seminar

1. Salivary gland And Role of
saliva in maintaining oral
health
Darpan Nenava
PG 1st year
1

2. CONTENTS


INTRODUCTION
ANATOMY OF SALIVARY GLANDS









PAROTID GLAND
SUBMANDIBULAR GLAND
SUB LINGUAL GLAND
EMBRYOLOGY
HISTOLOGY
PHYSIOLOGY
SALIVA
CONCLUSION
REFERENCES
2

3. Introduction

Salivary glands are group of compound exocrine glands secreting
saliva.

Parenchymal elements consists of terminal secretory units leading
into ducts.

Connective tissue forms a capsule around a gland, and extend into it
dividing groups of secretory units & ducts into lobes & lobules.

Tubulo acinar units are merocrine
3

4. Introduction

Salivary Gland is any cell or organ
discharging a secretion into the oral
cavity.
 Major and minor Salivary Glands

Major (Paired)
 Parotid
 Submandibular
 Sublingual

Minor
 Those in the Tongue,
Palatine Tonsil, Palate,
Lips and Cheeks
4

5. Anatomy
of salivary glands
5

6. Parotid Gland

Largest

Average Wt - 25gm

Irregular lobulated mass lying
mainly below the external acoustic
meatus between mandible and
sternomastoid.

On the surface of the masseter,
small detached part lies b/w
zygomatic arch and parotid ductaccessory parotid gland or ‘socia
parotidis’
6

7. Parotid Capsule

Derived from investing layer of deep cervical fascia.

Superficial lamina-thick, closely adherent-sends fibrous septa
into the gland.

Deep lamina-thin- attached to styloid process,mandible and
tympanic plate.

Stylomandibular ligament.
7

8. External Features

Resembles an inverted 3
sided pyramid

Four surfaces
Superior(Base of the
Pyramid)
 Superficial
 Anteromedial
 Posteromedial


Separated by three borders
Anterior
 Posterior
 Medial

8

9. 
Superior Surface
Relations
Concave
 Related to
 Cartilaginous part of ext
acoustic meatus
 Post. Aspect of
temperomandibular
joint
 Auriculotemporal
Nerve
 Sup. Temporal vessels


Apex

Overlaps posterior belly of
digastric and adjoining part of
carotid triangle
9

10. 
Superficial Surface
 Covered
by
Skin
 Superficial fascia containing facial
branches of great auricular N
 Superficial parotid lymph nodes and post
fibers of platysma


Anteromedial Surface
 Grooved
by posterior border of
ramus of mandible

Related to
Masseter
 Lateral Surface of temperomandibular
joint
 Medial pterygoid muscles
 Emerging branches of Facial N

10

11. 
Posteromedial Surface
 Related
 to mastoid process with
sternomastoid and posterior
belly of digastric.

Styloid process with
structures attached to it.

External Carotid A. which
enters the gland through
the surface

Internal Carotid A. which
lies deep to styloid process
11

12. Borders

Anterior border
 Separates
superficial surface
from anteromedial surface.
 Structures
border
which emerge at this
 Parotid
Duct
 Terminal Branches of
facial nerve
 Transverse facial vessels
12

13. 
Posterior Border
 Separates
superficial surface
from posteromedial surface
 Overlaps sternomastoid

Medial Border
 Separates
anteromedial
surface from posteromedial
surface
 Related to lateral wall of
pharynx
13

14. Structures within
Parotid Gland
tempora
l
 External
carotid A
 Retromandibular Vein
 Facial Nerve
Zygomaticotemporal
zygomatic
Facial Nerve
buccal
mandibula
r
cervical
Superficial temporal V
Maxillary V
Post auricular
V
External jugular
Cervicofacial
Superficial temporal A
Maxillary A
P.Auricular A
Common Facial V
14

15. 
Facial Nerve trunk lies approximately 1 cm
inferior and 1 cm medial to tragal cartilage pointer
of external acoustic meatus.
15

16. Parotid Duct

Ductus parotideus; Stensen’s duct

5 cm in length

Appears in the anterior border
of the gland

Runs anteriorly and downwards
on the masseter b/w the upper
and lower buccal branches of
facial N.
16

17. 
At the anterior border of
masseter it pierces




Buccal pad of fat
Buccopharyngeal fascia
Buccinator Muscle
It opens into the vestibule of
mouth opposite to the 2nd
upper molar
17

18. Surface anatomy of Parotid Duct

Corresponds to middle third of a line drawn from
lower border of tragus to a point midway b/w nasal
ala and upperlabial margin
18

19. Blood supply

Arterial


Branches of Ext. Carotid A
Venous

Into Ext. Jugular Vein
Lymphatic Drainage
Upper
Deep cervical nodes
via Parotid nodes
19

20. Nerve Supply

Parasymapthetic N
 Secretomotor via
auriculotemporal N

Symapathetic N
 Vasomotor
 Delivered from plexus
around the external
carotid artery

Sensory N
 Reach through the
Great auricular and
auriculotemporal N
20

21. Clinical Consideration
1.
2.
3.
A viral inflammation of the parotid gland (mumps)
causes it to swell, resulting to pain on movement of
the jaw.
Abcesses or cysts of the gland may result in pressure
to the facial nerve
Stones or calculi in the duct can block it, causing
painful swelling of the gland.
21

22. Submandibular Salivary Glands

It is a mixed serous and mucous secreting
gland.

Irregular in shape

Large superficial and small deeper part
continous with each other around the post.
Border of mylohyoid

Superficial Part



Situated in the digastric triangle
Wedged b/w body of mandible and mylohyoid
3 surfaces
 Inferior,Medial,Lateral
22

23. 23

24. 
Capsule
 Derived
from deep cervical fascia
 Superficial
 Deep
Layer is attached to base of mandible
layer attached to mylohyoid line of mandible
24

25. 
Relations

Inferior- covered by






Skin
Supeficial fascia containing
platysma and cervical
branches of facial N
Deep Fascia
Facial Vein
Submandibular Nodes
Lateral surface



Related to submandibluar
fossa on the mandible
Madibular attachment of
Medial pterygoid
Facial Artery
25

26. 
Medial surface

Anterior part is related to myelohyoid
muscle,nerve and vessles

Middle partHyoglossus,styloglossus,lingual nerve,
submandibular ganglion,hypoglossal
nerve and deep lingual vein.

Posterior Part-Styloglossus,stylohyoid
ligament,9th nerve and wall of pharynx
26

27. 
Deep part

Small in size

Lies deep to mylohyoid
and superficial to
hyoglossus and
styloglossus

Posteriorly continuous
with superficial part
around the posterior
border of mylohyoid
27

28.  Submandibluar
duct
Whartons duct
 5 cm long
 Emerges at the anterior end of deep
part of the gland
 Runs forwards on hyoglossus b/w
lingual and hypoglossal N
 At the ant. Border of hyoglossus it is
crossed by lingual nerve
 Opens in the floor of mouth at the side
of frenulum of tongue

28

29. 29

30. Blood Supply

Arteries
 Branches
of facial and
lingual arteries

Veins
 Drains
to the
corresponding veins

Lymphatics
 Deep
Cervical Nodes via
submandibular nodes
30

31.  Nerve
Supply
 Branches
from
submandibular ganglion,
through which it receives

Parasymapthetic fibers
from chorda tympani

Sensory fibers from lingual
branch of mandibular
nerve

Sympathetic fibers from
plexus on facial A
31

32. Sublingual Salivary Glands

smallest of the three glands

weighs nearly 3-4 gm

Lies beneath the oral mucosa
in contact with the sublingual
fossa on lingual aspect of
mandible.
32

33. 
Relations
 Above

Mucosa of oral floor,
raised as sublingual fold
 Below


Myelohyoid Infront
Anterior end of its fellow
 Behind

Deep part of
Submandibular gland
33

34.  Lateral
 Mandible
above the
anterior part of
mylohyoid line
 Medial
 Genioglossus
and
separated from it by
lingual nerve and
submandibular duct
34

35. 
Duct
Ducts of Rivinus
 8-20 ducts
 Most of them open directly into the
floor of mouth
 Few of them join the submandibular
duct

35

36. 
Blood supply
Arterial from sublingual and submental arteries
 Venous drainage corresponds to the arteries


Nerve Supply

Similar to that of submandibular glands( via lingual nerve ,
chorda tympani and sympathetic fibers)
36

37. 
Minor salivary glands are found throughout the
mouth:
– Lips
– Buccal mucosa (cheeks)
– Alveolar mucosa (palate)
– Tongue dorsum and ventrum
– Floor of the mouth

Together, they play a large role in salivary
production.
37

38. Minor salivary glands
38

39. Embryology
39

40. PRIMORDIA
TIME OF
DEVELOPMEN
T
EMBRYONIC
ORIGIN
REGION
Parotid gland
primordia
(anlage)
5th to 6th week
Ectoderm
Labiogingival
sulcus
Submandibular
gland primordia
6th week
Endoderm
Hyoid arch
Endoderm
Linguogingival
sulcus
Sublingual gland 7th to 8th week
primordia
Intraoral minor
salivary glands
3rd month
40

41. Development of Salivary
Glands
41

42. Histology
42

43. 
Compound Tubuloalveolar glands

Structure


Closely packed acini or alveoli with ducts scattered in
between
Supported by connective tissue which divides the gland into
lobules
43

44. 
Cells lining the alveoli
Serous or mucous
Serous





Stain darkly (zymogen granules)
Wedge shaped with round nucleus, lying
towards the base
Mucous





Lightly stained
Appears empty
Polyhedral
Contain mucinogen granules
Nucleus flattened ,close to the basement
membrane
44

45. 
Parotid


Parotid
Sublingual


Serous type
Mucous
Submandibular

Mixed type –some mucous
alveoli capped by serous
cresents –
‘Demilunes’
Sublingual
Submandibular
45

46. DUCTS
46

47. DUCTS
Intralobular
Intercalated
Striated
Intralobular
Excretory
47

48. DUCTS
48

49. 
Myoepithelial cells

Present in relation to alveoli and
intercalated ducts

Those on the alveoli are
branched-’Basket Cells’

Those on the ducts are fusiform

Contractile cells helps to squeeze
out secretions from alveoli
49

50. Physiology
50

51. 
Main function of Salivary
Gland-secretion of saliva

Daily secretion -800 to
1500 ml

pH : 6-7
51

52. Control of Salivary Secretion
Sup Salivatory Nu
Facial N
Otic Ganglion
Inf Salivatroy Nu
Parotid Gland
Chorda tympani N
Submandibular G
 Under neural control
 Mainly by parasympathetic signals from
Sup & Inf salivatory nuclei
52

53. 
Parasympathetic stimulationprofuse secretion of watery saliva

Sympathetic stimulationscanty viscid secretion

Sympathetic supply comes from cervical
sympathetic chain along the blood vessels
53

54. 
Salivatory nuclei are excited by

Taste and tactile stimuli from tongue
and other areas of mouth and
pharynx

Stimuli from esophagus and stomach
(due to stimulation of vagal afferent
fibers)
 (unconditioned reflex)

Stimuli arising from higher centers
of brain due to sight, smell or
thought of food
 (conditioned reflex).
54
Pavlov with his dog

55. SALIVA
55

56. 
Complex fluid found lubricating the mucosa and teeth of the oral
cavity.

Salivary glands, their cells and ducts are greatly responsible for
the modification and kind of saliva being secreted

It is of three types:



Serous Saliva
Mucous Saliva
Mixed Saliva
56

57. 
General characteristics:

Consistency - slightly cloudy due to presence of mucins and cells

Reaction - usually slightly acidic (pH 6.02-7.05).On standing or boiling, it
loses CO2 and becomes alkaline.

Specific gravity - 1.002-1.012

Freezing point - 0.07-0.34° Celsius
57

58. 
58
Percentage contribution of different salivary glands during
unstimulated saliva:

59. Unstimulated flow

Resting salivary flow―no external stimulus
o Typically 0.2 mL – 0.3 mL per minute
o Less than 0.1 mL per minute means the person has
hyposalivation
Hyposalivation – not producing enough saliva
59

60. Stimulated Flow

Response to a stimulus, usually taste, chewing, or
medication eg, at mealtime
o Typically 1.5 mL – 2 mL per minute
o Less than 0.7 mL per minute is considered hyposalivation
60

61. The average person produces approximately 0.5 L – 1.5 L per day
• Salivary flow peaks in the afternoon
• Salivary flow decreases at night.
• There is a difference in the quality between stimulated and
unstimulated saliva
61

62. Ions and salivary flow
As saliva passes
through the salivary
ducts, cations
(sodium and chloride)
are reabsorbed into
the adjacent
blood vessels.
62

63. As saliva passes through the salivary ducts, cations
(sodium and chloride) are reabsorbed into the adjacent
blood vessels. In exchange, bicarbonates and
potassium are transferred from the blood
63

64. Stimulated Salivary Flow
• Saliva passes through the salivary duct very rapidly
o It impedes the exchange of sodium and chloride for
potassium and bicarbonate
Unstimulated Salivary Flow
• Has a high content of potassium and bicarbonate
o The quality of unstimulated saliva will change when flow
increases because of a stimulus (chewing gum, thinking about
lemons, looking at a food you crave)
64

65. Saliva Compositon
Water (99.5%)
Solid (0.5%)
Organic
Ptyalin
Mucin
Lysozyme
IgA
Lactoferrin
Inorganic
Na+
K+
Ca+
ClHCO3
Mg
65

66. 
Ionic Composition
 Saliva
in the acini-isotonic with plasma
 Under
resting condition ionic composition of saliva reaching
the mouth



 During



Na+ and Cl- 15 mEq/l (1/7 to 1/10 conc of Plasma)
K+ 30 mEq/l (7 times that of Plasma)
HCO3- 50-70 mEq/l (2-3 times that of plasma)
maximal salivation
Na+ and Cl- (1/2 to 2/3 conc of Plasma)
K+ (4 times that of Plasma)
HCO3- 50-70 mEq/l (2-3 times that of plasma)
66

67. Functions of Saliva


Main function: maintaining the well-being of the mouth
Other important functions:
 Protection
 Buffering Action
 Digestion
 Facilitation of Taste
 Defensive Action against Microbes
 Ionic Exchange between Tooth Surface
67

68. Functions of Saliva
Effect
Active Constituent
Protection
Lubrication, lavage, pellicle
formation
Glycoprotein
Water
Buffering Action
Regulates pH
Phosphate and
Bicarbonate
Digestion
Digests starch
Digests lipids
Bolus formation
Amylase
Lingual Lipase
Facilitation of Taste
Taste bud growth and
maturation, dissolves
substances to carry to taste
buds
Gustin
Defensive Action Against
Microbes
Antibodies
Hostile Environment
Lysozyme
Lactoferrin
IgA
Ionic Exchange Between
Tooth Surface
Posteruptive Maturation of
Enamel
Repair
Calcium
Phosphate
68

69. Saliva and Dental Caries






Effect of desalivation and hyposalivation on dental caries
Salivary clearance from oral cavity
Flouride concentration of saliva
Salivary antibacterial substance
Protein inhibiting hydroxyapatite
Acquired salivary pellicle
69

70. Effect of desalivation and hyposalivation on dental caries


Total or partial aplasia is rare and accompanied by high caries
prevalence
Causes
Tumor growth
 Radiation therapy




This condition is called as XEROSTOMIA
Reduced salivary secretion is called as HYPOSALIVATION
Causes







Drugs such as atropine and other anticholinergics
Fever or prolonged diarrhea
Diabetes
Anemia
Hypovitaminosis A or B
Uremia
Dehydrating disease of old age
70

71. 
Patients with hyposalivation experience
Difficulty in mastication
 Swallowing
 Wearing dentures
 Speaking


Sjogren’s syndrome is an autoimmune
Acinar cells are destroyed
 Dry eyes as lacrimal gland cells are also destroyed
 And symptoms of rheumatoid arthritis

71

72. Salivary clearance from oral cavity

Role of bacteria and food debris removal from oral
cavity
 Bacteria


Bacteria is passed into stomach by salivary flow
Half life of any material in cavity is only few minutes
 Despite
continuous flow dental plaque can accumulate at
rapid rate of 10-20mg/day
 Rate of plaque accumulation is even more rapid in patients
with hyposalivation and xerostomia
72

73. 
Food Debris
When retained in mouth act as substrate for metabolic
activities of microbes
 Thus if clearance is retarded it will tend to promote the
development of caries
 Caramel and other toffees show prolonged retention
 Some studies show cariogenecity is not related to sugar
concentration


Sugar in non retentive forms as in soft drinks
73

74. Flouride concentration of saliva



The level of flouride ions in ductal saliva is as low as 0.010.03ppm.
Flouride level in saliva are independent of salivary flow rate and
determined by the amount ingested
Fluorapatite




Insoluble in saliva
Therefore beneficial to have high proportion of fluorapatite in surface
enamel as possible
Higher stable concentration of fluoride can accure slowly from saliva
But can be reached more rapidly by topical flourde applications
74

75. Flouride concentration of saliva

The importance of fluoride maintenance and augmentation of
fluoride in enamel surface

As the fluoride concentration is reduced protection against caries is also
decreased
75

76. Salivary antibacterial substance

A number of anti bacterial factors present in saliva





Lysozymes
Lactoperoxidase
Lactoferrin
Immunoglobulin A
It helps to prevent the establishment of more pathogenic
transient invaders
76

77. Lysozymes

Have property of cleaving cell walls of microbes causing there
lysis

Antibacterial action of lysozyme does not completely depend on
cell lysis

(Streptococcus mutans lose there viability in the presence of lysozyme
and some detergent or NaCl without lysis of cell wall
77

78. Lactoperoxidase




This factor exists in milk, saliva and tears and can inhibit the
growth and acid formation of some bacteria.
It oxidises thiocyanate (SCN-) in presence of hydrogen peroxide
Formed by microbes in hypothiocyanate(OSCN-)
To oxidize thiol group which leads to activation of many
bacterial enzymes
78

79. Lactoferrin

Bacteriocidal effects due to its strong iron binding capacity
Removing iron from solution and making it unavailable as an
essential bacterial nutrient

Lactoferrin has been shown to be antagonist to S.mutans

79

80. Immunoglobulins

There are two principal immunological mechanism involved in
protection against infectious diseases

Antibodies production (humoral immunity)


Involving cells (cell-mediated immunity)


Antibodies produced by plasma cells circulate in body (systemic immunity)
If produced by plasma cells with secretory tissues such as salivary gland (local
immunity)
Antibodies are





IgG
IgA
IgD
IgE
IgM
80

81. Immunoglobulins




In systemic circulation IgG dominates
In saliva IgA dominates in S-IgA form Secretory
Immunoglobulin A
Concentration of IgA in stimulated parotid and submandibular
saliva is 4mg/100ml
30mg/100ml in secretion from minor salivary glands
81

82. Protein inhibiting hydroxyapatite

Several salivary protein bind calcium and /or inhibit formation
of hydrooxyapatite these proteins are

Statherin

Proline-Rich Proteins
82

83. Protein inhibiting hydroxyapatite

Statherin





A polypeptide
Concentration in saliva 2-6 µM
Also prevents precipitation of calcium phosphate from supersaturated
solution by adsorbing onto early crystal nuclei
Causing demineralization of early carious lesion
Inhibition is due to the ability of the statherin to block crystal growth of
calcium phosphate
83

84. Protein inhibiting hydroxyapatite

Proline-Rich Proteins





A polypeptide
Concentration in saliva 2-6 µM
Also prevents precipitation of calcium phosphate from supersaturated
solution by adsorbing onto early crystal nuclei
Causing demineralization of early carious lesion
Inhibition is due to the ability of the statherin to block crystal growth of
calcium phosphate
84

85. Acquired salivary pellicle
85

86. Acquired salivary pellicle

Clinical relevance




Pellicle thickness


To prevent the contact of saliva prior to composite resin placement
Upon the etched enamel
Salivary protein tend to fill up defects in newly etched enamel
100nm after 2 hrs to about 400nm in 24-48 hrs
Pellicle is three layered



Subsurface :- has dendritic appearance penetrate in pores and
demineralized enamel
Centre :- uniformly forms a surface around tooth
Suprastructure :- variable thickness
86

87. Acquired salivary pellicle




This is predominantly bacteria free initially
Becomes highly insoluble with time due to protein denaturation
Coating becomes rapidly populated by mixed bacterial
aggregrates
Grow in number and coalesce to form bacterial dental plaque
87

88. Properties of salivary pellicle






Act as a lubricant prevent premature loss of enamel during
mastication
Reduces rate of demineralization of tooth surface by acidic food
and drinks
Act as a semi permeable membrane and reduces ion mobility
but the movement of water is unaffected.
Reduces mobility of calcium and phosphate from enamel to
fluid enviorment
Forms a surface for bacterial colonization leads to formation of
microbial dental plaque
Prevents continuous enlargement of tooth surface by crystal
growth of hydroxyapatite crystal
88

89. Amylases, Cystatins,
Histatins, Mucins,
Peroxidases
Cystatins,
Mucins
Histatins
AntiBacterial
AntiViral
AntiFungal
Buffering
Salivary
Functions
Carbonic anhydrases,
Histatins
Digestion
Mineralization
LubricatTissue ion &ViscoCoating elasticity
Amylases,
Cystatins, Mucins,
Proline-rich proteins, Statherins
Amylases,
Mucins, Lipase
Cystatins,
Histatins, Prolinerich proteins,
Statherins
Mucins, Statherins
89

90. SALIVATION REFLEX
ACTIVITY
90

91. Reflex Activity



Resting flow: keeps the mouth and oropharynx moist
Food and the prospect of eating: are most saliva-inducing stimuli
Whole-mouth saliva contribution when stimulated:



Parotid gland: 50%
Submandibular gland: 30%
Sublingual and minor salivary glands: 20%
91

92. Reflexes

Gustatory-salivary reflex
 Sour>salty>sweet>bitter

Masticatory-salivary reflex
 Saliva

flow is directly proportional to masticatory forces
Olfactory-salivary reflex
 No
reflex response from the parotid gland
 Increase in salivary secretion from the submandibular and
sublingual glands
92

93. Reflexes

Visual and psychic salivary reflex
 Stimuli:

thought and sight of food
Esophageal-salivary reflex
 Waterbrush
phenomenon: sudden filling of the mouth with
fluids
93

94. AGE CHANGES
94

95. Age Changes

the aging salivary glands are known to undergo
structural changes
The lobule structure becomes less ordered
 The acini vary more in size and eventually atrophy
 Interlobular ducts become more prominent and the
percentage of fibroadipose tissue increases

95

96. Age Changes

Changes in the salivary glands
(submandibular,parotid (less) and minor salivary
glands)
 Shrinkage
of cells
 Dilation of ducts
 Oncocytic transformation
 Increased adiposity
 Fibrosis
 Focal microcalcifications with obstruction
 Chronic inflammation
96

97. CLINICAL CONSIDERATIONS
97

98. Mucoceles



CAUSE: trauma to excretory ducts of the minor glands which
allows the spillage of mucus into the surrounding connective
tissue
PHYSIOLOGIC MANIFESTATION: formation of painless,
smooth surfaced, bluish lesions
TREATMENT:
self-limiting (acute) or
surgery (chronic)
98

99. Mucocele
99

100. Ranulas



Type of mucocele
CAUSE: blocked sublingual gland ducts
PHYSIOLOGIC MANIFESTATION: Unilateral, softtissue lesions, often with a bluish appearance.


Vary in size and may cross the midline of the mouth and cause
deviation of the tongue
TREATMENT:
self-limiting (acute)
surgery (chronic)
100

101. Ranula
101

102. Sialolithiasis

CAUSE: inactivity of the glands
Metabolic conditions that promote salt precipitation in the glands
 Predisposing factors: dehydration and poor oral hygiene



PHYSIOLOGIC MANIFESTATION: formation of caliculi
TREATMENT: massaged out by a specialist, surgery,
antibiotics
102

103. Sialolithiasis
103

104. Necrotizing Sialometaplasia

UNKNOWN CAUSE



Possible etiologic agent: smoking, trauma, vascular disease
PHYSIOLOGIC MANIFESTATION: uncommon benign
lesion and inflammatory condition that affects salivary glands,
usually the minor salivary glands
TREATMENT:
resolves spontaneously,
self-limiting
104

105. Necrotizing Sialometaplasia
105

106. Mumps





Aka. epidemic parotitis (viral)
Occurs usually during childhood
CAUSE: paramyxovirus that infects the parotid glands
PHYSIOLOGIC MANIFESTATION: inflammation of the
parotid glands located on either side of the face
TREATMENT: warm compress,
warm, salt water rinses, antibiotics,
surgery, anti-inflammatory
medications
106

107. Mumps
107

108. Salivary Gland Neoplasm




Aka. Salivary gland cancer
CAUSE: rapid cell growth of the salivary gland
PHYSIOLOGIC MANIFESTATION: present as painless,
slow-growing masses
TREATMENT: radiation therapy, chemotherapy
108

109. Salivary Gland Neoplasms
109

110. Irradiation Reaction (Xerostomia)




subjective complaint of dry mouth due to a lack of saliva
CAUSE: tumoricidal doses of ionizing radiation, excessive
clearance or breathing through the mouth, hyposalivation
(decreased saliva production)
PHYSIOLOGIC MANIFESTATION: dry oral mucosa
TREATMENT: frequent sips of water and frequent mouth
care
110

111. Xerostomia
111

112. thank you
112