandro Villa. Ther Clin Risk Manag. 2015;11:45-51

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 Salivary Substitute
Xerostomia Etiology, recognition and Treatment. Guggenheimer et al. JADA
Moi- Stir (Kingswood laboratories, Indianapolis)
MouthKote (Parnell Pharaceuticals, Larkspur, Calif.)
ORALbalance (Laclede)
Salivart (Xenex Laboratories, Coquitlam, British Columbia,
Canada)
Xero-Lube (Colgate Oral Pharmaceuticals, Canton, Mass.)

Denture Adhesive
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57
Denture Adhesives in Prosthodontics: An Overview. Ranjith Kumar et al.J Int
oral Health 2015; 7(1): 93-95
Adhesive Agents Anti-microbial
Agents
Other Agents
Tragacanth Sodium
tetraborate
Plasticizing agent
Geltin Ethanol Flavouring agents: Oil
of peppermint, oil of
wintergreen
Methylcellulose Hexacholophen
e
Wetting agents
Hydroxy-methyl
cellulose
Sodium borate
Karaya Gum
Sodium Carboxyl-
methyl cellulose
Pectin
Acrylamide,
Acetic polyvinyl
Polyethylene Oxide

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Mechanism of Action
 Adhesive powders absorb water, they swell to their
original volume and form anions which interact with
cations in the proteins in the tissue.
 ↑ viscosity of the adhesive thereby ↑ the denture
retention.
 Newer adhesive materials provide stronger bio-
adhesive and cohesive forces such as methyl
cellulose, hydroxyl methyl cellulose, sodium carboxyl-
methyl cellulose or poly methyl vinyl-ether maleic
anhydride, etc.
 The ↑ viscosity of the adhesive creams results in
their lateral spread excluding air and saliva thereby
increasing the retention.
oral Health 2015; 7(1): 93-95

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Requirements of an Ideal Denture Adhesive
1. Available as gels, creams, and powders.
2. Biocompatible, nontoxic and non-irritant.
3. It should have a neutral odour and taste.
4. Easy application and removal from the tissue
surface of the denture.
5. Discourage microbial growth.
6. Adhesiveness should be retained for 12-16 h.
7. Increase the comfort, retention and stability of
the denture.
oral Health 2015; 7(1): 93-95

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Mode of application:
1. Clean the denture surface (food debris, previous
adhesive).
2. Wet the denture surface
3. Small amounts to be applied
4. Close in centric occlusion for 5-10sec.
5. Remove excess adhesive by gauze.
oral Health 2015; 7(1): 93-95

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Indication Contraindication
1. Recording jaw relations and denture try in. 1. Allergies
2. Decrease the patient apprehension. 2. Gross inadequacies
in
3. Compromised denture bearing areas. 3. Excessive bone
resorption and soft
tissue shrinkage leading
to loss of vertical
dimension.
4. Comfort and function for Immediate
denture.
5. Reduced clinical findings of ulcers, tissue
irritation, inflammation and compression of
tissue.
6. Xerostomia patient. 4. Fractured dentures
or dentures with lost
flanges.
7. Stabilization of dentures (Parkinson’s and
Alzheimer’s disease, etc.)
8. Gross maxillofacial defects requires 5. Patients with inability to
maintain proper hygiene
of the denture.
9. Radiation carriers/ Radiation protection
prostheses.
oral Health 2015; 7(1): 93-95

Role of Saliva in Fixed Prosthesis
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 Saliva is to tooth enamel what blood is to the cells
of the body.
 Due to regional variation for the salivary flow, with
the mandibular anterior being high and maxillary
anterior and interproximals being low flow site.
 “Salivary highways and byways”.
Clinical implications of recent advances in salivary research. Moss S. J Esthet Dent

Role of Saliva in Implant
Prosthesis
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63
 Denture require salivary bed for its retention.
 But the implants “go” a step beyond.
 Implant being a stabilizer and fixture also serves as
intermediate. So no longer the conventional denture
require extension and flanges.
 As the patient need psychological and functional
satisfaction. Implant prosthesis can be given to
preserve the residual ridge instead of preservation of
the crippled tooth which will fail the prosthesis.
Effects of Xerostomia and the positive advantage of dental
implants in these patients. Sheppard. Implant Dentistry.

and thick saliva often provokes
nausea and gagging.
It aids in lubrication against scuffing and chafing.
and thin saliva interferes with seal and
provides poor protection against scuffing and
chafing.
Saliva and Impressions
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Complete Denture Prosthodontics. Sharry John J. 3rd edition.

19 June 2017
65
 During impression making for in sialorrhea
patients Neostigmine bromide (15mg orally) with
Methylscopolamine (0.4% solution submucosal
injection).
 Dry for 40 minutes and secretion normal again
about 90 minutes after injection.
 Atropine sulfate requires 2 hr to attain optimum
dryness.
 Methylscopolamine have side reaction like
abdominal pain so it can injected intramuscularly.

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66
 Alginate can be mixed with trisodiumphosphate
(0.3-1%) instead of water.
 Wiping off the secretion with gauze just before
placing the impression.

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67
 Cleaning the impression
 Thin saliva – Under stream of cool tap water.
 Thick Saliva – Sprinkle Stone as it acts as
disclosing agent.
 Xerostomia
 Ask the patient to gargle with warm water
(Vasodialator)
 Milking of glands
 Excess Salivation
 Ask the patient to gargle with cold water
(Vasoconstrictor).

Salivary Galvanism
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68
 Oral Galvanism - The
different alloy used in the
oral cavity develop electrical
potential difference in which
saliva act as an electrolyte.
 Symptoms:
 Sensation of pain in and
around the teeth
 Ulceration of mucosa
 Corrosion and discoloration

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69
 Metal tends to releases ions – Fluid becomes
positively charged – Metal is negatively charged.
 This causes potential difference.
 This potential is lowest among the noble metal.
 Prosthesis are alloys.
 Cu is not soluble in saliva – Al is soluble and
causes Cu to discharge its ion – thereby
disturbing the equibrilium between the Cu and the
Cu solution in saliva causing the Al and Cu to
corrode.

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70
 The chemical energy Electrical energy.
 If two different fillings are presents (e.g. Amalgam
and gold)
 Amalgam acts as anode (+), Gold act as cathode
(-).
 Anode releases ions and corrodes.
Cathode give rise to discoloration and
depositions.
 ↑in the acidity of saliva ↑Current
flow.
 According to Solomon and Reinhard (1936), a
protective mechanism viz., polarization and
cataphoresis takes place.
 Polarization: accumulation of H ions on cathode.
 Cataphoresis: Transport of particles where the

Salivary Biomarkers
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72
 Biological marker (biomarker): A characteristic that is
objectively measured and evaluated as an indicator of
normal biological processes, pathogenic processes,
or pharmacologic responses to a therapeutic
intervention. (NIH Biomarker Definition Working
Group. Atkinson et al. Clin Pharmaco Ther 2001)
 Biomarkers circulating in the blood are also found in
saliva.
 About 2,000 proteins in blood, 26% of it are found in
saliva.
Salivary Biomarkers – A review of powerful diagnostic tool. Yogesh Goswami.

WHY Saliva then the Serum?
19 June 2017
73
 Excellent alternative
 Sufficient quantity of the diseased biomarker.
 Collection method is non-invasive, safe and easy.
 Easier to handle then the blood and do not clot.
WHY Saliva then the GCF?
 Saliva is less technique sensitive than GCF collection.
 Proteins are absent in GCF
 GCF wash out period is 40 times/hr.
 GCF and give local diagnosis.
Salivary Biomarkers – A review of powerful diagnostic tool.
Yogesh Goswami et al. IOSR-JDMS 2015; 14: 80-87.

19 June 2017
74
 Diagnosis of following conditions
1. Hereditary disease
2. Autoimmune disease
3. Malignancy
4. Infection (Peri-implantitis, Periodontits etc.)
5. Monitoring of levels of hormones
6. Monitoring of levels of drugs
7. Bone turnover marker in saliva
8. Forensic Evidence
9. Oral diseases
10. Diagnosis of Oral Disease with Relevance for
Systemic Diseases
Salivary Biomarkers – A review of powerful diagnostic tool. Yogesh Goswami et al. IOSR-JDMS 201

75
CLASSIFICATION OF BIOMARKER
Biomarker
Proteomic
- Ig’s
- Acid
Phosphatase
- Histatin
- Mucin
- Epidermal
growth Factor
- Lactoferrin
- Osteocalcin
- Lysozyme
- MMP
Genomic
- Collagen
- Interlukin
(1,10)
- TNF
Microbial
- Mycoplasma
- Aggregatibacter
-Treponoma denticola
- Actinobacillus
Actinomycetemcomita
ns
- Streptococcus
gordonii
- Prevotella
intermedia
- Fusobacterium
vincentii
Other
- Calcium
- Cortisol
- PMN’s
-
Hydroge
n sulfide
- Pyridine
19 June 2017

19 June 2017
76
Proteomic Biomarkers:
 Oral and Breast cancer
 Periodontal disease, Dental
Caries
 Cardiovascular disease
 Sjögren's syndrome
Salivary Transcriptome
analysis
 Analysis mRNA
Multiplex detection:
 Lab on Chip(LOC)
 Point of care
(POC)

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77
OraSure or OraQuick (Home kit)
- HIV antibody test (not virus)
- Specimen between Buccal mucosa and
gingiva (transudate). It takes 20 minutes
My Periopath or My PerioID
- Type and concentration of bacteria
causing genetic susceptibility of periodontal
disease.
Integrated Microfluidic Platform for Oral
Diagnosis (LOC)
- Measures MMP and other biomarker
- 10ml saliva to be collected. It takes 3-10
minutes
Various products and Their Use

19 June 2017
78
Review of Literature

19 June 2017
79
1. The role of saliva in retention of maxillary complete
denture. Yasuyuki Kawazoe et al JPD 1978; 40(2):131-
136.
Aim: To analyze the role of the intervening saliva in the
retention of maxillary complete dentures.
Materials and Methods:
3 women and 3 men, Age: 50-60-
yrs
Series I Relation between the
palatal fluid and the dislodging
forces
• Baseplate was made on 6
edentulous pt.
• Forces were recorded in 1,2,3,4 and minutes after the
insertion.
Series II: Relation between changes in salivary volume and
dislodging forces.
• Electrical resistance of palatal mucous membrane
decreases with an increase of intervening salivary
volume.
• A Wheatstone bridge circuit was used to record

19 June 2017
80
 5 dentulous subjects were evaluated.
 Supports for the baseplate were placed on the central
incisors and first molars.
 The palate was dried and the experimental baseplate
placed in the oral cavity. The dislodging force were
evaluated.
Series III: Changes of salivary volume during tapping
movement.
 New denture was constructed and electrodes
following removal of the buccal flange to check the
movements.

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81
Results:
 Series I. Maximum dislodging force was observed 2
minutes after insertion with abundant palatal fluid. The
dislodging force then decreased.
 Series II. The dislodging force increased gradually
with the decrease of the resistance beyond the peak
value.
 Series III: When the intervening palatal fluid is in the
early stage, the resistance between electrodes and
mucosa is ↓ by the pressure of electrodes (jaw
closing). When the intervening palatal fluid is
excessive, resistance is increased↑.

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82
Discussion:
 In result I and II the salivary fluid results in greatest
retentive force.
 Chewing forces produce an inward flow of saliva and air
near the denture flange, increasing the volume of the
intervening saliva and decreasing retention.
 The denture is stable in function if the electrical resistance
of the palatal mucous membrane does not decrease during
the release of the chewing force.
Conclusion:
 Maxillary denture retention was influenced by the salivary
volume.
 The centric resistance of palatal mucous membrane that
inward and outward flow of intervening saliva was greater
in the denture with poor retention than in the one with
good retention.

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83
2. Salivary secretion and denture retention.
Wilhelm Niedermeier. JPD 1992; 67: 211-216.
Aim: Retention of the denture and the flow rates of
the parotid and palatal glands.
Materials and Methods: 86 Denture wearers, 44
women and 42 men, 86 maxillary and 56
mandibular denture. Periopaper in the palatal
region of the denture was kept for 1 min after
drying the mucosa with Periotron device.
Results: 1. The retention of the denture showed no correlation with
the age or sex.
2. Correlation between the flow rates of palatal secretion and
denture retention (and not parotid glands).
3. ↑retention with well formed ridge & resilient denture bearing
mucosa.
4. The subjective retention of denture was similar as measured with
dynamometer.
5. After administering pilocarpine 0.5mg/kg of body wt. the salivary

19 June 2017
84
Discussion:
 The results showed clinical importance as
only two glands were studied.
 No correlation between the secretion on
the palatal and parotid gland.
 The mandibular retention was improved
with palatal secretion rather then parotid
secretion.
 Secretion rate of the palatal glands
and maxillary denture retention was
improved even more.
Conclusion:
 Minor salivary gland (Palatal gland)
secretion have great clinical importance
for denture retention.

19 June 2017
85
3. Implant-Supported Electrostimulating Device to Treat
Xerostomia: A Preliminary Study. Clinical Implant
Dentistry and Related Research. 2010; 12(1): 62-71
Aim: The aims of this preliminary study were to observe and
evaluate the therapeutic effect on xerostomia of the Saliwell
Crown (Saliwell Ltd., Harutzim, Israel), an innovative saliva
electrostimulation device fixed on an implant, placed in the
lower third molar area.
Principles for xerostomia Rx: Established by the Commission on
Oral Health, Research and Epidemiology of the Federation
Dentaire Internationale (FDI) are as follows:
Stimulation of secretion has the great advantage of
providing the benefits of natural saliva.
Development of a sustained-acting preparation, who is
bound to remain a chronic patient.
“Saliwell crown” was introduced in US in 1980s with no
adverse effect.

19 June 2017
86
Materials and Methods: A Saliwell Crown was placed in
the lower third molar area of an 81-year-old female
patient with complaints of dry and burning mouth.
 Salivary secretion was measured, and the patient
was asked to fill in written satisfaction
questionnaires.
 The patient was monitored for a year, comparing
her salivary secretion rates and the written
questionnaires.

19 June 2017
87
Results: The results showed a constant slight but
significant increase in the salivary secretion and in the
patient’s personal feelings as presented in the
questionnaires.
Conclusions: The saliva stimulation device Saliwell
Crown, placed on an implant in an 81-year-old patient
with dry and burning mouth complaints, presented
promising results when both the salivary secretion
tests and the self-assessment questionnaires were
examined and compared.

19 June 2017
88
4. The effect of different adhesive materials on retention
of maxillary complete dentures. Figueiral et al. Int J
Prosthodontics. 2011; 24(2): 175-177.
Aim: Effect of denture adhesives on retention of complete
maxillary dentures and to evaluate an intraoral
transducer in the assessment of denture retention.
Materials and Methods: 26 patients with complete maxillary
and mandibular denture
Inclusion Criteria: Autonomous and co-operative adults of
both sexes.
Completely edentulous
No maxillofacial surgery involving the
evaluated area.
 Retention of only maxillary denture was evaluated
without the adhesive at first and last, then with five
different adhesive (Protefix cream, Corega Cream,
Corega Ultra powder, Protefix Powder, Corega strips)

19 June 2017
89
 The denture retention was checked by
vertical tensile test using an intraoral
resistance transducer with four extensometers.
 3 measurements was obtained from 7 test and mean
was calculated by
by Statistical software.
Result: Only Corega strips showed less retention.
The baseline and final test were equivalent.
Discussion: Retention measured was only in vertical
direction and not in other dislodging forces.
 Retention and Stability are difficult to differentiate.
Although improving retention improves stability .
 In this study retention was improved with the denture
adhesive.
Limitation: Mandibular Denture prosthesis retention was not
evaluated.
Conclusion: The high retention was obtained by Corega
cream, Corega Powder, Protefix powder.

19 June 2017
90
5. Thirteen-year follow-up of a mandibular implant-
supported fixed complete denture in a patient with
Sjogren’s syndrome: A clinical report. Paul P. Binon.
JPD 2005; 94(5) :409-413
Case report: 67 year old, with extensive fixed prosthodontic
treatment due to cervical caries.
 To preserve the ridge and provide retention:
Endodontic treatment of the retained roots, silver
amalgam coronal restorations, and 2 intraradicular
attachments (Zest Anchors, Escondido, Calif.) to
retain an overdenture.
 4 months later roots had recurrent caries and loss of
the silver amalgam restorations and the attachments,
Unstable overdenture.

19 June 2017
91
 C/F: Tissue discomfort, Recurrent denture sores, difficulty
masticating, and mandibular denture instability.
 Following examination he was diagnosed with SS.
 Recall was on an alternating 3-month, then alternating
6-month recall. During the course of approximately 28
recall appointments over a period of 13 years.
 Retightened to 20 Ncm with a mechanical torque
driver.
 Patient maintained above average home hygiene
during the entire follow-up period.

19 June 2017
92
 Pt. was on prednisone treatment for SS.
 It appears NSAID may have less effect on bone density
and the osseointegration of titanium implants in the
mandible than in skeletal bone in general.
SUMMARY
 Over the treatment has been successful and without
adverse effects.
 The patient reported dramatic improvements in comfort,
function, and esthetics immediately and after as well.
 Based on the long-term favourable results patients with SS
and severe dry mouth may benefit from the placement of
implant-supported prostheses.

Conclusion
19 June 2017
93
SALIVA: The “AQUA VITA” of the oral
cavity.

Reference
19 June 2017
94
1. Saliva: Its Secretion, composition and functions W. M. Edgar. BDJ
1992; 172: 305
2. Annual review.: The secretion, components and properties of
saliva. Guy Carpenter. 2013; 4: 267-276
3. Orban’s Oral Histology & Embryology edition
4. Gray’s anatomy 40th edition
5. Physical Factors in retention of Complete Denture. JPD 1971; 25:
230-235
6. Saliva and denture retention. Ostlund. JPD 1960; 10: 658-663
7. Salivary secretion and denture retention. Wilhelm Niedermeier.
JPD 1992; 67: 211-216.
8. A review of saliva: normal composition, flow, and function. Sue
Humprey. JPD 2001; 85:162-169.
9. Clinical implications of recent advances in salivary research.
Moss S. J Esthet Dent 1995;7:197-203.
10. The role of saliva in maintaining oral homeostasis. I. Mandel.

19 June 2017
95
11. The functions of saliva. I. Mandel. JDR 1987;66:623-627.
12. Special care in Dentistry. Arjan Vissink et al.1996; 16:95-103.
13. Essentials of complete denture prosthodontics. Sheldon
Winkler. 3rd edition.
14. Prosthodontic treatment for edentulous patient. Zarb. 13th
edition
15. Saliva: A powerful diagnostic tool for minimal intervention
dentistry. Ranganath et al. J of contemporary dental
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16. Salivary Biomarkers – A review of powerful diagnostic tool. Yogesh
Goswami et al. IOSR – JDMS. 2015; 14: 80-87.
17. Artificial saliva: present and future. Levine et al. J. Dent
Res.1987;66:693-698.
18. Xerostomia: A clarion call for Dental Implants. Morton Perel.
Implant Dentistry. 1999:8; 341-342
19. Effects of Xerostomia and the positive advantage of dental
implants in these patients. Sheppard. Implant Dentistry. 2000:9;17

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21. Xerostomia Etiology, recognition and Treatment. Guggenheimer
et al. JADA 2003;134: 61-69.
22. Dentures As Artificial Saliva Reservoirs In The Irradiated
Edentulous Cancer Patient With Xerostomia. Sanjay Lagdive
et al. IJBAMR 2011; 1:31-37.
23. Diagnostic Biomarkers for Oral and Periodontal Diseases.
Mario Taba et al. DCNA 2005; 49(3):551-571.
24. Implant-Supported Electrostimulating Device to Treat
Xerostomia: A Preliminary Study. Clinical Implant Dentistry and
Related Research. 2010; 12(1): 62-71.
25. Troubleshooting in complete denture prosthesis part IX.
Joseph Landa. JPD.1961; 11(2) :244-246.
26. Diagnosis and management of xerostomia and hyposalivation.
Alessandro Villa. Ther Clin Risk Manag. 2015;11:45-51.

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97
27. Thirteen-year follow-up of a mandibular implant-supported fixed
complete denture in a patient with Sjögren’s syndrome: A
clinical report. Paul P. Binon. JPD 2005; 94(5) :409-413.
28. Denture Adhesives in Prosthodontics: An Overview. Ranjith
Kumar et al.J Int oral Health 2015; 7(1): 93-95.
29. The role of saliva in retention of maxillary complete denture.
Yasuyuki Kawazoe et al JPD 1978; 40(2):131-136.
30. GPT9. JPD 2017; 117 (15): 1-105.
31. Complete Denture Protshodontics. Sharry John J. 3rd edition.

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