SALIVA

Presented by-
Dr Aishwarya Srivastava
PG 1ST YEAR
Department of
Paedodontics and
Preventive dentistry
 CONTENT
• DEFINITION
• CLASSIFICATION OF SALIVARY GLANDS
• NERVE SUPPLY OF SALIVARY GLANDS
• COMPOSITION OF SALIVA
• REFLEX REGULATION OF SALIVARY SECRETION
• CORELATION BETWEEN SALIVA AND DENTAL CARIES
• EFFECTS OF DRUGS ON SALIVARY SECRETIONS
• FUNCTIONS OF SALIVA
• FORMATION OF SALIVA
• PROPERTIES OF SALIVA
• CLINICAL CONSIDERATIONS OF SALIVA
• CONCLUSION
• REFERENCES
DEFINITION

According to British Medical Association-

Saliva is the watery , slightly alkaline fluid secreted into the mouth by salivary
glands and mucous membrane that lines the mouth.

According to Webster Medical Dictionary

A slightly alkaline secretion of water, mucin, proteins, salts, and often a starch
splitting enzyme(as ptylin) that is secreted into the mouth by salivary glands ,
lubricates ingested food, and often begins the breakdown of starches.
CLASSIFICATION OF SALIVARY GLANDS

According to size and location

MAJOR SALIVARY GLANDS
• Parotid gland
• Submandibular gland
• Sublingual gland.
MINOR SALIVARY GLANDS
• Lingual serous
• Lingual mucous
• Buccal glands
• Labial glands
• Palatal glands.
According to the histochemical nature of secretory products.

Serous glands.
• Parotid gland.
• Lingual gland.
Mucous glands.
• Lingual mucous.
• Buccal glands.
• Palatal glands.
Mixed glands.
• Submandibular gland.
• Sublingual gland.
• Lacrimal glands.
MAJOR SALIVARY GLANDS
PAROTID GLAND
•Parotid gland is the largest salivary gland. It is irregular, wedged shape and
unilobular.
•Parotid is 14-28 grams in weight and provides 60-65% of total salivary
volume.
•Size averaging 5.8 cm ( cranio-caudal dimension), 3.4 cm (ventral-dorsal
dimension).
• It lies between the mastoid process and vertical ramus of the mandible .
•These glands are situated at
the side of the face just below
and infront of the ear .
•The main parotid duct –
Stensen's duct leaves mesial
angle of gland traverses over
the masseter, pierces buccinator
and enters oral cavity buccal to
maxillary 2nd molar. Duct is
about 35 to 40 mm long .
Mainly Serous in secretion.
Blood supply : Parotid gland is supplied by the external
carotid artery and its branches near the gland.
Lymphatic drainage: Drains first to the parotid nodes and
from there to the upper deep cervical nodes.
Nerve supply: It is supplied by auriculotemporal nerve,
plexus around the external carotid artery and greater
auricular nerve.
Submandibular Gland
•Also called as Submaxillary gland. It
is irregular and Walnut shaped.

•It is 10-15gm in weight and

produces 20-30% of total salivary
volume.

•Located in the submandibular triangle

of the neck, inferior & lateral to
mylohyoid muscle.
•The posterior-superior portion of the gland curves up
around the posterior border of the mylohyoid and gives rise
to Wharton’s duct.

•Wharton’s duct passes forward along the superior surface

of the mylohyoid adjacent to the lingual nerve. It is 2-4mm
in diameter & about 5cm in length.

•Wharton’s duct, opens at the side of frenulum of tongue

by the means of small opening on the papilla called
Caruncula Sublingualis.
SUBLINGUAL
GLAND

• The sublingual glands are

the smallest of the major
salivary glands, produces 2-5%
of the total salivary volume.
• Each is of the size and shape
of an almond and weighs 3-4
gms.
•Glands lie beneath mucosa of
floor of mouth, above mylohyoid
muscle, medial to mandible and
lateral to genioglossus.
•The ducts of the sublingual glands are called
Bartholin’s ducts.
•In most cases, Bartholin’s ducts consists of 8-20
smaller ducts of Rivinus. These ducts are short and
small in diameter.
•Open into oral cavity at the sublingual fold on
either side of the tongue.
MINOR SALIVARY GLANDS
•The minor salivary glands are located beneath the epithelium in almost all
parts of the oral cavity. These glands usually consist of several small groups of
secretory units opening via short ducts directly into mouth.

•There are 600 to 1000 minor salivary glands lying in the oral cavity and
the oropharynx.

•The minor salivary glands are classified according to their anatomic location.
1. Labial and Buccal Glands
• Labial glands - situated beneath the mucous membrane around the
orifices of mouth. They are circular in form, and about the size of
small peas; their ducts open by minute orifices upon the mucous
membrane.
• Buccal glands – present between the mucous membrane and
buccinator muscle.

2. Glossopalatine Glands
• The glossopalatine glands are pure mucous glands, they are
principally localized to the region of the isthmus in the
glossopalatine fold.
3. Palatine Glands
•They consist of several hundred glandular aggregates in the lamina propria
of the posterior region of the hard palate and in the submucosa of the soft
palate.The opening of the ducts on the palatal mucosa are often large and
easily recognized.

4. Lingual Glands
•The glands of the tongue are divided into several groups:
(a)The anterior lingual glands (glands of BLANDIN AND NUHN).
• Location – near the apex of tongue.
• The anterior region of this glands are chiefly mucous in character, whereas
the posterior region is mixed.
(b)The posterior lingual mucous gland.
•Location -lateral and posterior to the vallate papillae and in association
with the lingual tonsil.
(c)The posterior lingual serous gland (Von Ebner’s glands).
• Location -between the muscle fibers of the tongue below the vallate
papillae.
NERVE SUPPLY OF SALIVARY
GLANDS
•Salivary glands are under the control of autonomic nervous
system and receive efferent nerve fibres from both parasympathetic
and sympathetic divisions of autonomic nervous system.

•The parasympathetic nerve fibers supplying the salivary glands

arise from the superior and the inferior salivatory nuclei, which are
situated in pons and medulla respectively.

•The sympathetic fibres to salivary glands arise from the lateral

horns of first and second thoracic segments of spinal cord.
Organic Substances
Enzymes
1-Amylases
• Calcium metalloenzyme.
• Hydrolyzes alpha (1-4) bonds of starches such as amylase and
amylopectin.
• Several salivary isoenzymes.
• Maltose is the major-end-product (20% is glucose).
• Appears to have digestive function.
2-Lactoferin
•Iron-binding protein.
•“Nutritional” immunity (iron starvation).
• Some microorganisms (e.g., E. coli) have adapted to this mechanism by
producing enterochelins.
• bind iron more effectively than lactoferrin.
• iron-rich enterochelins are then reabsorbed by bacteria.
• Lactoferrin, with or without iron, can be degraded by some bacterial
proteases.
3- Histatins
• A group of small histatine-rich proteins are the potent
inhibitors of Candida albicans growth.

4- Cystatins
• Are inhibitors of cystatine-proteases.
• Are ubiquitous in many body fluids.
• Considered to be protective against unwanted proteolysis.
• May inhibit proteases in periodontal tissues.
• Also have an effect on calcium phosphate precipitation.
5- Lingual lipase
• Secreted by Von Ebners' glands of tongue. Involved
in first phase of fat digestion.
• Hydrolyzes medium – to long – chain triglycerides.
• Important in digestion of milk fat in new-born.
• It is highly hydrophobic and readily enters fat globules.

6- Statherins
• Calcium phosphate salts of dental enamel are soluble under
typical pH and ionic strength.
• Super saturation of calcium phosphates maintain enamel
integrity.
• Statherins prevent precipitation or crystallization of supersaturated calcium
phosphate in ductal saliva & oral fluid.
• Produced by acinar cells.
• Also an effective lubricant.
7-Proline Rich Proteins (PRPs)
• Like statherins PRPs are also highly asymmetrical.
• Inhibitors of calcium phosphate crystal growth.
• Inhibition due to first 30 residues of negatively charged amino - terminal
end.
• Present in the initially formed enamel pellicle & in ‘mature’ pellicle.
8- Mucins
• Lacks precise folded structure of globular proteins.
• Asymmetrical molecule with open, randomly organized structure,
polypeptide backbone with -CHO side chains.
• Side chains may end in negatively charged groups such as sialic acid &
bound sulphate.
• Hydrophilic, entraining water.
• Unique rheological properties.
• Two major mucins ( MG1 & MG2).
 FUNCTIONS OF MUCIN

A) TISSUE CAPACITY
• Protective coating of hard & soft tissues.
• Primary role in formation of acquired pellicle.
• Concentrates anti – microbial molecules at mucosal interface.

B) LUBRICATION
• Have lubricating qualities and align themselves with direction of flow of
saliva.
C) AGGREGATION OF BACTERIAL CELLS
• Bacteria adhere to mucins may result in surface attachment.
• Mucin coated bacteria may be unable to attach to surface.

D) BACTERIAL ADHESION
• Mucin oligosaccharides mimics those on mucosal cell surface.
• React with bacterial adhesions, thereby blocking them.
Inorganic Substances

1-SODIUM
• Contributes to osmolarity of saliva (osmolarity is ½-3/4th of blood).
• Sodium concentration give diagnostic information relating to the efficiency
of ductal transport system.

2-CALCIUM
• Saliva is supersaturated with calcium and hence, prevents
dissolution of enamel.
• It also facilitates enamel mineralization.
3- POTASSIUM
• Contributes to osmolarity of saliva.
• Potassium reaches saliva by active processes in both acini and ducts.
• Concentration falls immediately after stimulation and then approximately
constant.

4- BICARBONATE
• Most important buffer in saliva [resist change in salivary pH when acid or
alkali added].
• Bicarbonates release weak carbonic acid when acid is added; this is rapidly
decomposed to H2O and CO2 which leaves the solution resulting in complete
removal of acids.
5- CHLORINE
• Contributes to osmolarity of saliva.
• Increased flow rate leads to increased chloride reabsorption.

6- FLUORIDE
• Fluoride is well known for its anti - caries property.
• Peak concentration of fluoride in saliva are observed some 30-60 minutes after
ingestion of fluoride dose.

7- PHOSPHOROUS
• It is actively transported into saliva, probably mainly in the acini but possibly
also in the ducts.
REFLEX REGULATION OF SALIVARY
SECRETION

•Salivary secretion is regulated by nervous mechanism & it is a

reflex phenomenon.
•Salivary reflexes are of two types:-
1)Unconditioned reflex.
2)Conditioned reflex.
1)UNCONDITIONED REFLEX
• Secretion of saliva when any substance is in the mouth is called the
unconditioned reflex.
• It is due to the stimulation of nerve endings in the mucuos membrane of the oral
cavity.
• This reflex is present since birth & hence it is also called inborn reflex.

2) CONDITIONED REFLEX
• Secretion of saliva by the sight, smell or thought of food is called conditioned
reflex.
• It is due to the impulses arising from the eyes, ear, etc. It is an
acquired reflex & needs previous experience
CO-RELATION BETWEEN SALIVA AND
DENTAL CARIES
• Saliva is capable of regulating the pH of the oral cavity with 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 and re - mineralization is enhanced by the
presence of copious salivary flow.
EFFECTS OF DRUGS AND CHEMICALS ON
SALIVARY SECRETION

SUBSTANCES WHICH INCREASE THE SALIVARY SECRETION

• Sympathomimetic drugs like adrenaline and ephedrine.
• Parasympathomimetic drugs like choline, pilocarpine,
muscarine and physostigmine.
• Histamine
SUBSTANCES WHICH DECREASE SALIVARY
SECRETION

• Sympathetic depressants like ergotamine and dibenamine

• Parasympathetic depressants like atropine and scopolamine.
FUNCTIONS OF
SALIVA
 FORMATION OF SALIVA
The secretory acinus produces the primary saliva, which is isotonic with an
ionic composition resembling that of plasma. In the duct system, the primary
saliva is then modified by selective reabsorption of Na+ and Cl- (without
water) and secretion of K+ and HCO3-.

 Salivary secretion is a two-stage process:

• Initial Formation stage involves acini to secrete a primary secretion
that contains ptyalin and/or mucus in a solution of ions similar in
plasma.
• Modification stage is when the primary secretion flows through the
ducts and the ionic composition of saliva is modified.
• Initial Formation Stage:

Stimulation of the parasympathetic nerve, or mainly muscarinic

cholinergic receptors, initiates intracellular second messenger
events of acinar cells, the signal transduction system involves the
release of Ca2+ from intracellular stores. The increase in
intracellular Ca2+ levels leads to the Cl– channels at the apical
membrane to open and an influx of Cl– into the lumen. Hence the
change in electronegativity by Cl– influx causes Na+ to diffuse
across the cation-permeable tight junction between acinar cells to
preserve electroneutrality within the lumen. The net influx of NaCl
creates an osmotic gradient across the acinus, which draws water
from the blood supply via a tight junction. Thus, saliva secreted in
the lumen (primary saliva) is an isotonic plasma-like fluid.
 • Modification Stage:

In the next step, the composition of primary saliva is modified in the duct
system. The intralobular ducts reabsorb Na+ and Cl– excluding water and make
the final saliva hypotonic. Stimulation of the sympathetic nerve, or ß-
adrenergic receptors, causes exocytosis but less fluid secretion. Activation of ß-
adrenoceptors increases the intracellular cyclic adenosine monophosphate
(cAMP) level, which is the primary second messenger for amylase secretion.
cAMP is thought to activate protein kinase which may regulate the process by
which cells release the contents of their secretory granules. This involves the
fusion of the granule membrane with the luminal plasma membrane of the
secretory cell followed by rupture of the fused membranes. The released
contents of granules comprise a wide variety of proteins which are unique to
saliva and show biological functions of particular importance to oral health.
Stimulation of the sympathetic nerve, or ß-adrenergic receptors.

Causes exocytosis.

Increases the cAMP level.

Activate protein kinase

Release the contents of their secretory granules.

Fusion of the granule membrane with the luminal plasma membrane.

Rupture of the fused membranes.

Released contents of granules comprise a wide variety of proteins.

Important for oral health.

PROPERTIES OF SALIVA
• VOLUME:- 1000 to 1500 ml of saliva is secreted per day and , it is
approximately about 1 ml/minute . Contribution by each major salivary
gland is
REACTION:- mixed saliva from all the glands is slightly acidic
with pH of 6.35 to 6.85.
SPECIFIC GRAVITY:- it ranges between 1.002 to 1.012.
TONICITY :- saliva is hypotonic to plasma.
CLINICAL CONSIDERATIONS OF
SALIVA
1.HYPOSALIVATION
The reduction in the secretion of saliva is called hyposalivation. It is of two types:
• Temporary

• Permanent

1) Temporary hyposalivation occurs in

i) emotional conditions like fear.
ii) fever.
iii) 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.
• Dry mouth (Xerostomia) – It is a frequent clinical complaint. A loss of
salivary function or a reduction in the volume of secreted saliva may lead to
the sensation of oral dryness. This occurs as a side effect of medications
taken by the patient for other problems.

• Many drug cause central or peripheral inhibition of salivary secretion.

• Loss of gland function occurs after radiation therapy for head and neck
cancer because the glands are included in the radiation field, chemotherapy
may also cause this condition. Temporary relief is achieved by frequent
sipping of water or artificial saliva .
SJOGREN’S SYNDROME

• Sjogren syndrome is a chronic autoimmune disorder characterized by

xerostomia (dry mouth), xerophthalmia (dry eyes), and lymphocytic
infiltration of the exocrine glands.

• This triad is also known as the Sicca complex. It is an autoimmune disorder

in which the immune cells destroy exocrine glands such as lacrimal glands
& sweat glands . It is named after HENRIK SJOGREN who discovered it.

• In some cases it causes dryness of skin , nose.

• In severe condition the organs like kidneys, lungs, liver, pancreas, thyroid,
blood vessels & brain are affected.
Caries: a major problem of a reduced salivary flow is the increased
risk of caries as saliva normally washes away acids. There may be
an increase in recurrent decay on coronal as well as root surfaces.

•Incisal edges of anterior teeth may also develop carious lesions

as well as recurrent lesions on the margins of restorations.

Dental erosion: salivary gland hypofunction can cause

deficient remineralisation. Low buffering capacity and flow rate
indicate a greater erosion risk and advice should be given to the
patient to minimise this.
Oral ulceration: reduced saliva flow may result in
recurrent aphthous ulceration, pain, lichen planus,
delayed wound healing and secondary infection,
such as candidiasis.

Mucositis: this is a painful condition where the

mucous membrane of the oral cavity becomes
ulcerated and inflamed. It increases susceptibility
to fungal infections such as candidiasis.
•Mucositis can lead to dysphagia, dehydration
and impaired nutrition.
Swallowing: there are problems with too much saliva or too little
often accompanied by complaints of dysphagia.

Dysgeusia: distortion of taste may occur due to lack of saliva as it

plays a critical role in taste, function as a solvent for food, a carrier
of taste.
• In addition, irradiation of the head and neck area may damage or
destroy taste buds or salivary glands.

Halitosis; Saliva gives rise to bad odours especially during mouth

breathing, prolonged talking or hunger. Eating reduces halitosis
partly because it increases salivary flow and friction in the mouth.
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, aspiration pneumonia, bacteremia, viral infections and
caries in the remaining teeth. Denture fixatives may be required
to retain the removable prosthesis.
2. HYPERSALIVATION
• The excess secretion of saliva is known as hypersalivation.
• Hypersalivation in pathological condition is known as
ptyalism, sialorrhea, sialism or sialosis.

•Hypersalivation occurs in the following conditions :-

• Decay of tooth or neoplasm of mouth or tongue due to continuous
irritation of nerve endings in the mouth.
• Disease of esophagus, stomach & intestine.
• Neurological disorder such as cerebral palsy & mental retardation.
• Cerebral stroke.
• Parkinsonism.
• Some psychological & psychiatric conditions.
• Nausea & vomiting.
DROOLING

• Uncontrolled flow of saliva outside the mouth is called

drooling . It is often called ptyalism.
• Drooling occurs because of excess production of saliva in
association with inability to retain saliva within the mouth.
• Drooling in small children is a normal part of development.
• Teeth are coming in, they put everything in their little mouths, and
they haven’t developed the habit of keeping the lips together.
• While child is teething ,their gums will produce excessive saliva.
• The saliva which is produced during drooling is designed to moisten
and lubricate baby's tender gums.
• Drooling serves to help make teething process more bearable for
child.

CHORDA TYMPANI SYNDROME

• Chorda tympani syndrome is the condition characterized by sweating
while eating. During the regeneration of the nerve fibers following
trauma or surgical division, which pass through chorda tympani
branch of facial nerve may deviate & join with the nerve fibers
supplying sweat glands.
FREY'S SYNDROME or GUSTATORY
SWEATING
• Also known as Baillarger’s syndrome, Dupuy’s syndrome,
Auriculotemporal syndrome or Frey-Baillarger syndrome.

•It is a food related syndrome which can be congenital or

acquired especially 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
 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. It may be
advantageous for dentists to measure the salivary flow of patients on a regular
basis to see if any changes occur over time.

•This knowledge enables early diagnosis, treatment and, if possible,

prevention of problems. Checking the patient’s medical history regularly
can identify conditions or medications that can adversely influence saliva
production.
REFERENCES
1. Kumar GS. Orban's oral histology & embryology. Elsevier Health Sciences;
2014 Feb 10.
2.Sembulingam K, Sembulingam P. Essentials of
medical physiology.
3.Anil govindrao ghom, jaypee brothers medical
publisher, third edition 2014.
4.Rajendran R. Shafer's textbook of oral pathology.
Elsevier India; 2009.