Saliva in dentistry

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“YOU NEVER MISS WATER… UNTIL THE WELL RUNS DRY. . . . . ”

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SALIVAP R E S E N T E D BY :

A P U R V A T H A M P I1 S T Y E A R P G ,

D E P A R T M E N T O F P R O S T H O D O N T I C S

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CONTENTSEmbryology

The development of salivary glands

HistologyThe cell structure of salivary glands

AnatomyThe anatomical structure of the

salivary glands, its nerve and blood

supply

BiochemistryThe composition of

saliva

PhysiologyThe flow of saliva, factors affecting it, and the functions

of saliva

Clinical significance

The collection of saliva and the saliva function

tests

Applied aspects saliva in dentistry

PathologyThe pathologies of the salivary gland,

hyper and hypo secretion of saliva

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Saliva lacks the Drama of Blood, the Sincerity of Sweat,

the Emotional Appeal of Tears and the Intimacy of GCF

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INTRODUCTION

• Watery and frothy in consistency – produced in humans and most animals

• Produced and secreted from the salivary glands• Contains a highly complex mixture of substances• Unique biomarkers that reflect oral and systemic health

THE WATERY ,SLIGHTLY ALKALINE FLUID SECRETED INTO THE MOUTH BY SALIVARY GLANDS AND MUCOUS MEMBRANE THAT LINES THE MOUTH

(British Medical Association)

Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ

(2000)50; 140-161

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HISTORY• Ancient records have proved the use of “Rice Tests” as a

means of proving innocence or guilt.• Traditional Chinese doctors used the thickness and smell of

saliva as diagnostic tools to assess the health of the patient– Over secretion of saliva – heart burn / cold stimulation of the stomach– Sweet saliva – spleen malfunctions

Sreebny, Leo M. : Saliva in health and disease: an apptraisal and update: IDJ

(2000)50; 140-161

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CLASSIFICATION OF SALIVARY GLANDS

Major Parotid

Submandibular

Sublingual

Minor Labial / buccal

Anterior

Palatine

Glossopalatine

Von – ebner’sOrban's oral histology and embryology 10th

ed

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CLASSIFICATION OF SALIVARY GLANDS

Mucous

Serous

Mixed

• Labial & Buccal Glands

• Glossopalatine

• Palatine

• Posterior tongue

• Submandibular & Sublingual

• Anterior tongue

• Parotid

• Glands of Von Ebner

BASED ON TYPE OF SALIVA SECRETED

Orban's oral histology and embryology 10th ed

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EMBRYOLOGY

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DEVELOPMENT OF THE SALIVARY GLANDS

Glands Origin Intrauterine life

Parotid Corners of the stomodeum

6th week

Submandibular Floor of the mouth End of 6th week

Sublingual Lateral to submandibular primordium

8th week

Minor salivary Buccal epithelium 12th weekTucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244

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STAGES IN FORMATION OF SALIVARY GLAND DUCTS

1. Bud formation2. Cord growth3. Branching of cords4. Lobule formation5. Canalization of cords6. Cytodifferentiation

Tucker A.S, salivary gland development, cell developmental biology : 18 (2007) 237-244

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STAGE 1 – BUD FORMATION• 6th week of IUL – cells initiates low level synthesis of salivary secretory proteins


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STAGE 2 – CORD GROWTH

• Formation of stalk - Primary end bud


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STAGE 3 – BRANCHING OF CORDS


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STAGE 4 – LOBULE FORMATION• Arborized pattern – glandular enlargement


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STAGE 5 – CANALIZATION OF CORDS

• First in distal ends of main cord & in branch cords then in proximal part of main cord

• Finally in central portion of main cord


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STAGE 6 - CYTOFIFFERENTIATION• Secretary cell differentiation• Epithelial mesenchymal interactions


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HISTOLOGY

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HISTOLOGY OF SALIVARY GLANDS

• Terminal units – Acini• Made up of epithelial secretory cells – serous and mucus• Arranged in a spherical or tubular shape• Mucous acini have larger lumen than serous acini• Secretory end piece – tubular configuration


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SEROUS CELLS• Pyramidal with broad base – typical of protein

secreting cell• Spherical nucleus placed at the basal region• Apical cytoplasm – accumulation of secretory granules

(1 mm diameter)ZYMOGEN (Formed by glycolated protiens)


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MUCOUS CELLS• Apex appears empty except for thin strands of cytoplasm –

trabecular network• Nucleus is oval or flattened in shape – above the basal

membrane


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MYOEPITHELIAL CELLS• Closely related to secretory and intercalated duct

cells.• Stellate or spider-like – flattened nucleus• Long branching process – fusiform shape• “basket cells” – basket cradling secretory unit• Similar to smooth muscle


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DUCTS• Consists of hollow tubes• Initially connected with acinus – gradually – with other ducts• Grow larger from inner to outer portion of the gland• Actively participates in the production of saliva• Small ducts – intercalated ducts, large ducts – striated ducts• Excretory – interlobular ducts – increase in size, increased amount of

connective tissue


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ANATOMY

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PAROTID GLAND

• Largest salivary gland• Provides 60 – 65% of

total salivary volume• Purely serous

secretions• Pyramidal in shape –

covered by a capusule• Located in the groove

between mastoid process and angle of mandible

Burketts oral medicine diagnosis and treatment planning 10th edition

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BORDERS OF PAROTID GLAND

Superiorly : lower border of the zygomatic archPosteriorly : anterior border of the sternocleidomastoid muscleAnteriorly : posterior border of the masseter muscle


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ANATOMY OF PAROTID GLAND

Nerve supply : • Parasympathetic :

auriculotemporal nerve

• Sympathetic : plexus around the ECA

• Sensory : auriculo temporal nerve

Blood supply : external carotid artery and its branchesBurketts oral medicine diagnosis and

treatment planning 10th edition

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The parotid duct (Stenson’s duct) opens into the buccal mucosa at the upper second molar region

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SUBMANDIBULAR GLAND

• Large salivary gland• Anterior part of

digastric triangle• Mixed secretions –

serous + mucous


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BORDERS OF SUBMANDIBULAR GLAND

• Lateral surface :• Submandibular fossa• Insertion of medial

pterygoid• Facial artery

• Medial surface• Anterior : mylohyoid• Middle : hyoglossus,

styloglossus, lingual nerve

• Posterior : styloglossus, stylohyoid ligament, wall of pharynx


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ANATOMY OF SUBMANDIBULAR GLAND• Nerve supply:

branches from the submandibular ganglion

• Blood supply: facial artery

• Venous drainage: facial and lingual veins

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Submandibular duct opens on the floor of

the mouth, on the summit od the

sublingual papillae, at the side of the frenulum of the

tongue – Warthin’s duct

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SUBLINGUAL GLAND

• Smallest salivary gland

• Almond shaped• Mixed secretions –

serous + mucous


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6-8 sublingual ducts open into the floor of the mouthMain duct – Bartholin’s duct

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MINOR SALIVARY GLANDS• Located beneath the epithelium• Consist of several small groups of secretory cells• Lack a distinct capsule• 600-1000 minor salivary glands• Classified based on anatomic location• Not present in gingiva, antr. raphae, antr 2/3rd of dorsum of

tongueLabial glands

Glosspalatine glands

Palatine glands

Lingual glands

Von Ebner’s glands


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LABIAL/BUCCAL GLANDS• Glands of lips and cheek• Mixed type

GLOSSOPALATINE GLANDS• Posterior extension of

sublingual gland to glands of soft palate

• Pure mucous


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PALATINE GLANDS• Posterolateral regions of

the hard palate and the submucosa of soft palate and uvula

• Pure mucous

LINGUAL GLANDS• Antr linual – apex of

tongue (Glands of Blandin and Nuhn) – mucous

• Postr lingual – postr to circumvallate papillae, tonsil – mucous


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VON EBNER’S GLANDS

• Posterior lingual serous glands• Secretions wash out the troughs of the papillae• Play a role in taste reception• Studies suggest – digestive and protective function


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BIOCHEMISTRY

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COMPOSITION OF SALIVA

Water99%

Others1%

Primary Composition of saliva

Water OthersBiochemical Composition of Human Saliva in Relation To Other Mucosal

Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

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COMPONENTS OF SALIVA (CONTD…)

Organic

protiens

Salivary amylase

immunoglubulins

Protiens synthesized

within glandsglycoprotiens

lipids Blood group

Antigen A,B

Hormones

ParathyroidGrowth factor

carbohydrates

Glucosehexosamine

• Alpha amylase• Kallikrien• Dextranases• Alpha phosphtase• lipase

• IgA• IgM• IgG

• Factor VII• Factor VIII• Factor IX• Platelet factor

• MG1,MG2• Protien rich glycoprotiens

Biochemical Composition of Human Saliva in Relation To Other Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw

Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

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inorganic

sodium potassium calcium phosphor

us chloride bicarbonate

Cells :• Yeast• Bacteria• Protozoa• Polymorphonuclear lymphocytes(PMNL)• Desquamated epithelial cells

Gases: • Oxygen• Nitrogen• carbondioxide



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PROPERTIES OF SALIVA

• Ph : 5-8• Specific gravity : 1.0024 – 1.0061• Freezing point : 0.07 – 0.34 degree Celsius• Velocity : 0.8 – 8 mm/minute• Flow rate : 0.3 ml/min when unstimulated and 1.5-2 ml/min

when stimulated



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PHYSIOLOGY

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FUNCTIONS OF SALIVA• Digestive

• Protective

• Taste

• Excretion

• Water balance

• Oral hygiene

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DIGESTIVE FUNCTION• -Amylase (ptyalin)

– It is a calcium dependent digestive enzyme– It is activated by Cl.– It acts on cooked starch– Optimum pH= 6.8– It is inactive below pH 4

• Lingual lipase– Von ebner gland– It is responsible for the first phase of fat digestion.

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Bolus formation• Moistening of food (Water)• Mucin – It is a lubricating material, makes food slippery,

facilitates swallowing

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PROTECTIVE FUNCTIONS• Lubrication properties

– Coating of tissue( Mucin)– Lubricatory film- resistance to friction– Prevent desiccation

• Maintenance of mucous membrane– Salivary mucins

• Tissue hydration• Control of permeability• Protective against proteolytic enzymes formed in

inflammation and ulceration

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Soft tissue repair• Nerve growth factor Wound • Epidermal growth factor healing

• Speeds up the coagulation properties.• Dilutes anti-thrombin factor in traumatic area

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Debridement/Lavage• Physical flow of saliva – removal of bacteria and food debris .

Aggregation• IgA system- Inhibit bacterial attachment• Mucin – aggregation of bacterial cells.• Macromolecules- compete for attachment site

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Direct antimicrobial • Enzymes:

– Lactoferrin– Lysozyme– Human Salivary peroxidase , Myeloperoxidases.– IgA system– Chitinase.

• Peptides:– Histidine rich peptide-(histatin-5) Growth inhibitory, Bactericidal.– B- defensins.– Calprotectin– Chromogranin A

DEFENDER OF THE ORAL CAVITY:

Mucins & Agglutinins

Cystatin

Von Ebner Gland Protein(VEGP)

Tissue inhibitors of metalloproteinase(TIMPS

Extra parotid glycoprotein

Secretary leucocyte proteinase inhibitor(SLPI)

8. Gingival crevicular fluid– IgG– Lysozyme, Lactoferrin (liberated from phagocytic

cells)– PMNs - Phagocytosis

9. Maintenance of pH (Buffer)• Bicarbonate

– Main buffering ion

–Unstimulated saliva--- Less bicarbonate–Flow rate Bicarbonate–Pass through the plaque—Acid

neutralization

9. Maintenance of tooth integrity– Enamel pellicle– Increased surface hardness, Resistance to caries– Decreased permeability– Regulation of ionic environment in plaque, oral

cavity

PRP, Statherin:• Subsurface lesion remineralization• Inhibition of calculus• Maintains Ca- phosphate

supersaturation in saliva

10. Antifungal activityHistatin peptide

11. Epidermal growth factor

–Maintenance of oro - esophageal and gastric tissue integrity

–Healing of ulcers–Stimulation of DNA synthesis

12. Hormonal function• Parotin-deposition of Ca on tooth• Nerve growth factor- growth of sympathetic ganglia.

13. Excretory functionDrugs- Route of elimination

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MECHANISM OF SALIVARY SECRETION

Acinar cells K+ and HCO3- by active process

Along with Cl- forelectrical neutrality

Simultaneous secretion of water into acinar lumen

Primary isotonic saliva

Salivary duct cells – Rich blood suply

Actively reabsorb Na+ and Cl-And transfer K+ and HCO3- Into saliva

Impermeable to water

Final Hypotonic

saliva

Salivary secretion can be defined as a unidirectional movement of fluid electrolytres and macromolecules into saliva in response to appropriate stimulation

Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Pete M

Smith

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MECHANISM OF SALIVARY SECRETIONTwo stage salivary gland secretion model.

In stage 1:• Acinar cell secrete a NaCl-rich fluid

called primary saliva - isotonic

In stage 2:• The primary saliva - modified -

passage along the ductal tree (reabsorbing NaCl and secreting KHCO3).

• Ductal epithelium - poorly permeable to H2O

• Final saliva - hypotonic.Glandular mechanism of secretions : Chpt 2,

Mechanism of salivary secretion : Pete M Smith

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CONTROL OF SALIVARY SECRETION

PARASYMPATHETIC STIMULATION SYMPATHETIC STIMULATION

Increased by parasympathetic and parasympathetic activity

Release of proteolytic enzyme – kallikrien

Alpha 2 globulinsInto the interstitial fluid

bradikynin Vasodilation of blood vessels

Stimulates secretion from acini

Release of saliva rich in Organic substances + mucus

(process similar to parasympathetic stimulation takes place)

Submandibular and sublingual glands

Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Pete M

Smith

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FACTORS AFFECTING SALIVARY FLOW RATEDiurnal variation

• Protein concentrations tend to be high in the afternoon• Sodium and chloride concentrations are high in the early hours

of the morning

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• Potassium high in the afternoon• Calcium and phosphate concentrations appear to

remain stable during the day• Calcium concentration increases in the night

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Duration of stimulus

If the salivary glands are stimulated for longer than 3 minutes, the concentration of many components is reduced , although after a short period , bicarbonate, calcium and protein concentrations begin to rise again

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Dietary factors Functional salivary glandular activity is influenced by

mechanical or gustatory factors Plasma concentrations Amino acid, calcium, glucose, urea are correlated with those in

plasma

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Hormonal influences

• Aldosterone – increased sodium reabsorption in the striated ducts

• Antidiuretic hormone – water reabsorption by the striated duct cells

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ROLE OF SALIVA IN DIAGNOSIS

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COLLECTION OF SALIVASTIMULATED

• Expectoration every 30-60 seconds

– Gustatory- Acids– Mechanical- Chewing

Paraffin wax, rubber band

UNSTIMULATED

• Draining method

• Spitting method

• Suction method

• Swab method

SALIVA AS A DIAGNOSTIC MEDIUM ; Biomed Pap Med Fac Univ Palacky Olomouc Czech

Repub. 2009, 153(2):103–110.

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SALIVA FUNCTION TEST

SIMPLE SCREENING TESTS

• Sialometry• Visual inspection of saliva• pH and buffering capacity• Dip stick tests

OTHER TESTS

• Carlson Crittenden collector (parotid gland)

• Peristron (minor salivary glands)


Repub. 2009, 153(2):103–110.

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SALIVA IN ONCOLOGIC DIAGNOSIS• Saliva used in the diagnosis of many malignancies (mutation of tumour suppressor - gene p53 – malignancy – 50%)

– Spino-cellular carcinoma– Breast cancer– Blood cancer (level of neutrophils)


Repub. 2009, 153(2):103–110.

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SALIVA IN CARDIOVASCULAR DISEASES

• Salivary amylase as a protien biomarker• Primary function – break down sugars• Studies show that there is an increased production of salivary

amylase during high stress


Repub. 2009, 153(2):103–110.

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SALIVA IN DIAGNOSTIC TESTING OF DRUGS

• Previously used – urine• Salivary glands – highly vascular – easy cross over of drugs

from blood to saliva• Level of drugs remain in saliva for a number of hours after

intake• Egs : Amphetamines, Barbiturates, Benzodiazepines,

Marijuana, Cocaine, Heroin, NIcotine


Repub. 2009, 153(2):103–110.

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SALIVA IN DIAGNOSIS OF INFECTIOUS DISEASES• Bacterial :

– Mycobacterium tuberculosis – high levels in saliva in acute stages• Viral :

– HIV : ELISA + Western blot tests – higher chances for accurate results with saliva

(studies also suggest levels of HIV will be lower in saliva than in blood)


Repub. 2009, 153(2):103–110.

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PATHOLOGY

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SALIVARY GLAND DISORDERS

Developmental

disordersFunctional disorders

Obstructive disorders

Inflammatory/ infectious

disorders

Immunological

disordersNeoplastic disorders

Asymptomatic

enlargement

• Burkett's Oral medicine diagnosis and treatment planning 10th ed

• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz

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DEVELOPMETAL DISORDERS• Abberancy• Aplasia• Hypoplasia• Hyperplasia• Atresia• Accessory Ducts • Diverticuli• Congenital fistula

• Burkett's Oral medicine diagnosis and treatment planning 10th ed

• Differential diagnosis of oral and maxillofacial lesions - Wood and Goaz

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FUNCTIONAL DISORDERS

• Sialorrhoea• Xerostomia

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OBSTRUCTIVE DISORDERS

• Sialolithiasis• Mucous plug• Stricture & Stenosis • Foreign bodies

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ASYMPTOMATIC ENLARGEMENT• Sialosis;• Allergy• Malnutrition & Alcohol related

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INFLAMMATORY/ INFECTIOUS DISORDERS• Bacterial• Viral

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AUTOIMMUNE DISORDERS

• Sjogren’s syndrome• Mikulicz’s disease

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NEOPLASMS

• Benign– Warthin’s tumor– Pleomorphic adenoma

• Malignant– Malignant Pleomorphic

Adenoma– Adenoid Cystic Carcinoma– Mucoepidermoid Carcinoma– Acinic cell tumor– Adenocarcinoma;– Squamous Cell Carcinoma

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SIALORROHEA

Etiology

Acute inflamma

tion of oral

cavity

Oral canc

er

teething

Patients with

neurological

disorders

Decreased

swallowing

frequency

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SIALORRHEA (CONTD…)

• TREATMENT– Drugs : Anti-histamine (xerostomia inducing)(Pilocarpin, Cevimeline cause increased salivation)– Temporary injection of botulinum toxin into parotid gland– Surgery : Mandibular duct diversion

• ANTISIALOGOGUES– They are parasympathetic or cholinergic blocking agents include

atropine and its related alkaloids obtained from the plant.

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XEROSTOMIAETIOLOGY• Aplasia or hypoplasia of the

gland• Surgical excision of the gland• Post menopausal period• Uncontrolled diabetes mellitus• Dehydration• Primary aldosteronism

• Alcoholism• Malnutrition• Sialolithiasis• Mumps• Sjogrens syndrome• Vitamin deficency• Fear,anxiety,over

excitemen

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Causes of long standing xerostomia

IatrogenicDrugsLocal radiationChemotherapy

DiseasesDiabetic mellitusCystic fibrosisPrimary biliary cirrhosisHepatitis c virus infectionHIV

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Preventive therapy

Symptomatic treatmentSalivary

stimulation

Treatment

XEROSTOMIA (CONTD…)

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PREVENTIVE THERAPY

Topical fluorides

Maintain meticulous oral hygiene

Remineralising solutions

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SYMPTOMATIC TREATMENT

waterIncreasing humidity of the environmentOral rinses and gels

Salivary substitutes

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SALIVARY STIMULATION

• Local or topical stimulation– Chewing – sour and sweet tastes– Electrical stimulation

• Systemic stimulation– Bromhexine (Mucolytic agent)– Anetoletrithione (mucolytic

agent)– Pilocarpin (Parasympathomimetic

drug)PILOCARPIN :• functions as a muscarinic cholinergici• Side effects – sweating, hot flashes, urinary frequency,

diarrhea, blurred vision• Dosage: 5.0-7.5 mg 3-4 times daily• Contraindicated : pulmonary disease, CVS diseases,

glaucoma, urethral reflux

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CLINICAL ASPECTS

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ROLE OF SALIVA IN PROSTHODONTICS• Denture retention (maxillary denture more than mandibular)• Difficulty in impression making if saliva too mucous

Atropine sulfate – prior to impression making• Denture stomatitis (due to lack of salivary mucins)• Alteration in taste perception due to denture

Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet

Dent 1971; 25: 230-235.

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Denture retention – physical agent• Cohesion• Adhesion• Surface tension• Capillary attraction• Atmospheric pressure


Dent 1971; 25: 230-235.

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COHESION• Molecular attraction between

two similar surfaces in close contact.

• It occurs in the layer of saliva between the denture base and mucosa.

ADHESION• Physical molecular attraction

of unlike surfaces in close contact.

• It acts when saliva wets and sticks to the basal surfaces of dentures


Dent 1971; 25: 230-235.

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SURFACE TENSION• Resistance to separation by

the film of liquid between two well adapted surfaces.

• It is found in the thin film of saliva between the denture base and the mucosa of basal seat.

CAPILLARY ATTRACTION• Force that causes the surface

of liquid to become elevated or depressed when it is in contact with a solid.

• On close adaptation of the denture, the space filled with a thin film of saliva acts like a capillary tube and helps retain the denture.


Dent 1971; 25: 230-235.

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DISTRIBUTION OF SALIVA OVER A DENTURE

Complete coverage of denture and

mucous membrane• No meniscus –

hence no retention

Coverage of mucous

membrane and partial coverage

of denture• Produces a meniscus – retentive force exists

Coverage of basal tissue denture

surface• Meniscus

present – hence considerable retentive force present


Dent 1971; 25: 230-235.

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ROLE OF SALIVA IN PERIODONTAL DIAGNOSIS

• Saliva used to identify the onset of certain diseases• Biomarkers – small molecules – monitor disease onset,

treatment response and outcome

Biomarkers

Specific

Systemic

Non- speci

ficGianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009,

52-64

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99Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009,

52-64

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CONCLUSIONThe components of saliva act as a mirror of the body’s

health. With emerging trends in microbiology, immunology and biochemistry, salivary testing for clinical & research purposes ,is proving to be a practical and reliable method of recognizing a number of diseases . As a consequence these advances in technology are not confined to oral health characteristics but may be used to measure features of overall health.

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BIBLIOGRAPHY• Orban's oral histology and embryology 10th ed• Burketts oral medicine diagnosis and treatment planning 10th

edition• Differential diagnosis of oral and maxillofacial lesions - Wood and

Goaz• Sreebny, Leo M. : Saliva in health and disease: an apptraisal and

update: IDJ (2000)50; 140-161• Tucker A.S, salivary gland development, cell developmental

biology : 18 (2007) 237-244• Biochemical Composition of Human Saliva in Relation To Other

Mucosal Fluids :Léon C.P.M. Schenkels, Enno C.I. Veerman and Arie V. Nieuw Amerongen; Crit. Rev. Oral Biol. Med. 1995; 6; 161

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• Glandular mechanism of secretions : Chpt 2, Mechanism of salivary secretion : Peter M Smith

• Saliva as a diagnostic medium ; Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009, 153(2):103–110.

• Blahova Zora et al: Physical factors in retention of complete dentures. J Prosthet Dent 1971; 25: 230-235

• Gianobelle William V., Saliva as a diagnostic tool for periodontal disease - current state and trends : Periodontal 2000 : 50m 2009, 52-64

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THANK YOU AND

HAVE A PLEASANT DAY!!!

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SALIVA IN DENTAL CARIES

• Saliva plays an important role in reduction of caries by its buffering, clearance, antibacterial and antibody actions.

• Xerostomia is usually associated with increased caries. This is due to:-

• pH• buffering capacity• clearance of food

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SALIVA IN FORENSICS• Saliva is deposited usually through bitemarks. • It can also be retrieved from cigarette butts, postage stamps,

envelopes, clothes and skin. OTHER TESTS INCLUDE:• Fluorescence detection method• Chemical method• Thiocynate test

Initially – detect the presence of alpha-amylase enzyme ( Phadebas – chemical reagent)Later – the molecule on the whole could be detectedLateral flow Immunochromatographic strip test, rapid stain identification – Confirmation.

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XEROSTOMIA – A COMPLICATION OF ANTIHYPERTENSIVES• Identify the drug• Decrease dosage or change the drug• Artificial salivary stimulants• Chewing or electrical stimulation• Sialogogues

– Cholinergic drugs

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CONTRAINDICATIONS OF ATROPINE• Glaucoma(atropine is used commonly for the dilation of pupils)• Pyloric stenosis• Prostate enlargement• Substitute : Propantheline bromide

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MODIFIED SCHIRMER’S TEST

• Variation of schirmer’s test used for the eye• Caliberated Whatman 41 filter paper• Stripis placed on the floor of the mouth – absorbed by the filter

paper• After 5 mins – wetted length is measured (in mm)• rate of saliva secretion is measured in mm/5min

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Saliva in dentistry

Health & Medicine