saliva

1. SALIVARY GLANDS AND SALIVA
MODERATORS
PROF DR PRAMITA SUWAL
DR PRAKASH K PARAJULI
DR ARATI SHARMA
DR INDRA LIMBU
DR BISHAL BABU BASNET
DR MEENA MISHRA
Presenter
Dr Suraj Gupta
(Junior Resident, 1st year)
Dept. of Prosthodontics and Crown-Bridge

2. CONTENTS
• INTRODUCTION
• SALIVARY GLANDS
• CONSTITUENTS OF SALIVA AND THEIR IMPORTANCE
• SALIVA FORMATION AND REGULATION
• PROSTHODONTIC IMPLICATIONS OF SALIVA
• CONCLUSION
• REFERENCES

4. CLASSIFICATION OF SALIVARY GLANDS
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 TYPE OF SECRETION
Gland type Saliva type
Parotid, and Von Ebner’s (on
the tongue)
Serous
Submandibular Mixed, predominantly serous
Sublingual Mixed, predominantly mucous
Most minor Mucous

6. ACCORDING TO THE LOCATION
Glands Whose Duct Open In The Vestibule
Lip : Superior Labial And Inferior Labial
Cheek : Parotid And Buccal.
Glands Whose Duct Open In The Oral Cavity Proper
Floor Of The Mouth : Submandibular, Sublingual,
Glossopalatine.
Tongue:
Body : Anterior Lingual gland Of Blandin & Nuhn
Base : Posterior Lingual, Von-Ebner.
Palate : Palatine

7. Parotid Gland
 Largest of all the salivary glands
 Purely serous gland that produce thin watery amylase rich saliva
 Superficial portion lies in front of external ear & deeper portion lies behind the ramus of
mandible
 Secretory duct- Stensen's duct (parotid papilla)
 Opens out adjacent to
Maxillary second molar buccally
 Associated with facial nerve

8. Submandibular Gland
 Second largest salivary gland
 Mixed gland, predominantly serous
 Located in the posterior part of floor
of mouth, adjacent to medial aspect
of mandible & wrapping around the
posterior border of mylohyoid muscle
 Secretory duct- Wharton's duct
• Opens beneath the tongue at
sub-lingual caruncle lateral to the
lingual frenum

9. Sublingual Gland:
 Smallest major salivary gland
 Mixed gland but mucous secretory cells predominate
 Located in anterior part of floor of mouth between
the mucosa and mylohyoid muscle
 Opens through series of small ducts (ducts of
Rivinus) opening along the sub-lingual fold & often
through a larger duct (Bartholin’s duct) that opens
with the Wharton’s duct at the sub-lingual caruncle

10. MINOR SALIVARY GLANDS
• Located beneath the epithelium and consists of several small group of
secretory cells
• Lack a distinct capsule
• 600-1000 in number
• Classified based on their anatomical location
• Not present on gingivae, anterior raphe and anterior 2/3rd of dorsum of
tongue

11. VASCULAR SUPPLY
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

12. NERVE INNERVATION
Nerve system that controls saliva production -
Autonomic nervous system
Controlled by two different type of nerves:
1. Parasympathetic
2. Sympathetic
Parasympathetic innervation to major salivary glands
 Otic ganglion suplies the parotid gland.
 Submandibular ganglion supplies the other major
glands.
Sympathetic innervation
Superior cervical ganglion in sympathetic truncus.

13. SALIVA
• Saliva is a clear, tasteless, odorless slightly acidic viscous fluid,
consisting of secretions from the parotid, sublingual, submandibular
salivary glands and mucous glands of oral cavity.(Stedman’s medical
dictionary 1999)
• Often neglected by dentists and ignored by physicians, saliva is the
least known and the least appreciated of all the body fluids.
• Yet, this secretion plays a vital role in the integrity of the oral tissues;
in the selection, ingestion and preparation of the food for digestion
and in speech mechanism

14.  Saliva plays a central role in the maintenance of oral homeostasis
 It participates in the clearing of the oral cavity of the food residues,
debris and bacteria;
 it buffers, as far as possible, the deleterious effects of strong acids and bases;
 It provides the ions needed to remineralize the teeth;
 It has antibacterial, antifungal and antiviral capacity.
 Additionally, components of saliva facilitate the motor functions of chewing,
swallowing and speaking as well as sensory and chemosensory functions in
the oral cavity .

15. Terminologies
• Whole saliva
• Secretions of the major & minor salivary glands together with the gingival
crevicular fluid
• Ductal saliva
• Saliva collected from the ducts of individual glands by cannulation of the duct
• Unstimulated or resting saliva
• Saliva collected under normal physiological conditions
• Stimulated saliva
• Secretion is promoted by mechanical and gustatory stimuli or by
pharmacological agents.

16. SOURCE OF SALIVA
• Saliva is a clear mucoserous exocrine secretion.
• It is a complex mixture of fluids, with contributions from major and minor salivary
glands and the gingival crevicular fluid.
• Additionally, it contains a high population of oral flora, desquamated epithelial
cells and transient residues of food or drink following their ingestion.

17. PROPERTIES OF SALIVA
• Color : slightly cloudy
• Reaction : usually slightly acidic
• Ph : 6.02-7.05
• Specific gravity : 1.0024 – 1.0061
• Freezing point : 0.07 – 0.34 degree celsius
• Flow rate : 500-1500 ml per day

18. COMPOSITION OF SALIVA
• Water – 99.5%
• Inorganic constituents – 0.2%
• Organic constituents- 0.3%

19. Inorganic constituents mg/100 ml
saliva

20. ORGANIC CONSTITUENTS
• Mucins
• Proline-rich proteins
• Amylase
• Lipase
• Peroxidase
• Lysozyme
• Lactoferrin
• Secretory Iga
• Histatins
• Statherin
• Blood group substances, sugars, steroid hormones, amino acids, ammonia, urea

21. MULTIFUNCTIONALITY
21
Functions of
Saliva
Anti-
Bacterial
Buffering
Digestion
Mineral-
ization
Lubricat-
ion &Visco-
elasticity
Tissue
Coating
Anti-
Fungal
AntiViral
Carbonic anhydrases,
Histatins
Amylases,
Mucins, Lipase
Cystatins,
Histatins, Proline-
rich proteins,
Statherins
Mucins, Statherins
Amylases,
Cystatins, Mucins,
Proline-rich proteins, Statherins
Histatins
Cystatins,
Mucins
Amylases, Cystatins,
Histatins, Mucins,
Peroxidases

23. MAJOR FUNCTIONS OF SALIVA
1. Protection
• Mechanical washing action:
- Flushes away non-adherent bacterial and acellular debris from
the mouth.
- Clearance of sugars from the mouth limits their availability to
acidogenic plaque microorganisms.
• Lubricant:
- Protects the lining mucosa by forming a barrier against noxious
stimuli, microbial toxins and minor trauma.
- Allows the oral surfaces to move over one another with minimal
friction during function.

24. 2. Buffering
- Bicarbonate, phosphate, some salivary proteins.
- Metabolism of salivary proteins and peptides produce
ammonia and urea which help in increase of ph.
- Buffers the acid produced by plaque microorganism.
3. Pellicle formation:
Salivary proteins bind to surface of the teeth and oral
mucosa, thus forming salivary pellicle which behaves as a
protective membrane .

25. 4. Maintainence of tooth integrity:
• Saliva is saturated with Ca+ & PO4
-
• High concentration of these ions ensures that ionic exchange
with the tooth surface results in post eruptive enamel
maturation, increase in surface hardness, decrease in
permeability and increase in resistance to demineralization.

26. 5. Antimicrobial action:
• Lysozyme is an enzyme that can hydrolyze the cell wall of some
bacteria.
• Lactoferrin binds free iron & in doing so deprives bacteria of this
essential element.
• Antibodies present in saliva (IgA)
- Aggregate oral bacteria such as S. Mutans and prevent the
formation of dental plaque
• Mucin and specific agglutins: aggregate microorganisms.
• Histatin and peroxidase: Inhibit the growth of candida
albicans and streptococcus mutans

27. 6. Role of saliva in tissue repair
• Epidermal growth factor(egf) and fibroblast growth factor
• Experiment have shown that saliva can encourage soft-tissue repair
by decreasing clotting time and increasing wound contraction
7. Digestion:
• Forms the food bolus which prepares the ingested food for
deglutition.
• Breaks down starch (amylase).
• Lipase - triglycerides
• Dilutes gastric chyme.

28. 8. Taste:
• Saliva is required to dissolve substance to be tasted & carry
them to the taste buds.
• It also contains a protein called gustin that is thought to be
necessary for growth & maturation of the taste buds. It is
thought to be secreted by circumvallate papillae.

29. 9. Salivary anticaries activity:
• By carbohydrate & microbial clearance from the oral cavity.
• Buffering action - salivary bicarbonates.
• Remineralization of incipient carious lesion- Ca+, PO4
--, F-
• Increase enamel resistance to acid decalcification- F-
• Salivary urea and bicarbonate can increase rate of glycolysis, thus
leading to faster carbohydrate metabolism, which in turn leads to
reduced duration of the enamel exposure to critical pH levels.

31. HYDROGEN BICARBONATE
• Derived actively from CO2 by carbonic anhydrase
• Low in unstimulated saliva, increases with flow rate
• Pushes pH of stimulated saliva up to 8
• Buffers acids produced by cariogenic bacteria

32. MUCINS
• Products of acinar cells from submandibular, sublingual and some
minor salivary glands.
• Asymmetrical molecule with open, randomly organized structure
• Glycoproteins - protein core with many oligosaccharide side chains
attached by glycosidic bond

33. Major salivary mucins are:
Mg1-adsorbs tightly to the tooth surface contributing to the
enamel pellicle formation, thereby protecting the tooth surface
from chemical & physical attack including acidic challenges
Mg2-also binds to the tooth surface but is easily displaced,
however it promotes clearance of oral bacteria by aggregation
 Mucins are hydrophilic and capable of absorbing and retaining large
amount of water due to their significant content of carbohydrates,
and therefore offer protection of the oral surfaces against
dehydration

34. AMYLASES
• Produced by acinar cells of major salivary glands
• Metabolizes starch and other polysaccharides into glucose &
maltose

35. STATHERINS
• Produced by acinar cells in salivary glands
• Acidic peptide containing relatively high levels of proline,tyrosine and
phosphoserine
• Inhibits spontaneous precipitation of calcium phosphate salts from
supersaturated saliva & favours remineralization
• Supersaturation of calcium phosphates maintain enamel integrity

37. FORMATION OF SALIVA
The formation of saliva takes place in
two stages.
In the first stage, the secretory end-
pieces (acini) produce isotonic
primary saliva with ionic composition
similar to that of plasma.

38. FORMATION OF SALIVA…
• In the second stage, the primary
saliva is modified as it passes
through the duct system by
selective reabsorption of Na+
and Cl- (but not water) and some
secretion of K+ and HCO3-
• The final saliva secreted into the
mouth thus becomes hypotonic
with salt concentration below
that of primary saliva

40. NEURAL REGULATION OF
SALIVARY SECRETION

41. Vii
SM
ganglion
IX
OTIC
GN.

42. Vii
SM
ganglion
IX
OTIC
GN.

44. Saliva and ageing
• With age, a generalized loss of salivary gland parenchymal tissue
occurs. The lost salivary cells often are replaced by adipose tissue.
Although decreased production of saliva often is seen in older
persons, whether this is related directly to the decrease in
parenchymal tissue is not clear.
• While some studies suggest an age related decrease in whole and
glandular salivary output (Navazesh & Christensen 1982; Pedersen et
al. 1985; Cowman et al. 1994; Percival et al. 1994)
• Other studies show no age related decline in healthy non medicated
subjects (Heintze et al. 1983; Ben-Aryeh et al. 1986; Tylenda et al.
1988).

45. • The most common cause of salivary disorders in elderly people is
prescription and nonprescription medications. 80 percent of the most
commonly prescribed medications have been reported to cause
xerostomia (Márton et al. 2004) with more than 400 medications
causing an adverse effect of salivary gland hypofunction (Smith &
Burtner 1994).
• These medications include tricyclic antidepressants, sedatives and
tranquilizers, antihistamines, antihypertensive agents, cytotoxic
agents, anti-parkinsonism agents and antiseizure drugs (Sreebny &
Schwartz 1997)

46. Gender and salivary flow
• Some studies suggest that a slight decrease in parotid reserve is
evident in females owing to parotid gland anatomy, however
significant difference in relation to gender is not observed.

47. Salivary pH
• Salivary buffer systems are responsible for maintaining the salivary pH
within the normal range of 6.02 to 7.05 (Bardew A, Pederson AML
2004)
• The phosphate and bicarbonate buffer systems are the most important
buffer systems respectively for unstimulated and stimulated saliva
(Amerongen & Veerman 2002)
• Salivary buffer systems offer protection in the mouth by preventing the
colonization of potentially pathogenic microorganisms by denying them
optimized conditions for growth and also by neutralizing the acid
produced by acidogenic microorganisms

48. Salivary flow rate
The average value of whole saliva is 0.5 to 1.5 litres per day.
Unstimulated salivary flow rate - 0.3 ml per minute
Stimulated flow rate - 1-2 ml per minute
(Wang et al. 1998).
The rate of secretion follows a circadian method, decreasing during sleep and
increasing during the day (Dawes 1972).
Hyposalivation is a condition when the values obtained for unstimulated
salivary flow rate is equal to or less than 0.1 ml/min and stimulated salivary flow
rate level is equal to or less than 0.5 ml/min, respectively(Sreebny & Valdini
1988)

49. Salivary flow rate
The parotid glands normally contribute about 20% of the total volume
of unstimulated whole saliva, while the submandibular glands
contribute upto 70%, the sublingual 7–8%, and the minor mucous
glands 7–8%.
•At very high stimulated flow rates, the parotid becomes the dominant
gland, contributing about 50% of the whole saliva.

51. Saliva can be classified as :
Class I : Normal quantity and quality of saliva. Cohesive and adhesive
properties are ideal.
Class II : Excessive saliva. Contains much mucous.
Class III : Xerostomia. Remaining saliva is mucinous
(Kasayuki .K, Taizo .H. Role of saliva in retention of maxillary complete
denture. J Prosthet Dent. 1978;40(2):131-136)

52. • Excessive salivation, particularly by the submandibular and sublingual
glands, presents a problem in impression making. When this problem
exists, appropriate drugs (eg.-Atropine sulfate) can be administered
orally before making the impression
• Excessive secretions of mucous from the palatal glands may distort the
impression material in the posterior two thirds of the palate
• Palate may be wiped with gauze.
• Astringent mouthwash just before inserting the impression material
• Palate may be massaged to encourage the glands to empty
• Warm gauze pads may be used to milk palatal glands, followed by cold
pads to constrict gland opening

53. • In patients with xerostomia
• Mucosa and lips are easily traumatized
• Lips should be coated with petroleum jelly to help with retraction and
access to the oral cavity.
• Gloved fingers should be wetted to prevent them from sticking to the
soft tissues
• Mirror should be used to facilitate insertion of the tray as it is less bulky
than the fingers
• Silicone impression materials are the best tolerated and least traumatic
to the mucosa. Zinc oxide eugenol paste will adhere to and burn the
mouth and materials such as plaster of paris will adhere to the mucosa
and abrade it.

54. Saliva And Irreversible Hydrocolloids
• Excessive amounts of saliva can displace alginate impression material and
contribute to an inaccurate impression
• Rinse the mouth with an astringent mouthwash and then with cold water.
Subsequently, the patient’s mouth should be packed with 4x4 inch gauze that
has been folded to form an absorptive strip.
• “Tandem” impression technique, in which one impression is taken to “soak
up” the bubbles and mucinous saliva, followed immediately by a second
impression which will record the tissues in a relatively saliva-free state.

55. • Use of an antisialagogue in combination with mouth rinses and
gauze packs may be used to control salivary flow in rare instances
of excess salivary flow.
• 15mg propantheline bromide tablet taken 30 minutes before the
impression.

56. • Alginate has a tendency to stick to teeth if the teeth are too dry.
• Sticking of alginate to the teeth occurs when alginate radicals
within the impression material form chemical bonds with
hydroxyapatite crystals of the enamel .
• As the impression is removed, tearing of the alginate occurs.
This produces surface inaccuracies in the impression and the
resultant cast.

57. • Adequate moisture control should be accomplished by packing the
mouth with gauze pads before making an impression.
• Gauze pads must be gently removed before the impression material is
placed in the oral cavity.
• Drying with compressed air is contraindicated, because this minimizes
the moisture content of tooth surfaces and contributes to sticking of
alginate.

58. Cleaning The Alginate Impression
• Most patients have thin, serous saliva.
• This type of saliva can be removed by briefly holding the
impression under a gentle stream of cool tap water.
• If running tap water is not effective, the saliva can be removed
using a soft camel hair brush and a mild detergent.

59. • On the other hand, some patients have thick, ropy saliva that is
difficult to remove.
• A thin layer of dental stone can be sprinkled on the surface of the
impression.
• The stone adheres to the saliva and acts as a disclosing agent.
When the impression is placed under running tap water, the saliva
can be removed by light brushing with a wet camel hair brush

60. Saliva and denture retention
• The contribution of physical forces to the retention of a denture is
heavily dependent upon the presence of a continuous thin film of
saliva between denture & mucosa, which wets both surfaces
• The various physical factors are:
• Adhesion
• Cohesion
• Interfacial surface tension
• Capillarity
• Atmospheric pressure

61. Adhesion
• Ionic forces between charged salivary glycoproteins and surface
epithelium or acrylic resin
• Through its promoting contact of saliva to both oral tissue and denture
base, adhesion works to enhance further the retentive force of interfacial
surface tension.
• The amount of retention provided by adhesion is proportionate to the
area covered by the denture. Mandibular dentures cover less surface area
than maxillary prostheses and therefore are subject to a lower magnitude
of adhesive retentive forces

62. • According to Bernard Levin– the most adhesive saliva is thin but containing some
mucous component
• This can be noticed by placing the index finger on the palatal side of recently
removed maxillary denture and drawing up a thin column of saliva.
• Thin and watery saliva can be identified by its inability to draw up a column of
saliva.
• Thick and ropy saliva is very adhesive but tends to build up and becomes too
thick in the palate area and pushes the denture away causing interference with
overall adaptation

63. • Another version of adhesion is observed between denture bases and
mucous membranes in xerostomic patient with sparse or absent saliva.
• The denture base material sticks to dry mucous membrane of basal seat
and other oral surfaces like lips, cheek and tongue.
• Such adhesion is not very effective for retaining dentures and predisposes
to mucosal abrasion and ulceration due to lack of salivary lubrication

64. Cohesion
• Cohesion is the physical attraction of like molecules for each other.
• It is a retentive force because it occurs within the layer of fluid (saliva)
that is present between the denture base and the mucosa and works to
maintain the integrity of the interposed fluid.
• Normal saliva is not very cohesive so that most of the retentive force of
the denture mucosa interface comes from adhesive and interfacial factors
unless the interposed saliva can be modified (with the use of denture
adhesive).

65. Interfacial Surface Tension
• Interfacial surface tension is the resistance to separation of two
parallel surfaces that is imparted by a film of liquid between them
• Interfacial surface tension is dependent on the ability of the fluid
to wet the rigid surrounding material.

66. • If the surrounding material has low surface tension, as oral
mucosa does, fluid will maximize its contact with the material,
thereby wetting it readily and spreading out in a thin film.
• If the material has high surface tension, fluid will minimize its
contact with the material, resulting in the formation of beads on
the material’s surface

67. • All denture base materials have higher surface tension than oral
mucosa, but once coated by salivary pellicle, their surface tension is
reduced, which promotes maximizing the surface area between
liquid and base.
• The thin saliva film between the denture base and the mucosa of
the basal seat therefore furnishes a retentive force by the virtue of
the tendency of the fluid to maximize its contact with both surfaces.

68. • Also, in case of saliva, the cohesive forces result in the formation of a
concave meniscus at the surface of the saliva in the border region of
the denture. When a fluid film is bounded by a concave meniscus the
pressure within the fluid is less than that of the surrounding medium;
thus a pressure differential will exist between saliva film and air and
thereby aids in the retention of the denture

69. • Interfacial surface tension may not play as important a role in retaining
the mandibular denture as it does for the maxillary one, because in
many patients, there is sufficient saliva to keep the external borders of
the mandibular denture awash in saliva, thereby eliminating the effect
of interfacial surface tension.

70. Capillarity
• When the adaptation of the denture base to the mucosa on which it rests is
sufficiently close, the space filled with a thin film of saliva acts like a capillary
tube in that the liquid seeks to increase its contact with both the denture and
the mucosal surface
• When the denture is adjusted on the tissue surface, a space of about 0.1mm is
created between the denture and the mucous membrane. In this way, the
condition for the capillary attraction to come into action is developed. The more
narrow the space, the greater the attraction

71. • Capillary attraction in a capillary tube or space ceases if the
tube is submerged under the surface of the same liquid. A
similar situation occurs in the lower complete dentures
thus capillarity plays a lesser role.

72. Viscosity of saliva
• The viscosity depends on the proportion of secretion of the serous
and mucous glands
• Serous saliva has a moderate flow favorably contributes to
retention.
• Thick ropy saliva often forces the denture out of their position thus
providing a detrimental factor for retention

73. Viscosity of saliva
• As denture is pulled away from the tissues, saliva is drawn into the space
being created beneath the denture. A retentive force is generated by a
resistance to this flow of saliva, resulting from the viscous properties of
saliva and the dimensions of the channel through which it flows
a) Wide channel, rapid flow, poor retention.
B) narrow channel, slow flow, good retention

74. • Interfacial viscous tension refers to the force holding two parallel plates
together that is due to the viscosity of the interposed liquid. Viscous
tension is described by Stefan’s law.
• For two parallel, circular plates of radius r that are separated by a
Newtonian (incompressible) liquid of viscosity k and thickness h, this
principle states that the force (F) necessary to pull the plates apart at a
velocity v in a direction perpendicular to the radius will be
F = (3/2) п k r4/ h3

75. • When applied to denture retention, the equation demonstrates the
essential importance of an optimal adaptation between denture and
basal seat (a minimal h), the advantage of maximizing the surface area
covered by the denture (a maximum r), and the theoretical
improvement in retention made possible by increasing the viscosity of
the medium between the denture and its seat.
• Thick, high-mucin saliva is more viscous than thin, watery saliva, yet
thick secretions usually do not result in increased retention because
watery, serous saliva can be interposed in a thinner film than the more
cohesive mucin secretions.
F = (3/2) п k r4/ h3

76. • It is also a key justification for use of metal bases and pressure-
injected acrylic bases, both of which virtually eliminate the
shrinkage distortion inescapable with traditional flasked, heat-
cured acrylic prostheses

78. Xerostomia
• Subjective symptom of oral dryness.
• Hyposalivation is a condition when the values obtained for
unstimulated salivary flow rate is equal to or less than 0.1 ml/min
and stimulated salivary flow rate level is equal to or less than 0.5
ml/min respectively (Sreebny & Valdini 1988).

79. Medications with
anticholinergic activity
Psychiatric comorbidities
such as mood and anxiety
disorders
Medical comorbidities
such as HIV/AIDS,
diabetes, renal failure
and Sjögren’s syndrome
Radiation for head
and neck
malignancies
Causes

80. • Generally, xerostomia will occur when the whole saliva secretion
rate decreases to a level below 50% of the normal whole saliva
secretion rate(Dawes 2004).
• However, people who are complaining of xerostomia may not have
hyposalivation and people with hyposalivation may not self-
evidently complain of xerostomia(Van der Putten et al. 2011)

81. SUBJECTIVE EVALUATION OF
XEROSTOMIA
Navazesh M, Christensen C, Brightman V. Clinical criteria for the diagnosis of salivary gland
hypofunction. J Dent Res 1992; 71(7):1363–69.

82. Signs and Symptoms
• Symptoms:
• Oral dryness (most common)
• Halitosis
• Burning sensation
• Loss of sense of taste or bizarre taste
• Difficulty in swallowing
• Tongue tends to stick to the palate
• Decreased retention of denture

83. • Signs:
• Saliva pool disappears
• Mucosa: dry or glossy
• Duct orifices: viscous and opaque saliva
• Tongue:
Glossitis  fissured  red with papilla atrophy
• Angular cheilitis
• Rampant caries: cervical or cusp tip
• Periodontitis
• Candidiasis
• Denture stomatitis

84. Patient with hyposalivation, dry mucosa and
chronic ulceration on lateral border of the
tongue
Candidiasis in patient taking antidepressant
medications that cause dry mouth. Oral findings
include pseudomembranous candidiasis with
white adherent patches on the palate and
erythematous candidiasis presenting with
erythema and depapillation on the mid-dorsum
of the tongue
Extensive demineralization and
cavitation of teeth in a patient with
hyposalivation.

85. Problems encountered in denture patients
 Retention in complete denture
 Increases frictional forces between dentures and oral
mucosa
 Prone to denture stomatitis
 Candidal infections

86. Management
• Symptomatic treatment
• Encourage to sip water
• Restrict caffeine intake
• Coat lips with lubricant
• Cautioned to avoid products containing alcohol, avoid tobacco
use, spicy, salty, and highly acidic foods that irritate the mouth
• Frequent use of products containing aloe vera or vitamin E
should be encouraged

87. • Identify and address the underlying cause
• Drug substitutions
• Drug dosage modification
• Better control of systemic diseases
• Reversible condition – stimulants
• Irreversible conditions- salivary substitutes.

88. • Stimulation of residual gland function
• Sugarless gums (xylitol / sorbitol) and candies

89. Pilocarpine HCl
Dose : 5mg tid up to 90 days
Cevimeline HCl
Dose- 30mg tid up to 6 weeks
Cholinergic agonists

90. SALIVARY SUBSTITUTES
Artificial saliva substitutes:
Commercially available products contain:
• Carboxy methylcellulose –lubrication,
• Animal mucins –to increase viscosity,
• Parabens- inhibit bacterial growth,
• Sugar free agents- xylitol, sorbitol- sweetners, mineral salts- simulate
electrolyte content,
• Flouride- reminaralisation.
Trade names: salivart(spray), mouthkote (spray), oral balance (gel).The
oral mucous and the intaglio surface of prosthesis can be sprayed
throughout the day with artificial saliva .

91. PROSTHODONTIC MANAGEMENT OF
XEROSTOMIA

92. FIXED PROSTHODONTICS
In dry environment, fixed non tissue bearing prosthesis are preferred
where indicated
FPDs should have full coverage retainers and easily cleaned pontics
and connectors
Margins of retainers should be supragingival

93. Health of residual teeth and periodontal tissues
Use of gingivally approching clasp avoided
Tooth supported denture with minimal tissue coverage
Metal denture bases are preferred
REMOVABLE PARTIAL DENTURE

94. COMPLETE DENTURE
Procedures -aim at optimizing retention and stability
Use dentures with metal bases
Use of soft liners to improve comfort
Use of denture adhesives to augment retention
Frequent recall – As more prone to candidal infections

95. SALIVA RESERVOIR-TECHNIQUE
Upadhyay R, Kumar L, and Rao J, Fabrication of a functional palatal saliva reservoir
by using a resilient liner during processing of a complete denture, JPD
2012;108:332-335

96. • Advantages of reservoir in maxillary prosthesis
• Greater available volume because of its larger base area,
• Better flow because of its superior position
• Reduced clogging of holes of reservoir because of less food
collection in palate than in floor of the mouth.
• Saliva reservoirs range in volume from 2.3 ml to 5.3 ml and
provide a flow of artificial saliva for 2 to 5 hours

97. Conclusion
• Saliva plays a profound role in the maintenance of oral health in the patients
requiring prostheses.
• The presence of a thin salivary layer is essential to the comfort of the mucosa
beneath a denture base and to denture retention.
• Evaluation of salivary flow and characteristics should be done as a routine
procedure because of an increase in systemic diseases in urban population which
increases their likelihood of being under xerogenic prescription medications
• Special care and attention is needed for the success of prosthodontic therapy in
patients with altered salivary flow and characteristics

98. References
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