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BDS1 BAMS oral biology > the oral environment > Flashcards

the oral environment Flashcards

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1
Q

what are the oral fluids?

A

Saliva
- Major and minor salivary glands
Gingival crevicular fluid
Oral bacteria
Food debris
Epithelial cells

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2
Q

what are the protective functions of oral fluid?

A

Cleansing
Mucosal protection
Buffering
Remineralisation
Antimicrobial

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3
Q

what are the digestive functions of oral fluid?

A

Taste
Digestive enzymes
Lubricates bolus for chewing, swallowing

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4
Q

what is xerostomia?

A

dry mouth- is a prominent symptom for patients with salivary gland disease

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5
Q

what is the consequence of reduced salivary flow?

A
  • increased amount of dental caries
  • caries on buccal and labial surfaces
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6
Q

what type of glands are salivary glands?

A

exocrine

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7
Q

what do salivary glands secrete?

A

serous and or mucous

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8
Q

what is the gland arrangement of salivary glands?

A

compound, tubulo-acinar

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9
Q

what are the major pairs of salivary glands and their secretions?

A
  • parotid (serous)
  • submandibular (mixed)
  • sublingual (mucous)
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10
Q

where are minor salivary glands found?

A

scattered all over the oral cavity (mainly mucous secretions except lingual which is mixed)

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11
Q

what is gingival crevicular fluid?

A

Fluid from epithelium lining the gingival crevice (sulcus):
- crevicular fluid or sulcular fluid
Little GCF from healthy gingivae, but flow increases with inflammation (e.g. gingivitis)
No ‘function’ as such, but is probably an inflammatory exudate

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12
Q

when is salivary flow highest?

A

during eating

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13
Q

when is salivary flow lowest?

A

during sleeping

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14
Q

what is the daily salivary flow?

A

500-700ml

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15
Q

what factors affect unstimulated saliva flow rate?

A

State of hydration
Previous stimulation
Circadian rhythms
Circannual rhythms
Medications
Salivary gland disease

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16
Q

what is the composition of saliva?

A

inorganic- water (99.5%), ions. (0.2%)
organic- proteins (0.3%), little carbohydrate/lipid

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17
Q

what is the function of fluoride ions in saliva?

A
  • antibacterial
  • forms fluorapatite
  • promotes remineralisation
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18
Q

what is the function of calcium and phosphate ions in saliva?

A

remineralisation

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19
Q

what is the function of thiocyanate ions in saliva?

A

antibacterial

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20
Q

what is the function of bicarbonate and phosphate ions in saliva?

A

buffering

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21
Q

what are buffers in saliva?

A

Bicarbonate: effective at high flow rates, when [HCO3] is highest
Phosphates: important ‘at rest’
Proteins: limited effect, as main buffering action occurs at pH <5
Bacterial NH3 : some role in buffering plaque acid

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22
Q

what are some main proteins in saliva?

A

Amylase
Cystatin
Gustin
Histatin
Immunoglobins
Lactoferrin
Lactoperoxidase
Lipase
Lysozyme
Mucoproteins
‘Plasma proteins’
Proline-rich proteins
Statherins

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23
Q

what is the function of amylase protein in saliva?

A
  • Enzyme, activated by Cl–, requires Ca+
  • Hydrolyses 1-4a starch glycosidic links -> maltose, maltriose, a-limit dextrins
  • Defence role
  • Present in most mucosal gland secretions
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24
Q

what is the function of lysozyme protein in saliva?

A
  • non-specific defence
  • present in many secretions eg saliva, tears
  • attacks bonds in bacterial cell walls causing lysis
25
Q

what is the function of cystatins protein in saliva?

A

antimicrobial

26
Q

what is the function of gustin protein in saliva?

A

facilitates taste by activating taste buds

27
Q

what is the function of histatins protein in saliva?

A
  • antimicrobial
  • histidine-rich
28
Q

what is the function of immuniglobins protein in saliva?

A
  • from plasma cells in salivary glands
  • immunity against bacteria
29
Q

what is the function of lactoferrin protein in saliva?

A
  • iron-binding
  • antibacterial
30
Q

what is the function of lipase protein in saliva?

A
  • hydrolyses triglycerides
31
Q

what is the function of mucins protein in saliva?

A
  • bind to tooth and epithelial surfaces
  • protective
  • lubrication
  • component of primary pellicle
32
Q

what is the function of proline-rich protein in saliva?

A
  • absorb on to hydroxyapatite
  • regulates bacterial attachment
33
Q

what is the function of statherins protein in saliva?

A
  • prevents precipitation of calcium phosphate
34
Q

what are examples of plasma-derived substances?

A
  • proteins
  • blood group substances
  • immunoglobins
  • hormones
  • drugs
35
Q

what are the salivary stimuli?

A

Mechanical
- pressure on PDL / oral mucosa
Chemical
- gustation
- olfaction
- common chemical sense

36
Q

what different potencies on taste buds stimuli most saliva?

A

acid > umami = salt > sweet > bitter

37
Q

what is the chemical salivary stimuli mediated by?

A

nociceptors

38
Q

what are learned responses surrounding conditioned salivary stimuli?

A

Psychic’ stimuli (thinking about food)
Visual stimuli
Auditory stimuli e.g. Pavlov’s experiments
Responses are easily lost (become ‘extinct’) if not regularly reinforced

39
Q

what controls saliva secretion?

A

Parasympathetic nerves
- Secretion
- Blood flow (vasodilation)
Sympathetic nerves
- Secretion
- Blood flow (vasoconstriction)

40
Q

how many stages are there in salivary secretion?

A

2

41
Q

what is the two-stage mechanism in salivary secretion?

A
  • primary secretion in acinus
  • secondary modification in ducts

Primary saliva modified as it passes through striated ducts
Reabsorption of Na+, Cl-
Secretion of K+, HCO3-
Final saliva is hypotonic to plasma
Some proteins secreted by ducts

42
Q

where is salivary flow velocity highest?

A

lower lingual region

43
Q

where is salivary flow velocity lowest?

A

labial and buccal regions

44
Q

what is clearance?

A

the rate at which substances are removed from the mouth

45
Q

why is clearance important?

A
  • Removal of ‘harmful’ substances (e.g. sucrose) is increased by high salivary flow rates (rapid clearance)
  • Retention of ‘beneficial’ substances (e.g. F– , Chlorhexidine) is improved by low salivary flow rates (slow clearance)
  • Thus, topical F– preparations should be tasteless and tablets should be sucked, not chewed
46
Q

what does increased salivary flow do to plaque?

A

neutralises it due to its increased bicarbonate content

47
Q

what effect does gum chewing have on saliva?

A

Large initial increase in salivary flow rate
The flow subsides to just above the unstimulated flow rate
The pH rises by 0.5 pH unit, but the increase persists for a long time
There is a much larger increase in salivary pH (by >1 pH unit) when bicarbonate-containing gum is chewed

48
Q

discuss the oral health aspects of chewing gum

A

Chewing gum manufacturers promote chewing ‘sugar-free’ gum as an oral health aid
Gum chewing does not remove plaque, but will increase salivary flow rate, although the increase is quite small
The salivary pH is increased
The stimulated saliva may promote remineralisation

49
Q

what are sweeteners?

A
  • ‘Fermentable’ carbohydrates, mainly sugars, can cause caries
  • Alternative sweeteners have a sweet taste, but can not metabolised to acids by plaque bacteria
  • These are called ‘sugar-free’, and are either:
    • Bulk caloric / low caloric sweeteners
    • Non-calorie, high-intensity sweeteners
50
Q

give examples of bulk sweeteners

A

Sucrose
Fructose
Glucose
Lactose

51
Q

what is a example of a low calorie sweetener?

A

xylitol

52
Q

what do patients complain of if salivary flow rates fall to less than 50%?

A

xerosomia

53
Q

why might a salivary gland need removed?

A

duct blocked by salivary calculus (stone)

54
Q

what are causes of decreased salivary flow?

A

Side effect of many drugs
Radiotherapy (for H&N tumours)
Diseases:
- specific salivary gland diseases
- systemic diseases that also affect salivary glands
- more general conditions that may affect salivary glands, e.g. fluid/electrolyte loss

55
Q

what is reduced salivary rate commonly linked to?

A

side effect of over 400 drugs- interferes with ANS control

56
Q

what is a condition affecting salivary glands?

A

sjogren’s syndrome

57
Q

what are consequences of reduced salivary flow?

A
  • increased dental caries
  • increased oral disease (stomatitis, fissured lips)
  • Dysaesthesia (‘burning’ mouth)
  • Impaired oral function (chewing, swallowing, speaking)
  • Diminished taste perception
  • loss of protective components
58
Q

treating xerostomia

A

If there is functioning gland tissue present, stimulate salivary flow,
by chewing, or by drugs (sialogogues)
If there is no functioning gland tissue, saliva substitutes may be used:
Mucin-based; cellulose-based
Water alone is not very effective

BDS1 BAMS oral biology (10 decks)

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