Cario - Saliva and Dental Caries

• It forms a protective mucoid coating on the  mucous membrane which acts as a barrier to  irritants and prevents dessication.

• Its flows helps to clear mouth of food and  cellular and bacterial debris and  consequently retards plaque formation

• It is capable of regulating the pH of the oral  cavity by the help of its bicarbonate content  as well as its phosphate and amphoteric  protein constituents.

• Increase in secretion rate usually results in  an increase in pH and buffering capacity.

• Because of its calcium and phosphate content it helps to maintain the integrity of teeth.

• Tooth dissolution is prevented or retarded  and re-mineralization is enhanced by the  presence of copious salivary flow.

• The film of glycoprotein formed on the tooth  surface by saliva (the acquired pellicle) may  also protect the tooth by wear due to erosion  and abrasion.

• Capable of considerable antibacterial and antiviral activity by virtue  of its content of specific antibodies  (secretory IgA) as well as lysozyme,  lactoferrin, and lactoperoxidase.

FUNCTIONS OF SALIVA

• Radiotherapy

• Drugs

• Disease

• Age

What are the causes of reduced salivary flow?

Radiotherapy

• Causes severe reduction in salivary flow  (less than 0.1ml/min).

• When the parotid gland is involved, there is  also a considerable increase in its total  protein content resulting in a thick, viscous  secretion.

parotid gland

When the ________ is involved, there is  also a considerable increase in its total  protein content resulting in a thick, viscous  secretion.

• Antidepressants

• Antihistamine

• Antipsychotics

• Sedatives

• Methyldopa

• diuretics

• Drugs that decrease saliva production including certain:

Disease

May all lead to hyposalivation.

• Acute and chronic inflammation of the  salivary glands (sialadenitis)

• Benign or  malignant tumors

• Sjogren  syndrome

• Acute and chronic inflammation of the  salivary glands (sialadenitis)

• Benign or  malignant tumors

• Sjogren  syndrome

Causes of hyposalivation

Age

• ______  itself affects  moisture in the  mouth only slightly.

• Older people are  more likely to take  drugs that may dry  the mouth.

Older people

________ are  more likely to take  drugs that may dry  the mouth.

0.3 and  0.5ml per minute

The normal resting or un-stimulated secretion rate in adults is between ______. 

1-2 ml per minute.

The normal stimulated secretion rate in  adults is ______. 

0.1 ml/min

However, the rates may be reduced to less  than ______ OR may not be  measurable in individuals with severe  salivary gland malfunction. 

0.7 and 1.0 ml/min.

In less severe cases of hypo-salivation the  stimulated secretion rate is between ______.

XEROSTOMIA

The term _______ is used to describe  the perception of a dry mouth.

• Parotid secretions are watery and clear

• Minor salivary glands in the mouth and throat  produce secretions that are more viscous  and ropy.

• Under normal conditions the parotid glands  produce 50% of the stimulated saliva and  20% of the resting saliva.

• Most of the resting saliva is produced by the  submandibular (65%), sublingual (7-8%) and  minor salivary glands (7-8%).

• Resting saliva is therefore more viscous than  stimulated saliva.

COMPOSITION AND VISCOSITY OF SALIVA

50%, 20%

Under normal conditions the parotid glands produce: 

1. ________ stimulated saliva

2. ________ of the resting saliva

65%, 7-8%, 7-8%

Most of the resting saliva is produced by the 

• submandibular:

• sublingual

• minor salivary glands 

• Mucositis presents as tenderness, pain, or a  burning sensation and is exacerbated by spicy  foods, fruits, carbonated beverages, hot drinks  and tobacco.

• Taste sensation is altered

• Chewing, speaking and swallowing present  difficulties.

• Extreme sensitivity of teeth to heat and cold,  especially if dentine is exposed

• Edentulous patients may have problems  tolerating dentures.

• Increase in dental plaque accumulation,  which makes gingivitis more likely

• There is also modification of the plaque flora  in favor of Candida, mutans streptococci and  lactobacilli.

GENERAL CONSEQUENCES OF REDUCED SALIVARY FLOW

• Drug history

• Salivary flow assessment: flow rate peaks during the afternoon. The patient should not eat or drink (except water) for at least 1 hour before collection.

CLINICAL MANAGEMENT OF DRY MOUTH

• Sipping water frequently all day long

• Restricting intake of substance that exacerbate dryness such as cigarettes, caffeine-containing drinks

• Avoiding astringents products such as alcohol-containing or strong mint flavored mouthwashes, strongly flavored toothpastes.

• Coating the lips with vaseline

• Humidifying the sleeping area.

CONSERVATIVE MEASURES TO RELIEVE SYMPTOMS

• Chewing a sugar free chewing gum (xylitol or chlorhexidine).

• Some fruits drops flavored with artificial sweeteners, normally marketed for diabetics, will not cause caries but are very acidic and may dissolve enamel and dentin

• SST (sinclair), is a saliva stimulating tablet which is sucked.

• It is formulated with the buffer(phosphate) so that it does not cause tooth damage

• Salivix (Provalis) lozenges

• Systemic use of drugs such as pilocarpine hydrochloride has proved successful in stimulating saliva

• Stimulates parasympathetic nervous system. (recommended dose 5 mg OD once side effects tolerated than 5mg*tds daily.

• Side effects: include sweating, flushing, nausea, and diarrhea, slow pulse rate, fall in BP, and cause reflex narrowing of airways.

• Contraindicated: in pts. with cardiac and respiratory problems.

SALIVARY STIMULANTS

• Sprays (saliveze, glandosane etc.)

• Lozenges (saliva orthana)

• Mouthwashes

SALIVA SUBSTITUTE

SALIVA AND CARIES

• The flow of saliva can reduce plaque accumulation on the tooth surface.

• The diffusion into plaque of salivary components such as calcium, phosphate, hydroxyl and fluoride ions enhances re- mineralization of early carious lesions.

• The carbonic acid-bicarbonate buffering system as well as ammonia and urea constituents of the saliva act as buffer

• The total concentration of IgA in saliva may be inversely related to caries experience.

• Lysozyme, lactoperoxidase and lactoferrin in saliva have a direct antibacterial action on plaque

• Salivary proteins could increase the thickness of the acquired pellicle and so help to retard the movement of calcium and phosphate ions out of enamel.

• carbonic acid-bicarbonate buffering system

• ammonia

• urea constituents

The ________ as well as ________ and ________ of the saliva act as buffer!

Lysozyme, lactoperoxidase and lactoferrin

______, ______, ______in  saliva have a direct antibacterial action on  plaque!

• Plaque control

• Dietary control

• The use of fluoride (sodium fluoride 0.05% NaF)

• Chlorhexidine gel application

PREVENTIVE MEASURES FOR PATIENTS WITH DRY MOUTHS

increase the  thickness of the acquired pellicle

Salivary proteins could _____________ and so help  to retard the movement of calcium and  phosphate ions out of enamel.

SALIVARY PROTEINS

It could increase the  thickness of the acquired pellicle and so help  to retard the movement of calcium and  phosphate ions out of enamel.

• The patients should see the  dentist at least every 3  months

• Plaque control needs to be  excellent and professional  plaque control should be  considered.

• The stimulated flow rate should be measured  every 3-4 months to help establish the level  of caries risk.

• Dentists should emphasize the importance  of avoiding sweet drinks and snacks. The  bedtime sweet drink is particularly  dangerous.

• Patients should be discouraged from  attempts to stimulate salivary flow by sucking  sweets. Instead, chewing xylitol gum will be  safer and effective.

• Patients should use a sodium fluoride (0.05%  NaF) mouthrinse daily for several year.

• A 1% chlorhexidine gel (Corsodyl) should be  applied by the patient in custom-made  applicator trays for 5 minutes every night for 14  days.

• This is repeated every 3-4 months until salivary  flow returns to normal.

• This keeps the level of mutans streptococci in  control for at least 3 months.

• Caution: Chlorhexidine is inactivated by  sodium lauryl sulfate, so patients therefore  be instructed to rinse toothpaste out  thoroughly before any application of  chlorhexidine.

• Patient should also avoid smoking, caffeine  based drinks since they exacerbate the  problem.

CARIES CONTROL STRATEGIES

TRUE

When the amount (concentration) of IgA in saliva is high, a person tends to have fewer dental caries (cavities); and when IgA is low, they tend to have more.

3-4 months

The stimulated flow rate should be measured  every ? to help establish the level  of caries risk.