Saliva and caries

DR. KAUSER SADIA FAKHRUDDIN

Saliva and dental caries

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.

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.

FUNCTIONS OF SALIVA

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.

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.

FACTS

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.

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.


GENERAL CONSEQUENCES OF REDUCED

SALIVARY FLOW


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.


SALIVARY FLOW

Extreme sensitivity of teeth to heat and cold,

especially if dentine is exposed.

Edentulous patients may have problems

tolerating dentures.


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

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

SALIVARY STIMULANTS

Chewing a sugar free chewing gum (xylitol or

chlorhexidine).

Some fruits drops flavored with artificialsweeteners, normally marketed for diabetics,will not cause caries but are very acidic and maydissolve enamel and dentine.

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.

SALIVARY STIMULANTS

SALIVA SUBSTITUTE

Sprays (saliveeze, glandosane etc.)

Lozenges (saliva orthana)

Mouthwashes

PhosphateCalcium

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.

SALIVA AND CARIES

lysozyme

lactoperoxidase

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.

SALIVA AND CARIES

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

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.

Dentist should emphasize on 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.

Patient 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.


Saliva and caries

Education

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