DCP by dr.Kauser

1. DR. KAUSER SADIA FAKHRUDDIN
Saliva and dental caries

3. FUNCTIONS OF SALIVA
 It forms a protective mucoid coating on the
mucous membrane which acts as a barrier to
irritants and prevent dessication.
 Its flows helps to clear mouth of food and
cellular and bacterial debris and
consequently retards plaque formation.

4.  It is capable of regulating the pH of the oral
cavity by the help of its bicarbonate content
as well as its phosphate and amphoteric
protein constituents.
 Increase in secretion rate usually results in
an increase in pH and buffering capacity.
FUNCTIONS OF SALIVA

5.  Because of its calcium and phosphate
content it helps to maintain the integrity of
teeth.
 Tooth dissolution is prevented or retarded
and re-mineralization is enhanced by the
presence of copious salivary flow.
FUNCTIONS OF SALIVA

6.  The film of glycoprotein formed on the tooth
surface by saliva (the acquired pellicle) may
also protect the tooth by wear due to erosion
and abrasion.
FUNCTIONS OF SALIVA

7.  Saliva is capable of considerable
anti-bacterial and anti-viral activity by virtue
of its content of specific antibodies
(secrtetory IgA) as well as lysozyme,
lactoferrin, and lactoperoxidase.
FUNCTIONS OF SALIVA

8. CAUSES OF REDUCED SALIVARY FLOW

9. RADIOTHERAPY:
 Causes severe reduction in salivary flow
(less than 0.1ml/min).
 When the parotid gland are involved, there is
also a considerable increase in its total
protein content resulting in a thick, viscous
secretion.

10. DRUGS:
DRUGS THAT DECREASE SALIVA
PRODUCTION INCLUDE CERTAIN
ANTIDEPRESSANTS,
ANTIHISTAMINES,
ANTIPSYCHOTICS,
SEDATIVES,
METHYLDOPA,
AND DIURETICS.

11. DISEASE
 Acute and chronic inflammation of the
salivary glands (sialadenitis), benign or
malignant tumors, as well as Sjogren
syndrome, may all lead to hyposalivation.

12. AGE: Although aging
itself affects
moisture in the
mouth only slightly.
Older people are
more likely to take
drugs that may dry
the mouth.

13. FACTS
 The normal resting or un-stimulated
secretion rate in adults is between 0.3 and
0.5ml per minute
 The normal stimulated secretion rate in
adults is 1-2ml per minute.

14.  However, the rates may be reduced to less
than 0.1 ml per min or may not be
measurable in individuals with severe
salivary gland malfunction.
FACTS

15.  In less severe cases of hypo-salivation the
stimulated secretion rate is between 0.7 and
1.0 ml per min.
 The term XEROSTOMIA is used to describe
the perception of a dry mouth.
FACTS

17. COMPOSITION AND VISCOSITY OF SALIVA
 Parotid secretions are watery and clear
 Minor salivary glands in the mouth and throat
produce secretions that are more viscous
and ropy.

18.  Under normal conditions the parotid glands
produce 50% of the stimulated saliva and
20% of the resting saliva.
COMPOSITION AND VISCOSITY OF SALIVA

19.  Most of the resting saliva is produced by the
submandibular (65%), sublingual (7-8%) and
minor salivary glands (7-8%).
 Resting saliva is therefore more viscous than
stimulated saliva.
COMPOSITION AND VISCOSITY OF SALIVA

20. GENERAL CONSEQUENCES OF REDUCED
SALIVARY FLOW

21. GENERAL CONSEQUENCES OF REDUCED
SALIVARY FLOW
 Mucositis presents as tenderness, pain, or a
burning sensation and is exacerbated by spicy
foods, fruits, carbonated beverages, hot drinks
and tobacco.
 Taste sensation is altered
 Chewing, speaking and swallowing present
difficulties.


22. GENERAL CONSEQUENCES OF REDUCED
SALIVARY FLOW
 Extreme sensitivity of teeth to heat and cold,
especially if dentine is exposed.
 Edentulous patients may have problems
tolerating dentures.

23. GENERAL CONSEQUENCES OF REDUCED
SALIVARY FLOW
 Increase in dental plaque accumulation,
which makes gingivitis more likely
 There is also modification of the plaque flora
in favor of Candida, mutans streptococci and
lactobacilli.

24. CLINICAL MANAGEMENT OF DRY MOUTH

25.  Drug history
 Salivary flow assessment: flow rate peaks
during the afternoon. The patient should not
eat or drink (except water) for at least 1 hour
before collection.

26. CONSERVATIVE MEASURES TO RELIEVE
SYMPTOMS
 Sipping water frequently all day long.
 Restricting intake of substance that
exacerbate dryness such as cigarettes,
caffeine-containing drinks

27.  Avoiding astringents products such as
alcohol-containing or strong mint flavored
mouthwashes, strongly flavored toothpastes.
 Coating the lips with vaseline
 Humidifying the sleeping area.
CONSERVATIVE MEASURES TO RELIEVE
SYMPTOMS

28. SALIVARY STIMULANTS
 Chewing a sugar free chewing gum (xylitol or
chlorhexidine).
 Some fruits drops flavored with artificial
sweeteners, normally marketed for diabetics,
will not cause caries but are very acidic and may
dissolve enamel and dentine.

29.  SST (sinclair), is a saliva stimulating tablets
which is sucked.
 It is formulated with the buffer(phosphate) so
that it does not cause tooth damage
SALIVARY STIMULANTS

30.  Salivix (Provalis) lozenges
 Systemic use of drugs such as pilocarpine
hydrochloride has proved successful in
stimulating saliva.
 Stimulates parasympathetic nervous system.
(recommended dose 5mg OD once side
affects tolerated then 5mg*tds daily.
SALIVARY STIMULANTS

31.  Side affects: include sweating, flushing,
nausea, and diarrhoea, slow pulse rate, fall
in BP, and cause reflex narrowing of airways.
 Contraindicated: in pts. with cardiac and
respiratory problems.
SALIVARY STIMULANTS

32. SALIVA SUBSTITUTE
 Sprays (saliveeze, glandosane etc.)
 Lozenges (saliva orthana)
 Mouthwashes

33. Phosphate
Calcium

34. SALIVA AND CARIES
 The flow of saliva can reduce plaque
accumulation on the tooth surface.
 The diffusion into plaque of salivary
components such as calcium, phosphate,
hydroxyl and fluoride ions enhances re-
mineralization of early carious lesions.

35. IgA

36.  The carbonic acid-bicarbonate buffering
system as well as ammonia and urea
constituents of the saliva act as buffer
 The total concentration of IgA in saliva may
be inversely related to caries experience.
SALIVA AND CARIES

37. lysozyme
lactoperoxidase

38.  Lysozyme, lactoperoxidase and lactoferrin in
saliva have a direct antibacterial action on
plaque
 Salivary proteins could increase the
thickness of the acquired pellicle and so help
to retard the movement of calcium and
phosphate ions out of enamel.
SALIVA AND CARIES

39. PREVENTIVE MEASURES FOR PATIENTS WITH
DRY MOUTHS
 Plaque control
 Dietary control
 The use of fluoride (sodium fluoride 0.05%
NaF)
 Chlorhexidine gel application

40. CARIES CONTROL STRATEGIES

41.  The patients should see the
dentist at least every 3
months
 Plaque control needs to be
excellent and professional
plaque control should be
considered.
CARIES CONTROL STRATEGIES

42.  The stimulated flow rate should be measured
every 3-4 months to help establish the level
of caries risk.
 Dentist should emphasize on the importance
of avoiding sweet drinks and snacks. The
bedtime sweet drink is particularly
dangerous.
CARIES CONTROL STRATEGIES

43.  Patients should be discouraged from
attempts to stimulate salivary flow by sucking
sweets. Instead, chewing xylitol gum will be
safer and effective.
 Patient should use a sodium fluoride (0.05%
NaF) mouthrinse daily for several year.
CARIES CONTROL STRATEGIES

45.  A 1% chlorhexidine gel (Corsodyl) should be
applied by the patient in custom-made
applicator trays for 5 minutes every night for 14
days.
 This is repeated every 3-4 months until salivary
flow returns to normal.
 This keeps the level of mutans streptococci in
control for at least 3 months.
CARIES CONTROL STRATEGIES

46.  Caution: Chlorhexidine is inactivated by
sodium lauryl sulfate, so patients therefore
be instructed to rinse toothpaste out
thoroughly before any application of
chlorhexidine.
 Patient should also avoid smoking, caffeine
based drinks since they exacerbate the
problem.
CARIES CONTROL STRATEGIES