SALIVARY GLANDS AND SALIVA

INTRODUCTION :
Saliva is a most valuable oral fluid that often is taken for granted. It is critical in the preservation and maintenance of oral health. Saliva has also become useful as a noninvasive systemic sampling measure for medical diagnosis and research. Consequently, it is necessary for clinicians to have a good knowledge base, concerning the norm of salivary flow and function.

SALIVARY GLANDS
DEVELOPMENT OF SALIVARY GLANDS The 3 ma or sets of salivary glands!the parotid, the submandibular and the sublingual!originate in a uniform manner by oral ectodermal epithelial buds invading the underlying mesenchyme. The parotid glands are the first to appear at the " th week of intrauterine life and the inner cheek near the angles of the mouth and grow back towards the ear. In the para!otid, or ear region, the epithelial cord of cell branches and canali#e to provide the acini and ducts of the gland. The duct and acinar system is embedded in a mesenchymal stroma that is organi#ed into lobules and become encapsulated. The submandibular salivary gland buds also appear in the " th week as a grouped series forming epithelial ridges on either side of the midline in the floor of the mouth. The epithelial cord proliferates back into the mesenchyme beneath the developing mandible, to branch and canali#e, forming the acini and ducts of the submandibular gland. The mesenchymal stroma separates off the paranchymal lobules and provides the capsule of the gland.

The sublingual glands arise in the $ th week of intrauterine, as a series of about ten epithelial buds ust lateral to the submandibular anagen. These branch and canali#e to provide a number of ducts opening independently beneath the tongue. % great number of smaller salivary glands arise from the oral ectodermal and endodermal epithelium, and remain as discrete acini and ducts scattered throughout the mouth.

SALIVARY GLANDS - GROSS MORPHOLOGY

PAROTID GLANDS &arotid glands provide "'!"() of total salivary volume. *ach parotid gland is pyramidal in shape. The base of the pyramid being rhomboidal and lying immediately beneath the skin. *ach gland weighs +(g. % dense fibrous capsule separates the gland from other structures. The superficial surface of the parotid gland ,The base of the pyramidis defined by the #ygomatic arch, the e.ternal antitory meatus, and ust behind and below the angle of the mandible. The gland e.tends into the groove between the mandibular ramus and sternocleidomastoid muscle to reach the styloid process and associated muscles which separate the gland from the internal carotid artery and ugular vein. The e.ternal carotid artery enters the glands and divides into its terminal branches. The facial nerve also passes through the gland, dividing close to the anterior border. The main parotid duct ,Stensen/s duct- leaves the mesial angle of the gland to traverse over the masseter muscle and turn abruptly to enter the buccinator muscle prior to opening into the oral cavity in a small papilla close to the buccal surface of the ma.illary first molar tooth.

SUBMANDIBULAR GLAND : The submandibular gland produces about +'!3') of the total salivary volume. The glands are irregular, walnut in shape, with the superficial inferior portion in contact with the skin and platysma muscle. 0aterally, the gland is in contact with the mandibular body and medially with the e.trinsic tongue and mylohyoid muscles. There may be a small, deeper portion of the gland between the mylohyoid, hyoglossus and styloglossus, muscles. This part of the gland e.tends forwards and inwards above the posterior edge of the sublingual gland. %fter leaving the superficial part of the gland, the duct ,1harton/s duct- passes beneath the deep part, between the mylohyoid and hyoglossus muscles and between the sublingual gland and genioglossus muscle to end at the summit of the sublingual papilla at the side of the lingual frenulum. The tortuous duct is appro.imately ( cm long. SUBLINGUAL GLAND : The sublingual glands are the smallest of the ma or salivary glands2 the produce +!() of the total salivary volume. *ach is of the si#e and shape of an almond and weighs 3!3 gms. The glands lie immediately beneath the oral mucosal lining of the mouth floor, raising a small fold on either side of the tongue. The glands rest on the mylohyoid muscle, with the mandible lateral and genioglossus muscle medial. This gland has a series of small ducts ,4artholins ducts- that open on the surface of the sublingual folds on either side of the tongue.

MINOR GLANDS (Accessory g !"#s$ A"%er&or L&"g'! G !"#s These two irregular glandular groups lie on either side of the frenulum on the under!surface of the tongue, with several ducts piercing the overlying mucosa. Sero"s g !"#s o( )o" E*"er These are small glands whose ducts open into the sulci of the circumvallate papillae. L&"g'! + *'cc! + !*&! !"# ,! !%! g !"#s : Small glands with short ducts, producing a secretion rich in mucoproteins are found scattered over the surface of the tongue, the inside of the lips and cheeks, and in the mucosa covering the hard and the soft palate. B oo# s',, y : The blood supply to the parotid is derived from the facial and e.ternal carotid arteries, with a richer vascular supply to the ductal than the acinar system. In fact the blood flow is parallel, but in opposite direction to the salivary flow. The facial and lingual arteries supply the submandibular gland, whereas the submental and sublingual arteries supply the sublingual gland. 5enous drainage of all the glands is mainly through the e.ternal ungular vein. Ner)e s',, y : The parasympathetic nerve!supply, carrying the secretomotor fibers to the parolid gland travels in a branch of the glossopharyngeal nerve to which synapses in the otic ganglion and passes from three with the auriculotemporal nerve to the gland.

4oth the submandibular and sublingual glands are served by parasympathetic secretomotor fibers originating in the facial nerve, lining in the middle ear and passing as the chordaympani to oin the lingual nerve. These fibers synapse in the submandibular ganglion and the postganglionic fibers pass to the glands. Symathetic fibers pass from the superior cervical ganglion with the blood vessels to all the glands.

SALIVARY GLANDS - MICROSTRUCTURE

The structure of the salivary glands is similar to other e.ocrine glands, comprising a series of secretory units ,acinar cells- clustered around a central lumen. These acini comprise the terminal or secretory end!piece of the gland, situated fasthest from the oral cavity. They are supported by the myoepithelial cells and a basement membrane. 6rom each acinus the secretions pass to a series of interconnected ducts before passing out through the ma or salivary duct into the oral cavity. *ach acinus consists comprises a series of polygonal cells on a basement membrane central around a central ductal lumen. The acinar cells are classified histologically into two types 7 serous cells and mucous cells according to their appearance after staining with eosin and heamato.ylin i.e this in a histochemical term rather than a functional description.

Sero's Ce s
They stain blue these cells make up most of the acini of the parotid gland and of von ebner. They are large and polygonal in shape. They are characteri#ed by a nucleus lying towards the basement membrane. The cells contain e.tensive endoplasmic reticulum and many mitochondria in the luminal portion of the cells are granules and vacuoles which fill up during resting periods but discharge by e.ocytosis on stimulation some of these can be shown to contain amylase.

The cells produce a secretion much less viscous or more serous than the secretion of the other glands. 8ence the term serous cells.

M'co's ce s
&redominantly pink 7 staining cells. Since their staining properties resemble those of other cells elsewhere which produce mucoid substances, and since the secretions of these cells are viscous and rich in protein 7 carbohydrate comple., they have been referred to as mucous cells. The acinar cells of the submandibular and sublingual glands are said to comprise mucous cells. The general form and appearance of mucous cells is not dissimilar to that of serous cells. 9ucous cells show more areas of smooth parallel cisternae and have larger secretory vacuoles.

DUCTS
I"%erc! !%e# #'c% ce s
The secretions pass from the acinus to a short intercalated duct: the duct cells tend to by cuboidal, they have large central nucleus and many mitochondria and little endoplasmic reticulum. The duct lining cells are closely interdigitated. The contain #ymogen granules, which may contribute to stable changes in salivary composition.

S%r&!%e# #'c% ce s
The intercalated duct then pass abrupt into another short but wide, striated duct, the striated duct are lined by cells which are much more columnar than the cells of the intercalated duct. The cells have marked cellular membrane interdigitations pro ecting towards the lumen. the striated ducts actively resorb sodium ions from the primary acinar secretion, with the associated capillaries then transporting the ions away from the glands into systemic circulation.

These striated ducts then pass abruptly into two epithelial cell layered e.cretory ducts and finally to the stratified squamous epithelial cell lined terminal duct. %lthough these latter e.cretory ducts resorb electrolytes from the primary secretion, they are probably less efficient than the stratified duct lining cells. Myoe,&%.e &! ce s These cells constrict the acini and ducts to falicitate salivary secretory flow. In myoepithelial cells the nucleus lies in a broader part of the cell and is surrounded by mitochondria and strands of endoplasmic reticulum. The remainder of the cells consists of longitudinally arranged myofibrils.

MECHANISM OF SALIVARY SECRETION

Stimulation of secretomotor nerves results in the release of neurotransmitter substances i.e., acetylcoline from the parasympathetic nerves and noradrenalinc from the sympathetic nerves. These neurotransmitters act on membrane receptor sites on the acinar cells to stimulate secretion. For/!%&o" o( %.e !c&"!r ( '&# The acinar fluid consists of water, ions, small molecules, synthesi#ed by the cells. This fluid arises from the interstitial fluid, which in turn arises from the blood in the capillaries. The capillaries behave in a similar manner as capillaries else were : hydrostatic pressure causes an outflow of water, and small ions and molecules diffuse from the plasma. The acinar cells behave as if freely permeable to lipid!soluble substances and water, but much less permeable to other molecules. *ntry of glucose and amino7acids probably occurs by active transport, their concentration in acinar fluid is low.

The ions of the acinar fluid are broadly similar to those of interstitial fluid. Sodium and chloride concentration are similar to those of plasma and it is probably that active transport of these two ions at the luminal membrane is the ma or factor producing an osmotic forces to speed water movement through the acinar cells. &otassium is lost from the acinar cells to the acinar fluid on stimulation and high acinar potassium level may arise from a cell membrane permeability when e.posed to acetyle coline. Synthesis of salivary proteins occurs at the ribosomes and the proteins pass into the cisternae of the endoplasmic reticulum 2 to be secreted from the cell surface by e.ocytosis. MODIFICATIONS OF THE ACINAR FLUID Mo#&(&c!%&o" &" %.e &"%erc! !%e# #'c% : &hysiological evidence from the animal studies suggests that the intercalated ducts are also involved in the initial secretion which is added to the acinar fluid 2 through histologically they do not resemble cells normally considered to show secretory activity. It is possible that the loss of potassium from the gland which occurs on stimulation may take place here as well as in the acinar cells. Mo#&(&c!%&o" &" %.e s%r&!%e# #'c% : The duct system, from the beginning of the striated ducts, plays an active part in the modification of saliva, in this area, the acinar fluid is transformed from an isotonic, or slightly, hypertonic fluid, with ionic concentration similar to plasma, to a hypotonic fluid, with low sodium and chloride concentration. The sodium pump mechanism of the membrane operate in a polari#ed fashion, since the massive infolding of the baeal wall of the cells increases the pump capacity in the side. %s a result, sodium is actively transported across the cell and the concentration gradiant in thus

enhanced between the cells and the luminal fluid, resulting in diffusion of sodium into the cells from the lumen. The active transport of sodium is linked with active transport of potassium in the opposite direction and also with passive diffusion of chloride to maintain the electrochemical balance. 4icarbonate is actively secreted to the lumen in this part of the gland. The cells behave as if largely impermeable to water, so that although salts are conserved in the area, water is not resorbed and a hypotonic secretion results. Stimulation either of sympathetic or parasympathetic nerves causes activation of the duct cells. The resting transmembrane potential of the cells of the striated ducts is around 7 $' mv with the inside of the cell negative. ;n stimulation of the glands, the transmembrane potential on the luminal side of the cells becomes much less negative ,around 7 +' mv-. Mo#&(&c!%&o" &" %.e #&s%! e0cre%ory #'c%s : In the distal part of the e.cretory ducts partial re!equilibration of saliva with plasma occurs and concentration of ions return from e.treme values to more plasma like concentrations.

SALIVARY CONTROL
The secretion of saliva is controlled by a salivary center composed of nuclei in the medulla but there are specific triggers for this secretion.

A((ere"% ,!%.1!ys (s%&/' &$

The triggers or stimuli for secretion are

Loc! (!c%ors
The act of chewing, the sensation of taste, the irritation of the mucous membrane of the mouth all these act as sensory stimuli which refle.ly

produce salivation. The fibers carrying sensations of taste and touch are carried in the same nerves carrying the secretomotor fibers 7 i.e., the chorda tympani fibers in the lingual nerve ,which originate in the facial nerve- from the anterior +<3rd of the tounge and glossophargneal nerve from the poterior =<3 and the tounge. The sensation of small and sight from the nose and eyes are carried by the =st and +nd cramial nerves respectively.

Psyc.&c s%&/' &

The sight of food, talking about or the noise of food preparation are sufficient to activate the conditioned refle.es for salivary secretion. This indicates that salivation can be influenced by higher centers, e.: hypothalamus.

S%&/' !%&o" (ro/ o%.er org!"s

*sophageal irritation causes refle. salivation, although gastric irritation leads to increased salivation as a component of the nausea < vomiting refle..

Ce"%r! co"%ro
The afferent stimuli reach the brain and spinal cord and are finally integrated in the cell bodies of the preganglionic secretomotor neurons. 1here efferent secretomotor impulses are generated. The cell bodies of the parasympathetic neurons are in the nuclei of the facial and the glossophsyngeal nerves. The area which gives salivary response on stimulation is termed. >nucleus salivatorius/. The nucleus salivatorius has been divided into two components. Superior salivary nucleus : stimulations of which causes secretion of submandibular and sublingual glands.

Inferior salivary nucleus : stimulation causes secretion of parotid glands. The cell bodies of the sympathetic nervous system lie in the lateral columns of the first fine thoracic nerves. The secretomotor cell!bodies, in addition receive inputs, both e.citatory and inhibitory, from other parts of the brain. 8ypothalamic activity is also associated with salivary responses.

THE EFFERENT PATH2AY

The flow of saliva is controlled entirely by nervous stimuli. Control in e.erted mainly by parasympathetic, but also by sympathetic stimuli. The parasympathetic fibers to the submandibular and sublingual glands arise from the superior salivary nucleus in the medulla as nervous intermedins and by 7 passing the geniculate ganglion descend downwards through the facial ,5II cranial- nerve. The chorda tympani nerve descends downwards and reaching the cavity of the mouth meets the lingual nerve. Then the secretory fibers leave the lingual nerve and end in the submandibualar ganglion. 6rom the submandibular ganglion of the post ganglionic fibers arise and reach the submandibular and sublingual glands and supply them with secretory and dialotory fibers. The parasympathetic fibers to the parotid gland arise from the inferior salivary nucleus ,dorsal nucleus of the I? nerve- in the medulla and descend downwards through the glossophargneal ,I?- nerve and being separated as the tympanic branch pass through the tympanic ple.us and then through the lesser superior petrosal nerve end ultimately in the otic ganglion. 6rom this the post ganglionic fibers arise and reach the parotid gland through the auriculotemporal branch of the trigemenal ,5 nerve- nerve to supply it with secretory and dilator fibers.

The sympathetic fibers to all these glands synapse in the superior cervical ganglion. The postganglionic fibers arising from this ganglion pass along the walls of the arteries and supply all the salivary glands. The sympathetic fibers are believed to end in the serous gland or the serous part of the mi.ed gland and supply vasoconstrictor fibers to the vessels of the glands and myoepitheilial cells of the ducts.

SALIVA
Saliva is a wonderful, marvelously equipped fluid to protect and preserve the oral tissues. %ccording to stedmans medical dictionary +"th edition. Saliva is clean, tasteless, odourless slightly acidic vicious fluid, consisting of secretions from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity. COMPOSITION OF SALIVA H'/!" s! &)! : To%! !/o'"% : =,+'' 7 =('' ml in +3 hrs. a large proportion of this volume is secreated at meal time. 1hen the secretory rate is highest. Co"s&s%e"cy : slightly cloudy, due to presence of cells and mucin. Re!c%&o" : usually slightly acidic ,ph ".'+ 7 @.'(S,ec&(&c gr!)&%y : =.''+ 7 =.'+ Fee3&"g ,o&"% : '.'@ 7 '.33'c.

COMPOSITION OF SALIVA
Saliva consists of AA.() water and '.() of solids

SALIVA
1ater ,AA.()Solids ,'.()-

;rganic ,'.3)!globulin &tyalin 9ucin Ballikrein 4radykymin 0ysosome Immunoglobulin IgC 4lood group antigen Derve growth factor 5it C and vit B. Erea and uric acid.

Inorganic ,'.3)%nions Cl! 8C;3! &;3! Thiocynate

Cations DaF BF CaFF 9gFF 6luoride

Cellular components These component interact in related function in the following general areas. =- 4iocarbonates, phosphates and urea act to modulate &h and buffering capacity of saliva. +- 9acromolecule proteins, mucins, severe to cleanse aggregate attach oral microorganisms and contribute to dental plaque matabolism. 3- Calcium, phosphate and proteins act together as an antisolubility factor and modulate deminerali#ation and reminerali#ation. 3- Immunoglobulins, proteins, and en#ymes provide antibacterial action.

Saliva is not considered as an ultrafiltrate of plasma initially saliva is isotontic as it is formed in the acin, but it becomes hypotomic as it travels through the duct network. The hypotonicity of the unstimulated saliva allows the taste buds to perceive different tastes. 8ypotonicity, especially during low flow periods, also allows for e.pansion and hydration of mucin glycoproteins, which protectively blanket the tissues of the mouth. F!c%ors A((ec%&"g T.e Co"ce"%r!%&o" O( S! &)!ry Co"s%&%'e"%s 6low rate in salivary glands on individual constituents ! Substances whose concentration increase with flow rate increases : Total protein, amylase, Da, 8C;3 ! Substances whose concentration decreases with the increase in flow rate : &hosphate2 Erea, aminoacids, uric acid, serum albumin. ! Substances whose concentration Goes not change with change in flow rate : &otassium ,B-, 6luoride ! Substances whose concentration decreases at first but increases as flow rate increases : Cl!, CaFF, &rotein!bound carbohydrates. F!c%or !((ec%&"g ( o1 r!%e D&'r"! )!r&!%&o" : Salivary flow rates e.hibit diurnal variation. &rotein concentrations tend to be high in the afternoon. DaF+ Cl! concentrations tend to be high in the early hours BF ! tend to be high in the afternoons CaFF ! tend to be high in the night N!%'re o( s%&/' 's : The stimulus may vary in its affect of different glands. 5ariations in composition of whole saliva may arise from differing proportion of the ma or secretions.

D&e%!ry (!c%ors : 6unctional salivary glandular activity is influenced by mechanical and gustatory factors eg: copious salivary flow results from the smell of food or new denture insertion. I"s'((&c&e"% s! &)!ry ( o1 res' %s &" 4 ge"er! or! -re !%e# e((ec%s : =- Heduced preparation of food for digestion and taste +- Increased susceptibility of oral structures to diseases. This may be the result of salivary gland hypofunction. 8ypofunction of stimulated salivary flow is not a normal age related change. % working knowledge of normal salivary flow is necessary for the clinician, discussing patient home care instructions. ! 0ow flow during sleep, mandates the need to carefully cleanse the mouth before going to bed and after breakfast. ! The use of sugarless chewing gum or candy containing ?ylitol or sorbitol can be recommended as a mean of stimulating e.tra salivary flow to aid caries management and lubrication. ! %cidic and sweet taste stimuli are better choices as triggers for desired e.tra flow. ! The successful use of removable prostheses by a patient may be affected dramatically by decreased salivary flow.

FUNCTIONS OF SALIVA : Salivary functions can be organi#ed into ( ma or categories that serve to maintain oral health and create an appropriate ecological balance. =- 0ubrication and protection. +- 4uffering action and clearance. 3- 9aintenance of tooth integrity. 3- %ntibacterial activity. (- Taste and digestion. The detrimental. 5$ L'*r&c!%&o" !"# ,ro%ec%&o" : %s a seromucous coating, saliva lubricates and protects the oral tissues, acting as a barrier against irritants. These irritants include proteolytic and hydrolytic en#ymes. &roduced in plaque, potential carcinogens from smoking and e.ogenous chemicals. The best lubricating components of saliva are mucins that are secreted from minor salivary glands. These mucins have the properties of low solubility, high viscosity, high elasticity and strong adhesiveness. %ny intraoral contact between soft tissues, between soft tissues and teeth and between soft tissues and prosthesis benefit from the lubricating capability of saliva supplied largely by these mucins. 9astication speech, and swallowing all are aided by the lubricating effects of mucins. 9ucins also perform an antibacterial function by selectively modulating the adhesion of micro organisms to oral tissue surfaces, which contributes to the control of bacterial and fungal coloni#ation. Secretions from the submandibular and sublingual glands contain high!molecular weight mucin ,9C=- and a low molecular weight mucin ,9C+-. The importance of these two ma or mucins has been the focus of salivary components work in concert in overlapping, multifunctioning roles, which can be simultaneously beneficial and

research for the last two decades. 9C= absorbs tightly to the tooth and thereby contributes to the enamel pellicle which protects the tooth from acid challenges. 9C+ binds to the enamel but in easily displaced. It promotes the aggregation and clearance of oral bacteria, including streptococci mutans. %n important part of the multifunctional role of salivary mucins is preserving mucosal integrity is their ability to regulate intercellular calcium levels. %s a part of the enamel pellicle, mucins help initiate bacterial coloni#ation by promoting the growth of benign commensal oral flora, forming, a protective barrier and lubrication against e.cessive wear, providing a diffusion barrier against acid penetration and limiting mineral aggress from the tooth surface. The results of research clearly indicate that salivary mucins performs a variety of function essential to maintaining a stable oral defense. 4$ B'((er&"g !c%&o" !"# c e!r!"ce : 4uffering action and clearance are a second function of salvia through the following components : 4icarbonates, phosphate, urea, and amphoteric proteins, and en#ymes, bicarbonate is the most important buffering system. It diffuses into plaque and acts as a buffer by neutrali#ing acids. 9oreover, it generates ammonia to form amines, which also serve as a buffer by neutrali#ing acids2 low molecular weight histidine!rich peptides. &resent in saliva also act as a buffer. Erea, another buffer releases ammonia after being metaboli#aed by plaque and thus increases plaque &8. 4uffering action of saliva is more effective during stimulated high flow rates. &hosphate is likely to be important as a buffer only during unstimulated flow. Thus salivary buffering, clearance, and flow rate work in concert to influence intraoral p8. Salivary flow can be augumented by the stimulus of chewing as well as the muscular activity of the tips and tongue. 1ith stimulated additional

flow, chewing products ,such as gum- that contain no fermentable carbohydrates can aid in the modulation of plaque &8. Sugar free gums containing .ylitol and sorbitol can be recommended. Indeed research has shown that the use of gum containing .ylitol or sorbitol reduces plaque accumulation and gingival inflammation and enhances reminerali#ation potential. 6$ M!&"%e"!"ce o( %oo%. &"%egr&%y : 9aintenance of tooth integrity is a third function of saliva, one that facilitates the deminerali#ation and reminerali#ation process. Geminerali#ation occurs when acids diffuse through plaque and the pellicle into the liquid phase of enamel between enamel crystal. Hesulting dissolution occurs at a &8 of ( to (.(, which is the critical &8 range for the development of caries. The buffering capacity of the saliva influences the &8 of plaque surrounding the enamel, thereby inhibiting caries progression. Heminerali#ation is the process of replacing lost minerals through the organic matri. of the enamel to the crystals. The high salivary concentrations of CaFF and &;3, may account for the maturation and reminerali#ation of the enamel. &roteins in the pellicle, such as statherin, histamines, and proline rich proteins, aid in controlling crystalline growth of enamel by allowing the penetration of minerals, into the enamel for reminerali#ation and limiting mineral egress. 6luoride in the salivary solution works to inhibit dissolution of apatite crystals. 6luoride speeds up crystal precipitation, forming a fluorapatite!like coating more resistant to caries than the original tooth structure. The contribution of saliva to the deminerali#ation and

reminerali#ation process points to the importance of monitoring salivary

flow especially in patients taking multiple medications or having systemic entities that decrease salivary flow. 6or patients with incipient caries fluoride supplements can promote reminerali#ation. Salivary stimulants and substitutes also should be encouraged for patients with salivary hypofunction. Hesearchers are currently investigating a method to genetically engineer salivary proteins and other salivary components for use in future artificial salivas. 7$ A"%&*!c%er&! !c%&)&%y : % fourth function of saliva in antibacterial activity. Salivary glands are e.ocrine glands, and as such, secrete fluid containing immunologic and non!immunologic agents for the protection of teeth and mucous surfaces. Immunologic contents of saliva include secretory Ig%, IgC and Ig9. Don immunologic salivary contents are selected proteins, mucins, peptides and en#ymes. ,lactoferin, lysosome and pero.idase-. 9C+ and Ig% comple. bind mucosal pathogens with great affinity. ! 0actoferin, binds to ferric iron in saliva, this process makes ferric iron unavailable as a food source for microbes, such as cariogenic streptococci, that need iron to remain viable. ! 0ysosomes, split bacterial walls, leading to destruction and inhibition of bacterial growth. ! &ero.idase, catalyses bacterial metabolic by!products with thiocynate, which is highly to.ic to bacterial systems, pero.idase also protects the mucosa from the strong o.idi#ation effects of hydrogen pero.ide produced by oral bacteria.

! Cystatins, have a ma or role in regulation of salivary calcium. 6inally, proteins such as glycoproteins, statherins, agglutinins, histadine!rich protein, proline!rich proteins work to aggregate bacteria, the clumping, inhibits adhereane and coloni#ation on to the hard or soft tissue intraoral surfaces. The concept of saliva/s antibacterial activity highlights the clinical value of stimulating natural saliva especially in patients with decreased function. 8$ T!s%e !"# D&ges%&o" : The fifth and final function of saliva is to enhance taste and begin the digestive process. The hypotonicity of the saliva enhances the tasting capacity of salty foods and nutrient sources. Saliva has an early, limited role in total digestion by beginning the breakdown of starch with amylase, a ma or component of parotid saliva salivary en#ymes also initiate fat digestion. 9ore importantly saliva serves lubricate the food bolus, which aids in swallowing. 1hen one considers the contribution of saliva to taste and early digestion, it becomes clear that artificial supplements would be difficult to develop. ARTIFICIAL SALIVA : 6rom the proceeding section it is clear that an adequate amount of salivary flow is essential in the host/s resistance to dental caries and also to vital importance in the comfortable and successful mastication and swallowing of food. It plays a vital role in the comfort of denture wearers. 1hen salivary flow is reduced, salivary stimulants or artificial salivary substitutes have been proposed. Salivary stimulants are most

satisfactory in the form of pastille, which require chewing, as chewing also acts a stimulant. The active ingradient is acidic in nature as this is well known to provoke salivation. 6or diabetic patients pastilles containing sorbitol rather than sugar are advised. Do artificial saliva that is fully satisfactory has yet been formulated. 4oth carbo.ymethyl cellulose and hydro.yethyl cellulose in aqueous solutions are in common use and are used as mouthwash as frequently as required. Deither of these materials have the viso!elastic properties of natural saliva and both require frequent use to maintain a moist oral environment. % possible alternative is high molecular weight polyethylene o.ide. %lthough +) aqueous solutions has similar viscoelastic properties of natural saliva, this sticky, stringing and viscous liquid is difficult to handle. 9any artificial saliva solutions contain acid, for dental patients as the acidic content ,usually citric acid- may cause erosion of teeth, acid!free artificial saliva is advised. IClandosaneJ a commercial mouth lubricant with a &8 of appro.imately (.3 which contain carbo.ymethyl cellulose together with calcium and phosphate ions in a promising product. Saliva orthane which has a p8 of @ and is now available containing sodium fluorides ,Da6- instead of methyl cellulose it contains mucin e.tracted from the gastric mucosa of pig to provide appropriate viscosity.

Ar%&(&c&! s! &)! c!" *e c !ss&(&e# =- Gepending on treatment approach *.trinsic 7 topically applied artificial saliva Intrinsic 7 Chemical < drug which stimulates salivary gland. *.trinsic is divided into two groups depending upon the presence or absence of natural mucin. Synthetic %nimal. +- %ccording to research development. =- =st generation +- +nd generation 3- Gisease oriented 3- 6unction oriented (- Contains design. D&s!#)!"%!ges : ! &oor taste ! 0ack of wettability ! Cannot be selectively targeted to different parts of the oral cavity. ! *.pensive

ROLE OF SALIVA IN PROSTHODONTICS 6rom a prosthodontist point on view, salivary glands are of great importance anatomically and physiologically. The submandibular gland is located in the submandibular fossa on the lingual aspect of the mandible, and a part of the gland is wrapped around the posterior part of the mylohyoid muscle, it is from this position wartons ducts curves forward and open at a papilla in anterior floor of mouth lateral to midline. *.tension of the lingual flange of a denture in this region, in such cases patient may complain of developing swellings under the aws when eating. The orifice of the stensons duct opens on the mucosal fold that is located in the cheek at the level of the crown of the = st molar, occasionally a complete denture may obstruct the orifice, however the occurrence is rare. Gentist should e.amine the duct and orifices to ensure they are open and good salivary flow is evident. Co"s&s%e"cy !"# A/o'"% o( s! &)! : The amount and consistency of saliva will affect the denture construction process and the quality of the final product itself. Co"s&s%e"cy o( s! &)! : The consistency of salvia ranges from thin serous type to the thick mucous ropy consistency. It is best to work with the serous type, and fortunately this is more commonly found. The thick, ropy saliva may create a problem for ma.illary complete denture rentention. Thick saliva can create hydrostatic pressure in

the area anterior to the posterior palatal seal, resulting in a downward dislodging force e.erted upon the denture base. In an effort to alleviate this potential problem, a fine line or cupid/s bow can be scribed on the mastee cast, anterior to the cluster of palatal mucous glands. This e.tension of the posterior palatal seal line will contain the thick mucous in the posterior part of the denture to provide a seal even if the posterior portion of the denture base is slightly out of contact with the palatal tissues. A/o'"% o( s! )&! : *.cess amount of saliva complicates denture conduction especially impression making. Guring impression making of the ma.illary arch. &alatal glands secretion may distort the impression material in the posterior +<3 of the palate to counteract this =- &alatal may be massaged to encourage the glands to empty. +- 9outh may be irrigated with astringent mouthwash ust prior to inserting the impression material 3- The palate may be wiped with gauge. *.cessive salivation, particularly of submandibular and sublingual glands may present a problem in impression making. Saliva inhibiting drugs like methanthaline bromide and %tropine may be administered.

These drugs are contraindicated in patients with Cardiac disease &rostate hypertrophy Clucoma Saliva should be controlled by mechanical means in these patients by using saliva e ector and cotton swabs. Dry /o'%. (9eros%o/&!$ It will affect the retention of the denture and increases the potential for soreness in the mouth due to frictional trauma. . Contarary to popular belief, recent studies have shown that salivary flow does not diminish with age. 8owever because of high incidence of elderly patients taking medications, that have an effect on salivary flow, dry mouth ,?erostomia- is not uncommon in the aged. Some of the medications causing .erostomia are. %ntihistamines %tropine %ntihypertensives Ditroglycerine %nti!an.iety drugs. %nti!depressants

Gifficulty in denture wearing is often the first sign of S ogrem syndrome. %lthough this condition is rare, the dentist must always consider it in an elderly patient with .erostomia. 9anagement of .erostomia depends on the cause of its condition. If a drug is suspected, alternate drug therapy must be discussed with the patients physician if possible. Sialogouges ,like pilocarpine- and salivary substituted may be ,against stimulating salivary flow- recommended. &etroleum elly may be applied to the dentures to reduce friction Some of the pathological conditions that decreases salivation are : =- Senile atrophy of the salivary glands. +- Irradiation therapy of head and neck tumours 3- Gisease of the brain stem that directly depress the salivary nuclei and block salivation. 3- Some types of encephalitis, including poliomyelitis. (- Giabetes mellitus < Giabetes insipidus. "- Giarrhea caused by bacteria or frod. @- *levated temp caused by acute infectious diseases. $- 5itamin % deficiency. &athological conditions that may be accompanied by increased salivation are :

=- Gigestive tract irritants +- &ainful afflictions of the oral cavity. RESEARCH APPLICATIONS : 9any areas of research involving salivary components and functions are in progress for local and systemic disease diagnosis, treatment and prevention. The value of saliva undoubtedly will continue to increase because it serves as a easily collected, non invasive. Source of information reflective of the status of health in the body, salivary samples can be analysed for =- Tissue fluid level of naturally, therapeutically, and recreationally introduced substances. +- *motional status 3- 8ormonal status 3- Immunologic status. (- Deurologic status "- Dutritional < metabolic influences. Saliva already is used to aid in the diagnosis of dental disease. *.amples include ! Caries risk assessment ! Identification markers for periodontal disease. ! Salivary gland disease and dysfunction. ! Candida infections. Salivary collections are used for diagnostic determinants for viral diseases, sarcoidosis, tuberculosis, lymphoma, gastric ulcers and cancers, liver dysfunction and s ogrens syndrome.

Saliva is also being used to monitor levels of polypeptides, steroids, antibodies, alcohol and various other drugs. Hesearch currently is being conducted to determine the value of saliva as a diagnostic aid for cancer and preterm labor. %nother area of research involves the possible regenerative properties and functions of growth factors found in saliva. *vidence suggests that these growth factors play a role in wound healing and maintenance of oral and systemic health. The multifunctional roles of salivary components continue to represent a very focused area of dental research. Can the reductant and synergistic effects of the salivary proteins be used to further enhance reminerali#ation K Could the salivary antibacterial factors be targeted to positively alter the biofilm community in plaque K Can salivary constituents more selectively control bacterial adherence and aggregation K Can the buffering system of saliva effectively and selectively be enhanced K Can salivary components be reproduced or replaced by new development in artificial saliva K Luestions such as these are being addressed through continuing research efforts.

CONCLUSION
The knowledge of normal salivary composition, flow and function is e.tremely important on a daily basis when treating the patients. Hecognition should be given to saliva for the many contribution it makes to the preservation and maintenance of oral and systemic health.

REFERENCES :
5$ 8uman &hysiology ==th edition : C:C: C.!%%ergee 4$ %pplied &hysiology of the mouth 3 rd edition :

C.r&s%o,.er L:B: L!)e e 6$ %pplied ;ral &hysiology +nd edition : C.r&s%o,.er L:B: L!)e e 7$ &hysiology for dental study : D:B: Ferg'rso" 8$ Heview of 9edical &hysiology =3th edition : 2& &!/ G1!"o"g ;$ 8uman %natomy ='th edition : D:B: C.!'r!s&! @- M&G +''= : 5ol. $( 2 ="+ ! ="A

SALIVARY GLANDS AND SALIVA

INTRODUCTION SALIVARY GLANDS De)e o,/e"% Gross Mor,.o ogy B oo# s',, y M&crosco,&c s%r'c%'re Mec.!"&s/ o( s! &)!ry secre%&o" - For/!%&o" o( !c&"!r ( '&# - Mo#&(&c!%&o" o( !c&"!r ( '&# SALIVA De(&"&%&o" Co/,os&%&o" o( S! &)! F!c%ors !((ec%&"g S! &)!ry ( o1 F'"c%&o" o( s! &)! Ro e o( s! &)! &" ,ros%.o#o"%&cs Rese!rc. !,, &c!%&o" CONCLUSION REFERENCES S! &)!ry co"%ro

COLLEGE OF DENTAL SCINECES DEPARTMENT OF PROSTHODONTICS INCLUDING CRO2N < BRIDGE AND IMPLANTOLOGY

SEMINAR ON

SALIVARY GLANDS AND SALIVA

PRESENTED BY : DR: SUNEEL G: PATIL