Clinical Significance of Saliva

Question 1

male salivary volume per day

Answer 1

0.32-1.55 mL

Question 2

female salivary volume per day

Answer 2

0.28-0.91 mL

Question 3

causes of xerostomia

Answer 3

primary Sjorgen’s syndrome

synergistic effect of some medication

radiation therapy

chemo- therapy

others: undiagnosed diabetes, bells palsy, cerebral palsy, trauma, Hep C, HIV

Question 4

clinical problems associated with xersotomia

Answer 4

rampant caries

glossitis (cracking)- lack of salivary lubrication

inflammation of tongue and gingiva

candida infection- aka oral thrush (white tongue)

Question 5

what is xerostomia

Answer 5

dry mouth- due to less/ no saliva production

Question 6

what are rampant caries

Answer 6

fast spreading caries

affect smooth surface of teeth e.g. incisal edge

Question 7

what is Sjorgens syndrome

Answer 7

an AUTOIMMUNE DISORDER that causes the DYSFUNCTION of PAROTID and SUBMANDIBULAR gland

blockage of their ducts

primary and secondary SS
primary= dry eyes, dry mouth
secondary= rheumatoid arthritis, lupus

Question 8

which medication can cause xerostomia

Answer 8

over 500

antidepressants, anti-histamines, diuretics, sedatives, muscle relaxants

nb. a lot of ‘anti…’

Question 9

how does radiation therapy cause xerostomia

Answer 9

serous acinar cells have higher heavy metal ion concentration

absorb more of the radiation energy

increased release of free radicals

more viscous saliva with lower buffering, yellow-brown colour, compromised anti-microbial activity

Question 10

how does chemotherapy cause xerostomia

Answer 10

depending on type of agent used/ duration =

1. changes FLOW RATE of saliva
2. COMPOSITION of saliva
3. IMMUNOSUPPRESION= changes the salivary immunoglobins= ORAL MUCOSITIS, gingivitis, opportunisitc infections

Question 11

what is amifostine and when can it be used

Answer 11

a chemo-protective drug that de-toxifies the toxic metabolites of cisplatin- breast/head/neck/lung cancer drug AND is scavenger of free radicals

is used for both chemotherapy and radiation therapy

Question 12

what is bells palsy

Answer 12

PARALYSIS of the facial nerve - passes through the parotid gland

Question 13

what can be prescribed for salivary stimulation/ replacement therapy

Answer 13

chewing sugar free gum/ sweets

artificial salivary substitute: carboxyl-methyl-cellulose. bad taste

water-based gels

2 prescription drugs: pilocarpine and cevimeline
used for SS patients

Question 14

what is the basis of pilocarpine and cevimeline function

Answer 14

cholinergic agonists
stimulate parasympathetic NS
exocrine glands —> increase SEROUS secretions

side effects: excessive sweating

Question 15

2 types of salivary pellices

Answer 15

1. mucosal pellicle

2. acquired pellicle

Question 16

list the 8 protective functions of saliva that enable it to maintain good oral health

Answer 16

airway maintenance: antibacterials

speech: lubrication

eating/swallowing/mastication: antibacterials, lubrication

control of bacteria/fungi: antibacterials, igs, glycoproteins, histatin, lysozyme

digestion: amylase

protection/ repair of oral mucosa: mucin film, EGF-wound healing

protection/ repair of dentition: Ca2+, PO43-, pellicle proteins, fluoride ion

GI tract: antibacterials, mucins swallowed into GI tract

Question 17

the total % of saliva is highest from ___ gland

Answer 17

sub-maxillary/ submandibular

Question 18

saliva FLOW is determined by which rhythm

Answer 18

circadian rhythm

highest flow= mid-day
lowest flow= night

Question 19

what is the significance of oral compartmentalisation

Answer 19

sugar retention/clearance
fluoride clearance/ retention
exposure to carcinogen
siting of slow release devices e.g. ionomers