MODULE 2: LECTURE 4

SALIVA & DENTAL CARIES

Amy Liew
Lecture Outline
 Introduction
 Saliva & Dental Caries:
 Flow rate
 Buffering capacity

 Inorganic composition

 Antibacterial properties
Introduction
Major Salivary Glands
1. Parotid gland
 Produces 25% of the total volume of saliva
 Serous saliva
2. Submandibular gland
 Produces 70% of the total volume of saliva
 Mixture of serous & mucous saliva
3. Sublingual gland
 Produces 5% of the total volume of saliva
 Mainly mucous saliva
Minor Salivary Glands
1. Minor salivary glands
 over 600 located throughout the oral cavity within the
submucosa of the oral mucosa
 coating the oral cavity with saliva

2. Von Ebner's glands

 found in circumvallate papillae of the tongue
 secrete a serous fluid that begin lipid hydrolysis
 facilitate the perception of taste
Composition
 99.5% water and 0.5% dissolved substance
Composition Description
Proteins/ A number of different types, collectively known as
Glycoproteins mucin. Gives saliva its viscosity.
The origin of the salivary pellicle.
Enzymes Salivary amylase (pytalin), lysozyme etc.
Serum proteins Albumin & globulin
Waste products Urea & uric acid
Gases O2, N2 & CO2 in solution.
Inorganic ions Including Na+, SO42-, K+, Ca2+, PO43-, Cl-, F-
Composition
 Varies with individual
 Varies according to what is being eaten
 Saliva is sterile until it enters the mouth.
 Whole saliva contains:
 Salivary secretions
 Gingival crevicular fluid
 Microorganism (bacteria, virus, fungi) & products
 Leucocytes
 Dietary substances
 Epithelial cells
 Nasal exudates
Functions
1. Mastication & deglutition
2. Oral hygiene
3. Speech
4. Taste
5. Helps maintain water balance of the body
6. Excretion – minor role
7. Digestion
8. Buffering action
Saliva & Dental Caries
Flow Rate
 No linear association exists between salivary flow
rate and caries activity

 Individual “Threshold Effect” - crossing it rapidly

increases caries activity if preventive measures are
not adequate.
Flow Rate

 Salivary glands are innervated by

PNS and SNS

 Both PNS and SNS stimuli  increase

salivary gland secretions
SNS: mucous saliva
PNS: watery saliva
Flow Rate
 Average amount produced daily by adults: 0.5 –
1litre
 More is secreted when required (reflex action)
 Chewing helps to stimulate salivary flow
 Flow almost ceases during sleep
Flow Rate
Down’s Syndrome, Parkinson’s Disease, Aging, anxiety, dehydration, mumps,
medications Sjogren’s syndrome, radiotherapy,
medications, Diabetes Mellitus

Overproduction Reduced production

Hypersalivation Hyposalivation

±Dribbling ±Xerostomia
 Dawes Model of Oral Clearance

Flow Rate

(Vmax) maximum
salivary volume: volume
just before swallowing
(mean= 1.1 mL)
 Dawes Model of Oral Clearance

(Resid) residual volume in

the mouth after
swallowing
(mean = 0.8 mL)
 clearance, Unstimulated
 half-time saliva

Low
Stimulated unstimulated
saliva  flow rate/
flow rate high Resid &
Vmax values

Chewing or Longer
place clearance
sugar/acid times
in the mouth
Dawes Model of Oral Clearance
 The rate of clearance varies markedly at different
oral sites
 Fastest:lingual to the mandibular incisors
 Slowest: buccal surfaces of the teeth (except buccal to
the maxillary molars)

  salivary flow rate:  caries susceptibility due to

development of deeper Stephan curves
 Clearance Time
 Some bacteria are capable to adhere to pellicle
 Bacterial accumulation in dental plaque
 Food debris impacted on hard-to-clean areas
 Some materials, such as fluoride or chlorhexidine,
have the ability to bind to oral structures
Buffer Effect
 bicarbonate (HCO-3) buffer system
 pK=6.1- 6.3
 main system during food intake and mastication
 increases progressively with the duration of stimulation
 diffuses into the plaque  neutralizes plaque acids   plaque
pH  favors remineralization

 phosphate buffer system

 main system in resting

 protein buffer system

 at very low pH
Buffer Effect
 Salivary flow rate and buffer effect correlate positively
 A negative association between buffering and dental
caries exists
 But salivary buffer capacity tests alone have only a
weak association with caries activity or outcome of
future caries
 Caries attack occur within dental plaque or even
beneath the outer surface of enamel where the action
of salivary buffering agents is minimal or negligible
Inorganic Components
 Saliva is supersaturated with respect to hydroxyapatite

 Statherin, the acidic Proline-Rich-Proteins, cystatins, and

histatins: maintenance of the homeostasis of the
supersaturated state of saliva.

 Thus, tooth mineral will not dissolve in saliva or plaque

fluid (which is even more supersaturated than saliva
during fasting), unless the saliva or plaque is acidified
Inorganic Components
 The fluoride concentration in saliva is low, about 1
micromole per liter (0.02 parts per million), but this
helps keep the saliva somewhat more
supersaturated with respect to fluorapatite than to
hydroxyapatite
Antibacterial Factors
 Lysozyme: typical oral flora are not affected
significantly, may repel transient bacterial invaders.

 Amylase, MUC5B and agglutinin: bind certain

oral microorganisms such as Streptococcus gordonii,
S. mitis and S.oralis.
Antibacterial Factors
 Cystatins: inhibit cysteine proteases (proteolytic
enzymes produced by several oral pathogens)

 sIgA & IgG: able to bind some soluble and

particulate antigens, including some bacteria and
viruses, and may take part in adaptive immunity
Antibacterial Factors

It is highly unlikely that any single antimicrobial agent of human saliva could have
an association with caries susceptibility or activity due to: limited study, various
measurement issues, great individual variation and complicated interactions. This
does not mean that the antimicrobial proteins are not important - on the contrary.
These agents indeed display a large number of protective functions against
cariogenic microorganisms and they form an essential part of host defense
against caries activity, although their diagnostic value is questionable.
Aggregation & Adherence
Acquired enamel pellicle
 a thin film consisting mainly of salivary proteins
selectively absorbed to the surface of the
enamel
 protects the enamel from dissolution: diffusion
fluxes are reduced by 50% in the presence of
pellicle
 a base to which the bacteria can adhere when
they enter the oral cavity.
Aggregation & Adherence
 Binding of bacteria is mediated by:
 non-specific electrostatic and van der Waals forces
 specific interactions between bacteria and the proteins on the
salivary pellicle

 Parotid saliva agglutinins, α-amylase, statherins, mucins,

acidic PRPs, and salivary immunoglobulins-are reported to
bind with oral streptococci, may mediate the specific
adhesion of bacteria to tooth

 On the other hand, when these same proteins exist in the

liquid phase, they may promote bacterial aggregation and,
hence, the clearance of bacteria from the oral cavity.
Conclusion

Aggregation Flow Rate

& Adherence

Antibacteri Buffer
al Factors Effect

Inorganic
Components