1

SALIVA: The
“AQUA VITA” of
the oral cavity

PRESENTED BY-: Shweta Singh

2nd year P.G.
Department Of Prosthodontics
 2
CONTENTS
 INTRODUCTION
 SALIVARY GLANDS
 TYPES & LOCATION
 DEVELOPMENT
 ANATOMY
 PATHOLOGY
 SALIVA
 PHYSICAL CHARACTERISTICS
 FORMATION OF SALIVA
 COMPOSITION & FUNCTIONS
 3

 PROSTHODONTIC
IMPLICATIONS
 TROUBLE SHOOTING
 XEROSTOMIA
 SALIVARY SUBSTITUTES

 REVIEW OF LITERATURE
 CONCLUSION
 REFERENCES
 INTRODUCTION
SALIVA
 Is a clear, slightly acidic , mucoserous secretion , which
provides chemical milieu of the teeth and oral soft tissue.

 The whole saliva is a complex mixture of fluids, containing

a high population of normal oral bacteria, desquamated
epithelial cells and transient residues of food or drink,
following their ingestion.

SALIVARY GLANDS
-Are essentially exocrine glands that secrete this valuable
oral fluid, into the oral cavity through a duct system.
4
 SALIVARY GLANDS

TYPES.
Based on their anatomical size
 MAJOR SALIVARY GLANDS
• Parotid gland
• Submandibular gland
• Sublingual gland

 MINOR SALIVARY GLANDS

• Buccal
• Labial
• Lingual
• Palatine
• Glossopalatine 5
Based on their type of secretion

 Serous
 Mucous
 Mixed

6
LOCATION OF SALIVARY GLANDS
Parotid gland
 Located anterior to the Ext. acoustic meatus and
mastoid process.
 Inferior to the zyg. Arch.
 Lateral and posterior to the ramus of the mandible.
 Superior to the massetor muscle.

 Parotid duct {Stensen’s duct}

7
LOCATION OF SALIVARY GLANDS
PAROTID GLAND

8
SUBMANDIBULAR GLAND
 Superficial part

Lies in a slight depression in the medial part of the lower

border of the mandible and extends below into the submandibular
triangle.

 The deep part.

Lies beneath the oral mucosa in the floor of the mouth,i.e. the
mylohyoid muscle. It communicates with the superior lobe around
the posterior free edge of the mylohyoid muscle.

 Submandibular duct- (Wharton’s duct)

It passes forward from the deep part of the submandibular

gland along the floor of the mouth to open into the oral cavity at the
sublingual papilla under the tongue. 9
SUBMANDIBULAR SALIVARY GLAND

10
SIALOGRAPHY : Submandibular & Sublingual Gland

11
SUBLINGUAL GLANDS

They are the smallest of the major salivary glands and lie beneath
the mucous membrane of the floor of the mouth.It opens through
multiple ducts into the submandibular ducts.

Sublingual duct {Bartholin’s duct}

It is the main excretory duct of the sublingual sal. gland, and may
open into the submandibular duct or the oral cavity, with a separate
sublingual papilla.

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MINOR SALIVARY GLANDS

 LABIAL{Superior and Inferior}Lips

 BUCCALCheeks
 LINGUALTongue
 PALATINEHard palate,Soft palate,Uvula
 GLOSSOPALATINEAnt.Faucial pillar,Glossopalatine fold

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VASCULAR SUPPLY TO THE SALIVARY GLANDS

PAROTID GLAND
Arterial:Ext.Carotid Artery and its branches
Venous: Ext.Jugular Vein
Lymphatic:Parotid NodesUpper deep cervical nodes

SUBMANDIBULAR GLAND
Arterial:Facial Artery,Lingual Artery
Venous: Common Facial Vein /Lingual Vein
Lymphatic:Submandibular Lymph nodes

SUBLINGUAL GLAND
Arterial:Lingual and Submental Arteries
Venous: Lingual Vein
Lymphatic: Submental nodes.
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 DEVELOPMENT OF SALIVARY GLANDS

Ectomesenchyme plays an essential role in the initiation, growth and

cytodifferentiation of glandular cells.
 Time of origin
Gland Location Intra uterine life
Parotid gland Corners of the stomodeum 6th week
Sub.Mand.gland Floor of the mouth End of 6th week
Sub.Ling.gland Lateral to S.m.primordium 8th week
Minor salivary Buccal Epithelium 12th week
Glands
15
 HISTOLOGY
Parotid Gland

16
Submandibular Gland

17
Sublingual Gland

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STAGES OF DEVELPOMENT

STAGE I: Bud formation:Induction of proliferation of oral

epithelium by underlying mesenchyme.

19
STAGE II:Formation and growth of epithelial cord.

20
STAGE III: Initiation of branching in terminal parts of
epithelial cord and continuation of glandular differentiation.

21
STAGEIV: Dichotomous branching of epithelial cord and
lobule formation.

22
STAGE V:Canalization of presumptive ducts.

23
STAGE VI: Cytodifferentiation.

Cells of  Terminal tubule cell  Proacinar cellsAcinar cells

Bulb region 
Intercalated duct cell

24
STRUCTURE OF THE SALIVARY GLANDS

DUCT SYSTEM:
•Intercalated
•Striated
•Excretory

25
SALIVARY GLAND ACINI

•Serous
•Mucous
•Mixed

26
MYOEPITHELIAL CELLS
 These are the cells situated between the basal lamina and the acinar
cells, the contractions of which facilitates the movement of
secretory products from the acinus towards the oral cavity

CONNECTIVE TISSUE CELLS

 They form the capsule and the septa of the salivary gland and serve
as the framework supporting the duct and the secretory system.
 They also support the nerves, blood supply ad the lymphatics of the
salivary glands.
 They secrete immunoglobulins{Ig A} which have anti bacterial
action.
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MINOR SALIVARY GLANDS

Sympathetic:

•Labial and Buccal Glands via Facial Artery

•Lingual Glands via Lingual Artery
•Palatine Glands via Palatine Artery

Parasympathetic:

•Ant.Lingual Glands via same as that of Sub.Mand.Gland

•Palatal Glands and those of Upper Lip and Upper part of the Vestibule
receive post gang.fibres from the Pterygopalatine Gang.through the
Palatine vessels.

•Glands of the Lower Lip and Lower part of the Vestibule receive post
gang. fibres from Otic gang.through Inf.Alv. And Buccal Nerves. 28
DISEASES OF THE SALIVARY GLANDS

I.Developmental Anomalies
Aberrant Salivary Glands
Aplasia and Hypoplasia
Accesory Ducts and Diverticuli

II.Obstructive Conditions
Sialolithiasis
Mucocele
Necrotizing Sialometaplasia

III. Inflammatory Disorders

Viral
Mumps
H.I.V. Associated
Bacterial
Sialadenitis 29
IV.Neoplastic Diseases
Benign
Malignant

Epithelial
Mesenchymal

V.Degenerative Conditions
Sjogren’s Syndrome
Ionizing Radiation

VI.Xerostomia

30
SIALOLITHIASIS
 They are calcified and organic matter that develop in the ducts of the
salivary glands.Caused due to the deposition of calcium salts on an
organic nidus.
 Most commonly seen in Wharton’s duct.

31
MUCOCELE
 It is a clinical term used to
describe the swelling caused
due to the pooling of saliva at
the site of damaged salivary
duct due to trauma.
 Most common site is the Lower
lip followed by Floor Of the
Mouth, tongue and palate.

•Two types:
 Mucous Retention Type
 Mucous Extravasation Type

• Clinical Appearance:
Characteristic blue swelling
fluctuant on palpation. 32
RANULA
Blue/Purplish Red enlargement occuring unilateral or occupying the
whole floor of the mouth.
Treatment:
Surgical removal

33
NECTCOTIZING SIALOMETAPLASIA

It is caused due to trauma resulting in

ischemia of the salivary gland.

•Cl. App.:Raised tumor like mass

frequently with a deep surface ulcer.

•Treatment:Debridement of the
lesion leads to healing in 6-12 weeks.

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INFLAMMATORY DISORDERS
Characterized by painful bilateral/unilateral swellings of the affected
glands esp. while eating food or opening the mouth.

MUMPS
Caused by Paramyxovirus.
H.I.V.Associated
Seen along with Kaposi’s Sarcoma and Lymphoma.

BACTERIAL SIALADENITIS
Caused by Staph.aureus,Strep.viridans.
ALLERGIC SIALADENITIS
Allergic reaction to certain drugs like Phenothiazine and
Sulfisoxazole.
SARCOID SIALADENITIS
It is a systemic granulomatous disease of unknown etiology.
TREATMENT: Symptomatic/Antibiotics/Surgical drainage. 35
NEOPLASTIC DISEASES
Benign Epithelial Tumors
Pleomorphic adenoma
Warthin’s tumor
Oncocytoma

Malignant Epithelial tumors

Malignant Pleomorphic
Adenoma
Adenoid cystic carcinoma
Squamous cell carcinoma
Mucoepidermoid carcinoma

Benign mesenchymal tumors

Fibroma
Lipoma
Haemangioma
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 Malignant mesenchymal tumors
Lymphoma
Melanoma
Fibrosarcoma

CLINICAL FEATURES:
Benign tumors : Slow growing masses
Painless
No ulceration
No fixation

Malignant tumors:Larger in size

Painful
Surface ulceration seen
Fixation seen

TREATMENT:Surgery/Radiotherapy
37
DEGENERATIVE CONDITIONS

Ionizing radiation: Progressive fibrosis and parenchymal

degeneration of the salivary gland.

Sjogren’s syndrome:It is an immunologic disorder described as a

triad of :
Keratoconjuctivitis sicca
Xerostomia
Rheumatoid arthritis

Two types:
Primary
Secondary

Treatment:Ocular lubricants and salivary substitutes, maintenance

of oral hygiene,frequent fluoride application, sialogogues.
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Physical properties
•Average Daily flow: 1-1.5 litres

•Normal pH : 6-7

•Normal flow rate

Unstimulated: >0.1 ml/min
Stimulated : 0.2 – 7 ml/min

•Residual volume of saliva : 0.8 ml

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TWO STAGE HYPOTHESIS OF SALIVA
FORMATION

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COMPOSITION
Saliva is made up of approx. 99% of water.
Organic components
 Protein
• 200mg/100ml.
• enzymes, immunoglobulins, mucins, traces of
albumin & polypeptides and glycopeptides.
 -amylase{Ptyalin}
• 60-120 mg/100 ml in parotid.
• 25 mg/100ml in submandibular.
 Immunoglobulins
• Ig A
• Ig G
• Ig M 41
 Anti bacterial properties
• Lysosyme
• Lactoferrin
• Sialoperoxidase
 Glycoproteins
• MG1 & MG2 seen in submand. And subling. Saliva.
• Proline rich glycoprotein seen in parotid saliva.
 Other compounds
• Siatherin
• Sialin
• Free amino acids
• Urea
• Glucose
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Inorganic constituents

• Sodium
• Potassium
• Chloride
• Bicarbonate
• Calcium
• Phosphorus
• Flouride
• Thiocyanate

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Functions of saliva

 Lubrication and Protection

•Forms a tissue coating film .

•Bolus formation.
•Forms a barrier against proteolytic and hydrolytic enzymes
in plaque, potential carcinogen from smoking and
dessication from mouth breathing.

 Buffering action and clearance

Saliva is alkaline.
• Bicarbonate.
• Urea.
• Dilution of food substances and clearance.

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 Maintenance of tooth integrity
• Calcium and phosphate ions  remineralisation.
• Flouride  flourapatite coating  caries resistant.
 Anti bacterial action
 Immunoglobulins  IgA,IgG,IgM.
• aggregate specific bacteria and prevent their adhesion.
 Non immunologic agents  proteins,mucins,peptides &
enzymes.
• MG2-IgA complex bind mucosal pathogens.
• Lactoferrin.
• Lysosymes.
 Taste and digestion
• Saliva is hypotonic.
• Carbohydrate digestion.
• Fat digestion.
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 PROSTHODONTIC IMPLICATIONS

 Excessive salivation presents a problem in impression making

procedures.

 Mucous secretions from the palatal glands may distort the

impresion materials in the posterior two thirds of the palate
causing dislodgement of the denture, voids on the impression
surface and gagging in the patients.

 Ideally there should be a moderate flow of serous type saliva.

 New dentures may feel like foreign bodies.

 In conditions of lack of saliva, there is reduced retention of a

denture and also causes cheeks and lips to stick to the denture
base.
46
Role of saliva in denture retention.
 Interfacial force/Surface tension
 It is the resistance to separation of two parallel surfaces that is
imparted by a film of liquid between them.
 It is dependent on the ability of the fluid to ‘wet’ the rigid
surrounding material(WETTABILITY).
 It may not play an as important a role in retaining the mandibular
denture as it does for the max. denture.

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Adhesion and cohesion.

 Adhesion is achieved through ionic forces between the

charged salivary glycoproteins and the surface epithelium or
acrylic resin.

 The amount of retention provided by adhesion is proportionate

to the area covered by the denture.hence it is of lower
magnitude in cases of mandibular dentures and smaller basal
seats.

 Cohesion occurs between the layers of saliva that is present

between the denture base and mucosa and works by
maintaining the integrity of the interposed liquid.

 Contribution to retention is low.

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Capillary attraction

It is the force that causes a liquid to rise in a capillary tube

because in this physical setting the liquid tries to maximize its
contact with the walls of the capillary tube thereby rising along
the tube wall at the interface b/w the liquid and the glass.

Viscosity

Interfacial viscous tension refers to the force holding two parallel

plates together due the viscosity of the interposed liquid.
This shows that viscous force increases proportionally to increase
in the viscosity of the interposed liquid,but decreases on increase
in its thickness.

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Conditions that affect salivation
 Physiologic
 Taste
 Dehydration
 Age
 Mastication
 Emotion
 Pathologic conditions that increase salivation
 Digestive tract irritants
 Ill fitting dentures/inadequate interocclusal distance
 Vitamin deficiency
 Trauma from surgery
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Pathologic conditions that decrease salivation
 Senile atrophy of the salivary glands
 Irradiation therapy
 Dieseases of the brain stem
 Diabetes mellitus/ insipidus
 Diarrhoea
 Acute infectious diseases

Drugs that increase salivation

 Cholinesterase inhibitors. Ex.prostigmine
 Adrenergic stimulating drugs. Ex.epinephrine
 Sialogogues. Ex.pilocarpine.
51
 Clinical considerations
Sialorrhea
 Caused due to an increased flow of blood through the salivary
glands and their excessive stimulation. The chief cause of
Sialorrhea in denture wearers is due to-
•Emotional stress
•Painful affliction of the oral cavity
•Reflex stimulation of the dentures.
 This may be due to
•Incorrect centric jaw relation registration
•Excessive vertical dimensions
•Overextension of denture borders
•Pain and excessive pressure on oral mucosa 52
•Pressure on nerves and their terminals
•Denture may act as a foreign body
•Excessive thickness of the dentures
•Patients anxiety about possible of the denture

 Management
•Correction of the dentures
•Reassurance /psychotherapy of the patient

53
Denture stomatitis
•The adherence and growth of
microorganisms on the Acquired
Dental Pellicle result in a granular
or inflammatory response by the
underlying mucosa,causing
denture stomatitis.
•Most common site is max. palatal
surface.
•Acquired dental pellicle also
causes extrinsic staining and
calculus deposition.

54
XEROSTOMIA
 It is a condition of reduced or absent salivary flow,leading to
the dryness of the mouth.
 It is not a disease by itself, but a symptom associated with
alterations of salivary function.
 Causes.
•Administration of drugs
•Systemic conditions:
Cystic fibrosis
Sarcoidosis
Diabetes mellitus
Thyroid disorders
Hepatic disorders
Depression
Neurologic disorders 55
•Nutritional deficiency
•Deficiency of vitamin A,riboflavin and nicotinic acid.
•Infection/obstruction of the salivary glands.
•Radiation.

 Prosthodontic implications
•Retention is affected.
•Frictional irritation to the denture supporting tissues
•Difficulty in mastication and deglutition.
•Patient may discontinue the use of dentures.

56
 Management
• Denture use limited to short periods.
• Nutritious diet/soft and moist food.
• Chewing sugarless gums and frequent liquid intake.
• Good denture hygiene to be maintained to prevent
candidiasis.
• Flouride application
• Pilocarpine therapy.
• Lowering the dosage or changing the drug..
• Salivary substitutes.

57
Sialography
 It is the radiographic evaluation of the ductal tree of the
salivary glands by means of the intraductal injection of a
radioopaque contrast solution to delineate the ductal pattern
which will be radiographically discernible.
Various radiographic appearances
 Normal salivary gland  Branched leafless tree
appearance.
Parotid gland  Tree in winter.
Submand.gland  Bush in winter.
 Sialedenitis  Apple tree in blossom
appearance.
 Tumours  Ball in hand appearance.
 Sjogren’s syndrome  Cherry blossom/Branchless fruit-
laden tree appearance. 58
.

59
Salivary substitutes/Artificial saliva
 They are useful agents for the palliative treatment of xerostomia.
 They are divided into 2 groups:
• Carboxymethycellulose {CMC} based .
• Mucin based.
 CMC is used to impart lubrication and viscosity.
 Salts are added to mimic the electrolyte content of saliva.
 Calcium,Phosphate,Flouride ions are added to provide
remineralisation potential.
 Mucin is derived from porcine gastric tissues or bovine
submaxillary glands.
 Mucin based sal. substitutes are known to have the lowest contact
angle and the best wetting properties on the denture base and the
oral mucosa. Their rheological properties are more comparable to
that of natural saliva.
 Available in forms of sprays and lozenges.
60
 CONCLUSION

 Mechanism of retention is a highly complex one ,under the

control of numerous factors.

 Chief among them are the forces related to the wetting of the
denture and the surface tension, adhesive and cohesive
characteristics of the saliva, without which denture wearing
becomes a painful process.

 Thus saliva plays a profound role in the maintenance of oral

health in the denture wearing patient .

61
 REFERENCES
 Medical Physiology By Sembulingam 4th Edition
 Human Antomy By B.D Chaurasia 4th Edition
 Boucher O.Carl, ‘Prosthodotnic treatment for edentulous patients’,
ed.12,Delhi, 2004, Elsevier.
 Charles M.Heartwell Jr., ‘Syllabus of Complete dentures’, ed.4;
Philadelphia, 1984; Lea and Febiger.
 Shafer, ‘A text Of Oral Pathology’, Ed.4;1966.
 Oral Histology And Embryology – Orban’s. 12th Edition
 Dental Pharmacology By K.D Tripati 6th Edition

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S A L I VA : T H E “ A Q U A
V I TA ” O F T H E O R A L
C AV I T Y
PRESENTED BY-: Shweta Singh
2nd year
P.G.
Department Of Prosthodontics
 SALIVA

 Saliva is a complex mixture of fluids with contributions from the

major salivary glands (parotid, submandibular and sublingual), the
minor / accessory glands and the crevicular fluid.

 Additionally it contains a high population of bacteria normally

resident in the mouth, desquamated epithelial cells and transient
residues of food or drink following their ingestion.
SOURCES OF SALIVA

MAJOR SALIVARY GLANDS

•Parotid Gland
•20%
Submandibular Gland
65%
Sublingual Gland
5%
MINOR SALIVARY GLANDS
10%
 FORMATION OF SALIVA
 Primary secretory phase:
• Formation of protein component:
Nucleus encodes message to mRNA

Synthesis of appropriate amino acids with a specific sequence

Proteins formed which have an NH2 terminal extension of 16-30

amino acids —Signal sequence.

Attachment of these proteins to Rough Endoplasmic Reticulum

(RER) membrane

Recognition of protein. Crosses the membrane along with growing

polypeptide chain.
Signal peptidase removes the signal sequence.

Newly synthesized protein reaches the internal space of RER.

Protein is sent to golgi apparatus via vesicles.

Vesicles enter convex face of GA and empty their contents.

Glycosylation occurs. Galactose / sialic acid/ glucosamine are added

to asparagine, serine and threonine.
 Packaging into variable density and sized vacuoles. These vacuoles have irregular
limiting membrane. Syn: condensing vacuoles/ pre-secretory
granules/ immature granules.

Fusion with other immature granules – maturation

•Formation Of Electrolyte Component:

Stimulation of parasympathetic nerves

Release of intracellular storage of Ca2+

Opening of channels apically and K+ channels laterally.

Movement of Cl- into the lumen

This ionic gradient pulls the Na+ into the lumen.

Change in the osmotic pressure results in movement of water into the lumen.

Isotonic plasma-like fluid is secreted by the acini into the lumen

 Secondary/Modification phase of secretion

Saliva produced by secretory acini contain electrolytes such as sodium and chloride.

The excretory ducts play a key role in reabsorbing sodium and chloride secreted in
saliva from acini.

The end product is hypotonic to plasma.

The striated duct modifies secreted saliva from acini by reabsorbing sodium and
chloride ions and simultaneously excreting potassium and bicarbonate ions.

The autonomic nervous system and mineralocorticoids control the modification step.
 Resting Flow of Saliva

 There is slow flow of saliva which keeps the mouth moist and
lubricates the mucous membranes.

 Approximately two-thirds of the total volume of the whole saliva is

produced by submandibular glands.

 The normal daily production of saliva varies between 0.5 and 1.5 liters.

 The whole unstimulated saliva flow rate is approximately 0.3-0.4 ml /

min.
 Residual Volume of Saliva

 The volume of saliva left in the mouth after swallowing

 When flow is unstimulated, the volume of saliva swallowed is

about 0.3 ml with each swallow and if the unstimulated flow rate is
0.3 ml/min, the swallowing frequency will be about once per
minute.

 The swallowing frequency is less during sleep [Lear et al., 1965],

when the salivary flow rate is reduced, but whether the residual
volume changes during sleep is unknown.
 Physiologic Factors That Effect Salivation

1. Agreeable taste
2. Smooth object inserted into the mouth
3. Dehydration
4. Ages
5. Emotions and other psychic effects
 Composition of
 Saliva is made upSaliva
of approx. 99% of water.
Organic components
 Protein
• 200mg/100ml.
• enzymes, immunoglobulins, mucins, traces of albumin & polypeptides and
glycopeptides.
 -amylase{Ptyalin}
• 60-120 mg/100 ml in parotid.
• 25 mg/100ml in submandibular.
 Immunoglobulins
• Ig A : The predominant immunoglobulin at approximately 20mg/100ml
• Ig G :1.5mg/100ml
• Ig M : 0.2mg/100ml.
 Anti bacterial properties
• Lysosyme : attacks components of the cell wall of certain bacteria
leading to lysis
• Lactoferrin: iron binding protein which removes free iron from saliva
depleting the supply of iron needed for bacterial growth.
• Sialoperoxidase: oxidizes salivary thiocyanate to hypothiocyanate, a
potent antibacterial substance, using hydrogen peroxide produced by
oral bacteria as an oxidant.
 Glycoproteins
• MG1 & MG2 (mucous glycoproteins )seen in submandibular and
sublingual saliva.
• Proline rich glycoprotein seen in parotid saliva.
 Other polysaccharides
• Siatherin
• Sialin
 Other organic compounds:

• Free amino acids

• Urea
• Glucose
Inorganic constituents

• Sodium
• Potassium
• Chloride
• Bicarbonate
• Calcium
• Phosphorus
• Flouride
• Thiocyanate
 Factors Influencing the Composition of Saliva

 Flow rate
 Differential gland contributions
 Duration of stimulus
 Nature of stimulus
 Diet
 Properties & Function of Saliva
 Taste and digestion
• Saliva is hypotonic.
• Carbohydrate digestion.
• Fat digestion.

 Lubrication and Protection

•Forms a tissue coating film .
•Bolus formation.
•Forms a barrier against proteolytic and hydrolytic enzymes in plaque

 Buffering action and clearance

Saliva is alkaline.
• Bicarbonate.
• Urea.
• Dilution of food substances and clearance.
 Maintenance of tooth integrity
• Calcium and phosphate ions  remineralisation.
• Flouride  flourapatite coating  caries resistant.
 Anti bacterial action
 Immunoglobulins  IgA, IgG, IgM.
• aggregate specific bacteria and prevent their adhesion.
 Non immunologic agents  proteins,mucins,peptides & enzymes.
• MG2-IgA complex bind mucosal pathogens.
• Lactoferrin.
• Lysosymes.
 PROSTHODONTIC IMPLICATIONS

 Excessive salivation presents a problem in impression making procedures.

 Mucous secretions from the palatal glands may distort the impresion materials in the
posterior two thirds of the palate causing dislodgement of the denture, voids on the
impression surface and gagging in the patients.

 Ideally there should be a moderate flow of serous type saliva.

 New dentures may feel like foreign bodies.

 In conditions of lack of saliva, there is reduced retention of a denture and also causes
cheeks and lips to stick to the denture base.
The physical factors consists of :

a)Adhesion.

b)Cohesion.

c)Surface tension.

d)Capillary attraction.
a) Adhesion:

 Adhesion It is the physical molecular attraction of unlike surfaces in

close contact.

 It acts when saliva wets and sticks to the basal surfaces of dentures
and at the same time to the mucous membrane of the basal seat.

 Effectiveness of adhesion depends upon close adaptation of denture

base to the supporting tissues and fluidity of saliva.
b) Cohesion:

 Cohesion It is the molecular attraction between two similar surfaces in

close contact.

 It occurs in the layer of saliva between the denture base and mucosa.

c)Interfacial surface tension:

 It is the resistance to separation possessed by the film of liquid between

two well adapted surfaces.

 It is found in the thin film of saliva between the denture base and the
mucosa of basal seat.
 d)Capillary attraction:

 It is the force that causes the surface of liquid to become

elevated or depressed when it is in contact with a solid.

 When the adaptation of denture base to mucosa on which its

rests is sufficiently close, the space filled with a thin film of
saliva acts like a capillary tube and helps retain the denture.
 Saliva as a physiological factor of retention affects the
effectiveness of physical forces.

 The higher the viscosity occurring to the mucoid content, the

lower the flow and greater is the fixation.

 Hence the mucous saliva provides better cohesion that serous

saliva.
  Intolerance to denture wear. It may be necessary to limit denture
use to short periods.

 Problems in mastication, swallowing, speaking etc. this predisposes

to nutritional deficiency.

The diet should be restricted to nutritious moist foods that are soft or
liquid.
 Clinical considerations
XEROSTOMIA
 It is a condition of reduced or absent salivary flow,leading to the dryness of the
mouth. Salivary flow less than 0.2ml/minute.
 It is not a disease by itself, but a symptom associated with alterations of salivary
function.

 Causes.
•Administration of drugs
•Systemic conditions
Diabetes mellitus
Thyroid disorders
Hepatic disorders
•Nutritional deficiency
•Deficiency of vitamin A,riboflavin and nicotinic acid.
•Infection/obstruction of the salivary glands.
•Radiation.
•Depression
•Neurologic disorders
CLINICAL FEATURES

Severe alterations in the mucous membranes and the patient may have
extreme discomfort. The mucosa will appear dry and atrophic, sometimes
inflamed or more often pale and translucent.

The tongue may manifest the deficiency by atrophy of the papillary

inflammation, fissuring and cracking and in severe cases by areas of
denudation.

Soreness, hardening and pain of the mucous membrane and tongue are
common symptoms.

Patients complain of difficulty in swallowing and talking, and also altered taste.

It will also predispose to opportunistic oral infections, particularly candidasis and
leads to an increase in periodontal disease and caries.
XEROSTOMIA PREDISPOSES TO:
Burning mouth syndrome

It forms an etiological factor for leukoplakia because of the lack of

protective salivary layer.

Etiological factor for oral thrush which along with chronic local
irritants act by alteration of oral mucous membranes predisposing
then to invasion of microorganisms.
Clinical examination:
 In healthy patients saliva pooling in the floor of the mouth is revealed whereas
in xerostomia the amount of saliva is reduced but may also appear frothy. A
useful test is to place a mirror against the buccal mucosa and this should lift
off easily
 when saliva is present in normal amounts. Degree of stickiness during this is a
useful indication of reduced saliva production. Each of the major glands
should be palpated and clear saliva seen to be expressed from each duct
orifice.

 Assessment of antinuclear antibody should be performed in patients with

xerostomia, particularly if Sjogren’s syndrome is suspected.
 Management
• Denture use limited to short periods.
• Nutritious diet/soft and moist food.
• Chewing sugarless gums and frequent liquid intake.
• Good denture hygiene to be maintained to prevent candidiasis.
• Fluoride application
• Lowering the dosage or changing the drug..
• Salivary substitutes.
Prosthodontic implications
•Retention is affected.
•Frictional irritation to the denture supporting tissues
•Difficulty in mastication and deglutition.
•Patient may discontinue the use of dentures.
Sialorrhea
 Caused due to an increased flow of blood through the salivary glands and their
excessive stimulation. The chief cause of Sialorrhea in denture wearers is due to-
•Emotional stress
•Painful affliction of the oral cavity
•Reflex stimulation of the dentures.
 This may be due to
•Incorrect centric jaw relation registration
•Excessive vertical dimensions
•Overextension of denture borders
•Pain and excessive pressure on oral mucosa
•Pressure on nerves and their terminals
•Denture may act as a foreign body
•Excessive thickness of the dentures
•Patients anxiety about possible of the denture

 Management
•Correction of the dentures
•Reassurance /psychotherapy of the patient
Denture stomatitis
•The adherence and growth of
microorganisms on the Acquired
Dental Pellicle result in a granular
or inflammatory response by the
underlying mucosa,causing
denture stomatitis.
•Most common site is max. palatal
surface.
•Acquired dental pellicle also
causes extrinsic staining and
calculus deposition.

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Sialography
 It is the radiographic evaluation of the ductal tree of the salivary glands by
means of the intraductal injection of a radioopaque contrast solution to
delineate the ductal pattern which will be radiographically discernible.
Various radiographic appearances
 Normal salivary gland  Branched leafless tree appearance.
Parotid gland  Tree in winter.
Submand.gland  Bush in winter.
 Sialedenitis  Apple tree in blossom appearance.
 Tumours  Ball in hand appearance.
 Sjogren’s syndrome  Cherry blossom/Branchless fruit-
laden tree appearance.

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.

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Salivary substitutes/Artificial saliva

 Artificial saliva comes in several forms

 Oral spray
 Oral rinse
 Gel
 Swabs
 Dissolving tablets

 They are useful agents for the palliative treatment of xerostomia.

 They are:
• Carboxymethylcellulose {CMC} based .
• Glycerin
• Minerals
• Xylitol

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 CONCLUSION

 Mechanism of retention is a highly complex one ,under the

control of numerous factors.

 Chief among them are the forces related to the wetting of the
denture and the surface tension, adhesive and cohesive
characteristics of the saliva, without which denture wearing
becomes a painful process.

 Thus saliva plays a profound role in the maintenance of oral

health in the denture wearing patient .

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 REFERENCES
 Medical Physiology By Sembulingam 4th Edition
 Human Antomy By B.D Chaurasia 4th Edition
 Boucher O.Carl, ‘Prosthodotnic treatment for edentulous
patients’, ed.12,Delhi, 2004, Elsevier.
 Charles M.Heartwell Jr., ‘Syllabus of Complete dentures’, ed.4;
Philadelphia, 1984; Lea and Febiger.
 Shafer, ‘A text Of Oral Pathology’, Ed.4;1966.
 Oral Histology And Embryology – Orban’s. 12th Edition
 Dental Pharmacology By K.D Tripati 6th Edition

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THANK YOU
THANK YOU

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