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(2)Salivary Glands (Salivation (Clinical Implications (Salivary Glands…

- - - - Aid speech, mastication and swallowing
      - Taste perception
      - 3) Ion Reservoir / Buffering / Maintain tooth integrity
        
        Supersaturation
        
        Normal conditions
        
        Ca2+ / PO43-
        
        Supersaturation
        
        Higher pH precipitate calcium
        
        Form dental calculus
        
        Stimulated Saliva:
        
        HCO3- inceases
      - 4) Digestion
        
        a-amylase: Starch to maltose
        
        Lingual Lipase: Lipids
      - 5) Healthy oral microbiology
        
        Pellicle Formation
        
        Bacteria Attachment
        
        Immunoglobulins:
        IgA: Stop adhesion
        IgM: Encourage phagocytosis
        
        Histatin: Prevent fungal infection
        
        Lysozyme: Prevent bacterial infection
        
        Mucin:
        
        Hydrophilic, glyocoproteins. 1)
        
        Lubrication
        
        Prevent bacteria attachment to soft tissue
        MG1: Lubricate
        MG2 Exist as random coils, Viscosity
        
        Lactoferrin:
        
        Bind to Fe3+
        
        Essential microbial nutrient
      - 2) Lubricant / Moisten
        
        Mucin:
        
        Hydrophilic, glyocoproteins. 1)
        
        Lubrication
        
        Prevent bacteria attachment to soft tissue
        MG1: Lubricate
        MG2 Exist as random coils, Viscosity
      - Excretion
      - Water Balance
      - 1) Protective Barrier
        
        Physical: Attrition
        
        Pellicle formation
        
        Chemical:
        
        Neutralize
        
        Antimicrobial
    - - 1-0.5%
        
        Ions: (K+, Na+, Ca2+, Mg2+, H+, Cl-, HCO3-, I-, F-, HPO42-
        
        Organic compounds: Mucus, Urea, Hormones, Enzymes, Products of B cells, PMNs, epithelial cells, bacteria
        
        Organic Compounds
        
        (2) Bacteria Attachment
        
        Histatin: Prevent fungal infection
        
        Secretory IgA: Immunity mediator
        
        Lysozyme: Prevent bacterial infection
        
        Mucin:
        
        Hydrophilic, glyocoproteins. 1)
        
        Lubrication
        
        Prevent bacteria attachment to soft tissue
        MG1: Lubricate
        MG2 Exist as random coils, Viscosity
        
        (1) Digestion
        
        Amylase/Lipase: Digestion
        
        Kallikrein: Vasoreactive substances
        
        Lactoperoxidase: Stimulate minor salivary glands
        
        (3) Acidity
        
        Urea:
        
        Plaque bacteria and cells
        
        Urease: Urea into CO2 and NH3
        
        Increases salivary pH
        
        Concentration lower than plasma
        
        (4) Buffering:
        
        Statherin:
        
        Prevent precipitation (CaPO4)
        
        Prevent crystallization (CaPO4)
        
        In ducts and oral fluid
        
        Proline Rich Proteins (PRP)
        
        Inhibit (CaPO4) crystalization
        
        In early and mature pellicles
        
        Epithelial cells
        
        Neutrophils
        
        Lymphocytes
        
        Bacterial flora
      - 99% Water
  - - - Sialo-rrhea (Hypersalivation)
      - Sialo-lithiasis (calculus/mineral mass) forms in salivary gland
      - Sialo-sis (Enlargement of salivary glands)
  - - - Classifications
        
        Minor Glands: Located within submucosa of tissue (buccal, labial, lingual, soft palate, lateral hard palate, floor of mouth) - Mucous
        
        Major Glands
        
        Sublingual: Mixed, smallest. more mucous (mucin rich), only unencapsulated major salivary gland
        
        Submandibular: Mixed, more serous, approximately 70% of saliva in oral cavity
        
        Parotid: Serous, largest secrete a-amylase
      - Arrangement of Acini
        
        Serous: Sphereical form
        
        Mucous: Tubular form with larger central lumen
        
        Mixed: Acini capped by serous demilune (i.e. half-moon shaped cell covering the acini, secrete mucous which contain lysozyme
      - Journey of Salivary Gland
        
        Intercalated duct (Cuboidal epithelium, narrow lumen)
        
        Striated duct (columnar epithelium with many mitochondria)
        
        Intralobular duct (cuboidal-tocolumnar epithelium)
        
        Interlobular duct (Pseudostratified columnar epithelium)
        
        Lobar duct (Columnar stratified epithelium)
        
        Acini (Produce saliva with composition similar to plasma (isotonic)
    - - Control: Reflex modulated by salivary centres
        
        Medulla Oblongata
        
        Superior salivary nucleus
        
        Inferior salivary nucleus
      - Salivary Flow Rates
        
        Abnormal Ranges
        
        Unstimulated: <0.1-0.2mL/min
        
        Stimulated: <0.5mL/min
        
        Normal Ranges (Negligible during sleep)
        
        Stimulated: 1-2mL/min
        
        Unstimulated: 0.3-0.4mL/min
        
        Daily Salivary Flow Rate: 0.5-1.5L
        
        Under Stimulation
        
        Low - Parotid: 25% Submandibular: 62% Sublingual: 5% Minor :8%
        
        Moderate - Parotid: 35% Submandibular: 53% Sublingual: 4% Minor: 8%
        
        High - Parotid: 44% Submandibular: 44% Sublingual: 4% Minor: 8%
        
        Parotid, Serous: 25% to 44% (Increase),
        Submandibular, More serous : 62% to 44% (Decrease), Sublingual, More mucous: 5% to 4% (Decrease),
        Minor Savliary Glands: 8% (Constant)
      - Factors affecting salivary flow
        
        Autoimmune disease (Sjogren's, Lupus)
        
        Sjogren's Syndrome
        
        Affect Salivary Glands
        
        Affect Lacrimal Glands
        
        Lupus
        
        Systemic diseases (Diabetes, Asthma, Kidney, Sarcoidosis, HIV)
        
        Cancer Therapy
        
        Chemotherapy
        
        Makes saliva thicker
        
        Radiation Therapy
        
        Damage to salivary glands
        
        52Gy causes severe salivary dysfunction
        
        Around 70Gy of radiation
        
        Physiological
        
        Circadian Rhythm
        
        Stress / Sympathetic Drive
        
        Dehydration
        
        Gender (Female)
        
        Post Menopausal
        
        Drug-Induced
        
        Antisialagogue
        
        Anticholinergic
        
        Polypharmacy
        
        Opiates
        
        Antidepressants/Antihypertensives
        
        Bronchodilators
        
        Diuretics
        
        Others
        
        Smoking
        
        Mouth Breathing
        
        Upper respiratory tract
        
        Diarrhea
        
        Vomiting
        
        Fever
      - Unstimulated Salivary Flow:
        1) Abstain from dental hygiene procedures / eating 1hr
        2) Drink water 1min
        3) Spit pooled saliva every 1 min for 5mins
  - - - Chronic academic stress (Reduced)
      - Acute academic stress (Increased)
  - - - Dental Caries
      - Acid erosion
      - Infections
        
        Oral candidiasis (Fungal Infection):
        
        Opportunistic infection with Candida
        
        Sialadenitis:
        
        Infection of parotid gland
        
        Bacterial up duct
      - Dysgeusia: Altered taste sensation
      - Dysphagia: Difficulty swallowing/chewing
      - Thrist
      - Dry sore lips/mouth
      - Unstimulated Saliva Test
        
        Refrain from eating, drinking, oral hygiene procedures (1hr)
        
        Rinse mouth with drinking water before collection (1min)
        
        Spit pooled saliva every minute for 5minutes
    - - Substitutes
        
        Mucin spray
      - Stimulants
        
        Chewing gum
        
        Organic acids