Dr. Anil kumar MDS Dept of Conservative Dentistry & Endodontics

 Introduction  Classification of salivary glands  Differential saliva production  Composition of saliva  Formation saliva  Regulation of secretion  Functions of saliva  Clinical significance Role of saliva in dental caries Role of pellicle Saliva & fluoride Deminerlaization & remineralization Conditions affecting salivation

 Clinical considerations Salivary gland disorders Salivary substitutes Saliva & operative dentistry Conclusion

INTRODUCTION The term „saliva‟ refers to the mixed fluid in the mouth in contact with the teeth & oral mucosa, which is often called whole saliva. Normally, the daily production of whole saliva ranges from 0.5 to 1.0lt. Major salivary glands contribute 90% of the secretion while the minor salivary glands contribute 10% of it. Whole saliva contains contributions from non-glandular sources such as gingival crevicular fluid in an amount that depends on the periodontal status of the patient. Whole saliva, in contrast to glandular saliva, also contains vast amount of epithelial cells from the oral mucosa & millions of bacteria. These componants give whole saliva its cloudy appearance, which is different from glandular saliva, which is transparent like water. Saliva protects oral cavity & teeth by number of mechanisms. It plays a key role in demineralization & remineralization of teeth. Assessment of salivary flow, composition, history helps the dentist in the process of differential diagnosis. A salivary gland is any cell or organ duct discharging a secretion in to the oral cavity. CLASSIFICATION 1. Major & minor salivary glands 2. Serous, mucous & mixed salivary glands Major salivary gland- located at some distance from oral mucosa with which they connect by extra glandular ducts Eg- parotid gland, submandibular gland, sublingual gland Minor salivary glands- lie in mucosa or submucosa, opening directly through the mucosa or indirectly via many short ducts. Eg- Von Ebner‟s anterior glands, Labial glands, Buccal glands & Palatal glands.

SALIVARY GLANDS The largest of the salivary glands are the parotid glands which lie in the groove between ramus of the mandible & mastoid process. They are purely serous glands that produce thin, watery, amylase-rich saliva. Parotid glands open via Stensen‟s duct that opens into the vestibule near the crown of the maxillary second molar tooth. Submandibular gland is a mixed gland comprising both mucous & serous acinar cells situated medial to the mandible in the submaxillary triangle. Its duct ( duct of Wharton) opens in the floor of the mouth. Although they are mainly serous glands. In contrast to the parotids, they secrete more viscous, slimy, mucin-rich saliva.

In spite of the low contribution by minor salivary glands. the smallest of the major glands. although they contribute a few percent of the total whole saliva. the minor glands secrete a large fraction of the total secretion of saliva protein with great importance for oral tissue lubrication. except for the palatine glands. & the lingual von ebner‟s glands which are strictly serous. They are found in many parts of the oral mucosa & named according to their location.the minor glands are mixed glands largely composed of mucous acinar cells.The sublingual glands. which are strictly mucous. consisting mainly of mucous acinar cells. also produce such viscous secretion. situated beneath the tongue & each gland has about 10 or so ducts (ducts of Ravinus) opening into the floor of the mouth. .

ribonuclease.7 ml/min for men & women respectively.proteases.lipase. ii.Lactoferrin .urease.Acid phosphatase. cholinesterase. It is a watery secretion.0. iv. vi.1ml/min. Kallikrein Dextranases Invertase Miscellaneous enzymes. Stimulated salivation Saliva production increases 5 fold.carboxypeptidases.Peroxidase system . Alpha amylase(ptyalin) Antibacterial substances .Sialoperoxidase iii.aminope ptidase etc. v. COMPOSITION The total volume of saliva secreted is approximately 1000-1500 ml per day.Differential saliva production by glands Unstimulated salivation (salivary glands at rest) Cut off value for unstimulated salivary secretion is ≤ 0. Saliva contains organic components & inorganic components. ORGANIC COMPONENTS a) Salivary enzymes i.5 – 0. .Parotid gland produce 90% of it while submandibular & sublingual & submandibular glands produce 70% of it. pH is about 6. Saliva contains primarily of water accounting 99% or more of saliva & other constituents account for 1% or less. Salivary secretion reaches ≤ 0.Lysozyme .

cholesterol and cholesterol esters .Platelet factor d) Glycoproteins .IgM c) Proteins synthesized within the glands .Sialin II.IgA .5-1 mg/100 ml in parotid saliva -hexose.Factor IX ( Christmas factor ) .Proline rich glycoproteins ( Parotid saliva) e) Other Polypeptides . HORMONES .IgG .b) Immunoglobulins . CARBOHYDRATES -glucose.MG1 and MG2 ( Submandibular and Sublingual saliva) .diglycerides . BLOOD GROUP SUBSTANCES III .Factor VIII ( Anti haemophilic globulin ) . 0.Parotin .Factor VII ( Pro-activator ) .triglycerides . small amounts of hexosamine and sialic acid in submandibular saliva V.Statherin .Nerve growth factor IV. LIPIDS .

WATER-SOLUBLE VITAMINS INORGANIC COMPONANTS OF SALIVA The final composition of saliva depends strongly on the saliva flow rate.0) CELLS OF SALIVA Yeast cells Bacteria Protozoa .0-8. Because the mechanism involved in reabsorption process have a maximal transport capacity & the ducts have limited time to modify the electrolyte composition at stimulated flow rate. NITROGEN CONTAINING COMPOUNDS VII. a) Sodium (0-80mg/100ml) b) Potassium (60-100mg/100ml) c) Calcium (2-11mg/100ml) d) Phosphate (6-71mg/100ml) e) Chloride (50-100mg/100ml) f) Fluoride (.04mg/100ml) g) Bicarbonate (0-40mg/100ml) h) Thiocyanate ( 2mg ) i) Hydrogen ion (Ph range is 5..01-. the reabsorption of salts fall behind the & the stimulated saliva becomes less hypotonic with higher concentration of sodium & chloride than that of unstimulated saliva.corticosteroids VI.phospholipids . UREA .12-20 mg/100ml VIII.

This is why low saliva pH values are more harmful for the teeth than total phosphate concentration in saliva. hold water & therefore effective in lubricating & maintaining a moist mucosal surface.25 vol% ) Nitrogen ( 0. MUC5B. In contrast. As in calcium. which is a prerequisite for the . ionizes& non-ionized) make up the total calcium concentration.. SALIVARY PROTEINS Mucins Acinar cells produce mucins & they contain more than 60% carbohydrates. Phosphate Inorganic phosphate consists of phosphoric acid (H3Po4) .9 vol% ) Carbon dioxide ( 10-20 vol% in unstimulated saliva ) Calcium The concentration of calcium increases from unstimulated to stimulated states of secretion with range of 1-2mmol/l.- Polymorphonuclear leukocytes Desquamated epithelial cells GASES DISSOLVED IN SALIVA Oxygen ( 0. In contrast to calcium. lower is the concentration of phosphate & higher is the concentration of phosphoric acid & vice versa. Ionised calcium with two positive charges binds to two negative charges forming a chelate ring. the saliva phosphate concentration is determined by the saliva pH because it will be reduced to a very low value by a low saliva Ph. bicarbonate. MUC7 are major mucins. Mucins are hydrophilic. & phosphate (PO4 3-). The ionized & free form of calcium at a given pH & ionic strength. hydrogen pdosphate (HPO42-). The lower the pH. Non ionised calcium is bound to inorganic ions like phosphate. 20% Ca is bound to statherine & proline rich proteins & unbound Ca is divided into half ionised & half non ionised calcium. with increasing salivary flow rates. dihydrogen phosphate (H2PO4-).18. is equal to the saliva calcium activity & combined all three forms (protein bound. even phosphate is ionized. concentration of total phosphate decreases dramatically. making up for the phosphate activity & some is non-ionized.

.has antimicrobial activity & protection of host cells from the toxicity of hydrogen peroxide. It also has bacteriostatic. Digestive enzymes Α amylase is the most abundant salivary enzyme. Peroxidise system. It is present in new born babies at levels equal to thise in adults & thus exerts antimicrobial functions before tooth emergence. It initiates the digestion of carbohydrates in the mouth. bacteria produced acids may be formed. Antimicrobial proteins & peptides Most of these proteins can inhibit the metabolism.they have attracted attention during past few decades. Most salivary proteins as secretory immunoglobulai. Some oligosaccharides in mucin inhibit the adhesion of bacterial cells to soft tissues. Many of them belong to a group called Proline rich proteins. containing starch. Such calcium binding proteins are Statherin & Proline rich proteins. Mucins aggregate bacteria thereby accelerating the clearance of bacteria from the mouth. accounting for as much as 40-50% of the total salivary gland produced proteins. which is important for the integrity of the tooth. some proteins are need to inhibit spontaneous precipitation of these salts in glands & in their secretions.subjective feeling of a healthy mouth. They have a broad antimicrobial spectrum against bacteria as well as oral yeasts. gingival crevicular fluid & salivary leukocytes. bactericidal. adherence or even the viability of cariogenic microorganisms in vitro but not very clear in vivo. fungicidal. Calcium binding proteins Because human saliva is supersaturated with respect to most calcium phosphate salts. lactoferrin.wt than mucins & contain less than 60% carbohydrates. Lactoferrin. from the mouth. peroxidises & agglutinins belong to this group. Mucins also interact with dental hard tissues & may mediate specific bacterial adhesion to the tooth surface. antiviral & anti-inflammatory activity. Lysozyme. but in this process.this protein in whole saliva comes from the salivary glands. It also clears food debris.its function is attributed to its high affinity to iron & hence its removal from the pathogenic organisms. Histatins. Supersaturated state of saliva with respect to calcium salt constitute a protective & reparative environment. Serous Glycoproteins They have much lower mol.

IgA antibodies without the complications of parenteral injection. The goal of immunizing infants and young children against colonization by mutans streptococci and hence diminishing the development of caries might be accomplished by applying new strategies of mucosal vaccination that would induce salivary. A large body of experimental work over several decades has demonstrated the feasibility of inducing protective immunity against mutans streptococci and the subsequent development of dental caries in animal models. Smith et al. FORMATION OF SALIVA To understand the process of formation of saliva.. 1998].Agglutinins. Fall in buffer capacity of saliva leads to increase in caries incidence. A buffer is a solution that tends to maintain a constant pH. The pH at which any particular saliva ceases to be saturated with calcium & phosphorous is referred to as critical pH 5. it is important to understand its histology & the nerve supply. infants promptly develop salivary IgA antibodies concomitantly with oral microbial colonization [Smith and Taubman. Each acinus is lined by a single layer of epithelial cells called acinar cells or end piece cells.they have the capacity to interact with unattached bacteria & result in their clumping into large aggregates. Normal Ph of resting saliva is 6-7. a duct called intercalated duct arises which opens into the striated duct. It is a glycoprotein produced by parenchymal cells. which are easily flushed. secretory compound acts as a receptor in parenchymal cell membrane for dimeric Ig A and facilitates the transfer of Ig A to lumen either by translation in cell or by endocytosis and secretion along with the secretory products of the parenchymal cells. and accumulation on. Below this value.1992.5. inorganic material of teeth may dissolve.. From the acinus. HISTOLOGY Each salivary gland consists of large no of acini. as well as possible inhibition of their metabolic activities [Russell et al. Secretory component increases the resistance of Ig A molecule to denaturation and proteolysis. tooth surfaces. Information has also accrued from several small scale trials in adult volunteers attesting to the applicability of these approaches to humans. Salivary IgA. The mechanisms of action of salivary IgA antibodies against mutans streptococci include interference with their sucroseindependent and sucrose-dependent attachment to. Development of Ig ASalivary Ig A /secretory Ig A differs from serum Ig A that is produced by plasma cells in connective tissue stroma of glands as it consists of two Ig A molecules and protein called a J birth salivary IgA levels are almost zero. 1999]. Several striated ducts opens .

into the excretory duct which opens into the mouth cavity. These parasympathetic motor fibres arise from a center called salivary nucleus situated in the lower part of the pons & upper part of the medulla. Dilatation of the blood vessels. Parasympathetic fibres arising from the superior salivatory nucleus proceed first via facial nerve & then via chorda tympani nerve to reach submaxillay & sublingual glands. . Myoepithelial cells contain actin & myosin. The parasympathetic nerve supply for the parotid gland comes via the inferior salivatory nucleus via glossopharyngeal nerve. Salivary secretion 2. A salivon is the secretory unit of the salivary gland. NERVE SUPPLY The secretomotar fibres of the salivary glands are parasympathetic fibres. A special variety of cells called myoepithelial cells surround the acini & the intercalated ducts. A salivon consists of acinus + intercalated duct + striated duct. Contactions of these contractile elements leads to expulsion of the accumulated secretion. Stimulation of the parasympathetic nerves causes1.

No water is reabsorbed (lining cells of the duct are impermeable to water) Thus the final product which appears in the mouth cavity is: hypotonic. 2. Na & Cl ions of the primary secretion are reabsorbed.Fig-Parasympathetic nerve supply to salivary glands Sympathetic supply although existing. deficient in NaCl but rich in KHCO3. The primary secretion reaches the intercalated & striated ducts where it is modified as follows. K & HCO3 ions are secreted by the duct cells & are added to the fluid in the ducts 3. STEPS OF SECRETION Current concept is as follows The material secreted by the acini is called the primary secretion. 1. REGULATION OF SECRETION There are 2 varieties of salivary secretion: 1) spontaneous & 2) stimulated. . its stimulation causes a small amount of secretion. is not of much importance.

the reflex is achieved via parasympathetic fibresEfferent limb of the reflex consists of parasympathetic fibres which supply:1) acinar & ductal cells. When the parasympathetic fibres are stimulated salivary secretion (of the efferent limb) are stimulated salivary secretion occurs from the acinar cells & there is contraction of the myoepithelial cells. Conditioned 2. Therefore the complete story is: sighting good food---afferent impulse---salivatory nucleus---efferent impulse--salivation PARASYMPATHETIC STIMULATION & VASODILATATION Parasympathetic induced salivary vasodilation (first noted by Claude Bernard of France) is not fully clear. 4. without any known stimulus & it is this secretion which keeps are mouth moist all the time. Stimulated secretion of saliva occurs after a known stimulus.Spontaneous secretion occurs all the time. 3. that is they are inborn & their presence requires no experience or training. however. Center of the reflex is in the salivary nucleus (superior & inferior).place lemon juice on the tongue of a new born baby. 2)myoepithelial cells. Classical example is Pavlov‟s experiment. retine etc. It appears i) parasympathetic stimulation causes release of a . For both the conditioned & unconditioned reflexes. Unconditioned Unconditioned reflexes are reflexes which are present since birth. Afferent fibres of the reflex come from such areas like tongue. Psychological Visual Taste Other (vomiting) Stimulated secretion of saliva is due to reflex & can be: 1. In short. 2. 3) blood vessels. Example. Parasympathetic stimulation also causes vasodilatation of salivary glands. there is salivation Conditioned reflexes. require previous experience or training. The known stimulus may be: 1. parasympathetic stimulation causes a smart flow of saliva because there is increased acinar cell secretion & ejection of the accumulated saliva.

The clearance of sugars from the mouth limits their availability to acidogenic plaque microorganisms. 4. The bicarbonates & phosphate ions provide a buffering action to saliva. Maintenance of tooth integrity Saliva is super saturated with calcium & phosphate ions. These ions help in the buffering capacity of saliva & protects teeth from decay. lactoferrin. the impulse spreads to the neighbouring salivary nucleus---salivary nucleus stimulated--salivation. This is due to location of vomiting center close to the salivary nucleus. Buffering The buffering power is the power to resist changes of pH when acid or alkali are added. . When vomiting center is stimulated. Pellicle formation The salivary proteins bind to the surfaces of the teeth & oral mucosa. FUNCTIONS OF SALIVA 1. 2. forming a thin film. Protection The fluid nature of saliva produces a washing action that flushes away nonadherent bacteria & other debris. Antimicrobial action Saliva has a major ecologic influence on the microorganisms that colonize oral tissues. Vomiting & salivation During the early stage of vomiting salivation occurs. It contains a spectrum of proteins with antimicrobial activity such aslysozyme. Immunoglobulin-A (IgA) causes agglutination of specific microorganisms.locally acting chemical bradykinin is a strong vasodilator ii)a direct vasodilatory role on the salivary blood vessels by parasympathetic nerves is also possible. 5. peroxidise & secretory leukocyte proteases inhibitor. 3. preventing there adherence to oral tissues.the salivary pellicle.

so that they can be sensed by taste receptors.6. The total volume of salive spread out in a thin film on teeth & mucosa varies depending on several factors.8-1.2ml (Lagerof & Dawes. 8. which gives the sliminess to the saliva. An important function of saliva is therefore to dilute & eliminate substances. Dilution & clearance of dietary sugars Neutralization & buffering of acids Supply of ions for remineralization Exogenous & endogenous antiplaque & antimicrobial factors ORAL CLEARANCE The oral cavity is frequently exposed to substances with harmful properties. The moistening & lubricative properties of saliva also allow the formation & swallowing of food bolus. located in taste buds. The saliva film is moving slowly towards the throat with a speed varying from 1 to 8mm/min. Digestion The digestive enzymes present in saliva are ptylin or salivary amylase & lipase. The lubrication of the mouth is necessary for the clear speech. Lubrication The glycoproteins of saliva are important proteins. Tissue repair A variety of growth factors like the nerve growth factor (NGF) 7 the epidermal growth factor (NGF) & other biologically active peptides & proteins are present in small quantities in saliva. . the saliva film is about 100micron & it varies between sites in the oral cavity. 4. Taste It helps in producing taste by solubilising food substances. 1984). but is usually small. 9. They make the food soluble & start the process of digestion. 2. Since the mucosal surface area of the oral cavity is about 200cm2. 0. ROLE OF SALIVA IN DENTAL CARIES Principal properties of saliva that protect teeth against caries are 1. 7. 3. Saliva produced by minor glands in the vicinity of the circumvalate papillae contains proteins that bind taste substances & present them to the taste receptors.

Thus the clearance rate depends on several factors. the most important being the salivary flow rate. the saliva is supersaturated & remineralization may occur. SALIVA BUFFER CAPACITY & Ph REGULATION After intake of sugar. 1959). The titrable base for stimulated whole saliva down to pH 4 normally ranges between 20 & 30mmol/l hydrogen ions. „titrable base‟. phosphate & hydroxyl ion activities are known. The clearance rate for a certain individual is fairly constant over time. the ion activity product will be equal to solubility product of the tooth substance. which eliminates some of the sugar from the oral cavity.. One is the amount of acid that is needed to lower the pH from the original saliva value to a predetermined lower value.After an intake of sugar the salivary glands will be stimulated by taste or chewing to increase the flow rate. Thus if the ion activity product is larger than the solubility product. when the calcium. This term could denoted the. resulting in a swallow. The buffer effect is determined by adding a fixed amount of acid to a fixed amount of saliva & then reading off a final pH value. A more simple measure for the buffering capacity of human saliva is the “buffer effect”. The clearance half time is a measure of the time it takes for the salivary sugar concentration to reach half of its initial concentration. For each swallow the concentration of sugar will gradually decrease. As tooth demineralization can occur when the actual pH drops below the critical pH. Various terms have been used for evaluation of saliva buffering capacity (Ericsson.containing foodstuffs the pH in plaque will drop & remain lowered until the sugar is cleared from the mouth & the bacterial produced acid is buffered. the saliva is undersaturated & hence demineralization can occur. DEGREE OF SATURATION Saliva has a composition that protects the teeth from demineralization. but it varies to a great extent between individuals. If the ion activity product is smaller than solubility product. The time it takes to reach a certain detectable low level has been used in a measure called clearance time. the ion activity product for hydroxyapatite (IAPhap) in saliva can be calculated asIAPHAp = (Ca2+)10 (PO43-)6 (OH-)2 In a pure aqueous solution where complte equilibration between teeth & water substance has taken place. it is crucial to reduce the time that actual pH stays below this value. Here the salivary activities of calcium & phosphate (ionized forms) become important as they are part of the unit. the ion activities are known. hydroxyapatite. The higher the final pH value. the better the buffering .

A small drop in saliva PCo2 occurs when it enters the mouth. The equilibrium for this buffer is as followsIn saliva. proteins can accept protons & above it they can release protons. Although the buffering effect of the proteins is far less than bicarbonate & phosphate in human saliva. At this value. The pK value for this equilibrium is around 7. The contribution from the bicarbonate buffer system to the overall buffer capacity varies from a little less than half in resting saliva to more than 90% in stimulated saliva. After some dilution has taken place the buffer system in saliva can overcome the remaining acidic challenge in acid producing dental plaque & thereby increase plaque pH. Below their isoelectric point. a buffer system will buffer hydrogen ions equal to a little more than half its total concentration in moles. There are three buffer systems that act in saliva1. Many salivary proteins have their isoelectric point between pH 5-9 & therefore they become good buffers at alkaline & especially acidic pH values. the contribution from phosphate to the overall buffer capacity decreases from around half in resting to as little as 10% in highly stimulated saliva. 2. Unstimulated saliva has mainly dihydrogen phosphate while the stimulated saliva mainly has hydrogen phosphate. Co2 is present primarily as dissolved gas with a partial pressure in parotid saliva of around 6kPa. The protein buffer system Saliva contains many different proteins. As the saliva total phosphate concentration decreases with increasing flow rate. 3. In . If the addition of large amounts of acid results in only a minor pH change the buffer capacity is high & vice versa. In the mouth the saliva buffer capacity therefore works in concert with the clearing effect of saliva. When Co2 is lost from saliva the PCo2 will drop & the pH increase. The bicarbonate buffer system The saliva bicarbonate concentration varies from 3-5mmol/l in resting saliva to 25-28mmol/l in highly stimulated saliva. which can act as buffers when the pH is above or below the isoelectric point.capacity & vice versa. The phosphate buffer system The dominant forms of phosphate within the physiological pH range are the hydrogen & dihydrogen phosphate forms. the latter because hydrogen ions are removed In spite of this the buffering capacity of human saliva is moderate. Buffers such as the phosphate & bicarbonate have their best effects in the range of +/-1 pH unit around their pK values & with the highest capacity at the pK values.

After ingestion the level of fluoride in the blood increases. Concentration of fluoride is not influenced by salivary flow rate. where it takes much longer. The thickness of the pellicle ranges between 1-10microns & thick over time. together with mucins & breakdown products from macromolecules of salivary. bacterial & even dietary background. The lack of pellicle will make the tooth surface more susceptible to acids & thus demineralization. In areas with low concentration of fluoride in the drinking water the basal concentration of fluoride in whole saliva may be lower than 1μmol/l. above all in the drinking water. The pellicle is not removed mechanically by regular tooth brushing but detergents from dentifrice & polishing with rubber cups & powders as well as acid etching & bleaching removes the pellicle layer. This layer froms the base for subsequent adhesion of microorganisms. Most glycoproteins. The pellicle layer even if thin plays an important role in protecting the tooth against mechanical & chemical damage. The relatively undisturbed layer of liquid in the pellicle will reduce the solubility as the movement of ions is slow through this layer resulting in higher concentration of calcium & phosphate. α amylase. Other foodstuffs rich in fluoride are fish & tea. the risk of systemic fluorosis of the enamel increases while caries prevalence decreases. The fluoride conc in the secreted saliva & the oral fluids depends strongly on the fluoride present in the environment. SALIVA & FLUORIDE The fluoride concentration in the secreted saliva is low. participate selectively in pellicle matrix formation.addition to their chemical buffering. mouth rinses are partly or fully swallowed & a minute amount of the ingested fluoride is excreted via the saliva. With increasing fluoride concentration. Some proteins & peptides of the pellicle act as receptors for oral bacteria such as streptococcus & actinomyces species. some of the saliva proteins increase the viscosity of the saliva whem the pH becomes acidic & thereby physically protect the teeth against acid load by forming a diffusion barrier. It is reformed within minutes except in dry mouth. ROLE OF PELLICLE Saliva is seldom in direct contact with the tooth surface. The adsorption of the first molecular layer on a clean surface is instantaneous. though is slightly higher in unstimulated saliva (Shannon et al). sIgA. peroxidise. after which it decreases. In areas with higher levels of fluoride in the drinking water. IgG. lysozyme. Products used for caries control like dentifrices. & also serves as a diffusion barriers to acids. the basal salivary concentration may be much higher. The rate of formation of the pellicle is fast during the first hour. carbonic anhydrases & glucosyltransferses. The saliva component is separated from the surface of the tooth by a thin bacteria free biofilm called the acquired pellicle (Lendenmann et al 2000) which is an acellular layer of adsorbed salivary proteins & other macromolecules. reaching a peak after 30min to .

the salivary concentration of the fluoride decreases rapidly owing to oral clearance. elevating the fluoride concentration in the plaque fluid ina short time. Tooth brushing before bedtime will increase the fluoride concentration during sleep when the clearance is very low. which is makes the mineral vulnerable to an acidic environment. Thus a strong tasting topical fluoride may counteract its own aim as a fluoride source. the solubility of the apatite increases. DEMINERALIZATION & REMINERALIZATION OF THE DENTAL HARD TISSUES Under physiological conditions saliva & the oral fluids are supersaturated with respect to hydroxyapatite & fluorapatite. After the initial fluoride exposure of the oral cavity. When the pH in the surrounding medium decreases. The most important factor for the fluoride clearance rate is the salivary flow rate. In that way.1hr. which explains why this salt only exists in the oral cavity for a limited time & will dissolve soon. The current approach to caries control stresses the importance of fluoride present in the oral fluids close to site of action. Even a very small amount of fluoride dissolved in this small volume of saliva will result in a high fluoride concentration that may be more than 10. If the oral fluids were unsaturated with respect to apatite the dental hard tissues would dissolve without any reason. The volume of saliva present in the mouth is small. In general. The solubility of apatite increases by a factor of 10 with a drop of each single pH unit. Carious lesion 2. such as observed during developmental maturation of enamel or remineralization of carious lesions. The supersaturation with respect to apatites may lead to mineral deposition in porous areas in the teeth. Erosion lesion . The concentration of fluoride in the duct saliva is at 20-40% lower level than that of plasma. Exposure to acids may lead to 2 types of lesions1.000 times the basal level. That is the precondition for the existence of dental apatite in the mouth. Fluoride will diffuse from the thin saliva film into the plaque. perhaps only a millilitre spread out in a thin film. mineral calcium fluoride will form. which is need for the optimum function of the enzyme. Saliva is unsaturated with respect to calcium fluoride. The calcium fluoride functions as a slow releaser of fluoride. the higher the suoersaturation with respect to the actual salt the greater is the tendency for its formation. Both in saliva & in plaque. fluoride diffusing into the microorganisms prevents the enzyme Enolase from taking part in the glycolytic pathway by binding magnesium.

The carious lesion contains partially demineralised crystals & considerable remineralization of surface layer is observed. rather well mineralized surface layer & a subsurface body of the lesion with a mineral loss upto 30-50% extending deep into the enamel & dentin. The formation of new crystals is uncommon. As pH is lowered in the oral fluids. the supersaturation with respect to hydroxyapatite is reduced & replaced by saturation at critical pH.. Thus the supersaturation with fluorapatite is responsible for the maintainence & integrity of surface layer Remineralization Remineralization of dental lesion requires the presence of partially demineralised apatite crystals that can grow to their original size on exposure to solutions supersaturated with apatite crystals. erosion lesion shows features of complete demineralization & dissolution layer by layer. it does not seem to be possible to maintain the supersaturation in the lesion fluid & thus its . except for acids used for conditioning. In such conditions. Caries demineralization Under normal conditions the oral fluids are supersaturated with respect to both hydroxyapatite & fluorapatite. very little remineralization of eroded areas can be expected. while the fluorapatite is formed in the surface layer of enamel. Caries is defined as chemical dissolution of the dental hard tissues by acidic bacterial products from degradation of lower mol. the fluids are unsaturated. a carious lesion forms. only that the etching acid penetrates considerably deeper into the enamel & exposes the prism patterns to a larger extent. indicative of a tendency for the formation of these two minerals.wt sugars. A third type of enamel dissolution by acids is seen when the enamel is conditioned for the retention of resin fillings.The initial stages of the carious lesion are characterized by a partial dissolution of the tissue leaving 20-50μm thick. saliva & plaque fluid. Below this. Erosion is defined as dissolution of apatite mineral caused by acids of any other origin. Because fluorapatite is less soluble than hydroxyapatite. In contrast. Owing to slow diffusion. Subsurface hydroxyapatite is dissolved. plaque fluid remains supersaturated with respect to fluorapatite when it is undersaturated with hydroxyapatite. Thus. the dental hard tissues remaining after even extensive erosion do not show sign of demineralization except that some of the enamel is gone while that of remaining enamel is unchanged. Erosion lesion is characterized as a lesion in which the enamel is etched away layer by layer. The etch pattern is similar to that of erosion.

prostigmine • Adrenergic stimulating drugs Example.remineralization is not observed. CONDITIONS AFFECTING SALIVATION  Physiologic • • • • • Taste Surface texture Dehydration Age Emotion  Pathologic conditions that increase salivation • • • • Digestive tract irritants Ill – fitting dentures / Inadequate interocclusal distance Vitamin deficiency Trauma from surgery  Pathologic conditions that decrease salivation • • • • • • Senile atrophy of the salivary glands Irradiation therapy Diseases of the brainstem Diabetes mellitus / insipidus Diarrhoea Acute infectious diseases  DRUGS THAT INCREASE SALIVATION • Cholinesterase inhibitors Example.epinephrine . The surface layer of the lesion protects the underlying lesion body not only from demineralization but also from remineralization.

pilocarpine  DRUGS THAT DECREASE SALIVATION • • • • • • • • • • Antihistamines Drugs for peptic ulcer Antihypertensives Antipsychotics Antiparkinsonian drugs Antianxiety agents Antidepressants Antisialogogues Diuretics Decongestants ANOMALIES OF THE SALIVARY GLANDS I.• Sialogogues Example.Developmental   Aberrant Salivary Glands Aplasia and Hyperplasia II.Obstructive conditions    Sialolithiasis Mucocele Necrotizing Sialometaplasia .

It is of two types: .Degenerative Conditions   Sjogren‟s Syndrome Ionizing Radiation VI. Inflammatory Diseases Viral  Mumps  H. It most commonly occurs on the Lower lip followed by Floor Of the Mouth.Xerostomia SIALOLITHIASIS It occurs by calcareous concentrations in the salivary ducts or glands.V. tongue and palate. MUCOCELE It is the clinical term used to describe the swelling caused due to the pooling of saliva at the site of damaged salivary duct.I.III. Associated Bacterial  Sialadenitis is formed by deposition of calcium salts around central nidus. It most commonly occurs in Wharton‟s duct due to the viscous secretion.Neoplastic Diseases     Benign Malignant Epithelial Mesenchymal V.

V. RANULA It occurs as a blue/purplish red enlargemaent occurion unilateral or occupying the whole of the mouth.Strep.-Extravasation Type -Retention Type It appears as blue fluctuant swelling on palpation. Treatment Marsupialisation or its surgical removal. surgical drainage is done. TREATMENT: Antibiotics are given for symptomatic relief. NECROTIZING SIALOMETAPLASIA It is caused due to trauma resulting in ischemia of the salivary gland.aureus.Associated. Treatment: Debridement of the lesion leads to healing in 6-12 weeks. ALLERGIC SIALADENITIS It occurs due to allergic reaction to certain drugs like Phenothiazine . It is a raised tumor like mass frequently appearing as a deep surface ulcer. while eating food or opening the mouth. VIRAL MUMPs . INFLAMMATORY DISORDERS It is characterized by painful bilateral/unilateral swellings of the affected glands esp.Caused by Paramyxoviru H.Seen along with Kaposi‟s Sarcoma and Lymphoma BACTERIAL SIALADENITIS Caused by Staph.viridans. .I. In severe situations.

. Malignant Epithelial tumors  Malignant Pleomorphic Adenoma  Adenoid cystic carcinoma  Squamous cell carcinoma  Mucoepidermoid carcinoma Benign mesenchymal tumors     Fibroma Lipoma Haemangioma Schwannoma Malignant mesenchymal tumors     Lymphoma Rhabdomyosarcoma Melanoma Fibrosarcoma CLINICAL FEATURES: Benign tumors : They are slow growing painless masses.NEOPLASTIC DISEASES Benign Epithelial Tumors     Pleomorphic adenoma Warthin‟s tumor Oncocytoma Mikulicz‟s disease. No ulceration or fixation to underlying tissues is seen.

Maintenance of oral hygiene is achieved by frequent fluoride application. Sialogogues are given to stimulate the salivary flow. XEROSTOMIA A subjective feeling of daily oral dryness. TREATMENT: Surgery/Radiotherapy DEGENERATIVE CONDITIONS 1. 2. Fixation to underlying structures is common.  Local /Systemic conditions a) Fever b) Oral infections c) Diabetes Mellitus d) Thyroid disorders e) Hepatic disorders . antidepressants etc. Surface ulceration is seen. They are painful. which often impairs oral functions such as swallowing & speech & thus the overall health related quality of life Causes : Administration of drugs like antihypertensives . Sjogren‟s syndrome: It is an immunologic disorder described as a triad of : -Keratoconjuctivitis sicca -Xerostomia -Rheumatoid arthritis Treatment : Ocular lubricants and salivary substitutes are advised to keep the mucosal surfaces moist.Malignant tumors: They are larger in size as compared to benign tumours. Ionizing radiation: Progressive fibrosis and parenchymal degeneration of the salivary gland.

5 .≤ 0. SIALORRHOEA/PTYALISM An increased flow of blood through the salivary glands and their excessive stimulation causes excessive salivation. 2.7ml/min Difficulty in swallowing food without additional fluids Burning sensation on eating spicy food & fruits Food continuously sticking to teeth Difficulty in speech Need to moisten the oral cavity repeatedly Treatment Artificial lubricants or stimulating agents like salivary substitutes are prescribed. 3. It is also seen as a manifestation of primary herpetic and other infections. fissured & have partial or total atrophy Unstimulated saliva. riboflavin and nicotinic acid  Infection/Obstruction of the salivary glands  Radiation Symptoms 1. 2. particularly during meals are strongly advised to maintain oral hygiene. 4. 3. 5. ARTIFICIAL SALIVA These are useful agents for the palliative treatment of Xerostomia .f) Depression  Nutritional deficiency  Deficiency of vitamin A .≤ 0. Mouth rinses.1ml/min Stimulated saliva rate . Sialogogues are given to increase the salivary flow. 5. 4. Signs 1. Lip dryness Buccal mucosa dryness Dental caries Tongue is beefy red. It is seen in some psychological conditions in cerebral palsy and epilepsy.0.

Mucin based  They have the lowest contact angle and the best wetting properties on the oral mucosa  Their rheological properties are more comparable to that of natural saliva Salivary substitutes are available in the form of sprays and lozenges CONTAMINATION OF OPERATIVE SITE WITH SALIVA 1.fluoride ions are added to provide remineralization potential 2. Root canal therapy Causes contamination of the pulp canal as well as the periradicular area .phosphate. preventing proper adhesion 5.Divided into 2 groups:1. mechanical properties affected & bonding is affected 3. solubitility increases. Cavity preparation Hampers access & visibility Causes contamination of a deep cavity 2. Composite restoration Blocks the micropores opened by etching. Base application Affects the physical & mechanical properties For GIC restorations. Amalgam restoration Affects physical & mechanical properties Causes delayed expansion 4. Carboxymethylcellulose (CMC) based  CMC is used to impart lubrication and viscosity  Salts are added to mimic the electrolyte content of saliva  Calcium.

CONCLUSION Saliva is a specialised which protects the teeth from dental caries and the oral cavity from various diseases. Thus saliva is multifunctional in its role. .

Edwin Kidd  Tooth erosion. Roger John A Kaidonis  Textbook of oral pathology.63:618-21  Amerongen AV.Axelsson  Dental caries.97:131-65  Lagerlof F. Dawes C.8:12-22  Internet resources .References  Gray‟s anatomy. clinical investigations of the salivary buffering action.shafer  Ericsson Y. J Dent Res 1984. saliva – the defender of the oral cavity.disease & its clinical significance Ole Fejerskov. Acta Odontol Scand 1959.prevention & treatment Kevin. the volume of saliva in the mouth before & after swallowing. Veerman E. HK Yip. Oral dis 2002.2nd edition  Dental caries.38th edition  Oral physiology – Chaudhary.