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Dentistry Module 4 > Oral Environment > Flashcards

Oral Environment Flashcards

1
Q

What is the most significant component of the acquired salivary pellicle?

A

Salivary glycoproteins (mucins)

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2
Q

What are the two different types of salivary mucins?

A
  1. Oligomeric mucin glycoprotein (MG1)
  2. Monomeric mucin glycoprotein (MG2)
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3
Q

What is the main role of proline rich proteins (PRP’s) in the oral microbiome?

A

Act as strong promoters of bacterial adhesion

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4
Q

which type of proline rich proteins (PRPs) are unique to saliva with a high affinity for hydroxyapatite?

A) basic
B) glycosolated
C) acidic

A

Acidic

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5
Q

what is the function of slatherin?

A

Prevents the precipitation of calcium phosphate in saliva, maintaining a high calcium level in saliva available for remineralisation of tooth enamel and high phosphate levels for buffering

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6
Q

What do bound pellicle-attached glucosyltransferases act as?

A

Binding sites for bacterial adhesion

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7
Q

what immunoglobulins are found in pellicle?

A

IgA and IgG

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8
Q

What immunoglobulin predominates the pellicle

A

IgA2

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9
Q

What is the protective role of cystatins in the oral environment?

A

Protects other salivary proteins from degradation

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10
Q

What cationic peptides, secreted into human saliva by salivary glands, are effective at promoting wound healing?

A

Histatins

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11
Q

Where is oral lysozyme derived from?

A
  • major and minor salivary glands
  • phagocytic cells
  • gingival crevicular fluid
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12
Q

What is the scale called used to assess oral dryness?

A

Challacombe scale

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13
Q

What does a score of 1-3 on the Challacombe scale indicate in terms of dry mouth?

A

Mild dryness

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14
Q

What does a score of 4-6 on the Challacombe scale indicate in terms of dry mouth?

A

Moderate dryness

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15
Q

What does a score of 7-10 on the Challacombe scale indicate in terms of dry mouth?

A

Severe dryness

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16
Q

What are the main clinical signs of dry mouth?

A
  • mucosa attaches to mirror
  • lobulated and fissured tongue
  • shortening of papillae (smooth tongue)
  • glossy appearance of mucosa
    -debri adhering to mouth
  • no saliva in FOM
  • Cervical caries
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17
Q

What would be the clinical steps required to take if the score is 1-3 on the Challacombe scale?

A

Routine check up monitoring

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18
Q

What would be the clinical steps required to take if the score is 4-6 on the Challacombe scale?

A

Further investigations if cause not clear

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19
Q

What would be the clinical steps required to take if the score is 7-10 on the Challacombe scale?

A

Cause needs to be determined to exclude Sjogren’s, may need to refer.

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20
Q

What would you advise a patient on management of dry mouth if they are a score of 1-3 on the Challacombe scale?

A
  • may not need treatment
  • sugar free chewing gum
  • attention to hydration
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21
Q

What would you advise a patient on management of dry mouth if they are a score of 4-6 on the Challacombe scale?

A
  • Sugar free gum or sialogogues
  • saliva substitutes
  • topical fluoride
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22
Q

What would you advise a patient on management of dry mouth if they are a score of 7-10 on the Challacombe scale?

A

-saliva substitutes
-topical fluoride

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23
Q

What are examples of local treatment to stimulate salivary flow rate in patients with dry mouth?

A
  • sugar free chewing gum/sweets
  • artificial saliva pastilles ( salivix)
  • SST (saliva-stimulating tablets)
  • xylimelts
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24
Q

What are options for treatment of dry mouth?

A

Local
Systemic therapy
Carboxmehylcellulose based
Mucin based
Gels

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25
Q

What fluoride treatment could you propose to someone with dry mouth?

A
  • sodium fluoride mouthwash (0.05%)
  • sodium fluoride toothpaste (2800 or 5000ppm)
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26
Q

What four components make up the basic unit structure of a salivary gland?

A
  • acini
  • intercalated ducts
  • striated ducts
  • secretory ducts
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27
Q

What is an acini and what is its function?

A

It is a rounded secretory unit which produces the primary salivary secretion

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28
Q

Do the secretory ducts of a salivary gland get smaller or bigger as we travel from the salivary gland towards the mouth?

A

Bigger

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29
Q

What type of saliva does the parotid gland produce?

A

Serous

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30
Q

What type of saliva does the submandibular gland produce?

A

Serous + mucous

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31
Q

What type of saliva does the sublingual gland primarily produce?

A

Mucous

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32
Q

What are the three different types of acinus?

A
  • serous acinus
  • mucous acinus
  • mucous acinus + serous demilune
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33
Q

What is the appearance of serous acinar cells down a microscope?

A
  • looks dark with a prominent basal nuclei
  • granular
  • stains purple/pink
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34
Q

What is the appearance of mucous acinar cells down a microscope?

A
  • pale cytoplasm
  • flattened basal nucleus
  • many large mucin granules
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35
Q

Why are mucous acinar cells pale in appearance?

A

Because contained mucins are lost or most easily stained

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36
Q

What is the appearance of mucous acinar cells + serous demilunes down a microscope?

A
  • mucous acinus capped by serous cells
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37
Q

What group of cells can be found around acini and intercalated ducts?

A

Myoepithelial cells

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38
Q

What are the two main functions of myoepithelial cells?

A
  1. “Squeeze” acinus, assisting secretion
  2. Regulate duct lumen diameter
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39
Q

What is the structure of intercalated ducts?

A
  • low cuboidal cells
  • large central nucleus
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40
Q

What salivary glands DO NOT contain striated ducts within their structure?

A

Sublingual glands

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41
Q

what is the main function of striated ducts?

A

Active modification of primary saliva composition

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42
Q

what is the key feature of striated duct structure?

A

Massive basal membrane folding

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43
Q

what does the basal membrane folding of striated ducts allow for?

A

Increased surface area for exchange of saliva, allowing for change in its composition

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44
Q

When do pseudo-stratified secretory ducts become stratified?

A

Near termination where cells merge with stratified squamous oral epithelium in oral cavity

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45
Q

What are the three constituents of saliva?

A
  • water
  • electrolytes
  • organic components
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46
Q

what are the four mechanisms & control of salivary secretion?

A
  1. Initial acinar secretion of H2O and electrolytes
  2. Ductal modification of primary saliva
  3. Secretion of organic compounds
  4. Control of secretory mechanisms
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47
Q

Where does ductal modification occur?

A

In the striated ducts

48
Q

In a resting acinar cells, what are the concentrations of sodium and potassium ions inside and outside the cell?

A

Inside: high potassium, low sodium

Outside: high sodium, low potassium

49
Q

In an activated acinar cells, what happens to potassium ion concentration?

A

There is an increase in membrane permeability to potassium ions resulting in an increased potassium concentration in salivary secretion

50
Q

what facilitates the increase in membrane permeability to potassium ions in an activated acinar cell?

A

Calcium ion release

51
Q

What are two results of an increase in basal sodium/potassium ion exchange in activated acinar cells?

A
  1. No increase in sodium ions, as they are taken out of the cell
  2. Chloride and potassium ions move into salivary secretion
52
Q

What activates basal Na+ K+ Cl- c—transporter?

A

Increase in extracellular K+

53
Q

Why is Na+ drawn into the salivary secretion down through between cells?

A

In order to balance out the charge that has been altered by flow of Cl-

54
Q

What substance is dragged down an osmotic gradient between activated acinar cells to enter the salivary secretion?

A

H2O

55
Q

What are the four changes in composition made to saliva in the striated ducts?

A
  1. Conversion from isotonic to a hypotonic solution
  2. Resorption of Na+ and Cl-
  3. Secretion of HCO3- and K+
  4. Becomes dependant upon flow rate
56
Q

What is the key role of HCO3- (bicarbonate) in salivary secretion?

A

It neutralises acid

57
Q

What components make up the primary secretion of saliva?

A

Na+
K+
Cl-

58
Q

At rest, are striated duct cells permeable or impermeable to water?

A

Impermeable

59
Q

what happens to basal ion pumping once striated duct cells are activated?

A

It increases resulting in K+ increase and Na+ decrease within the cell

60
Q

What do compensatory movements to and from the lumen during striated duct cell activity result in in regards to saliva secretion?

A

An increase in K+ and decrease in Na+ concentration within saliva

61
Q

What do compensatory movements to and from the lumen during striated duct cell activity result in in regards to Na+ and Cl- flow?

A

Decrease in both Na+ and Cl- as they flow out of lumen and cell

62
Q

what substance is Cl- exchanged for in the saliva?

A

HCO3-

63
Q

What is the effect of a low flow rate of saliva on striated duct modifications?

A
  • more time for resorption of Na+
  • results in very low Na+ in saliva
64
Q

What is the effect of a high flow rate of saliva on striated duct modifications?

A
  • less time for resorption of Na+
  • results in less reduction of Na+ in saliva
65
Q

What happens to salivary gland activity and HCO3- concentration if flow rate is high?

A

Gland activity increases, along with increased HCO3- in saliva

66
Q

What are most of the organic components of saliva secreted by?

A

Acinar cells

67
Q

What are the three main steps in formation of organic components of saliva?

A
  1. Synthesis of protein in association with ribosomes on the RER (requires ATP)
  2. Protein transferred to Golgi apparatus
  3. Glycoproteins packaged into vesicles which fuse with membrane and then discharge contents through exocytosis
68
Q

what is the predominant type of exocrine secretory mechanism in saliva?

A

Merocrine

69
Q

In sympathetic pathways, which axon is long and which axon is short? ( in terms of pre and post ganglionic axons)

A

Pre-ganglionic axon is short
Post-ganglionic axon is long

70
Q

In parasympathetic pathways, which axon is long and which axon is short? ( in terms of pre and post ganglionic axons)

A

Pre-ganglionic axons are long
Post-ganglionic axons are short

71
Q

In the sympathetic pathway, which transmitter is present at the synapse with the ganglion?

A

Acetylcholine

72
Q

In the sympathetic pathway, which transmitter is present once the target tissue is reached?

A

Noradrenaline

73
Q

In the parasympathetic pathway, which transmitter is present at the synapse with the ganglion, and the target tissue?

A

Acetylcholine

74
Q

what receptors control sympathetic salivary secretion?

A

Alpha 1 and beta 2 adrenergic receptors

75
Q

What are the receptors involved in parasympathetic control of salivary secretion?

A

Muscarinic receptors

76
Q

What is the antagonist for acetylcholine in parasympathetic control of salivary secretion?

A

Atropine

77
Q

What is atropine?

A

A drug that will cause dry mouth

78
Q

What does sympathetic control of salivary secretion result in once it reaches target tissue?

A
  • increased exocytosis of organic components
  • contraction of myoepithelial cells
  • increases production of thick low volume saliva
79
Q

What is Frey’s syndrome usually a result of?

A

Parotid surgery where damage to the auriculotempral nerve has occurred

80
Q

Why is the auriculotemporal nerve important in terms of parasympathetics and sympathetics?

A

Controls parasympathetics to salivary glands and sympathetics to facial sweat glands

81
Q

What is Frey’s syndrome characterised by ( which is a consequence of attempted regeneration of damaged auriculotemporal nerve)?

A

Gustatory sweating

82
Q

What is gustatory sweating?

A

Where a stimulation that normally causes salivation, ends up activating sweat glands (e.g. when you eat, your face sweats)

83
Q

what do sensation to gustatory afferents allow for?

A

Taste (i.e. sour, salt, sweet, bitter)

84
Q

Why would you describe saliva flow as Ipsilateral?

A

For example if you chew on the right side of your mouth, your salivary flow on the right side will increase much more than it does on the left side

85
Q

What two afferents are involved in reflex salivation?

A
  • gustatory afferents
  • mechanoreceptive afferents
86
Q

Most minor salivary glands are mainly mucous, which minor salivary gland is serous?

A

Serous glands of von ebner

87
Q

What is a very important ion for buffering in saliva?

A

Bicarbonate

88
Q

If a ground section is stained blue, what is this structure likely to be made of?

A

Collagen

89
Q

What is the normal average volume of saliva per day?

A

500-1000ml/day

90
Q

What is the volume of saliva produced per minute when flow rate is “unstimulated” (at rest)?

A

0.3-0.5ml/min

91
Q

What is the volume of saliva produced per minute when flow rate is “stimulated”?

A

2.0-4.0ml/min

92
Q

At rest, which salivary gland is predominantly producing saliva?

A

Submandibular gland

93
Q

When stimulated, which salivary gland is predominantly producing saliva?

A

Parotid gland

94
Q

what effect does the presence of acid within the oral cavity have on salivary flow?

A

Massively increases salivary flow

95
Q

Which salivary gland has been found to have an olfactory reflex associated with and increase in salivary flow?

A

Submandibular gland

96
Q

Which salivary gland has NOT been found to have an olfactory reflex associated with and increase in salivary flow?

A

Parotid gland

97
Q

What happens to salivary flow at night?

A

Decreases

98
Q

What condition is perceived when unstimulated salivary flow is less than 50% normal?

A

Xerostomia

99
Q

What are four main causes off xerostomia?

A
  1. Disease/damage
  2. Medications
  3. Dehydration
  4. During sleep
100
Q

What are examples of medications that can cause xerostomia?

A
  • analgesics
  • beta blockers
  • anti-histamines
101
Q

What dental problems can arise as a result of xerostomia?

A
  • increased caries
  • mucosal infections
  • pain from oral mucosa
  • difficulty chewing,swallowing or speaking
  • impaired taste
102
Q

what are the three main constituents of saliva?

A

Water
Electrolytes
Formed elements

103
Q

What anion in saliva is very important for buffering acids?

A

Bicarbonate

104
Q

What is a negative consequence of increase in calcium phosphate during mineralisation of teeth?

A

Increase in calculus formation

105
Q

What is the role of salivary amylase?

A

Breaks down polysaccharides (starch) into disaccharides (maltose)

106
Q

Which salivary glands produce salivary lipase?

A

Lingual serous minor glands (glands of von ebner)

107
Q

what is the role of salivary lipase?

A

Removal of fat deposits from tastebuds

108
Q

What are mucins also known as?

A

Mucous glycoproteins

109
Q

What are the three main roles of statherins?

A
  1. Prevent precipitation of Calcium and phosphate from saliva
  2. Prevent initial calculus formation
  3. Prevent mineralisation within salivary glands
110
Q

What is the role of amylase in the oral cavity?

A

Interferes with bacterial adherence

111
Q

what is the role of peroxidase/thiocynate in the oral cavity?

A

Poisons bacteria

112
Q

what is the role of lactoferrin in the oral cavity?

A

Deprives bacteria of iron

113
Q

what is the role of histatins in the oral cavity?

A

Antifungal and antibacterial

114
Q

what is the role of cystatins in the oral cavity?

A

Inhibit tissue-damaging bacterial enzymes

115
Q

When demineralisation of tooth substance occurs, how long (in minutes) does it take for pH to drop to its lowest ( most acidic)?

A

5-10 minutes after consuming sugar

116
Q

how long does it take for bicarbonate in saliva to buffer pH back above critical pH?

A

Approx 30-60 mins

117
Q

What two sugars are associated with highest risk of caries?

A

Fructose and sucrose

Dentistry Module 4 (20 decks)

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