Introduction to the Salivary Glands

1. Introduction to the Salivary Glands Dennis E. Lopatin, Ph.D Dept. of Biologic & Materials Sciences

2. Even Science Fiction Has Discovered the Importance of Saliva!

3. Saliva in Oral Health: Protective Functions • Lubrication • Mucins, proline-rich glycoproteins, water • Antimicrobial • Amylase, complement, defensins, lysozyme, lactoferrin, lactoperoxidase, mucins, cystatins, proline-rich glycoproteins, secretory IgA, secretory leukocyte protease inhibitor, statherin, thrombospondin

4. Saliva in Oral Health: Protective Functions (cont’d) • Growth Factors • Epidermal growth factor (EGF), transforming growth factor-alpha (TGF-a), transforming growth factor-alpha (TGF-), fibroblast growth factor (FGF), insulin-like growth factor (IGF-I & IGF-II), nerve growth factor (NGF) • Mucosal Integrity • Mucins, electrolytes, water

5. Saliva in Oral Health: Protective Functions (cont’d) • Lavage/cleansing • Water • Buffering • Bicarbonate, phosphate ions, proteins • Remineralization • Calcium, phosphate, statherin, anionic proline-rich proteins

6. Saliva in Oral Health: Food and Speech-related functions • Food Preparation • Water, mucins • Digestion • Amylases, lipase, ribonuclease, proteases, water mucins • Taste • Water, gustin • Speech • Water, mucins

7. Salivary Gland Anatomy • Parotid Gland • Submandibular Gland • Sublingual Gland • Minor Glands

8. Major Salivary Glands Parotid Glands Submandibular Glands

9. Structure of the Ducts

10. Salivary Constituents • Water & electrolytes • Proteins • Non-electrolytes • Non-glandular proteins

11. Components of Whole Saliva • Salivary glands • Water, proteins, electrolytes, small organic molecules • Blood and blood derivatives • Intraoral bleeding, gingival crevicular fluid (serum & inflammatory cells) • Extrinsic substances • Food debris, toothpaste and mouth rinse • Other fluids • Bronchial and nasal secretions • Lining cells • Epithelial keratins • Microbiota

12. Factors Contributing to Saliva Content • Normal Human Variability • Unstimulated vs. stimulated saliva • Aging • Medications • Disease • Circadian rhythms • Objective vs. subjective determinations

13. Human Variations • Large range defines “normality” • A little goes a long way • Changes over time

14. Normal Variations in Saliva Output

15. Unstimulated vs. Stimulated Saliva • Unstimulated • Basal production • Confers most protection • Importance of minor and submandibular output • Low output during sleeping hours • Stimulated • Protection during mastication • Assists in deglutition • Importance of parotid output

16. Circadian Rhythm

17. Effects of Aging on Saliva • Quantity • No significant changes in major secretions • No significant changes in minor secretions • Quality • No general changes

18. Stimulated Parotid Flow Over Time

19. Assessment of Salivary Flow • Objective measures (Clinical tests) • Major gland secretions • Minor gland secretions • Whole saliva • Subjective measures (Patient perceptions) • Xerostomia (Do you have a dry mouth?) • Questionnaires (Dry mouth, trouble swallowing?) • Thirst (Are you often thirsty?)

20. Factors Affecting Salivary Production • Local diseases • Systemic diseases • Medications • Head and neck radiation • Chemotherapy

21. Local Factors Affecting Saliva • Obstructive Diseases • Neoplasms, mucous plugs, calculi • Inflammatory Diseases • Acute viral sialadenitis (myxovirus of mumps) • Acute suppurative bacterial sialadenitis • Chronic recurrent sialadenitis • Allergic parotiditis • Head and Neck Irradiation • Diet

22. Sialadenitis: Inflammation of the Salivary Gland

23. Bacterial Parotiditis: Inflammation of the Parotid Gland

24. Medications Influence Saliva • Anti-cholinergics • Anti-histamines • Anti-depressants, antipsychotics • Sedative and hypnotic agents • Anti-hypertensives • Anti-Parkinson drugs

25. Oral Side-Effects of Prescribed Drugs Xerostomia - Dry mouth Dysgeusia - Impairment of taste Stomatitis - Inflammation of oral mucous membranes Glossitis - Inflammation of tongue RG Smith & AP Burtner, 1994

26. Systemic Diseases That Influence Saliva • Sjögren’s syndrome • Sarcoidosis (a systemic granulomatous disease, especially of lungs, but affecting many other organs, including parotid glands) • Cystic fibrosis • Diabetes • Alzheimer’s disease • AIDS • Dehydration

27. Submandibular Duct Obstruction 2° to Infection

28. Head and Neck Radiation • Parotid vs. Submandibular • Dysfunction is dose- and field-dependent • Threshold of permanent destruction: 2100-4000 cGy

29. Salivary Flow Following Radiation Therapy

30. Chemotherapy • Alters salivary constituents • Normal function returns • Bone marrow transplantation: graft vs. host disease

31. Salivary Dysfunction and Oral Sequelae • Caries • Mucositis • Oral ulceration • Taste • Swallowing • Dentures • Infections

32. Salivary Dysfunction and Oral Sequelae: Caries • Incipient decay • Recurrent decay • Root vs. coronal decay

33. Extensive Caries in a post-radiation patient

34. Caries in a xerostomic individual Glossitis Caries Mucositis

35. Salivary Dysfunction and Oral Sequelae: Mucositis • Pain • Infections • Dysphagia • Impaired nutrition • Dehydration

36. Mucositis

37. Salivary Dysfunction and Oral Sequelae: Oral Ulceration • Wound healing • Lichen planus • Recurrent aphthous ulcers • Pain • Secondary infection (Candidiasis)

38. Xerostomia: Dry Fissured Tongue

39. Salivary Dysfunction and Oral Sequelae: Taste • Reduced enjoyment of eating • Altered supra-threshold and threshold performance • Sucrose, sodium chloride • Citric acid, quinine sulfate

40. Salivary Dysfunction and Oral Sequelae: Swallowing • Subjective complaints of dysphagia • Increased duration in oral swallow times • Dry swallows • Wet swallows

41. Salivary Dysfunction and Oral Sequelae: Dentures • Decreased retention and stability • Increased complaints • Greater likelihood for Candida infections

42. Salivary Dysfunction and Oral Sequelae: Infections • Candidiasis • Caries • Gingivitis • Viral infections • Bacteremias • Aspiration pneumonia

43. Candida 7th Week Following Tonsil Radiation Treatment

44. Candida/Denture Stomatitis

45. Saliva and Oral health: Conclusions • Saliva in health • Saliva in disease • Prevention of disease • Treatment of disease

46. Saliva deficient