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SALIVA 1 8/19/2013

Saliva:

Saliva Saliva plays a vital role in the integrity of the oral tissues: in the selection, ingestion & preparation of food for digestion & in our ability to communicate with one another. It is a clean, tasteless, odorless, slightly acidic viscous fluid, consisting of secretions from parotid, submandibular , sublingual salivary glands & the minor glands of oral cavity (STEDMAN) It is considered as glandular saliva whole saliva- It is the mixed oral fluid 2 8/19/2013

COMPOSITION:

COMPOSITION 99% water 1% others 1 Organic substances. 2 Inorganic substances. 3 8/19/2013

Organic substances::

Organic substances: Proteins: Serum proteins amount to 20% including IgG,IgM,IgA along with albumin &alpha ,beta globulins. Synthesized in the glands Factor VII,VIII,IX and platelet factor. 4 8/19/2013

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Enzymes : Amylase: 30% of proteins is alpha-amylase(Ptyalin) Lyzozyme : more in submandibular. -bacteriolysis,-bactericidal,-inhibits mucosal colonization by microbes. Lipase : in parotid saliva. Acid phosphates , cholinesterase,ribonuclease. e) Peroxide s: a system comprising of Lactoperoxidase, thiocynate & Hydrogen peoxide. 5 8/19/2013

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- inhibits growth & acid production of various microbes,-retains activity when absorbed on enamel thus protecting it. Kallikrein: vasodilatation others: proteases, peptidases, lipases, urease, esterase, glycosidase, hyaluronidase. 3) Mucoproteins & Glycoproteins Galactose,mannose, hexosamine,fructose. Glycine,glutamic acid 6 8/19/2013

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- negatively charge enamel,- contribute to pellicle formartion, -enamel remineralisation, -preventing bacterial colonisation, 4) Blood Group substance: A,B,O antigen 5) Carbohydrates : glucose,hexose and fructose. 6) Lipids: Digylcerides,Triglycerides,cholesterol esters,phospholipids.-protein binding,-adsorption to apatite,-plaque formation. 7 8/19/2013

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7) Hormones: Parotin: calcifications,maintain serum levels Nerve Growth factor : affects growth and development of sympathetic nerves. 8) Nitrogen containing compounds: Urea, uric acid,citrates,lactate 9) Lactoferrin : Iron binding protein.-bactericidal,-in conjunct with antimicrobial agents, 8 8/19/2013

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Quantity of saliva: 1200-1500 ml/day Sub mandibular - 65 to 69% of total volume of flow Parotid- 26% Sublingual- 10%. Minor salivary gland- 7-8% Resting flow rate of whole saliva : 0.3 to 0.4 ml/min Stimulated salivary rate: 1 to 2 ml/min Consistency: slightly cloudy pH: 6.02 to 7.05( slightly alkaline to slightly acidic) 9 8/19/2013

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10 FUNCTIONS OF SALIVA 8/19/2013

Formation of saliva:

Formation of saliva It occurs in 2 stages: 1.Cells of secretory end pieces & intercalated ducts form primary saliva which is an Isotonic fluid – organic components & water 11 8/19/2013

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2.Primary saliva is modified as it passes through the striated & excretory ducts, mainly by re absoption & secretion of electrolytes. The final saliva which reaches the oral cavity is Hypotonic 12 8/19/2013

MECHANISMS OF SALIVARY SECRETION:

MECHANISMS OF SALIVARY SECRETION The key to understanding the mechanism of salivary secretion is in identifying the individual components of the secretory process and in visualising how these components fit together. Difficulties in understanding arise because there are a lot of components and more than one way of assembling them. 13 8/19/2013

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Salivary secretion may be defined as “A unidirectional movement of fluid, electrolytes and macromolecules into saliva in response to appropriate stimulation”. This simple statement encapsulates most aspects of the secretory process and points towards what is probably the most important and topical aspect of secretory physiology. 14 8/19/2013

Secretion of saliva:

Secretion of saliva Salivary secretion from major & minor glands are controlled by both parasympathetic & sympathetic stimuli. Parasympathetic stimuli: - increases output of water & electrolyte Sympathetic stimuli: enhances protein synthesis & secretions 15 8/19/2013

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Afferent pathways: taste; facial (VII) and glossopharyngeal (IX) nerves to solitary nucleus in the medulla. Also input from higher centres in response to smell etc. Efferent pathways: Parasympathetic; sublingual and submandibular from facial nerve via submandibular ganglion. Parotid from glossopharyngeal via otic ganglion. Sympathetic post ganglionic from cervical ganglion of sympathetic chain. 17 8/19/2013

CONTROL OF SALIVATION:

CONTROL OF SALIVATION Nerve supply to the major salivary glands is derived from both sympathetic and parasympathetic branches of autonomic nervous system. Sympathetic supply is derived from T1-T4 via superior sympathetic ganglion. stimulation leads to release of secretory proteins . Parasympathetic nerves derived from facial and glossopharyngeal nerves are secretomotor . 18 8/19/2013

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Adenylate cyclase,, ATP into cAMP. 20 8/19/2013

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cAMP binding to the regulatory subunit of pKA releases and activates the catalytic subunit (1)The catalytic subunit phosphorylates and upregulates many components of the secretory pathway including exocytosis (2) 23 8/19/2013

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Neurotransmitters are -norepinephrine → β (protein) and α (water,electrolytes,low protein) -acetylcholine→cholinergic Receptor stimulation ( α , cholinergic, P ) ↓ ↑ conc. of secondary mesengers ↓ ↑ permeability to Ca& changes in Ca-phospholipid membrane metabolism 24 8/19/2013

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↓ ↑ Ca and release of Ca from ER & plasma membrane ↓ K efflux ↓ water & electrolyte secreted. Receptor stimulation ( β ) ↓ plasma membrane enzyme adenylate cyclase 25 8/19/2013

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ATP is catalysed ↓ 3’ &5’ cyclic AMP ↑ c AMP ↓ activates protein kinase ↓ phosphorylates other proteins ↓ exocytosis 26 8/19/2013

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The phases of salivation (physiology) Salivation can be divided into:   1.Cephalic phase- which occurs even before the food enters the mouth. 2. Buccal phase- which occurs while food is actually in the mouth. 3. Gastrointestinal phase- which occurs after the food has been swallowed.   27 8/19/2013

Defense mechanism of saliva:

Defense mechanism of saliva - Saliva has major influence on plaque by mechanically cleansing the exposed oral surface, by buffering acids produced by bacteria & by controlling bacterial activity Antibacterial factors; - Various organic & inorganic factors are toxic to many bacterial cells. LYSOZYME:- - Cleaves the linkage between structural components of the glycopeptides muramic acid - Acts on both gram + ve & gram – ve organisms e.g : Aa , veillonella 28 8/19/2013

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LACTOPEROXIDASE- THIOCYANATE SYSTEM:- It is bactericidal to some strains of Lactobacillus, Streptococcus. LACTOFERRIN:- It is effective against Actinobacillus . MYELOPEROXIDASE:- It is bactericidal for Actinobacillus Inhibits attachment of Actinomyces strains to hydroxyapatite . 29 8/19/2013

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SALIVARY ANTIBODIES; IMMUNOGLOBULINS:- Inhibits the adhesion of oral Streptococcus to epithelial Surface. ANTIPROTEASES:- Inhibits the action of proteolytic enzymes cathepsins . SALIVARY BUFFERS & COAGULATION FACTORS ; Bicarbonate- Carbonic acid system-maintains pH 30 8/19/2013

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ROLE OF SALIVA IN DENTAL CARIES 31 8/19/2013

INTRODUCTION:

INTRODUCTION 8/19/2013 32 Caries is a unique multi- factorial infectious disease

Role of saliva in dental caries:

Role of saliva in dental caries There is general agreement that saliva may be one of innate mechanisms against dental caries. A number of potential mechanisms may be involved: Increased salivary flow, increase carbohydrate and microbial clearance from oral cavity, acid formed by carbohydrate fermentation are reduced due to buffering action of bicarbonates in the saliva. 33 8/19/2013

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Indisputably, an adequate secretion rate & saliva of good quality are essential for oral health. Saliva is well known to have specific protective effects against dental caries. Certain properties of saliva protect the teeth against dental caries . 34 8/19/2013

DILUTION & CLEARANCE OF FOOD COMPONENTS & MICROBES:

DILUTION & CLEARANCE OF FOOD COMPONENTS & MICROBES Food solids are first dissolved & then diluted as the saliva flows into the mouth. After swallowing the bulk of food & drinks, the residues are cleared by the continuous flow of unstimulated saliva. The clearance of oral microbes & food components from mouth to the gut, requires an adequate flow & volume of saliva. This is a pre-requisite for a healthy balance between pathological factors and protective factors, called as “CARIES BALANCE” 35 8/19/2013

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8/19/2013 36

HISTORY:

HISTORY Dawes (1983) Developed first physiologic computer model of oral cavity based on the postulate that following factors were important for clearance of dietary sugars – The volume of saliva before & after swallowing . # The unstimulated salivary secretory rate . # The computer predictions based on this postulate were confirmed in studies using an “artificial mouth system” & in human experiments . The computer predicted that the clearance was rapid when both salivary volumes were low & unstimulated salivary secretion rates were high 37 8/19/2013

Clinical importance:

Clinical importance The clearance rate is an individual property that is constant over time & directly varies with secretion rate . The associated factors are – # Health status . # Rheology of specific site . Health status If changes in health status cause a decrease in the secretory rate, a drastic change in clearance rate will ensue confirmed risk of caries incidence . 38 8/19/2013

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Rheology of specific site The film overlying the mucous membrane & the teeth moves at varying rates from 0.8 to 8 mm / min. Decreased secretory rate Decreased salivary film movement Decreased clearance rate Stagnation of saliva Specific caries patterns on different teeth & tooth surfaces 39 8/19/2013

Caries balance:

Caries balance 40 Based upon several studies about the caries process, it is very useful and constructive clinically to consider caries in its progression or reversal as an ongoing and often changing balance between pathological factors and protective factors. 8/19/2013

Affecting factors:

Affecting factors Extensive growth of bacteria as a consequence of- Poor oral hygiene . Excessive dietary intake of fermentable carbohydrates . Systemic diseases . # Hyposalivation due to reduced secretory rate . In highly caries susceptible individuals, a combination of these factors is common 41 8/19/2013

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BUFFER A solution that tends to maintain a constant pH BUFFERING CAPACITY The power to resist changes of pH when an acid or alkali is added . SALIVARY BUFFERS # Prim. – Bicarbonates (HCO3-) . # Sec. – Phosphates, macromolecular proteins . 42 8/19/2013

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Lilenthal (1955 ) – Bicarbonate is the most important buffer contributing about 64 – 85% of the total capacity. Reasons are – It buffers rapidly as compared to secondary buffering agents Its concentration increases dramatically, with increased secretory rate . 43 8/19/2013

Clinical relevance:

Clinical relevance The effective buffer capacity of saliva is enhanced by its rates of flow whereby the buffer is continuously renewed. Consequently, in areas of stagnation the production of acids/alkalies by bacterial action reduces the effective buffering action leading to caries . 44 8/19/2013

pH of carious lesions & dental plaque:

pH of carious lesions & dental plaque Within active carious lesions (dentin), a pH gradient exists. The deep advancing edges of such lesions are more acidic than the shallower layers, which have a pH similar to that of saliva . In enlarged & exposed cavities that are emptied of their contents, the carious layer is shallower & the pH closer to neutrality, because of the better access to saliva . 45 8/19/2013

Clinical measurement:

Clinical measurement The buffering effects of saliva are mostly measured in vitro by – lab. or chairside methods . Chairside measurement involves the use of a Dentobuff Strip System (D.S.S) method . It is simplified & discriminates among low, medium & high buffering capacities. It is particularly useful for caries risk assessment in high caries risk group individuals 46 8/19/2013

Chairside testing of the salivary pH with the Dentobuff Strip System :

Chairside testing of the salivary pH with the Dentobuff Strip System 47 8/19/2013

One drop of stimulated saliva is placed on a test strip containing an acid & a pH indicator :

One drop of stimulated saliva is placed on a test strip containing an acid & a pH indicator 48 8/19/2013

After the reaction between saliva & acid is completed , the color of the test pad is compared to a chart & the pH value is determined :

After the reaction between saliva & acid is completed , the color of the test pad is compared to a chart & the pH value is determined 49 8/19/2013

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The human mouth is quite frequently exposed to agents that have a pH different from that of saliva (6.5 – 7.5) and are more potentially damaging to the teeth (erosion) or to the mucosa. Under these conditions, the role of buffering agents in saliva is to restore the pH to the normal range as quickly as possible . 50 8/19/2013

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DEMINERALISATION AND REMINERALISATION 51 8/19/2013

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The main factors governing the stability of enamel apatite are pH & free active concentrations of Ca+, Po4- & F- in solution, all of which can be derived from saliva . # Critical pH The pH at which any particular saliva ceases to be saturated with calcium & phosphate . It is usually about 5.5. 52 8/19/2013

STEPHANS CURVE:

STEPHANS CURVE 53 8/19/2013

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The process of demineralisation starts when this critical pH <5.5, which leads to flow of Ca+,PO4- & F- ions from enamel through saliva – plaque interface . The free active concentrations of these ions are readily provided by saliva thus providing a barrier for demineralisation & a driving force for remineralisation at the dynamic equilibrium of the carious process . 54 8/19/2013

MECHANISM:

MECHANISM 55 8/19/2013

ROLE OF FLOURIDE:

ROLE OF FLOURIDE 56 When present in the liquid phase of remineralisation, F- will be incorporated into enamel crystals , thus rendering it resistant to demineralisation 8/19/2013 F- will diffuse from saliva into the pellicle & the plaque, thus rapidly elevating its concentration & pH to form CaF2 in plaque, pellicle & saliva

CaF2 releases F- slowly. When pH approaches 5 this coating of CaF2 particles vanishes :

CaF2 releases F- slowly. When pH approaches 5 this coating of CaF2 particles vanishes 57 8/19/2013

PATHO PHYSIOLOGY:

PATHO PHYSIOLOGY LEVINE’S THEORY – 1977 It established the chemical relation of enamel/plaque & the factors which determined the movement of mineral ions from saliva/plaque interface to enamel & vice-versa, called as “IONIC SEE-SAW MECHANISM” . This ionic movement balance is dependent upon chemical conditions of enamel/plaque interface which includes – # pH of plaque . # Ionic Reservoir Concentration ( I.R.C ) 58 8/19/2013

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pH Critical pH < 5.5 – Demineralisation – Caries. I.R.C Ca+ & PO4- Increased Actual Free Concentration Increase in pH Ionic movement from saliva/plaque to enamel REMINERALISATION 59 8/19/2013

CLINICAL RELEVANCE:

CLINICAL RELEVANCE It reduces acid production in plaque, so in caries preventive programs the aim of flouride administration is to ensure that its levels in oral fluids are adequate to prevent & inhibit caries . Flouride is present in saliva (ionic) that depends on its environmental concentrations (bound) . E.g – drinking water, detrifices, chewing gums, tablets & other products for caries prevention & control . The limiting factor for the formation of CaF2 is the Ca content of oral fluids. So the environmental preparations should be a combination of saliva stimulant & flouride agent which can be used for caries control. 60 8/19/2013

VISCOCITY:

VISCOCITY Saliva is a viscous oral fluid. It also shows the property of “ Spinnberkeit ” ,i.e, ‘the ability to be drawn into long elastic threads’ . The relative salivary viscosities of 3 major salivary glands are - Sublingual > Submaxillary /mandibular > Parotid (13.4) (3.4) (1.5) Increased viscosity of saliva from sublingual & submax./mand. glands is due to its high mucoid content 61 8/19/2013

SHEAR FORCE AND DRAG:

SHEAR FORCE AND DRAG Microbes free in saliva are carried around the mouth by saliva flow. The flow of saliva over a tooth surface creates a shear force over there which tends to remove the microbe from the vicinity of the surface or detach those which are being weakly held. Saliva flows at relatively high velocities, however, near tooth surfaces this flow is reduced by high viscosity which increases drag. 62 8/19/2013

CLINICAL IMPORTANCE:

CLINICAL IMPORTANCE The increased velocity and thus increased shear will inhibit accumulations of cells. As plaque builds up it experiences greater shear force which inhibits its development. Shear force exerts a major influence on plaque development, by effectively limiting it to the sites in the mouth which are sheltered from the flow of saliva 63 8/19/2013

Salivary flow rate, buffer effect & dental caries:

Salivary flow rate, buffer effect & dental caries Reduced salivary flow rate and the concomitant reduction of oral defense systems may cause severe caries and mucosal inflammations (Daniels et al., 1975; Van der Reijden et al, 1996). Dental caries is probably the most common consequence of hyposalivation (Brown et al, 1978; Scully, 1986). Caries lesions develop rapidly and also on tooth surfaces that are usually not susceptible to caries. 64 8/19/2013

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The buffer capacity of both unstimulated and stimulated saliva involves three major buffer systems: the bicarbonate (HCO-3), the phosphate, and the protein buffer systems. These systems have different pH ranges of maximal buffer capacity (Bardow et al, 2000). An inverse relationship between buffer capacity and caries experience is well established according to Ericsson (1959). 65 8/19/2013

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A low flow rate combined with a low or moderate buffer effect clearly indicates poor salivary resistance against microbial attack (Lagerlof and Oliveby, 1994). 66 8/19/2013

Diagnostic markers of saliva:

Diagnostic markers of saliva Saliva is a fluid that is readily available & contains locally produced microbial and host response mediators, as well as systemic markers that aid in diagnosis of periodontal disease. The markers- 1.Enzymes- alkaline phosphatase, alpha,beta- glucoronidase, collagenase, esterase, kallikrein, kininase, myeloperoxidase, trypsin. 2.Immunoglobulins- Ig-A, Ig-G, Ig-M 3.Phenotypic markers-epithelial keratins 67 8/19/2013

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4.Hormones-cortisol 5.Proteins- cystatins, fibronectin, lactoferrin, platelet activating factor, VEGF etc. 6. Ions-calcium 7. Bacteria & its products etc. By Nakamura & Slots (1983), enzyme activity in whole saliva & parotid saliva in patients adult periodontitis, -increased levels of alkaline phosphatase, elastase, β -glucoronidase & other aminopeptides. 68 8/19/2013

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The activity of salivary elastase correlated significantly with the number of deep pockets & the % of bleeding sites. It helps to assess disease severity & the response to treatment. There is increased collagenase, protease & elastase activity in patients with adult periodontitis. Hayakawa et. al (1994)reported – decreased concentration of collagenase in patients with periodontitis. Salivary peroxidase activity-marker for gingival inflammation in DM patients. 69 8/19/2013

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Immunoglobulins; The predominant Ig in saliva is Ig-A which is derived from the cells of parotid gland. Salivary Ig levels were increased in patients with juvenile periodontitis as compared with healthy controls. Proteins; Various proteins like cystatins, epidermal growth factors, lactoferrin, platelet activating factors were increased in patient with periodontitis. Hormones ; Elevated levels of cortisols were detected in patients with severe periodontitis with high levels of financial strain & emotional stress. 70 8/19/2013

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Salivary ions ; Salivary calcium & saliva calcium to phosphate ratio were higher in periodontitis affected subjects. Phenotypic markers To study epithelial cell function in disease & diagnosis, specific keratins antigens in saliva are evaluated. There is increased keratin concentration in GCF in patients with gingivitis & periodontitis. Saliva:a diagnostic biomarker of periodontal disease.journal of indian society of periodontology vol 15,issue:4;oct-dec 2011” 71 8/19/2013

Caries Activity Tests:

Caries Activity Tests 72 8/19/2013

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For the clinician : 1.To determine the need for caries control measures 2.As an indicator of patient cooperation 3.To act as an aid in timing of recall appointments 4.As a guide to insertion of expensive restorations 5.To aid in the determination of prognosis 6.As precautionary signal to the orthodontist in placing bands For the research worker : 1.As an aid in the selection of patients for caries study 2.To help in the screening of potential therapeutic agents 3.To serve as an indicator of periods of exacerbation and remission 73 8/19/2013

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Snyder has suggested that a suitable caries activity test should : 1.Have a sound theoretical basis 2.Show maximal co-relation with clinical status 3.Be accurate with respect to duplication of results 4.Be simple 5.Be inexpensive 6.Take little time In addition, a good caries-predictive test should possess at least three characteristics: validity, reliability, & feasibility. 74 8/19/2013

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Lactobacillus colony count Introduced by Hadley in 1933, estimates the number of acidogenic and aciduric bacteria tomato peptone agar plates (pH 5.0) LBS agar (Rogosa) Equipment : saliva-collecting bottles, paraffin, two 9-ml tubes of saline, two agar plates, two bent glass rods, incubator, Quebec Counter and pipettes. Procedure: (before breakfast ) Saliva is collected 1:10 dilution 1:100 dilution 75 8/19/2013

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No. Lactobacilli/ml of saliva Caries activity 0-1000 1000-5000 5000-10,000 >10,000 Little or none Slight Moderate Marked RESULTS COLONIES COUNT DONE BY QUEBEC COUNTER INCUBATED AT 37 C FOR 3 - 4 DAYS 0 0.4 ml of each dilution is spread on the surface of an agar plate 76 8/19/2013

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Snyder test : Action : rapidity of acid formation glucose agar pH 4 to 5 and with bromcresol green as color indicator. Indirectly the tests is also a measure of acidogenic and aciduric bacteria. Equipment : saliva-collecting bottles, paraffin, a tube of Snyder glucose agar containing bromcresol green and adjusted to pH 4 to 5, pipettes, & incubator Procedure:. Saliva is collected Snyder glucose agar melted ,cooled to 50 C Mixed for 3 minutes O 77 8/19/2013

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Time (hrs) 24 48 72 Color Caries Activity Color Caries Yellow Marked Green Continue test Yellow Definite Green Continue test Yellow Limited Green Inactive RESULTS 0.2 ml of saliva pipetted into the tube of agar & mixed Observed after 24, 48 & 72 hrs with white background. Agar allowed to solidify in tube incubated at 37 C 78 8/19/2013

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REDUCTASE TEST : ACTION : indicator molecule, diazoresorcinol,. Test “measures the activity of a single enzyme, reductase. EQUIPMENT: The reductase test comes in a kit (Treatex, C.W. Erwin & Co) that includes calibrated saliva collection tubes with the reagent on the inside of the tube’s cap, plus flavored paraffin. PROCEDURE: Saliva is collected upto 5 ml mixed with fixed amount of diazoresorcinol, 79 8/19/2013

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Color Time Score Caries activity Blue Orchid Red Red Pink or white 15 min 15 min 15 min Immediately Immediately 1 2 3 4 5 Nonconductive Slightly conducive Moderately conducive Highly conducive Extremely conducive RESULTS : Reaction of reagent with reductase enzyme Color change after 30 seconds and 15 minutes 80 8/19/2013

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BUFFER CAPACITY TEST : ACTION : The test measures the number of milliliters of acid required to lower the pH of saliva through an arbitrary pH interval, such as from pH 7 to 6, or the amount of acid or base necessary to bring color indicators to their end point. EQUIPMENT : pH meter and titration equipment, 0.05 N lactic acid, 0.05 N base, paraffin, and sterile glass jars containing a small amount of oil. PROCEDURE : This test, however, does not correlated adequately with caries activity 10 ml of saliva are collected under oil, 1 hr after eating 5 ml is taken, adjusted to pH 7, by adding of lactic acid/base level of lactic acid is re-recorded, L.A is added until a pH of 6 This number can be converted to milliequivalents per liter. 81 8/19/2013

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FOSDICK CALCIUM DISSOLUTION TEST : Action : The test measures the milligrams of powdered enamel dissolved in 4 hours by acid. EQUIPMENT : Powdered human enamel, saliva collection bottles, sterile test tubes, test tube agitation equipment, and equipment for determining the calcium content of the saliva. paraffin, in which case a 5% solution of glucose. PROCEDURE: 25ml of saliva is collected. Part of this is analyzed for calcium content rest is placed in a test tube with about 0.1 g of H.enamel. shaken for 4 hrs & it is again analyzed for calcium content. 82 8/19/2013

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DEWAR TEST : ACTION : similar to the Fosdick calcium dissolution test except final pH after 4 hrs is measured instead of the amount of calcium dissolved. This procedure has not been adequately tested for clinical correlation. MUTANS GROUP OF STREPTOCOCCI SCREENING TESTS : Plaque/ toothpick : Action : The test involves a simple screening of a diluted plaque sample streaked on a selective culture medium. Equipment : Sterile toothpicks, sterile Ringer’s solution (5 ml), platinum loop, mitis-salivarius agar plates containing sulphademeine (1 g/L), incubator. 83 8/19/2013

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RESULTS Dental caries experience Grade Colonies /10 fields No. cases No. cases with new lesions New lesions/yr/ 100 teeth 1 2 3 None < 8 > 8 21 11 12 4 5 12 0-8.34 0-8.64 8.34-21.40 Plaque samples are collected placed in Ringer’s solution mitis salivarious agar plate examined in a low-power microscope aerobic incubation at 37 C for 72 hrs o PROCEDURE: 84 8/19/2013

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SALIVA / TONGUE BLADE METHOD : ACTION: The test estimates the numbers of S mutans in mixed paraffin-stimulated saliva when cultured on mitis-salivarius bacitracin (MSB) agar EQUIPMENT : Paraffin wax, sterile tongue blades, disposable contact petri dish (RODAC) containing MSB agar, incubator. PROCEDURE : 85 8/19/2013

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S MUTANS ADHERENCE METHOD : Action : salivary samples based on the ability of S mutans to adhere to glass surfaces when grown in sucrose-containing broth. Equipment : Tubes, disposable pipettes, incubator. MSB broth Procedure: 86 8/19/2013

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STREPTOCOCCOUS MUTANS DIP-SLIDE METHOD : Action : Classify salivary samples according to estimates of S mutans colonies growing on modified mitis-salivarius agar. Equipment : Paraffin wax, plastic slides coated with MS agar, CO2 tablets, bacitracin disks or tablets, and buffered diluent. Procedure: 87 8/19/2013

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Functional disorders 88 8/19/2013

Hyposalivation:

Hyposalivation Decrease of saliva – hyposalivation. Seen in: Fear and anxiety. Fever. Oral infections. Following administration of drugs salivary antihistamines, phenothiazine, atropine, barbiturates. Mouth breathing. Facial nerve paralysis i.e. Bell’s palsy. 89 8/19/2013

Hypersalivation / Sialorehea/ Drooling :

Hypersalivation / Sialorehea/ Drooling Infants frequently drool; this is normal, especially when “teething”. The complaint of sialorrhoea (excess salivation) at other ages is very uncommon and not always associated with a genuine increase in saliva production. CAUSES OF SIALORHOEA   -         Painful oral lesions. -         Foreign bodies in the mouth. -         Drugs : Anticholinesterases, clorapine, cocaine, iodides, bromides, ammonium, digitalis, benzodiazepines. -         Poor neuromuscular coordination       Cerebral palsy, Parkinson’s disease, facial palsy, learning disability, other physical disability. 90 8/19/2013

Xerostomia :

Xerostomia It refers to subjective sensation of a dry mouth; causes; -Developmental Salivary gland aplasia -Water / metabolite loss Impaired fluid intake, hemorrhage, diarrhea -Iatrogenic Medications, radiation therapy -Systemic diseases Sjogren’s syndrome, diabetes mellitus, HIV infection 91 8/19/2013

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Medication that causes Xerostomia; 1.Antihistamines- Diphenhydramine Clorpheniramine 2.Decongestants- Pseudoephedrine 3.Antidepressants- 4.Antipsychotics- Phenothiazine derivatives 5.Antihypertensives- Methyldopa Chlorthiazide Calcium channel blockers 6.Anticholinergics- Atropine 92 8/19/2013

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Treatment; -Artificial saliva -Sugarless candy-to stimulate salivary flow -Systemic Pilocarpine-to increase salivary secretion 93 8/19/2013

Conclusion:

Conclusion Saliva is the most important oral fluid secreted by salivary glands and plays an important role in preservation and maintenance of oral tissues and for the metabolic health of the mouth as a whole. Saliva has also become useful as a non invasive systemic sampling measure for diagnosis and research. Consequently, it is necessary for the clinicians to have good knowledge base, regarding structure of salivary glands, salivary flow, function etc to assess treatment plan & prognosis and easier handling of clinical cases. 94 8/19/2013

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95 B.D.Chaurasia’s, Human Anatomy,Head and Neck, Vol 3, edition :4 ;2004 Anil Govindrao Ghom, Textbook of Oral Medicine, edition:1; 2005 Antonio Nanci ,Ten Cate’s Oral Histology, edition:6;2005 S.K.Chaudhary, Concise Medical Physiology,edition:5;2005 Shaffer’s Oral Pathology; edition:5;2006 Orban’s, Orban’s Oral Histology; edition:5;2007 Soben Peter, Essential of Preventive & Community Dentistry:2;2004 References 8/19/2013

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96 S.J Moss ; Dental erosion; I.D.J; 98 (48)’; 529 – 539 . John Featherstone; The caries balance: contributing factors and early detection; Feb. 03; Journal of California Dental Association . Bite sized tutorials ; www.google.com . Current concepts of caries – Nature, etiology & clinical aspects of caries diagnosis - practice information sheet no. 1; Colgate caries control program Shipley, Taylor, Mitchell; Identifying causes of dental erosion; C.D.E; Operative dentistry ; Jan – Feb. 05; 73 – 75 . Gandara, Truelove; Diagnosis & management of dental erosion; J. Contemp. Dent. Prac.; Vol.1 ; No. 1; Feb. 99 . Schroeder, Filler, Ramirez, Lazarchik, Vaezi, Richter; Dental erosion and acid reflux disease ;Annals of Internal Medicine; June 95; Vol. 122 ;Issue 11; 809 - 815 . Better oral health info.; professional ; www.google.com . www . gcamerica . com; saliva check; www.google.com 8/19/2013

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