Salivary Glands and saliva

1. 1

2. Presented by : Dr. Vini Mehta
MDS 1St Year
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3. Contents
• Introduction
• Development of Salivary Glands
• Classification of Salivary Glands
• Formation of Saliva
• Composition of Saliva
• Functions of Saliva
• Co relation between Saliva and Dental Caries
• Factors affecting flow of saliva
• Saliva as Diagnostic Aid
• Saliva and Oral Health
• Saliva Collection Methods
• Conclusion
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4. Introduction
• The oral cavity is a moist environment; a film of
fluid called saliva constantly coats its inner
surfaces and occupies the space between the
lining oral mucosa and teeth.
• Saliva is a complex fluid, produced by the salivary
glands, whose important role is maintaining the
well being of mouth.
• Saliva is referred to as the “AQVA VITA” of mouth
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5. Development of Salivary Glands
•Salivary glands are made up of cells
which are arranged in small groups
around a central globular cavity called
acinus & alveolus.
•The central cavity is continous with the
lumen of the duct.
•The fine duct draining each acinus is
called the intercalated ducts.
•Many intercalated ducts join together
to form intralobular ducts.
•Two or more intralobular ducts join to
form interlobular ducts , which unite to
form the main duct of the gland.
•The gland with this type of structure &
duct system is called racemose type. 5

6. Classification Of Salivary Glands
Major Salivary
Glands
Parotid
Gland
Submandibul
ar Gland
Sublingual
Gland
Minor Salivary
Glands
Lingual mucous
Lingual serous
Buccal glands
Labial glands
Palatal glands
(a)According to size and location
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7. MAJOR SALIVARY GLANDS
PAROTID GLAND
• Parotid gland is the largest salivary gland. It is irregular, wedge
shaped and unilobular.
• 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
• Stensen's Duct opens out adjacent to maxillary second molar.
Parotid gland
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8. Submandibular Gland
• Also called as Submaxillary gland.
• It is irregular and Walnut shaped.
• Second largest
• It is 10-15gms in weight,produces
60-65% of total salivary volume.
• Located in the submandibular
triangle of the neck, inferior &
lateral to mylohyoid muscle.
• Mixed gland
• Wharton's Duct opens beneath
the tongue
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9. SUBLINGUAL GLAND
• The sublingual glands are the
smallest of the major salivary
glands, produces 2-5% of the
total salivary volume.
• Almond shaped
• Glands lie beneath mucosa of
floor of the mouth, above
mylohyoid muscle , medial to
mandible and lateral to
genioglossus
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10. (b) According to the histochemical nature of secretory
products.
• This type of gland is made up of serous cells predominantly.
• These glands secrete thin & watery saliva .
• Parotid glands and lingual glands are serous glands.
SEROUS GLANDS
• This type of glands are made up of mucous cells mainly .
• These glands secrete thick & viscous saliva with more mucin .
• Lingual mucous, buccal glands & palatal glands belongs to
this type.
MUCOUS GLANDS
• Mixed glands are made up of both serous and mucous cells .
• Submandibular , sublingual & lacrimal glands are mixed
glands
MIXED GLANDS
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11. (c) Depending on the number of ducts
Monostomatic
• Parotid glands
• Submandibular
glands
Polystomatic
• Sublingual
glands
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(Duct of revinus &
Bartholine duct)

12. Resting flow of saliva
• Under resting condition , without the exogenous stimulation
associated with feeding , there is a slow flow of saliva which
keeps the mouth moist and lubricates the mucous membrane.
• This unstimulated flow , which is present most of the time is
very important for the health and well being of the oral cavity
• Basal or the ‘unstimulated’ salivary flow is considered to be a
protective secretion while the large stimulated flow is needed
to facilitate the digestive process
(food bolus formation & swallowing).

13. SALIVA FLOW RATE
• Resting flow rate 0.3-0.4 ml/min
• Stimulated flow rate 1-2 ml/min
5.6 ml in infants

14. Physical properties
• Approx. daily secretion of saliva 1.5 lts
• 20-25% parotid glands
• 60-65% submandibular glands
• 7-8% sublingual glands
• pH 6.7-7.4
• Specific gravity 1.002-1.012
• Freezing point : 0.07 to 0.34 degree C

15. Formation of Saliva
Formation of saliva occurs in 2 stages:
Stage 1 : Production of primary saliva from the
cells of secretory end pieces & intercalated ducts,
which is an isotonic fluid
Stage 2 : The primary saliva is modified as it
passes through the striated & excretory ducts
mainly by reabsorption & secretion of electrolytes.
The final saliva that reaches the oral cavity is
hypotonic.
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16. Composition of
Saliva
Water -99.5% solids 0.5%
Organic substance Inorganic substance
Gases
Enzymes Other org. substance
1.Amylase
2.Maltase
3.Lingual
lipase
4.Lysozyme
5.carbonic
anhydrase
6.kalikrein
1.Proteins- mucin &
albumin
2.Blood group antigen
3.Free amino acids
4.Non protein
nitrogenous
substances-urea, uric
acid, creatinine
1.Sodium
2.Calcium
3.Potassium
4.Biocarbonate
5.Bromide
6.Chlorine
7.Fluoride
8.phosphate
1.Oxygen
2.Carbon
dioxide
3.Nitrogen
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17. Whole Saliva
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18. Functions of Saliva
Functions Effect Active
constituents
Protection Lubrication , Pellicle
formation
Glycoprotein , Water
Buffering Maintains pH , Neutralizes
acid
Phosphate and
bicarbonates
Digestion Bolus formation , digest
starch
amylase , lingual lipase
Taste Solution of molecules
Taste and growth &
Maturation of taste buds
Water , gustin
Anti microbial action Barrier , antibodies ,
hostile environment
Glycoprotein , IgA ,
Lysozyme , Lactoferrin
Tooth integrity Enamel maturation , Calcium , Phosphate 18

19. Protection and lubrication
• Saliva forms a seromucosal covering that lubricates
and protects the oral tissues against irritating agents.
• This occurs due to mucins (proteins with high
carbohydrate content) responsible for lubrication,
protection against dehydration, and maintenance of
salivary viscoelasticity.
• They also selectively modulate the adhesion of
microorganisms to the oral tissue surfaces, which
contributes to the control of bacterial and fungal
colonization.

20. Buffering capacity
• Saliva behaves as a buffer system to protect
the mouth as follows:
1. It prevents colonization by potentially
pathogenic microorganisms by denying them
optimization of environmental conditions.
2. Saliva buffers (neutralizes) and cleans the
acids produced by acidogenic microorganisms,
thus, preventing enamel demineralization

21. Buffering capacity
• The carbonic acid-bicarbonate system is the most
important buffer in stimulated saliva, while in
unstimulated saliva it serves as the phosphate buffer
system
• Sialin, a salivary peptide, plays an important role in
increasing the biofilm pH after exposure to fermentable
carbohydrates
• Urea is another buffer present in total salivary fluid
which is a product of amino acid and protein catabolism
that causes a rapid increase in biofilm pH by releasing
ammonia and carbon dioxide when hydrolyzed by
bacterial urease

22. Diluting and cleansing
• In addition to diluting substances, its fluid
consistency provides mechanical cleansing of
the residues present in the mouth such as
nonadherent bacteria and cellular and food
debris.
• SF tends to eliminate excess carbohydrates,
thus, limiting the availability of sugars to the
biofilm microorganisms.

23. Integrity of Tooth Enamel
• Saliva plays a fundamental role in maintaining the
physical-chemical integrity of tooth enamel by
modulating remineralization and demineralization.
• The main factors controlling the stability of enamel
hydroxyapatite are the active concentrations free
of calcium, phosphate and fluoride in solution and
the salivary pH
• The high concentrations of calcium and phosphate
in saliva guarantee ionic exchanges directed
towards the tooth surfaces that begin with tooth
eruption resulting in post-eruptive maturation.

24. EFFECT OF DRUGS & CHEMICAL ON
SALIVARY SECRETION
1) Sympathomimetic drugs like adrenaline & ephedrine
stimulates salivary secretion
2) Parasympthomimetic drugs like acetylcholine ,
pilocarpine & physostigmine increase the salivary
secretion
3) Histamine stimulates the secretion of saliva
4) Parasympathetic depressants like atropine inhibit the
secretion of saliva
5) Anaesthetics like chloroform & ether stimulate the
reflex secretion of saliva . However , deep anaesthesia
decrease the secretion due to central inhibition.

25. Co relation between Saliva and Dental
Caries
IgA
Carbonic acid-
bicarbonate system
lysozyme
Lacto per
oxidase
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27. Factors affecting flow of saliva
• Individual hydration
• The Circadian and Circannual Cycle
• Body Posture, Lighting, and Smoking
• Medication
• Thinking of Food and Visual Stimulation
• Physical Exercise
• Fasting and Nausea
• Age
• Gender
• Alcohol

28. Saliva as Diagnostic Aid
SALIVA TESTS MAY REPLACE BLOOD TESTS
Patients may one day spit into a cup instead of
undergoing blood draws when being tested for the
presence of cancer, heart disease or diabetes..
JADA NEWS ….(MAY,2008) 28

29. Advantages of using Saliva as a
Diagnostic Specimen
• Non – invasive
• Limited training
• No special equipment
• Potentially valuable for children
• Cost effective
• Eliminates the risk of infection
• Easy, No pain and safest method
• Screening of large population
No Pain
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30. Disadvantages
• Samples are not sterile and subjected to bacterial
degradation
• Difficult interpretation of salivary essays
• Testing programme not yet available for saliva
Saliva in diagnostic technological assessment
consist of 5 basic levels of analysis:
1) Analytic
2) Diagnostic
3) Treatment efficacy
4) Operational (response to treatment)
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31. Saliva is used for diagnosis
Classified as
• 1 ) Quantative analysis
Hypo salivation -Sjogren’s syndrome
- Drug induced
Hyper salivation – Psychological Disturbance
- Pregnancy
- Parkinsonism
- Nausea / vomitting

32. • 2.Qualitative analysis .
Systemic diseases –Hereditary disease
-Autoimmune
-Malignancy
-Infections
Viral disease –HIV
Drug monitoring
Monitoring of hormone level

33. Hereditary diseases
• Cystic fibrosis
elevated Ca and Phosphate in children leads to
increase in calculus formation.
Raised PGE2
• Coeliac disease
involes malabsorption of gluten.
increase in salivary IgA-AGA
(Antiglaidin antibody)

34. Autoimmune diseases
• SJOGREN’S SYNDROME is a chronic autoimmune
disorder characterized by xerostomia (dry mouth),
xerophthalmia (dry eyes), and lymphocytic infiltration
of the exocrine glands
• Biopsies of minor salivary glands and predominant
infiltration of inflammatory CD4 lymphocytes
• Sialochemistry and elevated levels of IgA, IgG,
lactoferrin, and albumin, and a decreased
concentration of phosphate were reported in saliva
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35. Malignancy
BIOMARKER MALIGNANCY
p53 Squamous cell carcinoma
CA 125 Ovarian cancer
c-erb B2 Breast cancer
The use of saliva as a predictable and a sensitive marker for the
detection of either oral or systemic cancers appears to be a
practical reality.

36. INFECTION
ORGANISM DISEASE BIOMARKER
Streptococcus
mutans/lactobacillu
s species
caries Organisms
(culture)
Porphyromonas
gingivalis
Periodontal disease Organisms (culture)
Helicobacter pylori Peptic /duodenal
ulcer
H.Pylori DNA (PCR)
ANTIGEN (pigeon) Pigeon breeder's
disease
IgG antibodies

37. HIV Infection
1/5/2017 basic seminar- Dr.Vikneshan 37
HIV antibody
Decreased IgA levels prognostic indicator
• Oral mucosal transudate –IgG antibodies
Orasure – saliva testing system

38. Other viral disease
• Hepatitis B- IgM
• Hepatitis A- Virus RNA.
• HSV1 toHSV8- Multiplex Polymerase Chain
Reaction

39. Drugs
• Lithium, carbamazepine, barbiturates, benzo-
diazepines, phenytoin, theophylline and
cyclosporine can be detected in saliva
• High correlation between ethanol
concentrations in saliva and in serum. The
presence of thiocyanate in the saliva is an
excellent indicator of active or passive
smoking
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40. Hormone monitoring
• Salivary steroid levels are in general good
indicators of their blood concentrations.
• Consequently, the use of saliva for monitoring of
steroid hormone levels is now feasible
• At present, the following steroid levels can be
assessed using mixed saliva: cortisol, estradiol,
estriol, progesterone and testosterone.

41. Hormone monitoring
• Steroid hormone evaluation has been
demonstrated in a wide variety of situations ranging
from assessment of;
• Child health and development
• Mood and cognitive emotional behavior
• Cushing’s syndrome
• Ovarian function
• Monitoring full-term and preterm neonates
• Decreased salivary estriol was suggested as a marker
of fetal growth retardation

42. Saliva/Oral Fluid Biomarkers Possibilities for Use
DNA Bacterial infection
Diagnosing carcinomas of the head
&neck
Forensics
RNA Viral/bacterial identification
Carcinomas of the head and neck
Proteins Diagnosing periodontitis
Detecting dental caries
Mucins/glycoproteins Diagnosing carcinomas of the head&
neck
Detecting dental caries
Immunoglobulins Diagnosing viruses (HIV, hepatitis B
and C)
Viruses, bacteria Epstein-Barr virus reactivation
(mononucleosis)
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43. 1.HYPOSALIVATION
The reduction in the secretion of saliva is called
hyposalivation. 2 types :
- Temporary
- Permanent
1) Temporary hyposalivation occurs in
- emotional conditions like fear
- fever
- dehydration
2) Permanent hyposalivation occurs in
- sialolithiasis – obstruction of salivary duct
- congenital absence or hypoplasia of salivary glands
- bell’s palsy – paralysis of facial nerve
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44. Dry mouth (Xerostomia) –
• A loss of salivary function or a reduction in the volume of
secreted saliva
• This occurs as a side effect of mediations taken by the patient
for other problems.
• Symptoms – Oral dryness , loss of taste , difficulty in
swallowing, decreased retention in denture.
Signs – Fissured tongue , rampant caries , Candidiasis
• Temporary relief is achieved by frequent sipping of water or
artificial saliva .
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45. Management
 Dietary considerations
Avoid alcohol, smoking
Take protein and vitamin supplements
 Preventive Dental Care Measures
Mouth rinses.
Antifungal medications.
 Saliva stimulants
Oralbalance, XERO-Lube , Optimoist
 Saliva substitutes
Sugar free gum, lemon drops or mints – conservative
methods
Biotine chewing gum
Pilocarpine HCl.
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46. 2. HYPERSALIVATION
The excess secretion of saliva is known as hypersalivation .
Hypersalivation in pathological condition is known as ptyalism or
sialorrhea
Hypersalivation occurs in the following conditions :-
1) Decay of tooth or neoplasm of mouth or tongue due to continuous
irritation of nerve endings in the mouth
2) Disease of esophagus , stomach & intestine
3) Neurological disorder such as cerebral palsy & mental retardation
4) Cerebral stroke
5) Parkinsonism
6) Some psychological & psychiatric conditions
7) Nausea & vomiting
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47. Drooling
• Uncontrolled flow of saliva outside the mouth is called
drooling . It is often called ptyalism.
• Etiology -Decreased Saliva swallowing and clearance,
Excessive Saliva production, Neuromuscular disease and
Anatomic abnormalities
Management :
Non-specific Measures
 General measures to reduce Saliva
 Orthodontic appliances that aid swallowing
 Anticholinergic Medications
Specific Measures
 Treat Nausea
 Neuromuscular causes
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48. Saliva and Oral Health
• Gingivitis: lack of saliva leads to retention of food particles in
the mouth, particularly interdentally and under dentures. This
may result in gingivitis and in the long term, periodontitis.
• Oral ulceration: reduced saliva flow may result in recurrent
aphthous ulceration, pain, lichen planus and secondary infection
such as candidiasis. Antifungal rinses are used
•Mucositis: this is a painful condition where the mucous
membrane of the oral cavity becomes ulcerated and
inflamed. It can lead to dysphagia, dehydration and impaired
nutrition.
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49. • Glossitis: with salivary hypofunction,the tongue can appear red,
dry and raw, particularly on the dorsum, while the filiform papillae
may be lost.
•Dentures: patients with hyposalivation often complain their
dentures lose retention and stability. This can cause problems
with speech, chewing, swallowing and nutritional intake.
It also increases the risk of candidal infections, ulceration,
gingivitis, bacteraemia, viral infections and caries in the
remaining teeth. Denture fixatives may be required to retain the
removable prosthesis.
Treatment is soft and hard tissue relines and denture adhesives
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50. • FREY'S SYNDROME/ GUSTATORY SWEATING also
known as Auriculotemporal syndrome
• is a food related syndrome which can be congenital or acquired
specially after parotid surgery and can persist for life.
• The symptoms of Frey's syndrome are redness and sweating on
the cheek area adjacent to the ear.
• They can appear when the affected person eats, sees, thinks
about or talks about certain kinds of food which produce
strong salivation.
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51. Saliva Collection Methods
Draining / Spitting Method : The
subject is asked to accumulate saliva
in the floor of the mouth and then
spit into a graduated test tube
Suction Method:a plastic saliva
ejector tip connected to a vacuum
pump is placed under the tongue.
The saliva is led by a plastic tube into
a test tube. At the end of collection,
the ejector is moved around in the
mouth to collect the remaining saliva
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52. • Stimulated saliva-collected by masticatory action (from
a subject chewing on paraffin) or by gustatory
stimulation (application of citric acid on the subject's
tongue)
• Unstimulated salivary flow rate is most affected by the
degree of hydration, exposure to light, body
positioning, and seasonal and diurnal factors
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Swab Method: 3 preweighed cotton
rolls are placed in the mouth , one
below the tongue and two on
either side in the buccal vestibule.
At the end of collection time cotton
rolls are removed and weighed.

53. Conclusion
• Saliva has an important role in patient’s quality of life. Dental
professionals need to be aware of the problems that arise
when there is an overproduction or underproduction of saliva,
and also a change in its quality.
• Checking the patient’s medical history regularly can identify
conditions or medications that can adversely influence saliva
production.
• Understanding the role of saliva in maintaing health , as well
as its relation to oral diseases is vital for dentist
• What water is to desert , saliva is to the oral cavity.
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54. References
• Tencate’s oral histology- 8TH Edition
• Textbook of medical physiology- guyton 9th edition
• Textbook of Oral Pathology- Shafer,Hine & Levy
• Carranza’s clinical periodontology- 10 th edition
• de Almeida Pdel V, Grégio AM, Machado MA, de Lima AA, Azevedo
LR. Saliva composition and functions: a comprehensive review. J
Contemp Dent Pract. 2008 Mar 1;9(3):72-80
• Puy CL. The rôle of saliva in maintaining oral health and as an aid
to diagnosis. Med Oral Patol Oral Cir Bucal 2006;11:E449-55
• Gupta P, Dahiya P, Bansal S, Gupta R. Saliva A Revolutionary
Approach In Diagnosis. Indian Journal of Dental Sciences
2012;4(3)44-46
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55. Thank You
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