Saliva and dental caries

DR. KAUSER SADIA FAKHRUDDIN

FUNCTIONS OF SALIVA

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

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

FUNCTIONS OF SALIVA

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.

FUNCTIONS OF SALIVA

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.

FUNCTIONS OF SALIVA

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.

FUNCTIONS OF SALIVA

Saliva is capable of considerable anti-bacterial and anti-viral activity by virtue of its content of specific antibodies (secrtetory IgA) as well as lysozyme, lactoferrin, and lactoperoxidase.

CAUSES OF REDUCED SALIVARY FLOW

RADIOTHERAPY:

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

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

DRUGS:
DRUGS THAT DECREASE SALIVA PRODUCTION INCLUDE CERTAIN ANTIDEPRESSANTS, ANTIHISTAMINES, ANTIPSYCHOTICS, SEDATIVES, METHYLDOPA, AND DIURETICS.

DISEASE

Acute and chronic inflammation of the salivary glands (sialadenitis), benign or malignant tumors, as well as Sjogren syndrome, may all lead to hyposalivation.

AGE: Although aging itself affects moisture in the mouth only slightly. Older people are more likely to take drugs that may dry the mouth.

FACTS

The normal resting or un-stimulated secretion rate in adults is between 0.3 and 0.5ml per minute

The normal stimulated secretion rate in adults is 1-2ml per minute.

FACTS

However, the rates may be reduced to less than 0.1 ml per min or may not be measurable in individuals with severe salivary gland malfunction.

FACTS

In less severe cases of hypo-salivation the stimulated secretion rate is between 0.7 and 1.0 ml per min.

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

COMPOSITION AND VISCOSITY OF SALIVA

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

COMPOSITION AND VISCOSITY OF SALIVA

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

COMPOSITION AND VISCOSITY OF 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.

GENERAL CONSEQUENCES OF REDUCED SALIVARY FLOW

GENERAL CONSEQUENCES OF REDUCED SALIVARY FLOW

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.

GENERAL CONSEQUENCES OF REDUCED SALIVARY FLOW

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

Edentulous patients may have problems tolerating dentures.

GENERAL CONSEQUENCES OF REDUCED SALIVARY FLOW

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.

CLINICAL MANAGEMENT OF DRY MOUTH

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.

CONSERVATIVE MEASURES TO RELIEVE SYMPTOMS

Sipping water frequently all day long.

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

CONSERVATIVE MEASURES TO RELIEVE SYMPTOMS

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

Coating the lips with vaseline Humidifying the sleeping area.

SALIVARY STIMULANTS

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 dentine.

SALIVARY STIMULANTS

SST (sinclair), is a saliva stimulating tablets which is sucked. It is formulated with the buffer(phosphate) so that it does not cause tooth damage

SALIVARY STIMULANTS

Salivix (Provalis) lozenges

Systemic use of drugs such as pilocarpine hydrochloride has proved successful in stimulating saliva. Stimulates parasympathetic nervous system. (recommended dose 5mg OD once side affects tolerated then 5mg*tds daily.

SALIVARY STIMULANTS

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

Contraindicated: in pts. with cardiac and respiratory problems.

SALIVA SUBSTITUTE

Sprays (saliveeze, glandosane etc.) Lozenges (saliva orthana) Mouthwashes

Calcium Phosphate

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 remineralization of early carious lesions.

IgA

SALIVA AND CARIES

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.

lactoperoxidase

lysozyme

SALIVA AND CARIES

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.

PREVENTIVE MEASURES FOR PATIENTS WITH DRY MOUTHS

Plaque control Dietary control The use of fluoride (sodium fluoride 0.05% NaF) Chlorhexidine gel application

CARIES CONTROL STRATEGIES

CARIES CONTROL STRATEGIES

The patients should see the dentist at least every 3 months

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

CARIES CONTROL STRATEGIES

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

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

CARIES CONTROL STRATEGIES

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

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

CARIES CONTROL STRATEGIES

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.

CARIES CONTROL STRATEGIES

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.