Saliva is one of the major components in the defence mechanism of gingiva. Here is my presentation on it.

1. SALIVA
HARIPRIYA RAJARAM
DEPT OF PERIODONTICS
PANINEEYA DENTAL COLLEGE
HYDERABAD

2. CONTENTS
Introduction
Definition
Salivary glands
Formation of saliva
Nervous regulation of saliva
Compostion of saliva
Functions of saliva
Properties of saliva
Factors affecting rate of flow of saliva
Biomarkers of saliva
Collection of saliva
Conclusion
References

3. INTRODUCTION
 Saliva is a complex fluid produced by the salivary
glands.
 It forms a film of fluid coating the teeth and mucosa
thereby creating and regulating a healthy
environment in the oral cavity.

4. DEFINITION
• “Saliva is a clear, tasteless, odorless slightly acidic
viscous fluid, consisting of secretions from the
parotid, sublingual, sub mandibular salivary glands
and the mucous glands of oral cavity” - STEDMEN

5. SALIVARY GLANDS
•Salivary glands are compound, tubuloacinar,
merocrine, exocrine glands whose secretion is
conducted via ducts that opens into the oral cavity

6. CLASSIFICATION OF SALIVARY GLANDS
1. BASED ON SIZE
MAJOR SALIVARY
GLANDS
present
• Parotid outside
• Submandibular the
• Sublingual mouth
MINOR SALIVARY GLANDS
1. Labial located
2. Lingual in various
3. Palatal parts
4. Buccal of
5. Glossopalatine oral
6. Retromolar cavity

8. 2. BASED ON SECRETION
SEROUS
• PAROTID
• POSTERIOR
LINGUAL
MUCOUS
• LINGUAL
• BUCCAL
• PALATAL
MIXED
• SUBLINGUA
L
• SUBMANDI
BULAR
• LABIAL

9. STRUCTURE OF SALIVARY GLAND
• The salivary glands are characterized by aggregation of numerous
secretory units.
• These units consists of acini where secretion is produced and duct
system that carries the secretion to the oral cavity and regulates the
concentration of water and electrolytes.

10. SECRETORY CELLS
MUCOUS SEROUS

11. SEROUS CELLS
Pyramidal in shape with a broad base on the basement
membrane.
Spherical nucleus at the basal region
The apical cytoplasm of these cells show secretory granules
called zymogen granules.
They show acid phosphatase, esterases , glucoronidase ,
glucosidase and galactosidase activity.

12. MUCOUS CELLS
Pyramidal in shape but larger than the serous cells.
Nucleus is oval or flattened in shape and is present just
above the basal plasma membrane.
Apical cytoplasm shows large amount of secretory product
(mucin)

13. DUCTAL SYSTEM
The ductal system of salivary glands consists of hollow
tubes connected initially with the acini and then with other
ducts as the ducts progressively grow larger from the inner to
the outer portion of the gland.
Each type of duct is lined by different type of epithelium,
depending on its location in the gland.
The duct system also participates in the production and
modification of saliva.

14. TYPES OF DUCTS
1. INTERCALATED
2. STRIATED
3. EXCRETORY DUCT

16. NERVOUS REGULATION OF SALIVA
PARASYMPATHETIC SYSTEM
PAROTID GLAND
INFERIOR SALIVATORY NUCLEUS
GLOSSOPHARYNGEAL NERVE
OTIC GANGLION
AURICULOTEMPORAL NERVE
PAROTID GLAND

17. SUBMANDIBULAR AND SUBLINGUAL
GLANDS
SUPERIOR SALIVATORY NUCLEUS
FACIAL NERVE
CHORDATYMPANI NERVE
SUBMANDIBULAR GANGLION
LINGUAL NERVE
SUBMANDIBULAR AND SUBLINGUAL GLAND

19. SYMPATHETIC SYSTEM
LATERAL HORN OF 1ST AND 2ND THORACIC
SEGMENTS OF SPINAL CORD
SUPERIOR CERVICAL GANGLION
POST GANGLIONIC FIBERS FROM HERE ARE
DISTRIBUTED TO THE SALIVARY GLANDS ALONG
THE NERVE PLEXUS AROUND THE ARTERIES
SUPPLYING THE GLAND

21. FORMATION OF SALIVA
The formation of saliva occurs in two stages.
• First stage : Cells of the secretory end pieces and
intercalated ducts produce primary saliva.
• Second stage: The primary saliva is modified as it
passes through the striated and excretory ducts, mainly
by re-absorption and secretion of electrolytes

22. Stimulation of the parasympathetic nerve
the signal transduction system involves the
release of Ca2+ from intracellular stores
Cl– channels at the apical membrane to open
and an influx of Cl– into the lumen.
change in electronegativity by Cl– influx causes
Na+ to diffuse across the cation-permeable tight
junction between acinar cells to preserve
electroneutrality within the lumen.
The net influx of NaCl creates an osmotic gradient
across the acinus, which draws water from the blood
supply via a tight junction making the saliva isotonic
F
I
R
S
T
S
T
A
G
E

23. • HYPOTONIC
SALIVA
1.REABSORP
TION OF
SODIUM AND
CHLORIDE
2.SECRETION
OF
BICARBONAT
E AND
POTASSIUM
SECOND
STAGE

25. COMPOSITION OF SALIVA

26. 1. SALIVARY AMYLASE: It is a carbohydrate-digesting
(amylolytic) enzyme. It acts on cooked or boiled starch and
converts it into dextrin and maltose .
2. MALTASE: Maltase is present only in traces in human
saliva and it converts maltose into glucose.
3. LINGUAL LIPASE : It is a lipid-digesting (lipolytic)
enzyme. It is secreted from serous glands situated on the
posterior aspect of tongue. It digests milk fats .It hydrolyzes
triglycerides into fatty acids and diacylglycerol

27. 4.LYSOZYME:
• Is an antimicrobial enzyme with the ability to cleave
chemical bonds in the bacterial cell wall. It can lyse some
bacterial species by hydrolyzing glycosidic linkages in the
cell wall peptidoglycan.
• Patients with low levels of lysozyme in saliva are more
susceptible to plaque accumulation, which is considered a
risk factor for periodontal disease.
5. CARBONIC ANHYDRASE: helps in buffering of saliva

28. 6. KALLIKREIN:
• This enzyme hydrolyzes kininogen to release vasoactive
kinin peptides such as bradykinin .
• These peptides are important mediators of inflammation
• Kininogen levels in saliva from patients with periodontal
disease were higher than what was observed in saliva from
periodontally healthy patients.

29. 7. PEROXIDASE:
• This enzyme removes toxic hydrogen peroxide produced by
oral microorganisms and reduces acid production in the
dental biofilm, thereby decreasing plaque accumulation and
the establishment of gingivitis and caries.
• Patients with periodontal disease have demonstrated high
levels of this enzyme in saliva.

30. 7. MUCINS
• Mucins are glycoproteins.
• The physiological functions of the mucins (MG1 and MG2)
are cytoprotection, lubrication, protection against
dehydration, and maintenance of viscoelasticity in
secretions.
• The mucin, MG2, affects the aggregation and adherence of
bacteria and is known to interact with A.
actinomycetemcomitans, and a decreased concentration of
MG2 in saliva may increase colonization with this periodonto
pathogen .

31. LACTOFERRIN
• Lactoferrin is an iron-binding glycoprotein produced by
salivary glands, which inhibits microbial growth by
sequestering iron from the environment, thus depriving
bacteria of this essential element.
• Lactoferrin is strongly upregulated in mucosal secretions
during gingival inflammation and is detected at a high
concentration in saliva of patients with periodontal disease
compared with healthy patients.

32. IMMUNOGLOBULINS
•Important specific defense factors of saliva.
• Includes IgA, IgM, IgG.
• Interfere with the adherence of bacteria and inhibit
bacterial metabolism.

33. HISTATIN:
• Histatin is a salivary protein with antimicrobial properties .
• It neutralizes the endotoxic lipopolysaccharides located in the
membrane of gram-negative bacteria.
• Histatin is also an inhibitor of host and bacterial enzymes
involved in the destruction of the periodontium.
• In addition to its antimicrobial activities, histatin is involved
in the inhibition of the release of histamine from mast cells,
affecting their role in oral inflammation.

34. FIBRONECTIN:
• Fibronectin is a glycoprotein that promotes selective
adhesion and colonization of certain bacterial species
while inhibiting others.
• It mediates adhesion between cells and is also involved in
chemotaxis, migration, inflammation, and wound healing
and tissue repair.

35. CYSTATINS:
• Cystatins were found in saliva collected from the
submandibular and sublingual salivary glands, and to a lesser
degree in saliva from the parotid gland.
• They are proteolytic enzymes having collagenolytic activity,
which may cause tissue destruction

36. EPIDERMAL GROWTH FACTOR:
• Epidermal growth factor (EGF) is involved in oral wound
healing and functions with hormone-like properties to
stimulate epithelial cells. In humans, the parotid gland is the
major source of EGF.
VASCULAR ENDOTHELIAL GROWTH FACTOR:
• It is also known as vascular permeability factor .
• It is a multifunctional angiogenic cytokine important in
inflammation and wound healing.

37. EPITHELIAL KERATINS:
• Epithelial cells from the lining of the oral cavity are found in
saliva.
• Detection of keratins by monoclonal antibodies may have
diagnostic value in the detection of epithelial dysplasia, oral
cancer, odontogenic cysts, and tumors .
STATHERIN
• Inhibits spontaneous precipitation of calcium phosphate salts
from supersaturated saliva & favours remineralization

38. GLUCOSE
Is absent but is noticed in patients with diabetes.
BLOOD GROUP SUBSTANCES
The agglutinogens A, B & O may be present.
VITMAINS
Water soluble vitamins are present.

39. CORTICOSTEROIDS
• Cortisol and cortisone are present
CELLS IN SALIVA
• Epithelial cells
• Leucocytes
• Bacteria
• Yeasts and protozoa

40. INORGANIC COMPONENTS
1.CALCIUM
• Present in colloidal or ionic form.
• Concentration: 3 mE /lit.
• Binds with phosphate forming calcium phosphate salts
2.SODIUM
• Concentration:10-100mE / lit.

41. 3.PHOSPHATE
• 10% as pyrophosphate
• 6-24% as complexed form bound to proteins
4.BICARBONATE
• Buffer
• Low in unstimulated saliva, increases with flow rate
• Defence against acids produced by cariogenic bacteria
• Derived actively from CO2 by carbonic anhydrase.

42. 5. FLUORIDE
• Low concentration
6.THYOCYANATE
• Antibacterial
7.POTASSIUM AND CHLORIDE

43. FUNCTIONS OF SALIVA

44. VARIOUS ANTIMICROBIAL AGENTS

46. PROPERTIES OF SALIVA
1.Volume : 1- 1.5L/day
2.pH : 6.4-7.4
3.Specific gravity: 1.002- 1.012
4.Tonicity: Hypotonic to saliva
5. Consistency : cloudy and viscous

47. FACTORS AFFECTING SALIVARY FLOW RATE
1. Individual hydration: When the body water content is reduced
by 8%, SF virtually diminishes to zero, whereas hyper hydration
causes an increase in SF.
2. Body posture: Patients kept standing up or lying down present
higher and lower SF, respectively, than seated patients.
3. Smoking: Olfactive stimulation and smoking cause a temporary
increase in unstimulated SF . The irritating effect of tobacco
increases glandular excretion

48. 4.Circadian cycle: SF attains its peak at the end of the
afternoon but goes down to almost zero during sleep.
5.Medications: Many classes of drugs, particularly those that
have anticholinergic action (antidepressants, anxiolytics,
antipsychotics, anti-histaminics, and anti-hypertensives), may
cause reduction in SF and alter its composition .
6.Thinking of food and visual stimulation: Thinking of food
or looking at food are weak salivation stimuli in humans.

49. 7. Size of salivary gland: Stimulated SF is directly related to the
size of the salivary gland, contrary to unstimulated SF which
does not depend on its size.
8.Physical exercise: During physical activities sympathetic
stimulation appears to be strong enough to diminish or inhibit
salivary secretion .

50. 9.Alcohol: The intake of a single high dose of ethanol causes a
significant reduction of stimulated SF.
10. Fasting and nausea: Although short-term fasting reduces
SF it does not lead to hyposalivation, and the flow is restored
to normal values immediately after the fasting period ends .
Saliva secretion increases before and during vomiting .

51. SIALORRHEA/PTYALISM
• An increased salivary secretion is termed as sialorrhea or
ptyalism.
CAUSES
Drugs: cholinergic drugs , lithium.
Local factors: stomatitis, ANUG, erythema multiforme
Systemic disease: Parkinson’s disease, epilepsy, Down’s
syndrome.
Miscellaneous: Psychic factor, metal poisoning, and facial
paralysis.

52. Management:
1.ORAL MOTOR TRAINING
2.REMOVAL OF LOCAL FACTORS
3. ANTICHOLINERGIC DRUGS
4.SURGERY
• Relocation of the duct
• Bilateral tympanic neurectomy

53. XEROSTOMIA
• It is the subjective clinical condition of less than normal
amount of saliva.
CAUSES
1. Radiation
2. Drugs: anticonvulsants, antiemetics, antihistaminics,
antihypertensives.
3. Local factors: decreased mastication, smoking, and mouth
breathing.
4. Developmental: developmental anamolies of the glands
and tumors.
5. Nutrition: deficiency states like pernicious and iron
deficiency anemia , vitamin A deficiency.
6. Fluid loss associated with hemorrhage, sweating and
vomiting.
7. Diabetes mellitus and Sjogren’s syndrome.

54. MANAGEMENT
1. Local stimulation: chewing of gums, mints, citric acid.
2. Systemic stimulation: drugs such as bromhexine,
cholinergic drugs.
3. Salivary substitute: most of them contain carboxymethyl
cellulose or hydroxymethylcellulose as a lubricant.
4. Discontinution of drugs: drugs causing xerostomia should
be discontinued.

55. SALIVARY BIOMARKERS

56. Biochemical Mediators And Products Of
Inflammation
1. Cytokines- IL1, IL 6, IL8, TNF alpha
2. Prostaglandins- PG E2
3. α2- Macroglobulin and α1-antitrypsin
4. Acid phosphatase
5. Myeloperoxidase

57. Host-derived enzymes
1. Collagenase
2. Elastase
3. Matrix-metalloproteinases( MMP9, MMP8, MMP13)
4. Cathepsins
5. Alkaline phosphatase
6. Aspartate aminotransferase

58. Extracellular matrix components
1. Collagen
2. Proteoglycans & glycosaminoglycans
3. Osteonectin
4. Osteocalcin
5. Fibronectin
6. Osteopontin
7. RANKL
8. Osteoprotegrin

59. MARKER LEVEL IN PERIODONTAL
DISEASE
IMMUNOGLOBULINS INCREASES
MUCINS DECREASES (AP)
LACTOFERRIN INCREASES(AP)
LYSOZYME DECREASES
HYSTATIN INCREASES

60. PEROXIDASE INCREASES
INTERLEUKIN 1-𝛽 INCREASES
INTERLEUKIN- 6 INCREASES
TUMOUR NECROSIS
FACTOR
INCREASES
ALKALINE PHOSPHATASE INCREASES
OSTEOPROTEGRIN DECREASES

61. MARKERS OF SYSTEMIC DISEASE
1. CARDIOVASCUALR DISEASE: C reactive protein,
myoglobin and myeloperoxidase.
2. RENAL DISEASE: cortisol, nitrite, uric acid, sodium,
chloride, amylase, and lactoferrin.
3. STRESS OR PAIN: Salivary amylase, cortisol, substance
P, lysozyme .
4. AIDS: Detection of IgA anti HIV antibodies in saliva is the
prognostic indicator.
5. DIABETES: Inflammatory mediators- TNF α, IL-6
Adipokines- resistin and visfatin.
6. ORAL CANCER: CD44, Cyfra 21-1 , Tissue polypeptide
antigen , Cancer antigen 125 .

62. COLLECTION OF SALIVA
TYPES OF SALIVA
1.WHOLE SALIVA
• Whole saliva is of two types:
1. Stimulated - when secretion is promoted by use of
pharmacological agents.
2. Unstimulated- when no exogenous or
pharmacological stimulation is present.
• The stimulated and unstimulated saliva differ in their
protein composition.

63. METHODS OF COLLECTION
SWAB METHOD
SPITTING
SUCTION DRAIN

64. • 2. GLAND SPECIFIC SALIVA: from individual salivary
glands: parotid submandibular, sublingual and minor salivary
gland.
1. PAROTID GLAND: Lashley cup or modified carlson
Crittenden device.
• It is composed of 2 concentric circles and is made either of
plastic or metal.
• The center circle is designed to fit over the opening of
Stenson’s duct and is connected to a graduated collecting
tube.
• The outer circle is attached to a rubber bulb, which exhausts
air from the outer circle when collector is held in place and
draws the cheek surrounding the opening of Stenson’s duct
into it.

65. 2. SUBMANDIBULAR AND SUBLINGUAL GLAND
• Custom made device called segregators are being used.
• Usually contain a central chamber for the collection of
submandibular saliva and one or two lateral chambers for the
collection of sublingual saliva.
• Polyethylene tubing connects the chambers to graduated
receiving vessels.
• Fabrication of these collection devices is time consuming
because a mold of the floor of the subject’s mouth has to be
made and the device has to be fabricated and adjusted on an
individual basis.
• A simple method for collection of mixed submandibular and
sublingual saliva is blocking of stensons duct, isolating
wharton’s duct and collecting saliva from the floor of the
mouth with micropipette using gentle suction.

66. 3.MINOR SALIVARY GLANDS
• Minor gland secretions can be collected by pipette or
absorbent filter paper from the inner surface of lips, palate, or
buccal mucosa .

67. POINT OF CARE DIAGNOSTICS

68. SALIVAOMICS
• The term “ salivaomics “ was coined in 2008 to reflect the
rapid development of knowledge about the various
constituents of saliva.
• It includes
 Proteomics-The proteomics is the study of all protiens
present in the given sample .
 Microbiomics -The study of specific pathogens and oral
bacterial community in saliva.
Genomics- Isolation of DNA
Transcriptomics-Study of salivary mRNAs.
 Metabolomics- Study of analysis of the key molecular
metabolites in body fluids

69. CONCLUSION
• Saliva is important to oral health and promotes the natural
beneficial relationship between the resident oral microbiota
and the host.
• It is a mirror of oral and systemic health and is appealing for
use as a diagnostic fluid for oral-related disease due to its
many advantages over other diagnostic bodily fluids.
• Rapid advances in technology have led to a better
characterization and understanding of the distinct signatures
of saliva on the host’s defence systems and microbiome,
which could lead to improvements in oral and overall health.

70. REFERENCES
1. Orban’s oral histology
2. Tencate’s oral histology- 6TH Edition
3. Carranza’s clinical periodontology- 13 th edition
4. Essentials of medical physiology-
k.sembulingum,p.sembulingum,4th edition.
5. Eliaz Kaufman,Ira B.Lamster .The diagmostic applications of
saliva – A review.Crit Rev Oral Biol Med 2009
6. Kaufman E,Lamster ib.Analysis of saliva for periodontal
diagnosis.A review J Clini Periodontol 2000
7. J.D.Rudney Saliva and dental plaque Adv Dent Res December
2000
8. Patricia Machperson The role of saliva in oral health and
disease.Dental nursing october 2013

71. 9. Noha Ayman Ghallab-Diagnostic potential and future directions
of biomarkers in gingival crevicular fluid and saliva of periodontal
diseases: Review, Archives of Oral Biology 87 (2018) 115–124.
10. Mohammad A. Javaid- Saliva as a diagnostic tool for oral and
systemic diseases. J Oral Biol Craniofac Res. 2016; 6(1): 66–75.
11Gabriela Iorgulescu - Saliva between normal and pathological.
Important factors in determining systemic and oral health. J Med
Life. 2009; 2(3): 303–307.
12. Chad D. Carver- Comparison of protein composition in
stimulated vs. unstimulated whole human saliva.
13. Periodontology 2000, volume 70,2016.