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SALIVA

Dr. Greeshma Lal's presentation covers the composition, functions, and clinical significance of saliva, detailing its role in digestion, protection, antimicrobial action, and maintenance of tooth integrity. It also discusses the different types of salivary glands, their secretions, and factors influencing saliva flow, as well as the use of saliva as a biomarker for disease detection. The presentation emphasizes the importance of saliva in preventing dental caries and its potential in non-invasive diagnostic methods.

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1DR.GREESHMA LAL
Presented by :- Dr. Greeshma Lal Department of Conservative Dentistry and Endodontics 2DR.GREESHMA LAL
Introduction • ‘The watery, slightly alkaline fluid secreted into the mouth by salivary glands and mucous membrane that lines the mouth” – British Medical Association 3DR.GREESHMA LAL
History • Ancient records have proved the use of ‘rice tests’ as a means of proving innocence or gulit • Traditional Chinese doctors used the thickness and smell of saliva as diagnostic tools to assess the health of a patient o Over secretion of saliva – heart burn / cold stimulation of the stomach o Sweet saliva – spleen malfunctions Saliva in health and disease ; an appraisal and update IDJ 2000 sreeberg Leo 4DR.GREESHMA LAL
Classification of salivary glands Major Parotid Submandibul ar Sublingual Minor Labial/ Buccal Anterior Palatine Glossopalat ine Von - ebner’s Orban’s oral histology and embryology -10th edition 5DR.GREESHMA LAL
Classification of salivary glands Based on type of secretion • Labial and Buccal glands • Glossopalatine • Palatine • Posterior tongue Mucous • Parotid • Glands of Von EbnerSerous • Submandibular and Sublingual • Anterior tongue Mixed Orban’s oral histology and embryology -10th edition 6DR.GREESHMA LAL
Parotid gland • Largest of the 3 major glands • Parotid duct is also known as Stenson’s duct • exits opposing the maxillary second molar • Located anterior but inferior to the external auditory meatus • Innervated by sympathetic nerve divisions • Secretes serous type saliva7DR.GREESHMA LAL
Submandibular gland Second largest salivary gland • The duct is called Wharton’s duct • exits on the floor of the mouth opposing the lingual surface of the tongue. • Innervated by parasympathetic nerve endings • Mixed secretion – mostly serous 8DR.GREESHMA LAL
Sublingual gland • Smallest of the major glands • Saliva delivered via the ducts of Bartholin (Rivinus ducts) • exits on the base of the lingual surface of the tongue • Innervated by parasympathetic fibers • Mixed secretion – mostly mucous 9DR.GREESHMA LAL
Mechanism of secretion Stage 1 • Acinar cells secrete a NaCl rich fluid called primary saliva - isotonic Stage 2 • The primary saliva – modified – passed along the ductal tree (reabsorbing NaCl and secreting K ,HCO3 • Ductal epithelium – poorly permeable to water • Final saliva - hypotonic Saliva secretion can be defined as unidirectional movement of fluid electrolytes and macromolecules into saliva in response to appropriate stimulation 10DR.GREESHMA LAL
Primary Composition of saliva WATER 99% OTHERS 1% Orban’s oral histology and embryology -14th edition 11DR.GREESHMA LAL
ORGANIC Proteins Lipids Blood Groups Hormones Carbohydrates Glucose Hexasamine Antigen A,B Salivary amylase •Alpha amylase •Kallikrein •Alpha phosphatase •Lipase Immunoglobulins •IgA •IgM •IgG Proteins synthesised within glands •Factor VII •Factor VIII •Factor IX •Platelet Factor Glycoproteins •MG1, MG2 •Protein rich glycoproteins Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. 12DR.GREESHMA LAL
INORGANIC Sodium Potassium Calcium Phosphorous Chloride Bicarbonate • Yeast • Bacteria • Protozoa • Polymorphpneuclear lymphocytes (PMNL) • Desquamated epithelial cells CELLS • Oxygen • Nitrogen • Carbondioxide GASES Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. 13DR.GREESHMA LAL
 Mixed saliva (whole saliva) :- Glandular secretion + Desquamated oral epithelial cells , microorganisms and their products , Leukocytes , food debris and gingival crevicular fluid 14DR.GREESHMA LAL
Properties of saliva • pH : 6.2 – 7.4 • Specific Gravity : 1.0024 -1.0061 • Freezing point : 0.07 – 0.34 ̊C • Velocity : 0.8-8 mm/minute Total volume of saliva secreted by humans daily : 750 – 1000 ml approximately • Submandibular – 65- 70% • Parotid – 30% approximately • Sublingual – 5% or less • Minor salivary glands – 1% Saliva fact !! 15DR.GREESHMA LAL
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• Flow rate (Thomson et al, 2011) :- 0.2 – 0.4 ml/min when unstimulated and 0.2 -1.7 ml/min when stimulated Unstimulated rate of < 0.1ml/min and stimulated rate of <0.7 ml/min considered very low 17DR.GREESHMA LAL
Factors affecting flow of saliva  Individual Hydration When the body water content is reduced by 8%, SF virtually diminishes to zero, whereas hyperhydration causes an increase in SF  Diurnal variation/ Circadian cycle The concentration of total proteins attains its peak at the end of the afternoon, while the peak production levels of sodium and chloride occur at the beginning of the morning. 18DR.GREESHMA LAL
 Body Posture, Lighting, and Smoking • Patients kept standing up or lying down present higher and lower SF, respectively, than seated patients. • `There is a decrease of 30% to 40% in SF of people that are blindfolded or in the dark. • Olfactory stimulation and smoking cause a temporary increase in unstimulated SF. • Men that smoke present significantly higher stimulated SF than non-smoking men. 19DR.GREESHMA LAL
Medications • Many classes of drugs, particularly those that have anticholinergic action (antidepressants, anxiolytics, antipsychotics, antihistaminics, and antihypertensives) Visual Stimulation • Weak but positive stimulus Gustatory Stimulation • The action of chewing something tasteless itself stimulates salivation but to a lesser degree than the tasty stimulation caused by citric acid. 20DR.GREESHMA LAL
Size of Salivary Glands and Genderr • Stimulated SF is directly related to the size of the salivary gland, contrary to unstimulated SF which does not depend on its size Hormones • Aldosterone – increases Na reabsorption in the striated ducts • Antidiuretic hormone- Water reabsorption by striated duct cells 21DR.GREESHMA LAL
Functions of saliva 1. Digestion 2. Protection 3. Buffering 4. Antimicrobial action 5. Taste 6. Maintenance of tooth integrity 7. Tissue repair 22DR.GREESHMA LAL
 Digestive function • The moistening and lubricating action of saliva allows the formation and swallowing of the food bolus. • Salivary amylase and lipase are primary enzymes contained in saliva that begin the digestive process in the oral cavity itself. 23DR.GREESHMA LAL
α- Amylase (ptyalin) • Ca dependent digestive enzyme • Activated by Cl • Acts on cooked starch • Optimum pH = 6.8 • Inactive below pH 4 Lingual lipase • Von ebner gland • Responsible for the first phase of fat digestion Bolus formation • Moistening of food (water) • Mucin- lubricating material , makes food slippery ,facilitates swallowing 24DR.GREESHMA LAL
 Protective function • Salivary mucins and other glycoproteins provide lubrication, preventing the oral tissues from adhering to each other and also minimize friction. • Mucins form a barrier against noxious stimuli, microbial toxins and minor trauma. • Salivary proteins protect the tooth surface by binding to calcium and forming a thin protective film called salivary pellicle. 25DR.GREESHMA LAL
 Antimicrobial Action • Saliva contains a spectrum of proteins which possess antimicrobial properties such as o lysozyme, o lactoferrin, o peroxidase, o immunoglobulins and o secretory leukocyte protease inhibitor. • Some salivary proteins and peptides are also known to exhibit antiviral activity. • Antifungal activity o Histatin peptide 26DR.GREESHMA LAL
 Buffering (maintenance of Ph) • The resting pH of Saliva is 6 to 7. • Bicarbonate - buffering action - by diffusing into plaque and neutralizing the acidic products of sugars metabolized by cariogenic bacteria. • This protects the teeth from demineralization and subsequent dental caries. • Also, the metabolism of salivary proteins and peptides by oral micro flora produces ammonia which is basic in nature and further increase the ph. 27DR.GREESHMA LAL
 Maintenance of Tooth Integrity Salivary proteins such as • statherin, • proline rich proteins • histatins , help stabilize the calcium and phosphate salt solutions and bind to hydroxyapatite on the tooth structure increasing its resistance to acid attack. • The presence of fluoride ions in saliva also helps in the remineralization of the initial carious lesion. 28DR.GREESHMA LAL
 Tissue Repair • A variety of growth factors and biologically active peptides are present in the saliva which aid in tissue repair and regeneration. Nerve growth factor Wound healing Epidermal growth factor • Speeds up coagulation process 29DR.GREESHMA LAL
 Taste • The saliva produced by the minor salivary glands present in the vicinity of circumvallate papillae contains proteins that are believed to bind to the taste substances and present them to the taste receptor. • Saliva also aids in preserving the health of the taste receptor sites protecting them from mechanical and chemical stress or bacterial infection. • Solubilizes food substances so that they can be sensed by taste receptors located in the taste buds 30DR.GREESHMA LAL
31DR.GREESHMA LAL
Role of Saliva in Dental Caries 32DR.GREESHMA LAL
• Dental caries is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of calcified tissues –Sturdevant • It is defined as a ‘microbial disease of the calcified tissues of the teeth, characterized by dimineralization of the inorganic portion and destruction of the organic substance of the tooth. –Shafer, Hine, Levy 33DR.GREESHMA LAL
Preventive mechanisms :- 1. Flushing and neutralizing effects , referred to as “salivary clearance” or “oral clearance capacity” (Lagerlof and Oliveby, 1994 ) - Reduce plaque accumulation - Tooth dissolution is prevented / remineralisation enhanced Higher flow rate Faster clearance Higher buffering capacity 34DR.GREESHMA LAL
2. Regulating the pH with the help of its bicarbonate content as well as phosphate and amphoteric protein constituents 3. Maintaining tooth integrity • Diffusion into plaque of salivary components such as calcium, phosphate, hydroxyl and flouride ions enhance remineralisation of early carious lesions 35DR.GREESHMA LAL
Micriobes + Fermentable carbohydrates Plaque Acids Remineralization Demineralization Salivary Components : Calcium , Phosphate, pH Buffers, Flouride 36DR.GREESHMA LAL
Buffering systems • Carbonic acid/bicarbonate Stimulated • Inorganic phosphate Unstimulated • Salivary proteins Low pH 37DR.GREESHMA LAL
PHOSPHATE BUFFER HPO4 2- + H+→ H2PO4 - • This acid-base pair has a pKa value in the range 6.8-7.2 , which has a maximum buffering capacity that is relatively close to the salivary pH range: 6-8. • Has the potential to be an effective buffer in the mouth. • its effectiveness is limited - due to insufficient concentrations of phosphate in the oral cavity. • Nonetheless, in the resting state where there is no food in the mouth, the concentration of inorganic phosphate is rather high while the concentration of carbonic acid/bicarbonate is rather low. Hence the phosphate buffer (pKa = 6.8) is moderately efficient in unstimulated saliva. 38DR.GREESHMA LAL
CARBIONIC ACID/BICARBONATE BUFFER • major buffer in stimulated saliva • bicarbonate acting mainly to neutralize acids produced by bacteria when they digest sugars in the mouth or acids from the stomach • Once food is in the mouth, two important events occur: (1) Drop in pH (2) Rise in bicarbonate concentration. 39DR.GREESHMA LAL
• The concentration of bicarbonate is determined by the  stimulation of saliva  carbonic anhydrase VI Carbionic Anhydrase - Maintainence of pH by catalysing reversible hydration of CO2 40DR.GREESHMA LAL
Demineralization And Remineralization • Human salivary secretions are supersaturated with respect to calcium and phosphate but spontaneous precipitation from saliva to dental enamel does not normally occur. • the maintenance of the homeostasis of the supersaturated state of saliva is mediated by a group of salivary proteins namely,  statherin  the acidic PRPs  cystatins  histatins 41DR.GREESHMA LAL
 Statherin • Only identified inhibitor of primary precipitation in saliva, very potent inhibitor of crystal growth. • Hay and Moreno (1989), statherin is present in stimulated saliva in concentrations sufficient to inhibit the precipitation of calcium and phosphate salts effectively • Studies have shown that statherin may contribute to the early colonization of the tooth surfaces by certain bacteria, such as Actinomyces viscosus Gibbons RJ, Hay DI (1988). Human salivary acidic proline-rich proteins and statherin promote the attachment of Actinomyces viscosus LY7 to apatitic surfaces. Infect Immun 56:439-445 42DR.GREESHMA LAL
 The acidic proline-rich proteins (PRPs) • They account for 25-30% of all proteins in saliva • Have high affinity for hydroxyapatite . • The acidic PRPs bind free calcium, adsorb to hydroxyapatite surfaces and regulate hydroxyapatite crystal structure . 43DR.GREESHMA LAL
• The acquired enamel pellicle - thin film consisting mainly of salivary proteins selectively absorbed to the surface of the enamel. • The pellicle protects the enamel from dissolution. • The pellicle is also a base to which the bacteria can adhere when they enter the oral cavity. 44DR.GREESHMA LAL
45DR.GREESHMA LAL
• The two most abundant agglutinins in saliva are : » High molecular-weight agglutinin » Mucins. • Of the mucins, the low-molecular-weight form,MG2, is more efficient in bacterial aggregation and clearance than the high- molecular-weight form, MG1 46DR.GREESHMA LAL
Specific Defence Factors And Dental Caries • Immunoglobulins, IgG, IgM, IgA, and secretory IgA (s-lgA) 47DR.GREESHMA LAL
• The formation of specific IgAs in saliva correlates with the colonization of bacteria in the oral cavity. • In most children over three years of age, salivary IgAs against mutans streptococci can be detected and their amount increases with the length of exposure Ig A 48DR.GREESHMA LAL
• Mainly of maternal origin • is the only detectable Ig in the saliva of neonates. • concentration decreases to undetectable levels after some months but appears again after tooth eruption • It must also be noted that the presence of active caries lesions may induce the formation of specific IgGs , and that they may remain at a higher level for several weeks or months after eradication of the lesions. 49DR.GREESHMA LAL
FLUORIDE • Fluoride concentration in saliva is low, range of 0.4-2.6 μm , increases in fluoridated areas. • Salivary fluoride will diffuse into the dental plaque where some of the fluoride will be trapped as calcium fluoride. • This clearance is rapid during the first 20- 40 minutes but then slowly levels off depending on the salivary flow rate and the volumes of saliva in the mouth before and after swallowing. 50DR.GREESHMA LAL
According to Wong, scientists are now viewing saliva as “a valuable biofluid…with the potential to extract more data than is possible currently with other diagnostic methods.” 51DR.GREESHMA LAL
WHY SALIVA ?? • Non – invasive • Limited training • No special equipment • Cost effective • Eliminates the risk of infection • Fast screening of a large population 52DR.GREESHMA LAL
Biomarkers in saliva • A biomarker, or biological marker, is an indicator of a biological state, or the past or present existence of a particular type of organism. • Biomarkers are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. 53DR.GREESHMA LAL
Clinical Uses :- The following conditions can be detected through saliva testing: Detect disease Treatment efficacy Stage disease Response to treatment Monitor recurrence 54DR.GREESHMA LAL
• In 2010 Jou, et al., found that patients diagnosed with oral squamous cell carcinoma had elevated levels of transferrin in saliva-early detection of cancer. • salivary levels of two biomarkers, Cyclin D1 and Maspin had sensitivities and specificities of 100% for oral cancer. • Saliva testing for specific mRNAs has been found to possess significant potential for oral cancer diagnosis. • Saliva RNA diagnostics are slightly superior to serum RNA diagnostics value being 95% for saliva but only 88% for serum • In oral squamous cell carcinoma – presence of protein p53 has been detected in saliva 55DR.GREESHMA LAL
 Glucose dysregulation • Rao, et al., investigated salivary biomarkers that could aid identification of type-2 diabetic individuals. • In 2010 Soell, et al., determined that one particular salivary biomarker -chromogranin A was over- expressed. • In 2010 Qvarnstrom, et al., found that an increase in salivary lysozyme was significantly associated with metabolic syndrome. 56DR.GREESHMA LAL
 HIV & salivary testing • Zelin, et al., compared saliva antibody testing and serum antibody testing using ELISA technique & found 100% of sensitivity and specificity for saliva testing. • Pascoe, et al., compared saliva antibody testing to serum antibody testing using ELISA followed by confirmatory Western Blot analysis & accuracy of saliva anti-HIV antibody testing was confirmed 57DR.GREESHMA LAL
Salivary diagnostics of common oral diseases Salivary or GCF derived molecules are used as diagnostic biomarkers for oral diseases including: - conditions caused by fungi-Candida species - Viruses like HPV, Epstein-Barr Virus - Cytomegalovirus - multiple bacterial species involved in periodontal diseases and caries 58DR.GREESHMA LAL
 Periodontitis & salivary testing • Koss, et al., studied salivary biomarkers of periodontal disease & revealed three substances:peroxidase,Hydroxyproline, calcium were significantly increased in the saliva of patients with periodontitis. • A 2010 study found that elevation of three saliva biomarkers (MMP-8, TIMP-1, and ICTP), analyzed using time-resolved immuno-fluorometric assay, was suggestive of periodontitis. 59DR.GREESHMA LAL
60DR.GREESHMA LAL
 Saliva tests in forensics • Samples from drinking glasses, cigarette bits, envelopes- detect blood-group substances or salivary genetic proteins . • blood-group antigens including A, B, H, and Lewis antigens in saliva- used for identification of individuals in criminal cases and paternity law suits. • Saliva is often present at crime scenes, along with other body fluids, and since DNA is relatively stable in the dry state, these samples can be used to place an individual at the scene of a crime. 61DR.GREESHMA LAL
 Role of saliva in detection of substance abuse • Detection of marijuana/cannabinoids in oral fluid - better indicator of drug abuse. • Indicates recent use than detection of the metabolite in urine. • concentration of cocaine in oral fluid is generally higher than plasma and is detectable for longer time. 62DR.GREESHMA LAL
• The major opiates that are detected saliva:-morphine,codeine, 6-acetylmorphine etc. • Test Strip is used to quickly and accurately detect the presence of alcohol in saliva. • Suitable breathanalyzer are used for health or law enforcement fields to detect alcohol in saliva 63DR.GREESHMA LAL
 Hormone Level Monitoring • Saliva can be analyzed as part of the evaluation of endocrine function. • Salivary Cortisol levels - useful in identifying patients with stress,Cushing's syndrome and Addison's disease. • Other corticosteroids, like prednisone , prednisolone & aldosterone levels can be demonstrated in saliva. Salivary progesterone levels - for prediction of ovulation. Salivary estradiol & progesterone - evaluation of ovarian function. 64DR.GREESHMA LAL
65DR.GREESHMA LAL
Clinical Considerations 66DR.GREESHMA LAL
HYPOSALIVATION • Reduction in the secretion of saliva • Temporary :- o emotional situations like fear , anxiety o Fever o Dehydration • Permanent :- o Sialolithiasis – obstruction of salivary duct o Aplasia/ hypoplasia of the salivary glands o Bell’s palsy – paralysis of facial nerve Age changes With age a generalized loss of gland parenchymal tissue occurs The lost salivary cells are replaced by adipose tissue 67DR.GREESHMA LAL
Dry Mouth (Xerostomia) • A loss of salivary function or a reduction in the volume of secreted saliva may lead to sensation of oral dryness 68DR.GREESHMA LAL
Sjogren’s syndrome • Chronic autoimmune disorder charecterised by o Xerostomia o Xerophthalmia o Lymphocytic infiltration of the exocrine glands This triad is called sicca complex 69DR.GREESHMA LAL
• Reduced salivary flow rate and concomitant reduction of oral defense systems may cause severe caries and mucosal inflammations (Daniels et al., 1975; Van der Reijden et al 1996) • Dental caries is probably the most common consequence of hyposalivation (Brown et al , 1978; Scully, 1986) 70DR.GREESHMA LAL
Gingivitis Oral ulcer Glossitis Mucositis 71DR.GREESHMA LAL
Reduced denture retention and stability DYSPHAGIA DYSGUESIA HALITOSIS 72DR.GREESHMA LAL
HYPERSALIVATION Excess secretion of saliva – ptyalism , sialorrhea, sialism or sialosis Conditions :- o Neoplasms of the mouth or tongue o Neurological disorders : cerebral palsy , cerebral stroke o Parkinsonism 73DR.GREESHMA LAL
Drooling (ptyalism) • Uncontrolled flow of saliva outside the mouth • Cause :- • Excess production of saliva along with inability to retain saliva in the mouth 74DR.GREESHMA LAL
Chorda tympani syndrome • Characterized by ‘sweating while eating’ • During the regeneration of nerve fibers following trauma or surgical division, which pass through chords tympani branch of facial nerve may deviate and join with the nerve fibers supplying sweat glands 75DR.GREESHMA LAL
Frey’s Syndrome / Gustatory sweating Baillarger’s syndrome, Dupuy’s Syndrome or Frey- Baillarger Syndrome • Can be congenital or acquired especially after parotid surgery and can persist for life 76DR.GREESHMA LAL
Augmented Secretion of saliva If the nerve supplying salivary glands are stimulated twice, the amount of saliva secreted by the second stimulus is greater 77DR.GREESHMA LAL
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 and research purposes is proving to be a reliable and practical method of recognising a number of diseases. • These advances in technology are not only confined to oral health characteristics but may also be used to measure features of overall health 78DR.GREESHMA LAL
References :- • Saliva in health and disease ; an appraisal and update IDJ 2000 sreeberg Leo • Orban’s oral histology and embryology -14th edition • ROLE OF SALIVA IN COMPLETE DENTURES: AN OVERVIEW, Shabina Sachdeva, Rana Noor, Rizwana Mallick,3Eram Perwez, Annals of Dental Specialty Vol. 2; Issue2. Apr – Jun 2014 • Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. • Saliva Composition and Functions: A Comprehensive Review- The Journal of Contemporary Dental Practice, Volume 9, No. 3, March 1, 2008 • Saliva: an overview; The New Zealand dental journal · June 2014 • Salivary Diagnostics- David T Wong 79DR.GREESHMA LAL
80DR.GREESHMA LAL

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SALIVA

  • 1.
  • 2.
    Presented by :- Dr.Greeshma Lal Department of Conservative Dentistry and Endodontics 2DR.GREESHMA LAL
  • 3.
    Introduction • ‘The watery,slightly alkaline fluid secreted into the mouth by salivary glands and mucous membrane that lines the mouth” – British Medical Association 3DR.GREESHMA LAL
  • 4.
    History • Ancient recordshave proved the use of ‘rice tests’ as a means of proving innocence or gulit • Traditional Chinese doctors used the thickness and smell of saliva as diagnostic tools to assess the health of a patient o Over secretion of saliva – heart burn / cold stimulation of the stomach o Sweet saliva – spleen malfunctions Saliva in health and disease ; an appraisal and update IDJ 2000 sreeberg Leo 4DR.GREESHMA LAL
  • 5.
  • 6.
    Classification of salivary glands Basedon type of secretion • Labial and Buccal glands • Glossopalatine • Palatine • Posterior tongue Mucous • Parotid • Glands of Von EbnerSerous • Submandibular and Sublingual • Anterior tongue Mixed Orban’s oral histology and embryology -10th edition 6DR.GREESHMA LAL
  • 7.
    Parotid gland • Largestof the 3 major glands • Parotid duct is also known as Stenson’s duct • exits opposing the maxillary second molar • Located anterior but inferior to the external auditory meatus • Innervated by sympathetic nerve divisions • Secretes serous type saliva7DR.GREESHMA LAL
  • 8.
    Submandibular gland Second largestsalivary gland • The duct is called Wharton’s duct • exits on the floor of the mouth opposing the lingual surface of the tongue. • Innervated by parasympathetic nerve endings • Mixed secretion – mostly serous 8DR.GREESHMA LAL
  • 9.
    Sublingual gland • Smallestof the major glands • Saliva delivered via the ducts of Bartholin (Rivinus ducts) • exits on the base of the lingual surface of the tongue • Innervated by parasympathetic fibers • Mixed secretion – mostly mucous 9DR.GREESHMA LAL
  • 10.
    Mechanism of secretion Stage1 • Acinar cells secrete a NaCl rich fluid called primary saliva - isotonic Stage 2 • The primary saliva – modified – passed along the ductal tree (reabsorbing NaCl and secreting K ,HCO3 • Ductal epithelium – poorly permeable to water • Final saliva - hypotonic Saliva secretion can be defined as unidirectional movement of fluid electrolytes and macromolecules into saliva in response to appropriate stimulation 10DR.GREESHMA LAL
  • 11.
    Primary Composition ofsaliva WATER 99% OTHERS 1% Orban’s oral histology and embryology -14th edition 11DR.GREESHMA LAL
  • 12.
    ORGANIC Proteins Lipids Blood Groups HormonesCarbohydrates Glucose Hexasamine Antigen A,B Salivary amylase •Alpha amylase •Kallikrein •Alpha phosphatase •Lipase Immunoglobulins •IgA •IgM •IgG Proteins synthesised within glands •Factor VII •Factor VIII •Factor IX •Platelet Factor Glycoproteins •MG1, MG2 •Protein rich glycoproteins Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. 12DR.GREESHMA LAL
  • 13.
    INORGANIC Sodium Potassium CalciumPhosphorous Chloride Bicarbonate • Yeast • Bacteria • Protozoa • Polymorphpneuclear lymphocytes (PMNL) • Desquamated epithelial cells CELLS • Oxygen • Nitrogen • Carbondioxide GASES Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. 13DR.GREESHMA LAL
  • 14.
     Mixed saliva(whole saliva) :- Glandular secretion + Desquamated oral epithelial cells , microorganisms and their products , Leukocytes , food debris and gingival crevicular fluid 14DR.GREESHMA LAL
  • 15.
    Properties of saliva •pH : 6.2 – 7.4 • Specific Gravity : 1.0024 -1.0061 • Freezing point : 0.07 – 0.34 ̊C • Velocity : 0.8-8 mm/minute Total volume of saliva secreted by humans daily : 750 – 1000 ml approximately • Submandibular – 65- 70% • Parotid – 30% approximately • Sublingual – 5% or less • Minor salivary glands – 1% Saliva fact !! 15DR.GREESHMA LAL
  • 16.
  • 17.
    • Flow rate(Thomson et al, 2011) :- 0.2 – 0.4 ml/min when unstimulated and 0.2 -1.7 ml/min when stimulated Unstimulated rate of < 0.1ml/min and stimulated rate of <0.7 ml/min considered very low 17DR.GREESHMA LAL
  • 18.
    Factors affecting flowof saliva  Individual Hydration When the body water content is reduced by 8%, SF virtually diminishes to zero, whereas hyperhydration causes an increase in SF  Diurnal variation/ Circadian cycle The concentration of total proteins attains its peak at the end of the afternoon, while the peak production levels of sodium and chloride occur at the beginning of the morning. 18DR.GREESHMA LAL
  • 19.
     Body Posture,Lighting, and Smoking • Patients kept standing up or lying down present higher and lower SF, respectively, than seated patients. • `There is a decrease of 30% to 40% in SF of people that are blindfolded or in the dark. • Olfactory stimulation and smoking cause a temporary increase in unstimulated SF. • Men that smoke present significantly higher stimulated SF than non-smoking men. 19DR.GREESHMA LAL
  • 20.
    Medications • Many classesof drugs, particularly those that have anticholinergic action (antidepressants, anxiolytics, antipsychotics, antihistaminics, and antihypertensives) Visual Stimulation • Weak but positive stimulus Gustatory Stimulation • The action of chewing something tasteless itself stimulates salivation but to a lesser degree than the tasty stimulation caused by citric acid. 20DR.GREESHMA LAL
  • 21.
    Size of SalivaryGlands and Genderr • Stimulated SF is directly related to the size of the salivary gland, contrary to unstimulated SF which does not depend on its size Hormones • Aldosterone – increases Na reabsorption in the striated ducts • Antidiuretic hormone- Water reabsorption by striated duct cells 21DR.GREESHMA LAL
  • 22.
    Functions of saliva 1.Digestion 2. Protection 3. Buffering 4. Antimicrobial action 5. Taste 6. Maintenance of tooth integrity 7. Tissue repair 22DR.GREESHMA LAL
  • 23.
     Digestive function •The moistening and lubricating action of saliva allows the formation and swallowing of the food bolus. • Salivary amylase and lipase are primary enzymes contained in saliva that begin the digestive process in the oral cavity itself. 23DR.GREESHMA LAL
  • 24.
    α- Amylase (ptyalin) •Ca dependent digestive enzyme • Activated by Cl • Acts on cooked starch • Optimum pH = 6.8 • Inactive below pH 4 Lingual lipase • Von ebner gland • Responsible for the first phase of fat digestion Bolus formation • Moistening of food (water) • Mucin- lubricating material , makes food slippery ,facilitates swallowing 24DR.GREESHMA LAL
  • 25.
     Protective function •Salivary mucins and other glycoproteins provide lubrication, preventing the oral tissues from adhering to each other and also minimize friction. • Mucins form a barrier against noxious stimuli, microbial toxins and minor trauma. • Salivary proteins protect the tooth surface by binding to calcium and forming a thin protective film called salivary pellicle. 25DR.GREESHMA LAL
  • 26.
     Antimicrobial Action •Saliva contains a spectrum of proteins which possess antimicrobial properties such as o lysozyme, o lactoferrin, o peroxidase, o immunoglobulins and o secretory leukocyte protease inhibitor. • Some salivary proteins and peptides are also known to exhibit antiviral activity. • Antifungal activity o Histatin peptide 26DR.GREESHMA LAL
  • 27.
     Buffering (maintenanceof Ph) • The resting pH of Saliva is 6 to 7. • Bicarbonate - buffering action - by diffusing into plaque and neutralizing the acidic products of sugars metabolized by cariogenic bacteria. • This protects the teeth from demineralization and subsequent dental caries. • Also, the metabolism of salivary proteins and peptides by oral micro flora produces ammonia which is basic in nature and further increase the ph. 27DR.GREESHMA LAL
  • 28.
     Maintenance ofTooth Integrity Salivary proteins such as • statherin, • proline rich proteins • histatins , help stabilize the calcium and phosphate salt solutions and bind to hydroxyapatite on the tooth structure increasing its resistance to acid attack. • The presence of fluoride ions in saliva also helps in the remineralization of the initial carious lesion. 28DR.GREESHMA LAL
  • 29.
     Tissue Repair •A variety of growth factors and biologically active peptides are present in the saliva which aid in tissue repair and regeneration. Nerve growth factor Wound healing Epidermal growth factor • Speeds up coagulation process 29DR.GREESHMA LAL
  • 30.
     Taste • Thesaliva produced by the minor salivary glands present in the vicinity of circumvallate papillae contains proteins that are believed to bind to the taste substances and present them to the taste receptor. • Saliva also aids in preserving the health of the taste receptor sites protecting them from mechanical and chemical stress or bacterial infection. • Solubilizes food substances so that they can be sensed by taste receptors located in the taste buds 30DR.GREESHMA LAL
  • 31.
  • 32.
    Role of Salivain Dental Caries 32DR.GREESHMA LAL
  • 33.
    • Dental cariesis an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of calcified tissues –Sturdevant • It is defined as a ‘microbial disease of the calcified tissues of the teeth, characterized by dimineralization of the inorganic portion and destruction of the organic substance of the tooth. –Shafer, Hine, Levy 33DR.GREESHMA LAL
  • 34.
    Preventive mechanisms :- 1.Flushing and neutralizing effects , referred to as “salivary clearance” or “oral clearance capacity” (Lagerlof and Oliveby, 1994 ) - Reduce plaque accumulation - Tooth dissolution is prevented / remineralisation enhanced Higher flow rate Faster clearance Higher buffering capacity 34DR.GREESHMA LAL
  • 35.
    2. Regulating thepH with the help of its bicarbonate content as well as phosphate and amphoteric protein constituents 3. Maintaining tooth integrity • Diffusion into plaque of salivary components such as calcium, phosphate, hydroxyl and flouride ions enhance remineralisation of early carious lesions 35DR.GREESHMA LAL
  • 36.
    Micriobes + Fermentablecarbohydrates Plaque Acids Remineralization Demineralization Salivary Components : Calcium , Phosphate, pH Buffers, Flouride 36DR.GREESHMA LAL
  • 37.
    Buffering systems • Carbonicacid/bicarbonate Stimulated • Inorganic phosphate Unstimulated • Salivary proteins Low pH 37DR.GREESHMA LAL
  • 38.
    PHOSPHATE BUFFER HPO4 2- +H+→ H2PO4 - • This acid-base pair has a pKa value in the range 6.8-7.2 , which has a maximum buffering capacity that is relatively close to the salivary pH range: 6-8. • Has the potential to be an effective buffer in the mouth. • its effectiveness is limited - due to insufficient concentrations of phosphate in the oral cavity. • Nonetheless, in the resting state where there is no food in the mouth, the concentration of inorganic phosphate is rather high while the concentration of carbonic acid/bicarbonate is rather low. Hence the phosphate buffer (pKa = 6.8) is moderately efficient in unstimulated saliva. 38DR.GREESHMA LAL
  • 39.
    CARBIONIC ACID/BICARBONATE BUFFER •major buffer in stimulated saliva • bicarbonate acting mainly to neutralize acids produced by bacteria when they digest sugars in the mouth or acids from the stomach • Once food is in the mouth, two important events occur: (1) Drop in pH (2) Rise in bicarbonate concentration. 39DR.GREESHMA LAL
  • 40.
    • The concentrationof bicarbonate is determined by the  stimulation of saliva  carbonic anhydrase VI Carbionic Anhydrase - Maintainence of pH by catalysing reversible hydration of CO2 40DR.GREESHMA LAL
  • 41.
    Demineralization And Remineralization •Human salivary secretions are supersaturated with respect to calcium and phosphate but spontaneous precipitation from saliva to dental enamel does not normally occur. • the maintenance of the homeostasis of the supersaturated state of saliva is mediated by a group of salivary proteins namely,  statherin  the acidic PRPs  cystatins  histatins 41DR.GREESHMA LAL
  • 42.
     Statherin • Onlyidentified inhibitor of primary precipitation in saliva, very potent inhibitor of crystal growth. • Hay and Moreno (1989), statherin is present in stimulated saliva in concentrations sufficient to inhibit the precipitation of calcium and phosphate salts effectively • Studies have shown that statherin may contribute to the early colonization of the tooth surfaces by certain bacteria, such as Actinomyces viscosus Gibbons RJ, Hay DI (1988). Human salivary acidic proline-rich proteins and statherin promote the attachment of Actinomyces viscosus LY7 to apatitic surfaces. Infect Immun 56:439-445 42DR.GREESHMA LAL
  • 43.
     The acidicproline-rich proteins (PRPs) • They account for 25-30% of all proteins in saliva • Have high affinity for hydroxyapatite . • The acidic PRPs bind free calcium, adsorb to hydroxyapatite surfaces and regulate hydroxyapatite crystal structure . 43DR.GREESHMA LAL
  • 44.
    • The acquiredenamel pellicle - thin film consisting mainly of salivary proteins selectively absorbed to the surface of the enamel. • The pellicle protects the enamel from dissolution. • The pellicle is also a base to which the bacteria can adhere when they enter the oral cavity. 44DR.GREESHMA LAL
  • 45.
  • 46.
    • The twomost abundant agglutinins in saliva are : » High molecular-weight agglutinin » Mucins. • Of the mucins, the low-molecular-weight form,MG2, is more efficient in bacterial aggregation and clearance than the high- molecular-weight form, MG1 46DR.GREESHMA LAL
  • 47.
    Specific Defence FactorsAnd Dental Caries • Immunoglobulins, IgG, IgM, IgA, and secretory IgA (s-lgA) 47DR.GREESHMA LAL
  • 48.
    • The formationof specific IgAs in saliva correlates with the colonization of bacteria in the oral cavity. • In most children over three years of age, salivary IgAs against mutans streptococci can be detected and their amount increases with the length of exposure Ig A 48DR.GREESHMA LAL
  • 49.
    • Mainly ofmaternal origin • is the only detectable Ig in the saliva of neonates. • concentration decreases to undetectable levels after some months but appears again after tooth eruption • It must also be noted that the presence of active caries lesions may induce the formation of specific IgGs , and that they may remain at a higher level for several weeks or months after eradication of the lesions. 49DR.GREESHMA LAL
  • 50.
    FLUORIDE • Fluoride concentrationin saliva is low, range of 0.4-2.6 μm , increases in fluoridated areas. • Salivary fluoride will diffuse into the dental plaque where some of the fluoride will be trapped as calcium fluoride. • This clearance is rapid during the first 20- 40 minutes but then slowly levels off depending on the salivary flow rate and the volumes of saliva in the mouth before and after swallowing. 50DR.GREESHMA LAL
  • 51.
    According to Wong,scientists are now viewing saliva as “a valuable biofluid…with the potential to extract more data than is possible currently with other diagnostic methods.” 51DR.GREESHMA LAL
  • 52.
    WHY SALIVA ?? •Non – invasive • Limited training • No special equipment • Cost effective • Eliminates the risk of infection • Fast screening of a large population 52DR.GREESHMA LAL
  • 53.
    Biomarkers in saliva •A biomarker, or biological marker, is an indicator of a biological state, or the past or present existence of a particular type of organism. • Biomarkers are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. 53DR.GREESHMA LAL
  • 54.
    Clinical Uses :- Thefollowing conditions can be detected through saliva testing: Detect disease Treatment efficacy Stage disease Response to treatment Monitor recurrence 54DR.GREESHMA LAL
  • 55.
    • In 2010Jou, et al., found that patients diagnosed with oral squamous cell carcinoma had elevated levels of transferrin in saliva-early detection of cancer. • salivary levels of two biomarkers, Cyclin D1 and Maspin had sensitivities and specificities of 100% for oral cancer. • Saliva testing for specific mRNAs has been found to possess significant potential for oral cancer diagnosis. • Saliva RNA diagnostics are slightly superior to serum RNA diagnostics value being 95% for saliva but only 88% for serum • In oral squamous cell carcinoma – presence of protein p53 has been detected in saliva 55DR.GREESHMA LAL
  • 56.
     Glucose dysregulation •Rao, et al., investigated salivary biomarkers that could aid identification of type-2 diabetic individuals. • In 2010 Soell, et al., determined that one particular salivary biomarker -chromogranin A was over- expressed. • In 2010 Qvarnstrom, et al., found that an increase in salivary lysozyme was significantly associated with metabolic syndrome. 56DR.GREESHMA LAL
  • 57.
     HIV &salivary testing • Zelin, et al., compared saliva antibody testing and serum antibody testing using ELISA technique & found 100% of sensitivity and specificity for saliva testing. • Pascoe, et al., compared saliva antibody testing to serum antibody testing using ELISA followed by confirmatory Western Blot analysis & accuracy of saliva anti-HIV antibody testing was confirmed 57DR.GREESHMA LAL
  • 58.
    Salivary diagnostics ofcommon oral diseases Salivary or GCF derived molecules are used as diagnostic biomarkers for oral diseases including: - conditions caused by fungi-Candida species - Viruses like HPV, Epstein-Barr Virus - Cytomegalovirus - multiple bacterial species involved in periodontal diseases and caries 58DR.GREESHMA LAL
  • 59.
     Periodontitis &salivary testing • Koss, et al., studied salivary biomarkers of periodontal disease & revealed three substances:peroxidase,Hydroxyproline, calcium were significantly increased in the saliva of patients with periodontitis. • A 2010 study found that elevation of three saliva biomarkers (MMP-8, TIMP-1, and ICTP), analyzed using time-resolved immuno-fluorometric assay, was suggestive of periodontitis. 59DR.GREESHMA LAL
  • 60.
  • 61.
     Saliva testsin forensics • Samples from drinking glasses, cigarette bits, envelopes- detect blood-group substances or salivary genetic proteins . • blood-group antigens including A, B, H, and Lewis antigens in saliva- used for identification of individuals in criminal cases and paternity law suits. • Saliva is often present at crime scenes, along with other body fluids, and since DNA is relatively stable in the dry state, these samples can be used to place an individual at the scene of a crime. 61DR.GREESHMA LAL
  • 62.
     Role ofsaliva in detection of substance abuse • Detection of marijuana/cannabinoids in oral fluid - better indicator of drug abuse. • Indicates recent use than detection of the metabolite in urine. • concentration of cocaine in oral fluid is generally higher than plasma and is detectable for longer time. 62DR.GREESHMA LAL
  • 63.
    • The majoropiates that are detected saliva:-morphine,codeine, 6-acetylmorphine etc. • Test Strip is used to quickly and accurately detect the presence of alcohol in saliva. • Suitable breathanalyzer are used for health or law enforcement fields to detect alcohol in saliva 63DR.GREESHMA LAL
  • 64.
     Hormone LevelMonitoring • Saliva can be analyzed as part of the evaluation of endocrine function. • Salivary Cortisol levels - useful in identifying patients with stress,Cushing's syndrome and Addison's disease. • Other corticosteroids, like prednisone , prednisolone & aldosterone levels can be demonstrated in saliva. Salivary progesterone levels - for prediction of ovulation. Salivary estradiol & progesterone - evaluation of ovarian function. 64DR.GREESHMA LAL
  • 65.
  • 66.
  • 67.
    HYPOSALIVATION • Reduction inthe secretion of saliva • Temporary :- o emotional situations like fear , anxiety o Fever o Dehydration • Permanent :- o Sialolithiasis – obstruction of salivary duct o Aplasia/ hypoplasia of the salivary glands o Bell’s palsy – paralysis of facial nerve Age changes With age a generalized loss of gland parenchymal tissue occurs The lost salivary cells are replaced by adipose tissue 67DR.GREESHMA LAL
  • 68.
    Dry Mouth (Xerostomia) •A loss of salivary function or a reduction in the volume of secreted saliva may lead to sensation of oral dryness 68DR.GREESHMA LAL
  • 69.
    Sjogren’s syndrome • Chronicautoimmune disorder charecterised by o Xerostomia o Xerophthalmia o Lymphocytic infiltration of the exocrine glands This triad is called sicca complex 69DR.GREESHMA LAL
  • 70.
    • Reduced salivaryflow rate and concomitant reduction of oral defense systems may cause severe caries and mucosal inflammations (Daniels et al., 1975; Van der Reijden et al 1996) • Dental caries is probably the most common consequence of hyposalivation (Brown et al , 1978; Scully, 1986) 70DR.GREESHMA LAL
  • 71.
  • 72.
    Reduced denture retention and stability DYSPHAGIADYSGUESIA HALITOSIS 72DR.GREESHMA LAL
  • 73.
    HYPERSALIVATION Excess secretion ofsaliva – ptyalism , sialorrhea, sialism or sialosis Conditions :- o Neoplasms of the mouth or tongue o Neurological disorders : cerebral palsy , cerebral stroke o Parkinsonism 73DR.GREESHMA LAL
  • 74.
    Drooling (ptyalism) • Uncontrolledflow of saliva outside the mouth • Cause :- • Excess production of saliva along with inability to retain saliva in the mouth 74DR.GREESHMA LAL
  • 75.
    Chorda tympani syndrome •Characterized by ‘sweating while eating’ • During the regeneration of nerve fibers following trauma or surgical division, which pass through chords tympani branch of facial nerve may deviate and join with the nerve fibers supplying sweat glands 75DR.GREESHMA LAL
  • 76.
    Frey’s Syndrome /Gustatory sweating Baillarger’s syndrome, Dupuy’s Syndrome or Frey- Baillarger Syndrome • Can be congenital or acquired especially after parotid surgery and can persist for life 76DR.GREESHMA LAL
  • 77.
    Augmented Secretion ofsaliva If the nerve supplying salivary glands are stimulated twice, the amount of saliva secreted by the second stimulus is greater 77DR.GREESHMA LAL
  • 78.
    CONCLUSION • The componentsof saliva act as a mirror of the body’s health • With emerging trends in microbiology, immunology and biochemistry, salivary testing for clinical and research purposes is proving to be a reliable and practical method of recognising a number of diseases. • These advances in technology are not only confined to oral health characteristics but may also be used to measure features of overall health 78DR.GREESHMA LAL
  • 79.
    References :- • Salivain health and disease ; an appraisal and update IDJ 2000 sreeberg Leo • Orban’s oral histology and embryology -14th edition • ROLE OF SALIVA IN COMPLETE DENTURES: AN OVERVIEW, Shabina Sachdeva, Rana Noor, Rizwana Mallick,3Eram Perwez, Annals of Dental Specialty Vol. 2; Issue2. Apr – Jun 2014 • Schenkels LC, Veerman EC, Nieuw Amerongen AV. Biochemical composition of human saliva in relation to other mucosal fluids. Critical reviews in oral biology & medicine. 1995 Apr;6(2):161-75. • Saliva Composition and Functions: A Comprehensive Review- The Journal of Contemporary Dental Practice, Volume 9, No. 3, March 1, 2008 • Saliva: an overview; The New Zealand dental journal · June 2014 • Salivary Diagnostics- David T Wong 79DR.GREESHMA LAL
  • 80.

Editor's Notes

  • #19 During dehydration,the sg cease secretion to conserve water
  • #20 However, the flow is not less in blind people, when compared with people with normal vision. This suggests that blind people adapt to the lack of light that enters through the eyes. The irritating effect of tobacco increases glandular excretion, and nicotine causes severe morphologic and functional alterations in the salivary glands.
  • #21 Drugs -may cause reduction in SF and alter its composition. Acid substances are considered potent gustatory stimuli.
  • #22 Lower UWSFR in females as compared with males is due to the smaller gland sizes due to the smaller body sizes. Hormones influence function of sal glands. The modify salivary content but cannot initiate salivary flow
  • #26 The fluid nature of the saliva provides a washing action that flushes away non adherent bacteria and other debris.
  • #27 Saliva has a major ecological influence on the microorganisms that colonize the oral cavity
  • #28 Bicarbonate – main buffering ion More in stimulated saliva Flow rate increases- Bicarb increases Passes thru plaque – acid neutralisation
  • #29 In addition to its role of a buffer in preventing tooth decay, saliva is also supersaturated with calcium and phosphate ions, which have an important role to play in maintaining the demineralization – remineralization balance.
  • #35 Diluting and eliminating sugars Increase in secretion resluts in increase in pH and buffering capacity
  • #38 Human mouth is quite frequently exposed to components whose pH differs from saliva pH(6.5 -7.5) Buffering agents in saliva try to bring ph back to normal ranges as faster as possible
  • #39 The mechanism for the phosphate buffer system is due to the ability of the secondary phosphate ion, HPO42-, to bind a hydrogen ion and form a primary phosphate ion H2PO4-.
  • #45 Thus, colonization of microbial flora on the tooth surface is strongly modified by salivary proteins
  • #46 Several proteins-like parotid saliva agglutinins, a-amylase, statherins, mucins, acidic PRPs, and salivary immunoglobulins-are reported to bind with oral streptococci . These proteins are also found in the salivary pellicle, and therefore, they are likely to mediate the specific adhesion of bacteria to tooth surfaces. When these same proteins exist in the liquid phase, they may promote bacterial aggregation and hence, the clearance of bacteria from the oral cavity
  • #48 The immunoglobulins, IgG, IgM, IgA, and secretory IgA (s-lgA), form the basis of the specific salivary defense against oral microbial flora, including mutans streptococci. The most abundant Ig in saliva, as in all other human secretions, is dimeric slgA, which is produced by plasma cells located in the salivary glands.
  • #51 Plaque and salivary fluoride contribute significantly to the remineralization process but it should be kept in mind that there is a constant clearance (elimination) of fluoride from the mouth Although the fluoride clearance influences the acid production in the plaque as well as caries scores, the diagnostic value of salivary fluoride measurement at both individual and population level is as yet questionable
  • #77 Symptoms : redness and sweating on cheek adjacent to ear; appears wen affected person sees eats or thinks abt fuds wij produse strong salivation
  • #78 This increased secretion of saliva after the parasympathetic nerve fibre is cut is called paralytic secretion This is bcoz the 2st stimulus causes excitation of the acinar cells, hence wen 2nd stimulus is applied secretion is augmented