Prevention / 5th stage ‫ مظفر فاضل‬.

‫د‬
Lec. 8

Saliva
(part 1)
Saliva is an important fluid that plays an essential role in maintaining the
integrity of the oral structures and the human body as whole. It is a
unique and complex fluid that contains a number of systems which
functions a variety of physiological needs to protect the oral mucosa and
the whole body from infection.

Salivary composition?
Saliva is a watery substance that is composed of about 98% water while
the remaining 2% are solids, mostly electrolytes, glycoprotein and
antibacterial components such as certain types of immunoglobulins and
lysozyme enzyme, the latter giving saliva its characteristic viscosity.
The term ‘saliva’ refers to the mixed fluid in the mouth in contact with
the teeth and oral mucosa, which is often called ‘whole saliva’.
Normally, the daily production of whole saliva ranges from (0.5 to 1.0)
liters. 90% of whole saliva is produced by three paired major salivary
glands, the parotid, submandibular and sublingual glands. Secretions
from the many minor salivary glands in the oral mucosa also contribute,
although only somewhat less than 10%.
In addition, whole saliva contains contributions from non-glandular
sources such as gingival crevicular fluid in an amount that depends on the
periodontal status of the patient. Whole saliva, in contrast to glandular
saliva, also contains vast amounts of epithelial cells from the oral mucosa
and millions of bacteria. These components give whole saliva its cloudy
appearance, which is different from glandular saliva, which is transparent
like water.

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Several factors can affect the composition of saliva; these are:-
1- Flow rate. 2- Plasma composition. 3- Duration of stimulation.
4- Nature of salivary stimulation. 5- Circadian rhythm. 6- Diet.
7- Genetic. 8- Drugs.

Control of salivary secretion

Salivary secretion is initiated by afferent signals from the sensory
receptors in the mouth transmitted by the trigeminal, facial and
glossopharyngeal nerves. These nerves carry nerve impulses from
chewing-activated mechanoreceptors in the periodontal ligament
(masticatory-salivary reflex) and from taste-activated chemoreceptors in
the taste buds within the lingual papillae of the tongue (gustatory-salivary
reflex) to the salivary nuclei in the medulla oblongata of the brain.
Then, the salivary nuclei convey information to the efferent part of the
reflex arch which consisting of two branches, the parasympathetic and the
sympathetic autonomic nerve bundles traveling separately to the glands.
The sympathetic fibers follow the blood vessels supplying the glands and
then separately innervate the glands, and the parasympathetic fibers
follow the efferent facial or glossopharyngeal nerves.

The masticatory-salivary and the gustatory-salivary reflexes are referred

to as unconditioned reflexes. However, the saliva secretion is also
controlled by conditioned reflexes. Besides receiving impulses from the
afferents, the salivary nuclei also receive impulses from higher centers of
the brain.

This gives rise to the release of a variety of neurotransmitters and

neuropeptides resulting in facilatory or inhibitory effects on the
preganglionic efferents.
Accordingly, the integration of the nervous output to the salivary glands
is a result of a complicated central control of the incoming signals to the

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salivary nuclei. As a result of such a control, unstimulated salivation is
normally inhibited during sleep, fear and mental depression. Stress may
increase saliva flow when it produces a will to fight, but may also
decrease saliva flow when it produces a feeling of anxiety or defeat.

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Formation of salivary secretion
Formation of saliva is a result of a unilateral, central reflex. Thus,
stimulation of one side of the mouth induces ipsilateral salivation where
the flow rate is dependent on the stimulus intensity of taste or chewing
applied. In general, the parasympathetic pathway provides the
predominant control path of the salivary glands. The outcome of such
stimulation is saliva with a high flow rate. Sympathetic stimulation leads
to a lower flow rate and more protein-rich saliva.
At the peripheral salivary gland level, the control of salivation depends on
neurotransmitter release from the parasympathetic and sympathetic nerve
endings in the vicinity of salivary glands. The classical transmitters that
activate secretion of saliva are acetylcholine and norepinephrine, but
other substances released from the peripheral nerve endings also have
important modulator effects on formation of saliva by the glands.
Binding of neurotransmitters and neuropeptides to specific cell-surface
membrane receptors on the richly innervated secretory endpieces and
ductal systems activates a large number of biochemical events within the
gland tissue.

Major salivary glands (Gray's Anatomy, 2008).

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General functions of saliva

1) : - The salivary fluid initially formed inside the glandular

acini is isotonic with respect to plasma; however, as it runs through
the ducts of the salivary gland, it becomes hypotonic. The
hypotonicity of saliva (i.e. low levels of glucose, sodium chloride,
and urea) and its capacity to provide the dissolution of substances
allows the gustatory buds to perceive different flavors.

2) : - A number of protective functions which

are part of the total body's ability to maintain homeostasis can be
performed via the complex physical and chemical composition of
salivary secretion.
Saliva forms a seromucosal covering that lubricates and protects
the oral tissues against irritating agents. This occurs due to mucins
(proteins with high carbohydrate content) responsible for the
lubrication, protection against dehydration, and maintenance of
salivary viscoelasticity.

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 They also selectively modulate the adhesion of microorganisms to
the oral tissue surfaces which contributes to the control of bacterial
and fungal colonization. In addition, they protect these tissues
against proteolytic attacks by microorganisms.

3) : - Sugars in their free form are present in total

stimulated and unstimulated saliva at a mean concentration of 0.5
to 1 mg/100mL. Salivary fluid tends to eliminate the excess of
carbohydrates, thus, limiting the availability of sugars to the
biofilm microorganisms. The greater the salivary fluid, the greater
the cleaning and diluting capacity; therefore, if changes in health
status cause a reduction in salivary fluid, there would be a drastic
alteration in the level of oral cleaning.

4) : - Buffer is the solution that tends to maintain a

constant pH when acid or base is added, the buffer capacity is
related to its concentration.
Hydrogen ion present in saliva via their secretion through salivary
glands in form of inorganic and organic acids, produced by the oral
microbiota and taken by food or acid drinks with an average pH of
mixed saliva 6.7 and it is vary with salivary flow rate from 5.3 with
low flow to 7.8 with peak flow.
The most important salivary buffering systems are: bicarbonate,
phosphate and proteins. Regulation of oral pH is an important
function of the salivary buffering system. The role of saliva
includes not only supply calcium and phosphate ions to teeth but
also buffering capacity to neutralize acids produced by the
metabolism process by oral bacteria to prevent demineralization of
teeth and stop the formation and progression of dental caries.

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5) : - Saliva plays a fundamental role in
maintaining the physico-chemical integrity of the tooth enamel by
modulating remineralization and demineralization. The main
factors controlling the stability of enamel hydroxyapatite are the
active concentrations of salivary calcium, phosphate, and fluoride.
The availability of calcium and phosphate ions in saliva can
enhance remineralization of carious tooth before cavitation occurs.
The presence of fluoride in saliva, even at physiologically low
levels, is decisive for the stability of dental minerals.

6) : - Saliva is responsible for the initial digestion of starch,

favoring the formation of the food bolus. This action occurs mainly
by the presence of the digestive enzyme alpha-amylase (ptyalin) in
the composition of the saliva.
This enzyme divides the starch into maltose, maltotriose, and
dextrins, so this is considered to be a good indicator of properly
functioning salivary glands; however, its action is limited to mouth
because it is inactivated by the acid portion of GIT.

7) :- A tissue repair function is attributed to saliva since

clinically the bleeding time of oral tissues appears to be shorter
than other tissues. When saliva is experimentally mixed with
blood, the coagulation time can be greatly accelerated (although
the resulting clot is less solid than normal). This may be due to the
epidermal growth factor it contains which is produced by the
submandibular glands.

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8) : - Saliva contains a variety of immunological
and non-immunological antibacterial proteins.
 Secretory immunoglobulin A (IgA) is the largest immunological
component of saliva. It can neutralize viruses and bacterial toxins
and serves as an antibody for bacterial antigens. It is able to
aggregate bacteria, and inhibit their adherence to the oral tissues.
Other immunologic components, such as IgG and IgM, occur in
less quantity and probably originate from the gingival crevicular
fluid.
 Among the non-immunological salivary protein components, there
are enzymes (lysozyme, lactoferrin, peroxidase, mucin
glycoproteins, agglutinins, histatins, proline-rich proteins,
statherin, and cystatins).

To be continued