saliva

generally what is saliva composed of

99.5% water and 0.5% dissolved solutions

what are the components that makes up saliva

• salivary proteins and glycoproteins

• inorganic ions

• gases

what type of salivary proteins and glycoproteins are in saliva

amylase, cystatins, mucins, growth factors, antimicrobials, lipase

what type of inorganic ions are in saliva

bicarbonate, calcium, and phosphate ions

critical pH for enamel

5.2 to 5.5

critical pH for cementum

6.1-6.7

what is the most common cause of dry mouth

medication, usually >/= 4

other than medications, what are some causes of dry mouth

• therapeutic radiation

• autoimmune disease → Sjogren’s syndrome

how do medications alter signaling within salivary glands

alter receptors

what receptors are affected by medications inducing dry mouth

• adrenergic receptors

  • alpha and beta

• cholinergic

• Ca signaling and cross-talk

how can radiation to the head/neck region cause salivary dysfunction

salivary glands will get direct toxicity from radiation; damage occurs when dose to gland > 2000cGy

how might pts present w salivary dysfunction caused by head and neck radiation

pt will complain of lack of saliva or excessive, thick mucus and ropy saliva

what do you look for in a saliva test

• hydration

• unstimulated saliva

• stimulated saliva

if you do a saliva test and it came out healthy, but your pt has severe caires, what is the likely cause to the pts caries

diet

what are the 5 preventative strategies for dry mouth

• strengthen enamel and root cement/dentin

• compensate for loss of saliva

• compensate for loss of buffer capacity

• reduce glucose intake

• reduce bacterial growth

how can you strengthen enamel/tooth structure in your pt w dry mouth

• NaF- toothpaste, rinse, varnish, SDF

• aid in remineralization w Ca → Ca containing toothpaste

how can you compensate for loss of saliva in your pt w dry mouth

• drink water→ NOT carbonated water

• lubricate oral mucosa

how can you compensate for loss of buffer capacity in your pt w dry mouth

• alkalinize water w baking soda, avoid carbonation

• brush w baking soda toothpaste

• change diet to more neutral pH foods

• incorporate more raw food into diet → chew more → inc saliva secretion → inc pH

how can you reduce glucose intake in your pt w dry mouth

use xylitol instead- not more than 5g/day

how can you reduce bacterial growth in your pt w dry mouth

• chlorhexidine MW for short term

• antimicrobial rinse for temporary use

• reduce sugar intake

pH in blood is super stable, what is it

7.35-7.45

fluid and electrolytes present in saliva are derived from where

blood plasma → ion channels and water channels

what are the 3 major salivary glands

• parotid gland

• submandibular gland

• sublingual gland

which salivary gland is more active during eating and chewing → more active during stimulation

parotid → 50% of secretions come from here

what are the minor salivary glands

• mucous glands

• serous glands

• mixed glands

what are the mucous salivary glands

• palatine glands

• posterior lingual glands

what are the serous glands

glands of von ebner

what are the mixed salivary glands

• anterior lingual glands

• buccal glands

• labial glands

which major salivary gland secretes more unstimulated/resting saliva

submandibular gland

what are factors that explain why the pH of the saliva isn’t the same as the pH of the blood/plasma

• may contain potential refluxed materials

• fluids from gingival sulcus

• food derived compounds

• blood-derived compounds

• secretions from salivary glands and epithelial cells and bacteria

what role does carbonic anhydrase play in saliva

is found in saliva, will catalyze the rxn between free hydrogen ions from the acid and the bicarbonate ions → H ions will combine w bicarb ions in the oral cavity → inc pH → normal pH

what are the buffer capacity/acid neutralization components of saliva

salivary pH increasingly more alkaline w increased flow rates

• bicarb buffer

• phosphate buffer

• protein buffer

funx of bicarb buffer in saliva

main buffering system, highest buffering capacity for pH above 4.5; between pH 5-7

phosphate buffer capacity

between pH 5-7

protein buffer capacity

between pH 4 -5

first step of saliva test

dry mucosa, and time 60 seconds to see if rehydration occurs

if the mucosa DOES NOT rehydrate within 60 seconds…

low hydration

if the mucosa DOES rehydrate within 60 seconds…

normal hydration

second step of saliva test

check unstimulated saliva → the pt will spit out saliva continuously → we will collect this in a medicine cup → do this for 5 min → will use a scale to measure amount in cup and check pH

if unstimulated saliva test flow is <0.1 mL/min

low unstimulated salivary flow

if unstimulated saliva test flow is 0.2-0.4 mL/min

normal flow

what foamy saliva means

lots of protein → good protein buffer → is GOOD

third step of saliva test

stimulated saliva → pt chew on paraffin wax for 5 min → check pH, buffering capacity, and flow

if stimulated salivary flow is <0.7 mL/min

low stimulated saliva

what factors can contribute to root surface lesions

• diet

• plaque

• fluoride program

• saliva secretion

• caries risk

what kind of diet would contribute to root surface lesions

frequency in meals → 6-7 meals/day or 7+ meals/day

what amount of plaque could contribute to root surface lesions

large quantities

what kind of fluoride program could contribute to root surface lesions

pt is avoid fluoride

what kind of salivary secretion contribute to root surface lesions

• unstimulated saliva, </= 0.16 mL/min

• stimulated saliva, </= 0.7 mL/min

what caries risk would contribute to root surface lesions

high caries risk

what are some dental products you can rx and recommend to pts w dry mouth

• toothpaste → OTC or Rx

• apple a paste during the day → MI paste/plus

• use a gel to moisturize → oralbalance

• moisturize your own saliva during the day and night → xylitol

• Good Candy → xylitol candy

• chlorhexidine MW → for high caries risk pts ONLY

it is indicated to evaluate salivary flow if (2)

• if pt has visibly dry mouth OR is assessed as having a high caries risk

• is salivary flow is low due to polypharmacy

you can work w your pt on stimulation salivary flow through…

• dietary changes

• preventative care → Rx, oral hygiene

how is salivary flow stimulated

• mechanoreceptors

• tastebuds

• masticatory stimuli

low pH for exposed root surfaces are food w a pH at or below…

6.1-6.5

what type of foods do you wanna encourage your pt to remove from their diet if they have salivary issues

sticky foods, foods containing simple carbohydrates, and foods w low erosive pH