Role of Saliva in Dental

Caries
Objectives
 Definition of saliva
 Composition and flow rate of Saliva
 Function of saliva
 Effect of saliva on dental caries
 Xerostomia
 Introduction
 Salivais a complex oral fluid consisting of a
mixture of secretions from the major salivary glands
and the minor glands of the oral mucosa.

 Itcontains gingival crevicular fluid, microorganisms,

food debris, leucocytes and epithelial cells.
 Saliva

 90% of saliva is produced by the three

pairs of major glands:
 parotid,
 submandibular,
 sublingual.
 Composition
 Normal salivary pH slightly acidic range from
6-7
 99% water and 1% solutes
 Solutes include:
• Electrolytes (sodium, potassium, calcium
,bicarbonate and phosphate), glucose,
nitrogenous products like urea.
• Proteins (enzymes, immunoglobulin, mucin,
mucosal glycol proteins)
 COMPOSITION FUNCTION
Inorganic Calcium Modulate demineralization and
remineralization
Magnesium
Sodium
Potassium
Cl
Bicarbonate Modulate PH, buffering
Organic Urea Modulate PH, buffering
Uric acid Indication for kidney function
AminoAcids
Glucose
Fatty Acids
Macromolecules Proteins Lubricant, cleanse
Glycoprotein sugars Cleanse
Amaylase Digestive (convert starch to
Lysozyme maltose)
IgA, IgG, IgM Antibacterial action
Antibacterial action
 Function of Saliva

Digestive
 Function:
saliva aids swallowing
Facilitating the digestion of carbohydrates
Protective effect:
•Regulates pH
Antibacterial activity against foreign microorganisms.
Flushing the oral cavity to clear and remove food

particles and debris from the tissues.
 Function of Saliva
 Chemically maintaining an environment rich in
calcium, phosphate and acid buffering agents (has been
recognized as having the ability to reduce the incidence
of dental caries).

 Lubricating the oral tissues, protecting the oral soft

tissues from abrasion during mastication.
 Effect Active component
Protection Lubrication, protective Glycoprotein
mucoid coating, Pellicle Water
formation
Buffering action Regulates PH by its Phosphate and Bicarbonate
bicarbonate
content
Digestion Digests starch Amylase
Digest Lipids Lingual Lipase
Bolus Formation
Facilitation of Taste Taste bud growth and Gustin
maturation, Dissolve
substances to carry to taste
buds
Defensive Action Against Antibodies Lysozyme
Microbes Hostile Environment Lactoferrin
IgA
Ionic Exchange Between Post-eruptive maturation of Calcium
Tooth Surface enamel, repair Phosphate
 Saliva and Dental Caries

 Characteristics
of saliva that have an influence
on dental caries:
 Quantity of saliva
 Composition of saliva
 pH
 Viscosity
 Salivary influences on Plaque PH

 Saliva
has a strong buffering capacity which will
reduce the effect of acid.
 Three major buffer system in saliva:
 Carbonate acid / bicarbonate
 Phosphate
 Protein buffer
 Carbonate/ bicarbonate is the most important
buffering system in saliva during food intake and
mastication
 During food intake two events occur:
First event: Bacteria ferment carbohydrate and
produce organic acid causing drop in pH.
Second event: Increase in salivary flow rate leads
to an increased carbonate acid HCO3
concentration which will further convert to carbon
.dioxide and water
The Saliva pH affects the Plaque pH which is-
more important in dental caries

Saliva carbonate
 PLAQUE pH
Resting
 Plaque pH is usually 6-7 (2 to 2.5 hours after
carbohydrate intake)
After carbohydrate intake:

In first 5 min__________ PH decrease rapidly
between 5-20 min _________PH Reach minimum

Role of saliva :
•Affects the minimum value of plaque pH .
•The rate at which the pH decreases .
STEPHAN CURVE
The pH of the dental plaque
decreases each time the
host ingests a snack or meal
that contains fermentable
carbohydrates; afterwards,
the pH
returns to the resting level
because
of saliva.
 Other Anticariogenic effects of Saliva

Salivaryproteins: increase the thickness of the

acquired pellicle and so help to retard the
movement of calcium and phosphate ions out of
enamel.
 The diffusion of salivary components into plaque
such as calcium, phosphate, hydroxyl, and
fluoride ions can reduce the solubility of enamel
and promote remineralization of early carious
lesions.
 Salivary Flow

 Normal resting or unstimulated secretion rate in

adults is between 0.3 and 0.5 ml/minute and 1 to
1.5 L daily

 An unstimulated secretion of less than

0.1 mL/minute is considered as a risk value.
 The normal stimulated secretion rate in adults is
1–2 ml/minute.

 values below 0.7 ml/minute should be

considered as low and indicate a caries risk.
 Reduced Salivary flow

CAUSES:

Radiotherapy

Drugs

Age

Salivary
 gland Disease
Systemic diseases

 MEDICATIONS THAT RETARD
SALIVARY FLOW
• Antidepressants
• Antiemetics • Appetite
• Antihistamines suppressants
• • Diuretics
Antihypertensives • Expectorants
• Antinauseants • Hypnotics
• Antiparkinsonian • Muscle relaxants
drugs • Tranquilizers
• Antipsychotic Anticholinergics
drugs
SYSTEMIC CAUSES OF ‘DRY MOUTH’
 Psychological factors
 Sjögren’s syndrome
 Hormonal changes
(pregnancy, post-menopause)
 Diabetes mellitus
 Dehydration
 Neurological diseases
 Smoking
• Pancreatic disturbances
• Liver disturbances
• Nutritional deficiencies
(anorexia nervosa,
malnutrition)
• Systemic lupus
erythematosus
• Immunodeficiency disease
(AIDS)
• Duct calculi
Preventive measures for patients with dry
mouths
 Patientmust then be encouraged to adopt the
following necessary preventive measures:
 Patient should visit dentist every 3 month
 Dietarycontrol: Reinforce the importance of
avoiding sweet drinks and snacks.
 Oral
hygiene measures: Daily tooth brushing and
excellent plaque control is very important.
Preventive measures for patients with dry
mouths
 The use of Fluoride :Patients should use a sodium
fluoride (0.05% NaF) mouth rinse daily for several
years to help arrest any initial carious lesions.
 Anypatient with a dry mouth should avoid
smoking, alcohol, and caffeine based drinks since
any of these can exacerbate the problem.
 References
1. Essentials of dental caries , Third edition by Edwina Kidd
2. Dental Caries: Principles and Management Edition 2015 by Zhou Xuedong
THANK YOU