Saliva and clinical significance

1. PRESENTED BY
A.THIRUMAGAL ANURAAGA
1ST YEAR POST GRADUATE STUDENT
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY
SALIVA
THE BODY’S MIRROR

2. CONTENTS
 INTRODUCTION
 HISTOLOGY AND BIOCHEMISTRY OF SALIVA
 FORMULATION OF SALIVA
 NERVE AND BLOOD SUPPLY OF SALIVARY GLANDS
 COMPOSITION AND PROPERTIES OF SALIVA
 FUNCTIONS OF SALIVA
 REGULATION OF SALIVARY SECRETION

3.  BUFFERING POWER OF SALIVA
 CO RELATION B/W SALIVA AND DENTAL CARIES
 SALIVA AS DIAGNOSTIC AID
 SALIVARY BIOMARKERS
 CLINICAL CONSIDERATIONS OF SALIVA
 CONCLUSION
 REFERENCES

4. INTRODUCTION
DEFINITION: By Stedmann’s & Lipincott Medical Dictionary.
A Clear, Tasteless, Odourless, Slightly Acidic (Ph 6.8) Viscous
Fluid, consisting of the secretion from the Parotid, Sublingual,
And Submandibular Salivary Glands and the Minor Glands of
the Oral Cavity.

5.  Saliva is the mixed glandular secretion which
constantly bathes the teeth and the oral mucosa.,
 There is an extensive body of research on saliva as a
diagnostic fluid. it has been used to indicate an
individual’s caries susceptibility; it has also been used
to reflect systemic physiological and pathological
changes which are mirrored in saliva.

6. HISTOLOGY AND BIOCHEMISTRY OF SALIVA

7. MINOR SALIVARY GLANDS:
 Buccal / Labial
 Palatine
 Tonsillar (Weber’s Gland)
 Molar Or Retromolar Gland (Carmalt’s
Gland)
 Anterior Lingual Glands (Blandin-Nuhn)
 Posterior Lingual Glands (Von-ebner)

8.  Salivary glands are made up of the cells which are arranged
in small groups called ACINUS /ALVEOLUS/TERMINAL
SECRETORY UNIT.
 Many intercalated ducts join to
form STRIATED DUCTS.
 Two or more striated ducts join to form
interlobular ducts, which unite to form
main duct of the gland.

9. Acini consists of pyramidal cells:
Serous
Mucous
Seromucous

10. Salivary Glands Its Secretions
Parotid Purely Serous
Sub Mandibular Mixed, With Serous Units
Predominating
Sub Lingual Mixed, With Mucous Units
Predominating
Buccal / Labial Mixed
Palatine & Glossopalatine Purely Mucous
Glands Of Blandin & Nuhn Chiefly Mucous
Von Ebner Glands Purely Serous

11. FORMULATION OF SALIVA:
The formation of saliva occurs in 2 stages:
INITIAL FORMATION STAGE:
 Stimulation of the parasympathetic nerve, initiates intracellular
second messenger events of acinar cells, the signal
transduction system involves the release of Ca2
+ from
intracellular stores.

13. MODIFICATION STAGE:
• Saliva produced by secretory acini contain electrolytes such
as sodium and chloride. Prevention the loss of sodium and
chloride ions from the body is necessary.
• The excretory ducts play a key role in reabsorbing sodium and
chloride secreted in saliva from acini. thus, the end product is
hypotonic to plasma.

14. NERVE SUPPLY OF SALIVARY GLANDS
 The volume and type of saliva secreted is controlled by the
AUTONOMIC NERVOUS SYSTEM.
 The glands receive both parasympathetic and sympathetic
nerve supplies.

15. PARASYMPATHETIC FIBRES
PARASYMPATHETIC FIBRES TO SUBMANDIBULAR AND
SUBLINGUAL GLANDS
The parasympathetic preganglionic fibers to submandibular &
sublingual glands arise from the superior salivatory nucleus
situated in pons .

16. PARASYMPATHETIC FIBRES TO PAROTID GLAND.
The parasympathetic preganglionic fibres to parotid gland arises
from inferior salivatory nucleus situated in the upper part of
medulla oblongata.

17. SYMPATHETIC FIBERS:

18.  The sympathetic preganglionic fibres to salivary
glands arise from the lateral horns of first and second
thoracic segments of spinal cord.
 The postganglionic fibres from this ganglion are
distributed to the salivary glands along the nerve
plexus around the arteries supplying the glands

19. BLOOD SUPPLY OF SALIVARY GLANDS
 Blood supply to the glands also influences secretion.
 Salivary secretion is usually accompanied by a large increase
in blood flow to the glands.
 An extensive blood supply
is required for the
rapid secretion of saliva.

20. PROPERTIES OF SALIVA
 VOLUME: 1000 to 1500 ml of saliva is secreted per day
and it is approximately about 1ml/minute .
 For unstimulated saliva,
 25% - parotid glands
 60% - submandibular glands,
 7-8% - sublingual gland
 7-8% - minor mucous glands.

21. For highly stimulated saliva,
 The contribution from the parotids increases to an
estimated 50%,
 The submandibular contribute 35%,
 The sublingual 7-8% and
 7-8% comes from the minor mucous glands.

22. REACTION: mixed saliva from all the glands is slightly
acidic with Ph of 6.35 to 6.85.
SPECIFIC GRAVITY: it ranges between 1.002 to 1.012.
TONICITY: saliva is hypotonic to plasma.

23. FLOW RATE: salivary flow rate exhibits circadian variation
and peaks in the late afternoon; the acrophase.
 Normal salivary flow rates are in the region of 0.3-0.4 ml/min
when unstimulated and
 1.5-2.0 ml/min when stimulated, although both rates have
wide normal ranges
 During sleep, flow rate is negligible.

24. COMPOSITION OF SALIVA

25. Organic
proteins
Salivary
amylase
immunogl
ubulins
Protiens
synthesized
within glands
glycopro
teins
lipids
Blood
group
Antigen A,B
Hormones
Parathyroid
Growth
factor
carbohy
drates
Glucose
hexosamine
Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M.et,al.,
Crit. Rev. Oral Biol. Med. 1995; 6; 161

26. Cells :
 Yeast
 Bacteria
 Protozoa
 Polymorphonuclear lymphocytes(PMNL)
 Desquamated epithelial cells
Gases: Oxygen, Nitrogen, carbondioxide
Inorganic
sodium potassium calcium phophorus chloride bicarbonate

27. Functions of saliva:
Salivary
functions
Buffering
Digestion
Mineralizat
ion
Tissue
coating
Anti
bacterial/
Anti
viral/anti
fungal
Lubrication
and
viscoelasti
city

29. DIGESTIVE FUNCTION:
α-Amylase (ptyalin):
 It’s a carbohydrate splitting enzyme (amylolytic).
 It is a calcium dependent digestive enzyme.
 Cl required as co-factor.
 Optimum pH= 6.8
 It is inactive below pH 4

30. SALIVARY LIPASE:
 Secreted by Von Ebner’s gland.
 Initiation of digestion of fats.
 Synergy with pancreatic lipase.
MALTASE:
 Present only in traces in human.
 Convert maltose into glucose.

31. BOLUS FORMATION:
 Moistening of food (Water)
 Mucin – It is a lubricating material, makes food slippery,
facilitates swallowing

32. ANTI BACTERIAL/ANTI VIRAL/ANTI FUNGAL:
IMMUNOGLOBULINS:
 IgG (1.5 mg/ 100 ml)
 IgM (0.2 mg/ ml)—From crevicular fluid
 IgA is the predominant immunoglobulin (20 mg/100 ml) and
comprises of 90% of total parotid IgA.

33. LYSOZYMES- ANTIBACTERIAL PROTEINS:
 Attacks the cell wall component— lysis.
 The antibacterial effect has been shown to be
exerted against mutans streptococci.
 It is present in newborn babies at levels equal to
those of adults, suggesting a pre-eruptive
antimicrobial function.

34. LACTOFERRIN:
 Iron-binding protein.
 Depletion of iron supply for bacteria that require it for
metabolism.
 This bacteriostatic effect is lost if the lactoferrin molecule
is saturated with iron.

35. PEROXIDASE / SIALOPEROXIDASE:
This system inhibits growth and acid production of a variety of
micro-organisms, including streptococcus, lactobacilli, fungi
and enteric bacteria.

36. GLYCOPROTEIN (MUCINS):
 Lubricant.
 Aids in mastication, speech, swallowing by lubrication.
 Types — MG1 & MG2.

37. MG1:
 High molecular-wt .
 Binds tightly to tooth surface.
 High in caries susceptible patients
MG2:
 Low molecular-wt
 Binds to enamel but displaces easily.
 High in caries resistant cases.

38. AGGLUTININ:
 These are glycoproteins that have the capacity to interact with
unattached bacteria, resulting in clumping of bacteria into large
aggregates that are more easily flushed away by saliva and
swallowed.
 Extremely sticky properties.
VON EBNER’S GLAND PROTEIN:
 Known as tear specific pre albumin (TSPA).
 Antiviral agent.

39. PROLINE-RICH PROTEINS & STATHERIN:
 Inhibit the Spontaneous precipitation of calcium
phosphate salts & the growth of hydroxyapatite
crystals on the tooth surface
 Preventing the formation of salivary and dental
calculus

40. CYSTATINS:
 The cystatins are also related to acquired film
formation and to hydroxyapatite crystal equilibrium.
 Due to its proteinase inhibiting properties, it is
suggested that they act in controlling proteolytic
activity.

41. HISTATINS:
 Group of histidine rich proteins that show antimicrobial
activity against
1) Some strains of Streptococcus mutans
2) Inhibit hemoagglutination of the periopathogen
P.gingivallis.
 Several histatins are present, most common types in saliva
are histatin 1, 3 and 5.
 Kills C.Albican in yeast form and mycelial form.

42. Inorganic
Calcium
and
phosphate
Thio-
cynate
Na,k,
bicarbo
nate

43. REGULATION OF SALIVARY SECRETION:
Salivary secretion is regulated by nervous mechanism &
it is a reflex phenomenon.
Salivary reflexes are of two types:-
1)unconditioned reflex
2)conditioned reflex

44. UNCONDITIONED REFLEX:
Secretion of saliva when any substance is played in the mouth is
called the unconditioned reflex.
CONDITIONED REFLEX:
Secretion of saliva by the sight, smell, heaving or thought of
food is called conditioned reflex.

46. BUFFERING POWER OF SALIVA:
 Solutions containing both weak acids and their salts are
referred to as ‘BUFFER SOLUTIONS’.
 The buffer capacity of human saliva is regulated by three
buffer systems:
1) The Carbonic Acid / Bicarbonate System.
2) Phosphate System.
3)the Proteins – Mucin.

47.  In stimulated saliva it is largely due to the bicarbonate
ion which provides 85% of the total buffering capacity.
 As the salivary flow increases during a meal the
concentration of bicarbonate also increases, thus
increasing the buffering capacity of saliva.

48. THE CARBONIC ACID / BICARBONATE SYSTEM:
H+ + HCO3- ↔ H2CO3 ↔ H20 + CO2
 When an acid is added, the bicarbonate releases the weak
carbonic acid.
 Carbonic acid is readily decomposed into H2O and CO2 which
leaves the solution.
 This change of phase for CO2 from dissolved states to gas
phase for which the term “PHASE BUFFERING” is used

49.  Dental caries is one of the most prevalent infectious diseases to afflict mankind.
 The caries process is dependent upon:
 The interaction of protective and deleterious factors in saliva and plaque,
 The balance between the cariogenic and noncariogenic microbial population
within saliva and in particular plaque, and
 The physicochemical characteristics of enamel, dentin and cementum that make
the dental hydroxyapatite more or less vulnerable to an acidogenic challenge.
CO-RELATION BETWEEN SALIVA AND
DENTAL CARIES
Hicks,John et al., 2003/02/01, Biological factors in dental caries: Role of saliva and dental plaque in the dynamic
process of demineralization and remineralization (part 1) ;The Journal of clinical pediatric dentistry.

50.  Demineralization and remineralization (repair or healing) of dental
hydroxyapatite are continuous processes that are intimately related and
occur episodically based upon the presence of cariogenic bacteria in
dental plaque and the availability of refined carbohydrates for
fermentation to organic acids

51.  Saliva provides a protective coating for both the mucosa and
exposed tooth surfaces. It allows for lubrication and
humidification of the oral cavity and associated structures due
to its viscosity and elastic properties.
 There are many and varied biological factors in saliva and
plaque that protect enamel dentin and cementum from caries
development and facilitate remineralization.
Hicks,John et al., 2003/02/01, Biological factors in dental caries: Role of saliva and dental plaque in the dynamic
process of demineralization and remineralization (part 1) ;The Journal of clinical pediatric dentistry.

52.  A protein called pH rise factor, sialin, and other basic
(alkaline) proteins allow a more rapid return to a neutral pH
following an acidic challenge.
 Individuals with a resting salivary pH of approximately 7.0
tend to have low caries activity or no caries; while those with
a resting pH of 5.5 have very high caries experience.
 Those with pH values between 5.5 and 7.0 have less severe
caries activity.

53. REMINERALIZATION PROCESS:
 Saliva is supersaturated with calcium and phosphate with respect to
hydroxyapatite.
 The presence of calcium, phosphate and fluoride within saliva enhances
the resistance of exposed tooth surfaces to a cariogenic attack, therefore
decreasing the likelihood of demineralization and favoring
remineralization into previously demineralized enamel and root surfaces.
 Several salivary proteins bind hydroxyapatite and aid in the maintenance
of the supersaturated state of saliva.

54.  This allows calcium and phosphate containing mineral components to
remain in solution at the resting pH of saliva (approximately 7.0) and
avoid removal by precipitation out of solution.
 These salivary proteins release calcium and phosphate ions when
levels drop within the saliva. With increased calcium and phosphate
secretion upon salivary gland secretion, the level of these proteins is
also increased to maintain the supersaturated state.
 Not only do these salivary components maintain high calcium and
phosphate suspended within the saliva, but they also increase the
stability of the mineral phases within exposed tooth surfaces.

55. SALIVA - AS A DIAGNOSTIC AID
 Human saliva performs a wide variety of biological functions
that are critical for the maintenance of the oral health.
Javaid MA ET AL., Saliva As A Diagnostic Tool For Oral And Systemic Diseases. J Oral Biol
Craniofac Res. 2016 Jan-apr;6(1).

56.  Salivary diagnostics is a DYNAMIC AND EMERGING FIELD
utilizing nanotechnology and molecular diagnostics to aid in
the diagnosis of oral and systemic diseases.
 There has been increasing interest in, and support for, the use
of saliva as a diagnostic fluid for screening not only oral
conditions, such as caries, periodontal diseases or oral
cancer, but also for other systemic conditions, such as breast
and pancreatic cancers.

57. 1. Noninvasive diagnosis of disease and monitoring of general health.
2. Painless, patient suffers no discomfort and little anxiety in the collection
process.
3. Simple in collection with a modest trained assistant and applicable in
remote areas.
WHY SALIVA?

58. 4. Relatively cheap technology as compared to other tests.
5. Cost Effective Applicability For Screening Large Population.
6. Can be used to study special population where blood sampling is a
problem e.g Children, Anxious /Handicap/ Elderly Patients.
7. Convenient for Multisampling.
8. Safer For Health Professionals than blood tests.
9. Compared to blood and urine, saliva is also cheaper to store and ship.
10. In Addition Saliva does not clot and can be manipulated more easily
than blood.
Madalli, Vijaylaxmi 2013/01/01 Saliva-A Diagnostic Tool
VL - 11 Journal of Dental and Medical Sciences.

59. ANALYSIS OF SALIVA DONE FOR THE DIAGNOSIS OF
FOLLOWING:
1. HEREDITARY DISEASE: Cystic fibrosis (CF) is a genetically
transmitted disease of children and young adults.
2. AUTOIMMUNE DISEASE: Sjogren’s syndrome serum chemistry can
demonstrate polyclonal hypergammaglobulinemia and elevated levels of
rheumatoid factor, antinuclear antibody, anti-ss-a, and anti-ss-b antibody were
reported in saliva of patients with SS
Madalli, Vijaylaxmi 2013/01/01 Saliva-A Diagnostic Tool VL - 11 Journal of Dental and Medical Sciences.

60. 3. MALIGNANCY:
 The mRNA levels for specific proteins are elevated in the saliva of head
and neck cancer patients.
 The p53 antibodies can be detected in the saliva of patients diagnosed
with oral SQUAMOUS CELL CARCINOMA (SCC
 Elevated levels of salivary defensin-1 were found to be indicative of the
presence of oral SCC.
 CA 125 is a tumor marker for cancer.

61. 4. INFECTION:
 Reactivation of herpes simplex virus type-1 (hsv-1) is involved
in the pathogenesis of bell’s palsy and PCR based
identification of virus DNA in saliva is a useful method for the
early detection of hsv-1 reactivation in patients with bell’s
palsy.

62. 5. DETECTION OF DRUGS:
 Saliva has been proposed for the monitoring of systemic
levels of drugs.
 Saliva is also useful for the monitoring of antiepileptic drugs
and anti-cancer drugs.
 Nicotine saliva can be used to monitor tobacco smoking and
exposure to tobacco smoke.

63. 6. MONITORING OF LEVELS OF DRUGS
7. BONE TURNOVER MARKER IN SALIVA:
Saliva can be used to measure bone turnover. Mcgehee And
Johnson used commercially available ELISA to test for the
presence of osteocalcin (OC) and pyridinoline (PYD) in the
whole human saliva of women.

64. 8. FORENSIC EVIDENCE: Saliva may be found on victims of several
violent crimes. Saliva can potentially be recovered from bite marks,
cigarette butts, postage stamps, envelopes and other objects.

65. 9. DENTAL CARIES AND PERIODONTAL DISEASE:
A number of caries risk assessment tests based on measurements in saliva
have been developed.
Examples are tests which measure
Salivary Mutans Streptococci
And Lactobacilli and
salivary buffering capacity.

66. 10. DIAGNOSIS OF ORAL DISEASE WITH RELEVANCE FOR
SYSTEMIC DISEASES:
 Quantitative alterations in saliva may be a result of
medications.
 Atleast 400 drugs may induce xerostomia.
 Reduced salivary flows may lead to progressive dental
caries, fungal infection, oral pain, and dysphagia.

67.  Qualitative changes in salivary composition can also provide
diagnostic information concerning oral problems.
 Increased levels of albumin in whole saliva were detected in
patients who received chemotherapy and subsequently
developed stomatitis.
 It is envisioned that with the human salivary proteome
available, one can begin to exam and as Sjogren Syndrome,
Osteoporosis, Rheumatoid Arthritis, Diabetes, And Cancers.

68. ROLE OF SALIVA IN COVID-19

69.  The COVID-19 (caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2)) epidemic started in
Wuhan (Hubei Province, China) and quickly spread across
the world as a pandemic.
 As a key to tracing the disease and to implement strategies
aimed at breaking the chain of disease transmission,
extensive testing for SARS-CoV-2 was suggested.
Sapkota D, Søland TM, Galtung HK, et al. J Clin Pathol 2021;74:344–349.

70.  In this context, saliva is emerging as a promising alternative to
nasopharyngeal/oropharyngeal swabs for COVID-19 diagnosis
and monitoring.
 In addition, various salivary biomarkers including the salivary
metabolomics offer a high promise to be useful for better
understanding of COVID-19 and possibly in the identification of
patients with various degrees of severity, including asymptomatic
carriers.
Sapkota D, Søland TM, Galtung HK, et al. J Clin Pathol 2021;74:344–349.

71. COVID-19 infects mouth and may spread in saliva:
Study
When infected saliva is swallowed or tiny particles of it are
inhaled, we think it can potentially transmit SARS-CoV-2
further into our throats, our lungs, or even our guts," said Dr.
Kevin Byrd of the American Dental Association Science and
Research Institute, who worked on the study--as quoted by
the news outlet.

72. 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
Yoshizawa et al., Salivary biomarkers: toward future clinical and
diagnostic utilities. Clin Microbiol Rev. 2013 Oct;26(4)

73. Saliva emerges as a useful diagnostic tool for the
detection of biomarkers involved with oral and systemic
diseases, since it reflects the pathophysiological
conditions of the organism and allows early, rapid,
practical and noninvasive detection of biomarkers..

74. CLASSIFICATION OF SALIVARY BIOMARKERS:
Locally Produced
Proteins of Host
And Bacterial
Origin (Enzymes,
Immunoglobulins
And Cytokines)
Genetic ⁄
Genomic
Biomarkers such
as DNA AND mRNA
of host origin
Bacteria And
Bacterial
Products, Ions,
Steroid Hormones
And Volatile
Compounds

75. Proteomic biomarkers
Zhang, L. et al. “The clinical value of salivary biomarkers for periodontal disease.” (2009).

76. Yoshizawa, 2013/10/01,Salivary Biomarkers: Toward Future Clinical and Diagnostic Utilities,Clinical
microbiology reviews
Microbial biomarkers
PERIODONTAL
DISEASES
1.Aggregatibacter
actinomycetemcomitans,
2.Porphyromonas
gingivalis
3.Prevotella intermedia,
4.Tannerella forsythia,
5.Campylobacter rectus
6.Treponema denticola
DENTAL CARIES
1.Streptococcus
mutans
2.Lactobacillus spp
ORAL CANCER
1.Capnocytophaga
gingivalis,
2.Prevotella
melaninogenica,
3.Streptococcus
mitis.

77. Genomic biomarkers
Cathepsin c gene
mutation
Collagen gene
mutation
IL-1 polymorphism
IL-10 polymorphism
TNF polymorphism

78.  Salivary biomarkers have been used to examine the effect of
lifestyle factors, including smoking, on periodontal health.
 Levels of Salivary Markers including Prostaglandin E2,
Lactoferrin, Albumin, Aspartate Aminotransferase, Lactate
Dehydrogenase, Alkaline Phosphatase Were Significantly
Lower In Current Smokers Than In Non-current Smokers.

79. Stress markers in saliva

81. VARIOUS OTHER BIOMARKERS:
FOR CANDIDIASIS: Through The Presence Of Candida Spp In
Saliva.
OPIORPHIN: In 2006, A Peptide Named
Opiorphin Was Found In Human Saliva
By Researchers At Institute
Pasteur International In Paris, France.
Wisner, Anne et al. “Human Opiorphin, a natural antinociceptive modulator of opioid-dependent
pathways.” Proceedings of the National Academy of Sciences of the United States of America vol.
103,47 (2006)

82.  Opiorphin Resembles Enkephalin, But, Rather Than Binding
To Opioid Receptors To Inhibit Their Activity, They Prevent
Enkephalins From Being Broken Down.
 So The Amount Of Enkephalin – The Body’s Natural Painkiller
– Is Increased And Pain Signals Are Blocked.
 When You Experience Pain, Enkephalins Are Released And
Opiorphin Boosts Their Action.
Wisner, Anne et al. “Human Opiorphin, a natural antinociceptive modulator of opioid-dependent
pathways.” Proceedings of the National Academy of Sciences of the United States of America vol.
103,47 (2006)

83.  In neonates the presence of IgA is an excellent marker
of Rota virus infection.
 HIV antibody detection is as precise in saliva as in
serum.

84. CLINICAL CONSIDERATIONS OF SALIVA:
1.HYPOSALIVATION:
The Reduction In The Secretion Of Saliva Is Called Hyposalivation.
1) Temporary Hyposalivation Occurs In
i) Fear
ii) Fever
iii) Dehydration
2) Permanent Hyposalivation Occurs In
i)Sialolithiasis – Obstruction Of Salivary Duct.
ii)Congenital Absence Or Hypoplasia Of Salivary Glands.
iii)Bell’s Palsy – Paralysis Of Facial Nerve.

85.  DRY MOUTH (XEROSTOMIA) –
 It is a frequent clinical complaint a loss of salivary
function or a reduction in the volume of secreted saliva
may lead to the sensation of oral dryness.
 This occurs as a side effect of mediations taken by the
patient for other problems. Many drug cause central or
peripheral inhibition off salivary secretion.

86.  Loss of gland function occurs after radiation therapy for head and neck
cancer because the glands are included in the radiation field,
chemotherapy may also cause this condition.
 Temporary relief is achieved by frequent sipping of water or artificial
saliva.

87. SJOGREN’S SYNDROME:
 Sjogren syndrome is a chronic autoimmune disorder characterized
by xerostomia (dry mouth), xerophthalmia (dry eyes), and
lymphocytic infiltration of the exocrine glands.
 This triad is also known as the sicca complex.
 It is an autoimmune disorder in which the immune cells destroy
exocrine glands such as lacrimal glands & sweat glands .
 In some cases it causes dryness of skin, nose.

88. AGE CHANGES:
 With age a generalized loss of gland parenchymal
tissue occurs.
 The lost salivary cells often are replaced by adipose
tissue.

89. ORAL MANIFESTATIONS:
CARIES:
A major problem of a reduced salivary flow is the increased risk of
caries as saliva normally washes away acids.
There may be an increase in recurrent decay on coronal as well as
root surfaces.
Incisal edges of interior teeth may also develop carious lesions as
well as recurrent lesions on the margins of restorations

90. DENTAL EROSION:
 Salivary gland hypofunction can cause deficient
remineralisation.
 ‘Low Buffering Capacity and flow rate indicate a
greater erosion risk and advice should be given to the
patient to minimise this.

91. • Chewing sugar-free gum also stimulates
production of saliva.

92. ORAL ULCERATION:
Reduced saliva flow may result in recurrent aphthous ulceration, pain, lichen
planus, delayed wound healing and secondary infection, such as candidiasis.
GINGIVITIS:
Lack of saliva leads to retention of food particles in the mouth, particularly interdentally and
under dentures. This may result in gingivitis and, in the long term, periodontitis.

93. MUCOSITIS: This is a painful condition where the mucous membrane of
the oral cavity becomes ulcerated and inflamed.
 It increases susceptibility to fungal infections such as candidiasis.
 Mucositis can lead to dysphagia, dehydration and impaired nutrition.

94. SWALLOWING:
 There are problems with too much saliva or too little often accompanied
by complaints of dysphagia.
DYSGEUSIA:
 Distortion of taste may occur due to lack of saliva as it plays a critical
role in taste function as a solvent for food, a carrier of taste.
 Irradiation of the head and neck area may damage or destroy taste buds
or salivary glands.

95. GLOSSITIS: With salivary hypofunction,the tongue can appear
red, dry and raw, particularly on the dorsum, while the filiform
papillae may be lost.

96. Halitosis- Saliva gives rise to bad odours especially
during mouth breathing prolonged talking or hunger.
Eating reduces halitosis partly because it increases saliva
flow and friction in the mouth.

97. 2. HYPERSALIVATION:
The excess secretion of saliva is known as hypersalivation .
Hypersalivation in pathological condition is known as ptyalism,
sialorrhea, sialism or sialosis.
Hypersalivation occurs in the following conditions :-
1. Decay of tooth or neoplasm of mouth
or tongue
2. Disease of esophagus , stomach
& intestine

98. DROOLING:
 Uncontrolled flow of saliva outside the mouth is called drooling
. it is often called ptyalism. Drooling occurs because of excess
production of saliva in association with inability to retain saliva
within the mouth.
 Drooling in small children is a normal part of development.

99.  While child is teething ,their gums Will produce excessive
saliva.
 The saliva which is produce during drooling is designed to
moisten and lubricate babys’ tender gums. Drooling serves to
help make teething process more bearable for Child.

100. FREY'S SYNDROME or GUSTATORY SWEATING :
 Also known as baillarger’s syndrome, dupuy’s syndrome,
auriculotemporal syndrome) is a food related syndrome which
can be congenital or acquired specially after parotid surgery
and can persist for life.

102. PARALYTIC SECRETION OF SALIVA:
 When the parasympathetic nerve to salivary gland is cut ,
salivary secretion increases for the first 3 weeks & later
diminishes; finally it stops at about 6th week.
 The increased secretion of saliva after cutting the
parasympathetic nerve fibers is called paralytic secretion.

103. AUGMENTED SECRETION OF SALIVA :
 If the nerve supplying salivary glands are stimulated twice ,
the amount of saliva secreted by the second stimulus is more
than the amount secreted due to the first stimulus.
 It is because, the first stimulus increases excitability of acinar
cells, so that when the second stimulus is applied, the salivary
secretion is augmented.

104. Effect Of Drugs & Chemical On Salivary Secretion
1) Sympathomimetic Drugs Like Adrenaline & Ephedrine Stimulates Salivary
Secretion
2) Parasympthomimetic Drugs Like Acetylcholine , Pilocarpine , Muscarine &
Physostigmine Increase The Salivary Secretion
3) Histamine Stimulates The Secretion Of Saliva
4) Sympathetic Depressants Like Ergotamine .
5) Parasympathetic Depressants Like Atropine Inhibit The Secretion Of Saliva
6) Anaesthetics Like Chloroform & Ether Stimulate The Reflex Secretion Of Saliva
However , Deep Anaesthesia Decrease The Secretion Due To Central Inhibition.

105. CONCLUSION :
 Saliva has an important role in patient’s quality of life. Dental professionals
need to be aware of the problems that arise when there is an overproduction or
underproduction of saliva, and also a change in its quality.
 It may be advantageous for dentists to measure the salivary flow of patients on
a regular basis to see if any changes occur over time. This knowledge enables
early diagnosis, treatment and, if possible, prevention of problems.
 Checking the patient’s medical history regularly can identify conditions or
medications that can adversely influence saliva production.

106. REFERNCES
 A Text Book Of Oral Pathology: William G.Shafer
 Medical Physiology- Guyton
 Burket’s Oral Medicine
 Saliva Composition And Functions: A Comprehensive Review. Journal Of
Contemporary Dental Practice 2008:9(3) 94
 Saliva And Oral Health : The Journal Of American Dental Association-may 2008
 The Effect Of Saliva On Dental Caries, Stookey, George K. The Journal Of The
American Dental Association, Volume 139.
 Galina ET AL .,2018 Salivary Protein Roles In Oral Health And As Predictors Of
Caries Risk,vl - 13

107.  Javaid MA ET AL., Saliva As A Diagnostic Tool For Oral And Systemic
Diseases. J Oral Biol Craniofac Res. 2016 Jan-apr;6(1).
 Wisner, Anne Et Al. “Human Opiorphin, A Natural Antinociceptive
Modulator Of Opioid-dependent Pathways.” Proceedings Of The
National Academy Of Sciences Of The United States Of America Vol.
103,47 (2006)
 Madalli, Vijaylaxmi 2013/01/01 Saliva-A Diagnostic Tool VL - 11 Journal
of Dental and Medical Sciences.