SALIVA :

functionality beyond oral health

 INTRODUCTION

– The oral cavity is kept moist by a film of fluid called saliva that coats the teeth and the mucosa. Saliva is a complex
fluid, produced by the salivary glands.
– Salivary fluid is an exocrine secretion consisting of approximately 99% water, containing a variety of electrolytes.
– A healthy person’s mean daily saliva production ranges from 1 to 1.5L.
– The saliva produced by each major salivary gland, differs in amount and composition.
– The parotid glands secrete a watery saliva rich in enzymes, Submandibular saliva, contains highly glycosylated
substances called mucins, sublingual gland produces viscous saliva also rich in mucins.
– Oral fluid, which is referred to as mixed, or whole, saliva, includes the secretions of the major glands, the minor
glands, desquamated oral epithelial cells, microorganisms and their products, food debris, and serum components
and inflammatory cells that gain access through the gingival crevice.
– Secretion elicited in response to sympathetic stimulation will differ in protein and electrolyte from that due to
parasympathetic stimulation. Saliva is more viscous in cases of sympathetic stimulation.
 FUNCTIONS

– PROTECTION AND LUBRICATION

– DILUTION AND CLEANING
– BUFFERING
– PELLICLE FORMATION
– MAINTENANCE OF TOOTH INTEGRITY
– ANTIMICROBIAL ACTION
– TISSUE REPAIR
– DIGESTION
– TASTE
– MASTICATION AND DEGLUTITION
– SPEECH
– EXCRETION
MECHANISM OF SECRETION & CONTROL
Factors Influencing Salivary Flow and
Composition

– Individual Hydration
– Body Posture, Lighting, and Smoking
– The Circadian and Circannual Cycle
– Medications
– Thinking of Food and Visual Stimulation
– Regular Stimulation of Salivary Flow
– Size of Salivary Glands and Body Weight
– Salivary Flow Index
– Contributions of Different Salivary Glands
– Physical Exercise
– Alcohol
– Systemic Diseases and Nutrition
– Fasting and Nausea
– Age
– Gender
 DIAGNOSTICS

– It is becoming increasingly apparent to investigators and clinicians in a variety of disciplines that saliva has many diagnostic uses and is
especially valuable in the young, the old and infirm and in large scale screening and epidemiologic studies.
– There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a
"mirror of the body," can reflect the physiological and pathological state of the body. 
– The highly sensitive test procedures that are now commonplace makes it practical to quantitate, despite very low concentrations, a large
number of hormones and drugs in saliva. 
– Among the "non invasive methods" available for biologists, salivary determinations seem of interest, particularly in endocrinology and
clinical pharmacology.
– Saliva has found use as a diagnostic aid in an increasing number of clinical situations and in systemic diseases that can affect salivary
gland function and composition such as Sjögren's syndrome, cystic fibrosis and diseases of the adrenal cortex. The list keeps growing.
– The use of saliva for early cancer detection in the search for new clinical markers is a promising approach because of its noninvasive
sampling and easy collection methods.
– This diagnostic modality in the field of molecular biology has led to the discovery and potential of salivary biomarkers for the detection
of oral cancers.
 COLLECTION OF SALIVA

– Saliva can be collected in different forms - a) resting or unstimulated whole saliva, b) stimulated whole saliva, c)
glandular saliva (mainly parotid) - with or without stimulation, sub-mandibular/ sub-lingual saliva, d)palatine
saliva.
– In salivary diagnostics, unstimulated saliva is often preferred to the stimulated whole saliva, , since the latter
contains only a diluted concentration of biomarkers, that may be difficult to detect.
– Stimulated saliva is secreted in response to either masticatory or gustatory stimulations.
– The study of unstimulated salivary secretion is an accurate method to analyse salivary gland status, while
stimulated saliva is useful for the study of the functional reserve.
Methods for collection of saliva:

 Whole Saliva:
 Draining Method
 Spitting Method
 Suction Method
 Swabbing Method
 Gland Specific / Glandular Saliva :
 Parotid saliva: Lashley cup or modified Carlson Crittenden device.
 Submandibular/ sublingual saliva: Suction method, Cannulation, Segregator
method.
 Saliva from minor glands: periopaper / sialopaper absorbent method.
Guidelines for collection of saliva:
– The subject should be made to sit comfortably in a calm and isolated room.
– He / she should rinse the mouth thoroughly using distilled water or deionized water to remove any food de-bris.
– The subjects are then asked to spit out the saliva that has been collected in the initial 30 seconds.
– High quality polypropylene tubes or vials should be used for collection.
– Collection should be made at a standard time, preferably between 8 to 11 am.
– The subject should preferably be in the fasting state or two hrs after breakfast.
– The participants should not brush their teeth for a duration of 45 min prior to the sample collection. Denture
wearers should remove their dentures prior to saliva collection.
– Dental work or oral ex-amination should not be performed within 24 hrs prior to the sample collection.
– Partici-pants should be screened for any oral health problems or injuries.
– Visibly contaminated samples with blood should be discarded.
– The subjects should avoid smoking for at least two hours prior to saliva collection.
 RECENT TECHNIQUES

– Oragene
– Saligene
– Oracol
– Verofy
– Oracol
– With more sensitive and standardized techniques and standard reference values, salivary diagnostics is
gaining promise as a technique of choice presently.
– Recent advances in methods of salivary collection and use of multiplex assays that are versatile, sensitive,
specific, rapid, cost effective for broad implementation in diagnostic programs makes the future of salivary
diagnostics to appear very promising.
 CLINICAL CONSIDERATIONS

– Saliva regulates the oral environment and has widespread distribution of the salivary glands in the oral cavity.
Hence there is a great impact of salivary gland pathology on clinical practice in dentistry.
– Sialorrhea, Ptyalism
– Xerostomia
– Sjögren’s syndrome
– The common drugs causing dry mouth are anticholinergics, antidepressants, antipsychotics, antihypertensives,
anoretics and drugs used in the treatment of parkinsonism.
THANK YOU