Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

saliva - body's mirror

1,741 views

Published on

about significance of saliva

Published in: Health & Medicine
  • Be the first to comment

saliva - body's mirror

  1. 1. 8/27/2015 1
  2. 2. SALIVA Presented by PRAVEEN KUMAR GALI P.G STUDENT DEPARTMENT OF CONSERVATIVE DENTISTRY & ENDODONTICS 8/27/2015 2
  3. 3. SEMINAR DETAILS • Title: SALIVA • Total slides: 179 • Textslides : 117 • Illustrations:64 • Time for presentation: 45 minutes approx. 8/27/2015 3
  4. 4. TEXTBOOK REFERENCES 1. Concise Medical Physiology – Choudhary. 7th Edition 2. Human Physiology By A.K. JAIN 5th Edition 3. Medical Physiology By Sembulingam 4th Edition 4. ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12th Edition 5. Text Book Of Oral Pathology – William G. Shafers. 6th Edition 6. Salivary Diagnostics By David T Wong 1st Edition 7. Dental Materials By S.Mahalaxmi 1st Edition 8. Sturdervant’s Art And Science Of Operative Dentistry 5th Edition 9. Human Antomy By B.D Chaurasia 4th Edition 10. Dental Pharmacology By K.D Tripati 6th Edition 11. Dyspahgia diagnosis and treatment by Ekberg 1st edition 8/27/2015 4
  5. 5. JOURNAL REFERENCES • British dental journal 1992, 172 : 305 – Saliva : its selection, composition and functions by W.H. Edgar. • Badruddin et al storage medium for avulsed teeth Indian Journal of Multidisciplinary Dentistry, Vol. 3, Issue 3, May-July 2013. • The salivary gland fluid secretion mechanism The Journal of Medical Investigation Vol. 56 2009. • Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3. 8/27/2015 5
  6. 6. • A review of saliva: Normal composition,flow, and function JPD volume 85 number 2. • Health benefits of saliva: a review Michael W.J. Dodds Journal of Dentistry (2005) 33, 223–233 • Management of Xerostomia Related to Radiotherapy for Head and Neck Cancer; journal of oncology ;December 2005 By Shannon T. Kahn 8/27/2015 6
  7. 7. CONTENTS 1. Introduction 2. Development 3. Anatomy and Histology Of Salivary Glands 4. Formation And Secretion 5. Composition Of Saliva 6. Factors effecting composition 7. Properties And Functions 8. Methods Of Collecting Saliva 9. Analysis Of Saliva (Salivary Biomarkers) 10.Clinical Considerations In Dentistry & salivary disorders 11.Saliva As Storage Medium 12.Journal References 13.Conclusion 8/27/2015 7
  8. 8. INTRODUCTION 8/27/2015 8 ‘Salvindo’
  9. 9. Definition “Saliva is a clean, tasteless, odorless slightly acidic viscous fluid, consisting of secretions from the parotid, sublingual, sub mandibular salivary glands and the mucous glands of oral cavity” HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition8/27/2015 9
  10. 10. Types of salivary glands • Salivary glands can be divided into Major and minor salivary glands. • Major – There are their pair of major glands namely: – Parotid. – Sub Mandibular – Sub lingual • Minor – These are distributed in mucosa and sub mucosa of the oral cavity namely: – Labial and Buccal glands. – Glossopalatine glands. – Palatine glands. – Lingual glands. Human antomy by B.D chaurasia 4th edition8/27/2015 10
  11. 11. DEVELOPMENT • Similar pattern • They originate from oral epithelial buds invading the underlying Mesenchyme. • ECTODERMAL in parotid and minor salivary gland • ENDODERMAL in sub Mandibular and Sublingual glands. • PRIMORDIA – 6th week (sublingual glands- 7-8 weeks) The minor salivary glands - third month. ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION8/27/2015 11
  12. 12. Stages in development Pre bud Initial bud Pseudo glandular Canalicular Terminal bud 8/27/2015 12 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  13. 13. 8/27/2015 13
  14. 14. PAROTID GLAND •Largest of all glands •Average Wt - 25gm •Located in the preauricular region and along the posterior surface of the mandible. 148/27/2015 Human antomy by B.D chaurasia 4th edition
  15. 15.  Divided by the facial nerve into a superficial lobe and a deep lobe.  The superficial lobe  Overlying the lateral surface of the masseter,  Part of the gland lateral to the facial nerve.  The deep lobe  Medial to the facial nerve  Located between the mastoid process and the ramus of the mandible 158/27/2015 Human antomy by B.D chaurasia 4th edition
  16. 16. PAROTID DUCT •Ductus parotideus; Stensen’s duct •5 cm in length •Anterior border of the gland •Runs anteriorly and downwards on the masseter b/w the upper and lower buccal branches of facial N. At the anterior border of masseter it pierces •Buccal pad of fat •Buccopharyngeal fascia •Buccinator Muscle 168/27/2015 Human antomy by B.D chaurasia 4th edition
  17. 17.  Because of oblique course of duct through buccinator inflation of duct is prevented during blowing.  It opens into the vestibule of mouth opposite to the 2nd upper molar. 178/27/2015 Human antomy by B.D chaurasia 4th edition
  18. 18. SUBMANDIBULAR GLANDS Large superficial and small deeper part continuous with each other around the posterior border of mylohyoid. Superficial Part Situated in the digastric triangle Wedged b/w body of mandible and mylohyoid. 188/27/2015 Human antomy by B.D chaurasia 4th edition
  19. 19. 8/27/2015 19
  20. 20. SUBMANDIBULAR DUCT Also called as Wharton's duct 5 cm long Emerges at the anterior end of deep part of the gland. Opens in the floor of mouth at the side of frenulum of tongue. 208/27/2015 Human antomy by B.D chaurasia 4th edition
  21. 21. 8/27/2015 21
  22. 22. SUBLINGUAL SALIVARY GLAND Smallest of the three glands 3-4 gm Lies beneath the oral mucosa in contact with the sublingual fossa on lingual aspect of mandible. 228/27/2015 Human antomy by B.D chaurasia 4th edition
  23. 23. Duct of Rivinus •8-20 ducts •Most of them open directly into the floor of mouth •Few of them join the submandibular duct. 238/27/2015 Human antomy by B.D chaurasia 4th edition
  24. 24. Minor salivary glands • Located beneath the epithelium in almost all parts of the oral cavity Labial Buccal or molar glands Palatal glands Lingual mucus / tip and margins of tongue Lingual serous / circumvallate and foliate glands •Small groups of secretory units •Opening is via short ducts directly into the mouth . •They lack connective tissue capsule 248/27/2015 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  25. 25. Based on secretions • Parotid • Lingual serousSerous • Lingual mucus • Buccal and palatalMucus • Submandibular • Sublingual and labial glandsMixed 8/27/2015 25 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  26. 26. HISTOLOGY OF GLANDS ACINI serous mucous myoepithelial SECRETORY UNIT8/27/2015 26
  27. 27. 8/27/2015 27
  28. 28. SEROUS CELLS •Acini - spherical. •8-12 cells . •Cells - pyramidal •The spherical nucleus is located in the basal region of the cell. 288/27/2015 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  29. 29. 29 Membrane bound ribosome Cisternal space of RER Golgi apparatus (Carbohydrate addition,post transitional modification) Packed into secretory granules SECRETION OF SALIVARY PROTEINS 8/27/2015 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  30. 30. MUCOUS CELLS •Polyhedral & contain mucinogen granules. •Little or no enzymatic activity. •Lubrication and protection of the oral tissues. •The ratio of carbohydrate to protein is greater. •Larger amounts of sialic acid and sulphated sugar. 308/27/2015
  31. 31. 31 Single droplet discharged Fused with apical plasma membrane Plasma membane seperates droplets from lumen Membrane may remain intact or dissolved after discharging droplet SECRETION OF MUCOUS DROPLET 8/27/2015
  32. 32. 32 synthesis Storage Secretion of protein N - linked Glyco protein Serous cells mucin Lubricate Microbial barrier O – linked Glyco protein Mucous cells 8/27/2015
  33. 33. Myoepithelial cells – Related to the secretory and intercalated duct cells – Between the basal lamina and the basal membranes of parenchymal cells. – Contractile function, helping to expel secretions form the luminal space of the secretory units and ducts. 8/27/2015 33 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  34. 34. INTERCALATED DUCTS •The small ducts •Thin branching tubes •Variable length •Connect to the terminal secretory units to the next larger ducts. •Primary saliva passes first thorough intercalated ducts. •Contain secretory granules in their apical cytoplasm (Lysozyme or lactoferritine may be localized ) 348/27/2015
  35. 35. STRIATED DUCTS •Largest portion of ductal system •Located within lobules •Contain kallikrein •Synthesize secretory glycoproteins 358/27/2015 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  36. 36. EXCREATORY DUCTS •Located in connective tissue septa •Larger in diameter then striated duct . 368/27/2015 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  37. 37. FORMATION AND SECRETION OF SALIVA Fluid and electrolyte secretion is two step procedure. • 1st step : Occures In acinar cells (primary saliva) • 2nd step : Occurs In salivary ducts. 378/27/2015 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  38. 38. 8/27/2015 38The salivary gland fluid secretion mechanism The Journal of Medical Investigation Vol. 56 2009. ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  39. 39. 8/27/2015 39 ORAL HISTOLOGY AND EMBRYOLOGY– ORBAN’S. 12TH EDITION
  40. 40. Control of salivary secretion Afferent pathway Central pathway Efferent pathway 8/27/2015 40 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  41. 41. 8/27/2015 41 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  42. 42. Afferent pathway Resting flow Psychic flow Unconditional reflexes 8/27/2015 42 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  43. 43. Resting flow Circadian variation Light and arousal Hydration Exercise and stress • morning • night • Bright • Dark • Hydrated • Dehydrated 8/27/2015 43 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  44. 44. Psychic flow • Anticipation of food or sight of food • Awareness of saliva in mouth • IVAN PAVLOV 8/27/2015 44 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  45. 45. Unconditioned reflexes Mastication Gustatory stimuli Others 8/27/2015 45 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  46. 46. Central control •Superior salivatory nucleuspons •Inferior salivatory nucleusmedulla 8/27/2015 46 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  47. 47. Efferent pathway Parasympathetic Sympathetic 8/27/2015 47 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  48. 48. Parasympathetic fibers Nucleus salivatorius superior •Submandibular & sublingual glands Nucleus salivatorius inferior •Parotid gland 8/27/2015 48 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  49. 49. Parasympathetic fibers to submandibular and sub lingual glands 8/27/2015 49 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  50. 50. Parasympathetic fibers to parotid gland 8/27/2015 50 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  51. 51. Sympathetic fibers Pre ganglionic fibers from Lateral horns of First and second thoracic segments of spinal cord Anterior nerve roots Superior cervical ganglion in sympathetic chain Post ganglionic nerve fibers– glands 8/27/2015 51 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  52. 52. Profuse saliva Watery Less organic content Dialate blood vessels Less saliva Thick and mucoid Vasoconstriction More organic content 8/27/2015 52 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  53. 53. Composition of saliva SALIVA 99.5% water Solids 0.5% 8/27/2015 53
  54. 54. solids Organic substances 0.2% Inorganic substances 0.3% Gases Small fraction 8/27/2015 54 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  55. 55. Organic substancesEnzymes Amylase maltase Lingual lipase lysozyme phosphatase Carbonic anhydrase Kallikrein Acid phospahatase Peroxidase Lactoferrin others proteins Blood group antigens Amino acids Non protein nitrogenous substances (Urea,uric acis,creatinine ,xanthine,and hypoxanthine) Hormones Water soluble vitamins 8/27/2015 55 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  56. 56. Inorganic substances • sodium • calcium • potassium • bicarbonate • bromide • chloride • fluoride • Phosphate 8/27/2015 56 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  57. 57. Gases Oxygen 1ml/100ml Nitrogen 2.5ml/100ml Co2 5ml/100ml 8/27/2015 57 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  58. 58. Glycoprotein Mucin • Tissue coating • Protective coating about hard and soft tissues • Formation of acquired pellicle • Concentrates anti-microbial molecules • Lubrication • Forms a moist mucosal environment 8/27/2015 58 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  59. 59. Amylases • abundant salivary enzyme (50 % of proteins ) • 80 % - parotid • Hydrolyzes starches →maltose, maltotriose, dextrins •Anti bacterial •Digestion •Tissue coating 8/27/2015 59 1. SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION 2. HUMAN PHYSIOLOGY BY A.K. JAIN 5th edition
  60. 60. Lingual Lipase • von Ebner’s glands of tongue • Fat to medium or long chained triglycerides (1st phase ) • Increase the efficacy of pancreatic polypeptide • digestion of milk fat in new-born 8/27/2015 60ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  61. 61. Statherins • By acinar cells • Both Parotid and submandibular glands • prevent precipitation or crystallization of supersaturated calcium phosphate in ductal saliva and oral fluid 8/27/2015 61ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  62. 62. Proline-rich Proteins (PRPs) • Inhibitors of calcium phosphate crystal growth • Present in the initially formed enamel pellicle and in “mature” pellicles • Lubricaion • Mineralization • Tissue coating Acidic • Binding of tannins • Tissue coatingBasic • Anti viral • lubricationGlycosylated 8/27/2015 62 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  63. 63. Lysozyme ( LZ ) • Oral LZ is derived from 1. major and minor salivary glands 2. phagocytic cells 3. gingival crevicular fluid (GCF) • Is an antibacterial enzyme. • The mean concentration in whole saliva resting is 2.2mg/100ml stimulated-11mg/100ml. 8/27/2015 63 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85 number 2.
  64. 64. Lysozyme ( LZ ) Anti-microbial activity by: • Inhibition of bacterial adhesion to tooth surfaces • Inhibition of glucose uptake and acid production • Muramidase activity (lysis of peptidoglycan layer) 8/27/2015 64ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  65. 65. Lactoferrin • Iron binding glycoprotein secreted by serous cells • High affinity for iron • Bacteriostsatic, cidal, fungal, antiviral and anti inflammatory 8/27/2015 65ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  66. 66. Histatins • A group of small histidine-rich proteins • Potent inhibitors of Candida albicans growth • Wound healing 8/27/2015 66 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85 number 2.
  67. 67. Kallikrein • It splits beta-globulin into bradykinin • Bradykinin passes back into the gland and into B.V.’s thus causing functional vasodilatation to supply an actively secreting gland. 8/27/2015 67ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  68. 68. Cystatins • Are inhibitors of cysteine-proteases • Protective against unwanted proteolysis (bacterial proteases, lysed leukocytes) • Inhibit proteases in periodontal tissues 8/27/2015 68ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  69. 69. Salivary peroxidase systems • Antimicrobial • protection of host proteins and cells from toxicity of H2O2 • Sialoperoxidase (SP, salivary peroxidase) Myeloperoxidase (MP),thiocyanate systems • From leukocytes entering via gingival crevice 8/27/2015 69ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  70. 70. Agglutinins • Interact with unattached bacteria • Cause clumping of bacteria into large aggregates which are easily flushed by saliva 8/27/2015 70ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  71. 71. IMMUNOGLOBULINS • Secretory Ig A - inhibit adhesion – 90% • Ig G – enhance phagocytosis • Ig M - enhance phagocytosis • IgA has 3 main functions: – Inhibition of bacterial colonization. – Binding to specific bacterial antigen. – Affects specific enzymes essential for bacterial metabolism 8/27/2015 71 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85 number 2.
  72. 72. Blood group substances • Blood group antigens are also present in saliva • Ag A and AgB. 8/27/2015 72ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  73. 73. Hormones • “Parotin” and a “nerve growth factor”. • Parotin – facilitates calcification and helps to maintain serum calcium levels. • Nerve Growth Factor (NGF) – affects growth and development of symphathetic nerve fibres. 8/27/2015 73ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  74. 74. Carbohydrates • Has glucose at a concentration of 0.5-1mg/100ml (parotid). • In submandibular – glucose, hexose, fructose with small amounts of hexosamine and sialic acid. 8/27/2015 74ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  75. 75. Amino acids • 9 types in parotid • 12 in submandibular • 18 in whole saliva at low concentration of about 0.1mg /100ml 8/27/2015 75ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  76. 76. Lipids • Small amount of diglycerides, triglycerides, cholesterol and cholesterol esters, phospholipids, corticosteroids. • Play a role in salivary protein binding ,bacterial absorption to apatite, and plaque microbial aggregation 8/27/2015 76ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  77. 77. Inorganic contents cations Sodium Potassium Calcium Magnesium anions Chloride Bicarbonate Phosphate Trace elememnts of halides Less sodium and Higher potasium than ECF 8/27/2015 77ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  78. 78. Element Concentration mE/lit Details Sodium 10 to 100 Flow dependant Potassium 8.20 Independent of flow 1.5 to 4 times plasma conc. Calcium 3 Ionic or bound form Colloidal calcium phosphate Magnesium 0.6 Trace Chloride 15 to 25 Less conc. Than plasma Bicarbonate 5 to 60 Osmolarity Buffering 8/27/2015 78ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  79. 79. FACTORS AFFECTING COMPOSITION • Altered as the saliva passes in the duct system, mainly due to re absorption of sodium chloride and secretion of potassium and inorganic phosphates. 8/27/2015 79CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION
  80. 80. Factors affecting composition Flow rate Hormones Fatigue Plasma concentration Diet Nature of stimulus Duration of stimulus Circadian rhythm Differential contributions 8/27/2015 80
  81. 81. PROPERTIES OF SALIVA • Daily secretory volume 500-7500ml • Consistency slightly cloudy and viscous • Saliva is acidic in nature usually. • Saliva is colourless opalscent fluid. • Specific gravity is 1.002 to 1.012 • Saliva is usually hypotonic but approaches isotonicity when flow rates are high. • It is rarely hypertonic. 8/27/2015 81CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION
  82. 82. • pH  5 to 8 & Mean pH  6.4 – pH becomes alkaline with high flow rates. – Bacterial action may also alter the pH of saliva. • Freezing point – 0.07-0.34°C • Osmotic pressure – ½ -3/4 of blood (1400milli osmol/L) • Flow rate – 0.02ml / min. – At rest 7ml / min. – In stimulated saliva. • Velocity – 0.8-8mm/min. – Lowest velocity films occurred on facial surfaces of upper incisors – Highest velocity occurred on lingual surfaces of teeth. 8/27/2015 82 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85 number 2.
  83. 83. VISCOSITY-‘SPINN BARKEIT PHENOMENA’ • Viscosity depends on their glycoprotein content as described by Gottschalk 1961. • non-newtonian. • viscoelastic properties. • Ability to draw out a thread of saliva is typical of a viscoelastic fluid and is known “Spinn Barkeit”. • The relative viscosity of the three main secretions after acetic acid stimulation were found by Schneyer (1955). 1. Parotid - 1.5 2. Submandibular - 3.4 3. Sublingual - 3.4 8/27/2015 83 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION A review of saliva: Normal composition,flow, and function JPD volume 85 number 2.
  84. 84. Volume Total volume – 500-750ml/day Submandibular – 60% Parotid – 30% Sublingual 3-5% Minor salivary glands – 7% In Sleep • Parotid - 0% • Submandibular - 72% • Sublingual - 8% Resting stage Submandibular – 72% Parotid – 21% Sublingual -1-2% Minor salivary glands – 7% Acidic stimulation Submandibular – 46% Parotid – 45% Sublingual – 1.5% Mechanical stimulation Parotid – 58% Submandibular – 33% 8/27/2015 84
  85. 85. Functions of saliva Digestion of polysaccharides Diluent and cooling effect Moistening , cleansing and tooth integrity Anti microbial function Lubrication and wound healing Buffering As a solvent and taste Thirst mechanisms Excretory Middle ear pressure adjustment 8/27/2015 85CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  86. 86. Buffering capacity of saliva Carbonic acid / bicarbonate system Phosphate system Protein system (mucin) 8/27/2015 86CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  87. 87. Carbonic acid / bicarbonate system H+HCO3 - H2CO3 8/27/2015 87CONCISE MEDICAL PHYSIOLOGY – CHOUDHARY. 7TH EDITION ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  88. 88. Phosphate buffer system HPO4 2- H+H2PO4 - 8/27/2015 88
  89. 89. Pellicle and plaque deposition • Both pellicle and plaque matrix contain protein predominantly derived from saliva. • Pellicle formation is a physico-chemical process • Plaque formation involves incorporation of salivary proteins 8/27/2015 89 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  90. 90. 8/27/2015 90
  91. 91. Plaque mineralization and calculus formation • Salivary calcium and phosphate are the source of minerals • statherin and proline-rich proteins inhibit precipetation 8/27/2015 91 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  92. 92. Saliva and Dental Caries Static Antebacterial Supersaturation Ca ,phosphate Substrates for pellicle Dynamic Buffering Clearance Supersaturation Of HCO3 8/27/2015 92 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  93. 93. Critical pH • “The pH at which any particular saliva ceases to be saturated with calcium and phosphate is referred to as ‘ critical pH ’ • It is usually 5.5 • High salivary calcium and phosphate – Remineralization • Low calcium , phosphate – Demineralization 8/27/2015 93 ORAL HISTOLOGY AND EMBRYOLOGY – ORBAN’S. 12TH EDITION
  94. 94. 8/27/2015 94
  95. 95. 8/27/2015 95
  96. 96. WHOLE SALIVA 8/27/2015 96SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION Whole saliva collection method: Resting saliva • Draining method. • Spitting method. • Suction method. • Swab method. Stimulated saliva • Masticatory method. • Gustatory method.
  97. 97. Parotid saliva • Lashley cup • Cannulation • Personalized plastic cup • Snail collector 8/27/2015 97SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  98. 98. Submandibular saliva • Cannulation • Segregator device • Wolfe appartatus • Suction 8/27/2015 98SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  99. 99. Minor salivary glands • Labial and buccal saliva • Palatine saliva  Pipette  Filtration paper  Impression of palate  Individual collection prosthesis 8/27/2015 99SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  100. 100. Salivary diagnostics 8/27/2015 100SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  101. 101. Why saliva??? • Non – invasive • Limited training • No costly equipment foe collection • Potentially valuable for children and older patients • Cost effective • Eliminates the risk of infection • Easy, No pain, No needle prick, Fast • Screening of large population No Pain 1018/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  102. 102. What is a biomarker??? “A biomarker is an objective measure that has been evaluated and confirmed either as an indicator of physiologic health, a pathogenic process, or a pharmacologic response to a therapeutic intervention.” 8/27/2015 102SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  103. 103. Biomarker Monitor progression / recurrence Detect disease Stage disease Treatment efficacy Response to treatment 8/27/2015 103SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  104. 104. Salivary genomics or salivary proteomics or salivomics 8/27/2015 104SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  105. 105. 8/27/2015 105SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  106. 106. AUTO IMMUNE DISEASES BONE TURNOVER MARKERS Systemic disorders DENTAL CARIES AND PERIODONTAL DISEASES DRUG LEVEL MONITORING FORENSIC EVIDENCE AND SUBSTANCE ABUSE GENETIC DISORDERS INFECTIONS OCCUPATIONAL AND ENVIRONMENTAL MEDICINE PSYCHOLOGICAL STRESS RENAL DISEASES MALIGNANCY DISEASES OF ADRENAL CORTEX 8/27/2015 106
  107. 107. Autoimmune diseases Sjögren's syndrome • A low resting flow rate and abnormally low stimulated flow rate of whole saliva • Elevated levels of 1. Rheumatoid factor 2. Antinuclear antibody 3. Anti-ss-a 4. Anti-ss-b antibody . 8/27/2015 107SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  108. 108. Bone turnover markers 8/27/2015 108SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  109. 109. Cardio vascular markers • CRP and MMP-9 with intima–media thickness • LTB4 and PGE2 with arterial stiffness • lysozyme with hypertension. 8/27/2015 109SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3.
  110. 110. Diabetic markers For type II diabetes • KRAS • EGFR • PSMB2 8/27/2015 110SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3.
  111. 111. Biomarkers for caries risk assessment • The Levels of Salivary Mutans Streptococci and Lactobacilli • Salivary Flow Rate • Salivary pH and Buffer Capacity • Salivary Proteins(MUC7,PRPs) • alpha-defensins HNP1-3 in children • sIgA levels 8/27/2015 111SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3.
  112. 112. Periodontal disease • IL 1,2,4,10 • MMP 1, MMP 8 • PGE2 • ICTP • TNF • fibronectin degrading enzymes • IgA2 • Epidermal growth factor (EGF) • Vascular endothelial growth factor (VEGF) 8/27/2015 112SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  113. 113. Drug monitoring • Phenytoin • Lithium • Primidone • Methadone • Ethosuximide • Cyclosporine • Carbamazipine • Marijuana • Theophylline • Cocaine • Caffeine • Alcohol 8/27/2015 113SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  114. 114. Forensic evidence • High levels of salivary amylase • Desquamated cells • Same proteins as blood and urine 8/27/2015 114SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  115. 115. Genetic disorders Cystic fibrosis •The submandibular saliva contains more lipid •The levels of neutral lipids, phospholipids, and glycolipids are elevated. •The altered physico-chemical properties of saliva in this disease. •Elevations in electrolytes (sodium, chloride, calcium, and phosphorus), urea and uric acid, and total protein 8/27/2015 115SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  116. 116. VIRAL DISEASES •the salivary glands and serum – Ig •Secretory IgA (sIgA) - main specific immune defense mechanism in saliva. •Antibodies against viruses and viral components 1168/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION Salivary Diagnostics: An Insight Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3.
  117. 117. •Acute (HAV) & (HBV) -IgM antibodies in saliva. • The ratio of IgM to IgG •Determining immunization and detecting infection with measles, mumps, and rubella. 1178/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  118. 118. • sIgA best marker for ROTAVIRUS in infants •The shedding of herpesviruses in saliva •PCR-based identification in HSV-1 reactivation in patients with Bell's palsy. 1188/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  119. 119. HIV •Diagnosis of infection is equivalent to serum in accuracy •Antibody to HIV in whole saliva of infected individuals, which was detected by ELISA and Westernblot assay, correlated with serum antibody levels . 1198/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  120. 120. •95% sensitivity •100% specificity when compared to serum diagnostics •Salivary IgA levels to HIV decline as infected patients become symptomatic •A prognostic indicator for the progression of HIV infection. 1208/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  121. 121. Stress biomarkers in saliva • Salivary α-amylase • Chromogranin A • Salivary cortisol 8/27/2015 121SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  122. 122. MALIGNANCY •early detection. • p53 •Inactivation of p53 suppressor through mutations and gene leads to malignancy •Elevated levels of salivary defensin-1in oral SCC. •salivary defensin-1 levels and serum levels of SCC- related antigen. 1228/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  123. 123. The Monitoring of Hormone Levels •Lipid solubility and steroid hormones •Salivary cortisol levels in cushing's syndrome and addison's disease •Monitoring the hormone response to physical exercise and the effect of accelerating stress. 1238/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  124. 124. •Salivary aldosterone levels with serum aldosterone levels •Increased salivary aldosterone levels with primary aldosteronism. •Salivary insulin 1248/27/2015 SALIVARY DIAGNOSTICS BY DAVID T WONG 1ST EDITION
  125. 125. Lab now analyser with nano bio chip elements 8/27/2015 125
  126. 126. Clinical considerations in restorative dentistry and endodontics • Isolation • Interactions with dental materials • Chance of infection • Aberrations in salivary flow and management • Age changes • Saliva as a storage medium for avulsed tooth 8/27/2015 126
  127. 127. Isolation 1. Rubber Dam 2. Cotton rolls & cellulose wafers 3. Throat shields 4. High volume evacuators & saliva ejector 5. Mirror & evacuator tip retractor 6. Mouth props 7. Air Water syringe 8. Cheek retractor 9. Drugs 8/27/2015 127STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
  128. 128. Rubber Dam Isolation 8/27/2015 128STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
  129. 129. • Cotton rolls, gauze & cellulose wafers absorbents are helpful for short period of isolation of the teeth especially where rubber dam application is not possible. • Usually placed in Buccal & lingual sulcus specially where salivary gland ducts exit, to as to absorb saliva. Cotton rolls 8/27/2015 129
  130. 130. • It is used to remove water and saliva with high suction speed. • Also helps in retracting the soft tissues. High volume evacuators & saliva ejector 8/27/2015 130STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
  131. 131. Hygroformic saliva ejector 8/27/2015 131Pulp dent dental products manual – isolation
  132. 132. • By air water syringe an air blast can be useful to dry tooth and soft tissue during examination or used during procedure. Air water syringe 8/27/2015 132STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
  133. 133. Svedopter 8/27/2015 133
  134. 134. • Anti sialogogues • Local anaesthetics Drugs 8/27/2015 134STURDERVANT’S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
  135. 135. Anti sialogogues Methantheline bromide • Banthine • 50 mg 1 hour before Propantheline bromide • Pro banthine • 15 mg 1 hour before Clonidine Hydrochloride • Anti hypertensive • 0.5 mg 1 hour before Anti cholinergics Act by inhibiting myoepithelial cells 8/27/2015 135DENTAL PHARMACOLOGY BY K.D TRIPATI 6TH EDITION
  136. 136. Interactions with dental materials While restoring • GIC • AMALGAM • Composites 8/27/2015 136
  137. 137. SALIVA AS ELECTROLYTE • May cause wet corrosion 8/27/2015 137
  138. 138. Chances of getting infected • Potential infections are 1. Hepatitis B 2. Respiratory infections 3. Conjuctivitis 4. Herpes infections 5. HIV 8/27/2015 138OSHA GUIDELINES
  139. 139. DO s and DON’T s 8/27/2015 139
  140. 140. 8/27/2015 140
  141. 141. Aberrations in flow • Hyposalivation,xerostomia and Aptyalism • Hyper salivation • Drooling • Chordatymapani syndrome • Paralytic secretion • Augmented secretion 8/27/2015 141 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  142. 142. Xerostomia • Xerostomia (dry mouth) is the subjective feeling of oral dryness. • It is generally accompanied by salivary gland hypofunction and a severe reduction is the secretion of unstimulated (resting) whole saliva. 8/27/2015 142Dyspahgia diagnosis and treatment by Ekberg 1st edition
  143. 143. Etiology • Autoimmune disease (Sjogren’s syndrome, lupus) • Systemic diseases (diabetes, asthma, kidney malfunction, sarcoidosis, HIV) • Stress/anxiety/depression • Radiation therapy to the head and neck – 30 Gy = glandular fibrosis (gland can still produce some saliva) – 60-70 Gy = glandular destruction (gland can no longer produce saliva) 8/27/2015 143Dyspahgia diagnosis and treatment by Ekberg 1st edition
  144. 144. • Antacid • Antianxiety • Anticholinergic • Anticonvulsant • Antidepressant • Antiemetic • Antihistamine • Antihypertensive • Antiparkinsonian • Antipsychotic Factors that Affect Salivary Flow Medications •Cholesterol reducing •Decongestant •Diet pills •Diuretic •Hormonal replacement therapy •Muscle relaxant •Narcotic analgesic •Sedative •Bronchodilator Over 400 Medications Can Produce the Side Effect of Xerostomia 144Dyspahgia diagnosis and treatment by Ekberg 1st edition
  145. 145. • Ageing • Decreased mastication • Salivary gland tumors and neoplasms 8/27/2015 145 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  146. 146. • Viscous saliva • Sticky saliva • Difficulty speaking • Difficulty swallowing • Halitosis • Altered taste • Complaint of dryness • Complaint of burning mouth, lips, or tongue • Altered sense of smell XEROSTOMIA Symptoms 146 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  147. 147. • Increased caries • Food sticking to the oral structures • Frothy saliva • Gingivitis • Absence of saliva • Cracking and fissuring of the tongue • Ulceration of oral mucosa • No pooling of saliva in the floor of the mouth • Recurrent candidal infections • A toothbrush, mouth mirror, or instrument that sticks to the soft tissues • Poorly fitting prostheses XEROSTOMIA: signs 147 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  148. 148. ORAL SYSTEMIC Saliva: decrease in amount, foamy, viscous Ropy (increase in spinnbarkeit) Lips: dry, cracked, fissured (chelosis) Tongue: Burning (glossopyrosis), pain (glossodynia) Cheeks: dry Salivary glands: Swelling, pain Thirst: frequent ingestion of fluids especially while eating: keep water at bedside Mastication: difficulty with eating dry foods; difficulty with the use of a denture, difficulty with swallowing (dysphagia) speech difficulty (dysphonia), Taste abnormality (dysgeusia) Throat: dryness, hoarseness, persistent dry cough Nose: dryness, frequent crust formation, decrease in olfactory acuity. Eyes: dryness, burning, itching gritty sensation, feeling that the lids stick together, blurred vision, sensitivity to light. Skin: dryness, butterfly rash, vasculitis. Joints: Arthritis, pain, swelling, stiffness GI tract: constipation. Vagina: dryness, burning, itching history of recurrent fungal infections, dyspareunia. General symptoms: fatigue, weakness, generalized aching, weight loss, depression. 148 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  149. 149. Treatment 1. Preventive therapy. 2. Symptomatic treatment. 3. Local/Topical salivary stimulation 4. Systemic salivary stimulation 5. Specific disease therapies 8/27/2015 149 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  150. 150. Preventive therapy • Topical fluoride therapy • Remineralising solutions 8/27/2015 150 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  151. 151. Topical fluorides • Sodium fluoride • Stannous fluoride • APF • Amine fluorides • Fluoridated mouth rinses 8/27/2015 151
  152. 152. Remineralization • CPP-ACFP (GC TOOTH MOUSSE PLUS) • BETA TRICALCIUM PHOSPHATE (CLINPRO) • NOVA MIN (BIO ACTIVE GLASS) • PRONAMEL • ENAMELON • XYLITOL 8/27/2015 152
  153. 153. Symptomatic treatment 8/27/2015 153 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  154. 154. XEROSTOMIA: Management Treatment of Xerostomia-Associated Problems 1548/27/2015 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  155. 155. Topical stimulation • Topical lozenges • Sugarless gums • Gentle massage • Sour foods • Mild electric discharge • Artificial saliva 8/27/2015 155 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  156. 156. Artificial saliva components • Xanthan gum • Sodium carboxymethylcellulose • Potassium chloride • Sodium chloride • Magnesium chloride • Calcium chloride • Di-potassium hydrogen orthophosphate • Potassium di-hydrogen orthophosphate • Sodium fluoride • Sorbitol • Methyl p-hydroxybenzoate • Spirit of lemon 8/27/2015 156 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  157. 157. • Commercially available: – Orabalance – Dry mouth – XERO – Lube – Salivart – Optimoist – Oralub 8/27/2015 157 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  158. 158. Systemic salivary stimulation • Anetholetrithione • Bromhexine mucolytics • Pilocarpine hydrochloride (5 to 7.5 mg TID) • Cevimeline hydrochloride (30 mg TID) parasympatho mimetics 8/27/2015 158
  159. 159. Recent approaches • Acupuncture may increase parasympathetic activity, causing a release in neuropeptide, stimulating salivary flow and secretions. 8/27/2015 159
  160. 160. 8/27/2015 160
  161. 161. • The daily ingestion of 2,000 units of gamma- linoleic acid (found in evening primrose oil) for at least 6 weeks may increase parotid and submandibular salivary flow 8/27/2015 161 Management of Xerostomia Related to Radiotherapy for Head and Neck Cancer; journal of oncology ;December 2005 By Shannon T. Kahn
  162. 162. Restorative considerations • Fluoride releasing materials preferred • Restorations are more prone to surface deterioration • Permanent restorations are preferred • Frequent topical fluoride application 8/27/2015 162 Dyspahgia diagnosis and treatment by Ekberg 1st edition
  163. 163. Hypersalivation • Excess secretion • Physiological in pregnancy • Pathological - sialorrhoea/sialism/sialosis 8/27/2015 163 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  164. 164. • Deacy of tooth • Neoplasm of oral cavity • GIT imbalance • Cerebral palsy and mental retardation • Cerebral stroke • Parkinsonism • Nausea and vomiting 8/27/2015 164 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  165. 165. Management at dental office Name of drug Dosage in milligrams 30 min before procedure Atropine (atronex , atrover ) 0.4 to 1.5 Scopalamine (belloid , buscopan etc) 0.3 to 0.6 Hyoscyamine (levcin , levbid ) 0.125 to 0.75 Methantheline 50 to 100 Propantheline (pro banthine ) 15 to 30 Glycopyrrolate (robinul) 1 to 2 Blocking or inhibiting acetyl choline action Salivary inhibition at a low dose 8/27/2015 165DENTAL PHARMACOLOGY BY K.D TRIPATI 6TH EDITION
  166. 166. Drooling/ptyalism • Uncontrolled & outside mouth • Excess production and inability to retain • Occurs in 1. Children during teeth eruption 2. Upper respiratory tract infection 3. Difficulty in swallowing 4. Tonsillitis 5. Quincy 8/27/2015 166 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  167. 167. Chorda tympani syndrome • Sweating while eating • Nerve fibers supplying salivary gland in relation to chordatympani while regenerating may join those fibres supplying sweat glands • Salivary secretion associated with sweat secretion 8/27/2015 167 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  168. 168. Paralytic secretion • Increased secretion after cutting parasympathetic nerve fibers • Due to release of large amounts of adrenaline from supra renal glands • Acinar cells are hypersensitive to adrenaline 8/27/2015 168 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  169. 169. Augmented secretion • Double stimulation • First stimulation increases excitability • Second stimulation augments salivary secretion 8/27/2015 169 MEDICAL PHYSIOLOGY BY SEMBULINGAM 4TH EDITION
  170. 170. Saliva as a storage medium • For not more than one hour • Its osmolality (60-70 mOsm/kg) is much lower than the physiologic • Can damage pdl • chance of infection • More readily available • Better than tap water or dry state Badruddin et al storage medium for avulsed teeth Indian Journal of Multidisciplinary Dentistry, Vol. 3, Issue 3, May-July 2013 8/27/2015 170
  171. 171. Journal references 8/27/2015 171
  172. 172. Effect of artificial saliva contamination on adhesion of dental restorative materials Kisaki SHIMAZU et al (Dental Materials Journal 2014; 33(4): 545–550) • The purpose of this study was to evaluate the effects of artificial saliva contamination on three restorative materials, namely, a glass ionomer cement (GIC), a resin-modified GIC (RMGIC), and a composite resin (CR) • The dentin bond strength for CR was significantly lower after artificial saliva contamination. 8/27/2015 172
  173. 173. • artificial saliva contamination did not affect the shear bond strengths of GIC and RMGIC or their degrees of microleakage. 8/27/2015 173
  174. 174. Salivary Cells in Patients with Dental Amalgam and Composite Resin Material Restorations Irena Kasacka, Joanna Łapińska Polish J. of Environ. Stud. Vol. 19, No. 6 (2010), 1223-1227 • The aim of our study was to compare the composition and morphological activity of sali- vary cells in patients with amalgam and composite material restorations. • Significant morphological changes were observed in the salivary smears in patients with amalgam restorations • There was a slight difference in salivary cells in patients with composite restorations in compar- ison to the control group. 8/27/2015 174
  175. 175. Effect of salivary contamination at different steps of the bonding process on the micro leakage around Class V restorations Cristiane Becher Rosa et al. Braz J Oral Sci. October-December 2007 - Vol. 6 - Number 23 • This study aimed to investigate the influence of the moment of salivary contamination during the bonding procedure (before or after acid conditioning) on the micro leakage around composite resin restorations • salivary contamination after acid etching increases the micro leakage around composite resin restorations, especially at dentin margins. 8/27/2015 175
  176. 176. Correlation between Dental Caries and Salivary Albumin in Adult Indian Population– An In Vivo Study Mithra N. Hegde et al. British Journal of Medicine & Medical Research 4(25): 4238-4244, 2014 • To analyze the relationship between dental caries, albumin in young adults between the age group of 20 to 30 years • there is an increase in the levels of caries with decrease in the levels of albumin. Serum albumin levels were also found to be decreased in caries prone individuals, hence showing a significant correlation between serum and salivary albumin levels. 8/27/2015 176
  177. 177. Potential areas for research • Dental materials that can sustain moisture contamination without compramising in mechanical properties function 8/27/2015 177
  178. 178. 1788/27/2015
  179. 179. 8/27/2015 179

×