SALIVA

IMPLICATIONS IN
PROSTHODONTICS

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1.Introduction
2.Source composition & Properties.
3.Functions.
4.Anatomy & Histology of Salivary Glands.
5.Control of salivation.
6.Salivary flow rate.
7.Salivary flow and ageing.
8.Mastication, Oesophageal Function & Saliva
9.Xerostomia and its management.
10.Sialorrhea.
11.Prosthodontic considerations.
12.Saliva as a diagnostic tool.
13.Conclusion.
14.Bibliography. www.rxdentistry.net
 INTRODUCTION
Saliva is largely an unheralded ,unsung and ignored
secretion.
Is saliva important? There”s an old axiom which states
“you never miss the water till the well runs dry”. How true this
is, especially for saliva. The fact is, a world without saliva is a
world without pleasure….like living with a drought…..
Saliva is most valuable oral fluid that is often taken for
granted. It is critical for the preservation and maintenance of
oral health, yet it receives little attention until quality or
quantity is diminished. Consequently it is necessary for
clinicians to have a good knowledge base concerning the norm
of salivary flow and functionwww.rxdentistry.net
 SOURCE
Saliva is a clear and slightly alkaline mucoserous
exocrine secretion. It is a complex mixture of fluids, with
contributions from major salivary glands ,parotid
submandibular and sublingual, the minor or accessory
glands and the gingival crevicular fluid. Additionally, it
contains a high population of bacteria normally resident in
the mouth , desquamated epithelial cells , and transient
residues of food or drink following their Ingestion.

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 When referring to the fluid normally present in the

mouth the term “whole saliva” is commonly used, as

distinct from “duct saliva” which is that flowing from the

individual glands.

Secretions enter into the oral cavity by way of:

Parotid –stensens duct- orifice in the cheek above the

molar teeth.

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 Submandibular gland-whartons duct-sublingual

caruncle situated to the lingual side of the mandible in

the submandibular fossa.

Sublingual gland- Bartholins duct- empties along the

sublingual fold in the floor of the mouth.

Accessory salivary glands empty through individual

ducts at their respective locations.

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 COMPOSITION
99.5%water and balance made of solid substances-
inorganic 0.2%,organic 0.3%.
The concentration of which are characterized by wide
variation , both between individuals and with a single
individual.
Organic constituents:
Protein:
200mg/100ml(only 3% of the protein concentration in
plasma)
Enzymes ,immunoglobulins, mucous glycoprotiens ,
traces of albumin , poly peptides etc.
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Alpha amylase :
 Major digestive enzyme.

 Parotid-60to120mg/100ml.

 Submandibular-25mg/100ml.

 Hydrolysis of alpha 1:4 glycoside bond- end product is

maltose.

Immunoglobulins:
 Secretary IgA- predominant-20 mg /100ml
 IgG-1.5mg/100ML

 IgM-0.2mg/100ml,arising from gingival crevice.

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Antibacterial Proteins

Lysozyme-attacks components of the cell wall of certain

bacteria leading to lysis.
Lactoferrin-iron binding protein- removes free iron
from saliva –depleting the supply of iron needed for
bacterial growth.
Sialoperoxidase- oxidizes salivary thiocyanate ion to
hypothiocyanate- potent antibacterial substance using
hydrogen peroxide produced by oral bacteria as an
oxidant.

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Glycoprotiens :
MG1 and MG2- submandibular and sublingual saliva & a
group of Proline rich glycoprotiens (PRPs)-parotid saliva

Other poly peptides:

Statherin- rich in tyrosine and proline- inhibits the
hydroxyapatite crystal growth- inhibitor of calculus
formation both in glands and on the teeth.
Sialin- helps to regulate the Ph of plaque.

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 Other Organic Compounds
 Many free amino acids are present at low concentration.

While saliva can be used by some oral bacteria as a sole

source of nutrient ,the amino acid content is too low to
provide a rich growth medium.
 Urea - hydrolyzed by many bacteria with release of
ammonia – increase in pH.
 Glucose- 0.5mg/100ml- are too low to support extensive
growth, but may be raised in diabetics.

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Inorganic constituents of whole saliva(mg/100ml)

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 Major ions –main contributors to the osmolarity of
saliva.
Bicarbonate –principal buffer in saliva.
Fluoride- anticaries action.

Calcium and phosphate in saliva

Saliva is super saturated w.r.t hydroxyapatite at normal

intraoral Ph, submandibular saliva to a greater extent
than parotid saliva.
CA10(PO4)6(OH)2 10 CA2+ + 6PO43- +20H-
ph Decreases- Dissolution
pH Increases- Rimenarilisation

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 PROPERTIES
pH
6.7 TO 7.4 - whole saliva
6.0-7.8 - parotid saliva varies over a greater range
Depends on the bicarbonate concentration- concentration of
which increase with increase in salivary flow.
Initially saliva is isotonic as is formed in the acini but it
becomes hypotonic as it travels through the duct network
.Hypo tonicity of unstimulated saliva allows the taste buds to
perceive different taste and during low flow periods allows for
expansion and hydration of mucin glycoprotiens which
protectively blanket the tissues of the mouth.
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 Lower levels of glucose ,bicarbonate and urea in
unstimulated saliva augment the hypotonic environment
to enhance taste.

Viscosity
Viscosity of saliva is non newtonian. It exhibits different
viscosities at different rates of shear , and has visco elastic
properties.
Viscous behaviour changes with time after secretion
because of its non newtonian properties and post-
secretory degradation of mucous glycoprotiens by bacterial
enzymes.
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Volume:

Mean daily salivary output -500ml-1500ml.

Average volume of saliva present in the oral cavity is

approximately– 1 ml. Contribution to the Total
unstimulated volume of saliva-

Parotid-20%

Submandibular -60%

Sublingual-5%

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 Factors influencing the composition of saliva

Flow rate
Increased flow rate-increase concentration of proteins,
sodium chloride and bicarbonate, decreased phosphate &
magnesium.

Differential gland contributions

In unstimulated whole saliva parotid glands contribute
only 20% of fluid volume whereas in stimulated saliva
they become predominant. Thus the composition of the
mixed fluid reaches that of parotid saliva at high flow
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Duration of stimulus

At a constant rate of flow the composition may vary with the

duration of stimulation.

Nature of stimulus

Not biologically significant though salt stimulates- increase

in protein content , sugar- increase amylase content.

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 FUNCTIONS
Digestion:
Salivary amylase initiates digestion of starch-
inactivated in stomach- low ph and proteolytic activity.
Starch digestion in the mouth may be either beneficial in
aiding starch clearance, or detrimental in liberating
maltose for fermentation by oral bacteria to form acid-
overall effect on caries is still undecided.

Lubrication:
Aids in speech, mastication, swallowing and for general
oral health and comfort- property –water & mucous
gylcoproteins.
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 Glycoprotiens- high – minor & sublingual secretions,
Intermediate – submandibular ; low in parotid saliva.
Dilution and clearance:
Effect of water content of saliva is the dilution of
substances into the mouth and their subsequent removal
by swallowing or spitting.
Clearance is more rapid in some parts of the mouth than
others. Unstimulated saliva is present as a thin film
covering the hard and soft tissues of the mouth & the
velocity with which this film moves over the surface
determines the rate of clearance of a substance from
different sites,rapid clearance eg lower anteriors and
upper posterior teeth.
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 Neutralisation and Buffering:
 Saliva is alkaline and is an effective buffer system.
Reduces the drop in plaque ph- cariogenic potential of
foods.
Saturation:
 Saliva is supersaturated w.r.t tooth mineral- responsible
for growth of hydroxyapatite crystals during the
remineralisation phase of the caries process.
 Inhibitors of precipitation- statherin & proline prevents
the excessive calcification in the mouth, however they
cannot penetrate the plaque due to large molecular size -
unable to prevent seeding and calculus formation.
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Bacterial competition:
Saliva plays a role in the control of the bacterial flora by
acting as a selective growth medium.

Antibacterial effects

Pellicle and plaque formation

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 CONTROL OF SALIVATION
The salivary glands are unusual among the glands of the
digestive tract in being under purely nervous control.
Hormonal influences can alter the composition of saliva
but are not responsible for its secretion.
Salivary glands are strongly stimulated by the
parasympathetic nervous system, the sympathetic system
has little or no direct effect on salivation. The indirect
effect , a reduction in the rate of secretion from
sympathetic stimulation is a result of vasoconstriction of
blood vessels to the gland.
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Stimulation of submaxillary & sublingual glands is by –

superior salivary nuclei. Parotid – inferior salivary nuclei.

parasympathetic fibres from-

7th nerve - submandibular; 9th nerve-parotid- are

secretomotor and vasodilator.

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ANATOMY AND HISTOLOGY OF THE
SALIVARY GLANDS
CLASSIFICATION OF SALIVARY GLANDS
According to the size:
 Major-3pairs
 Parotid
 Submandibular
 Sublingual
 Minor-400 TO 500 .- Glossopalatine, Buccal , Mucous
glands of the cheek etc , spread in the oral cavity except
at the gingiva and anterior part of the hard palate.
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According to the location
Glands whose duct open in the vestibule

 Lip : superior labial and inferior labial

 Cheek: parotid and buccal.

Glands whose duct open in the oral cavity proper

 Floor of the mouth: submandibular, sublingual,

glossopalatine.
 Tongue: Body: anterior lingual (of blandin & nuhn)
Base: posterior lingual, von ebner.
 Palate- palatine.
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According to the type of salivary secretion and duct opening:

a serous secretion (thin watery) containing the enzyme

ptyalin for the digestion of starchy foods.

a mucous secretion (viscid sticky or adhering) for

lubrication.

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serous- parotid , von ebner.

mucous- palatine, posterior lingual

mixed- predominantly serous - submandibular

mixed- predominantly mucous-sublingual

blandin & nuhn,

buccal &labial

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Location of salivary glands

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Parotid
 superficial portion- in front of the external ear deeper part
fills the retromandibular fossa.
Submandibular
 In the submandibular triangle behind and below the free
border of the mylohyoid muscle with a small extension lying
above mylohyoid.
Sublingual
 Between the floor of the mouth and the mylohyoid muscle-
one main gland and several smaller glands.
Labial and buccal glands
 Lips and cheek, although buccal glands are not examined by
electron microscopy they are usually described as continuation
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of the labial glands.
 Glossopalatine-

 principally localized in the region of isthmus in glossopalatine fold.

Palatine glands-

 aggregates in the lamina propria of the posterolateral region of the

hard palate and in the submucosa of the soft palate and the uvula.

Lingual–

 anteriorlingual -apex of the tongue;

Posterior Lingual (mucous):

 lateral and posterior to the vallate papilla

Posterior lingual( serous):

 between the muscle fibers of the tongue below the valate papilla.

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Main features of parenchymal cells of salivary glands:

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Functions of ducts:

The main function of salivary gland ducts is to, convey the

primary saliva secreted by the terminal secretory units to
the oral cavity. They are not just passive conduits also they
actively modify the primary saliva by secretion and
reabsorption.

Essentially all of the water enters saliva at the level of

terminal secretory units, the striated and excretory ducts
appear to be relatively impermeable to water

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 SALIVARY FLOW RATE
Flow rate= volume (milli litres) of saliva
minute
there is great variability in individual salivary flow rate.
The accepted range of normal flow ml/min is as follows:

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Methods of measurement of flow rate:

techniques for assessing salivation & salivary secretion

rate has been reviewed and evaluated by many authors.

Accurate measures of salivary flow rate are required for a

variety of clinical and experimental situations.

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Two methods- a.measurement of whole saliva

b.measurement of parotid saliva..

Techniques for measurement of whole saliva unstimulated
(resting)
 Draining method
 Spitting method
 Suction method
 Swab method

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 Techniques for collection stimulated whole
saliva
Masticatory method (standardized piece of paraffin
used)

Gustatory method(1% to 6% citric acid used )

The spitting method for estimating resting flow and

masticatory method with paraffin chewing for
stimulating saliva for measuring flow rates are reliable.

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 SALIVARY FLOW AND AGEING
Flow rate of unstimulated (resting )whole saliva with age:

 Since 70% of whole resting saliva comes from

submandibular and sublingual glands , the decrease in
its flow with age must largely be due to decrease in
production.
 Histological findings demonstrate that there is 20 to
30% decrease in volume of salivary acini with age.
 On the other hand numerous functional studies have
failed to show any age related decrease in the flow of
parotid saliva as the normal resting flow rates of parotid
saliva are extremely small 0.04 to 0.06 ml/min
.Therefore often no saliva can be obtained and the
frequency of not obtaining it increases with age .
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Flow rate of stimulated whole saliva:

The relationship – SFR and ageing- of whole saliva is

mixed. Most studies show no change or only a modest
decrease in flow rate even though the histological
findings show a significant decline in the volume of
salivary acini. The fact that this acinar reduction does not
affect the stimulated flow rate of saliva should not be
surprising- most organs when stimulated, compensate
for the loss of parenchyma.
Other factors influencing salivary flow rate:
Diurnal variation, drugs, source of saliva, diet, duration
and type of stimuli, hormones

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MASTICATION ,OESOPHAGEAL FUNCTION
AND SALIVA
Decreased mastication and saliva

Mastication is the exercise of the oral apparatus. Chewing

increases ,function and lack of chewing induces atrophy of
disuse. Indeed impaired mastication is associated with a
reduction in the mass of salivary gland and a decrease in
the synthesis & secretion of saliva.
Findings indicate that the partial or total loss of teeth,
the presence of dentures , the decrease in bite force, TMJ
dysfunction , extensive caries , pdl disease , pain ,
immobilization of jaws and other clinical conditions
contribute to in flow of saliva and salivary gland
hypofunction.
Implicit in these findings is that dentists should place a
high priority in restoration of masticatory function.
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Increased mastication and saliva
Chewing induces an increase in the flow of stimulated
whole saliva.
This facilitates taste, swallowing and alimentation,
enhances clearance, buffers harmful oral and oesophageal
acids and aids in the remineralisation of teeth .
Given the beneficial effects of stimulated saliva it is not
surprising that considerable attention is given to agents
which stimulate saliva – eg: chewing of paraffin wax
,sugarless chewing gum can increase flow, diminish the
fall in plaque pH & accumulation of harmful acids.
Clinical trials have therefore shown that chewing
sugarless gums reduces incidence of dental caries .

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Saliva and oesophageal function

The reflux of gastric acid and food into the lower

oesophagus-gastro oesophageal reflux (GERD) is a
common condition that is associated with heart burn and
nausea.
The clearance of acids from the oesophagus, like that of the
mouth is a two stage process and saliva plays a significant
role in it. Influx of saliva Vmax induces swallowing-
initiates first phase of oesophageal clearance (primary
peristalsis) This is manifested as a peristaltic wave which
clears 90-95% of refluxed acid. A small amount of acid 5%
remains, which is diluted and buffered by successive
swallows of stimulated saliva .
Therefore patients with xerostomia, sjogrens syndrome
and rheumatoid arthritis- advised to take chewing gum and
sugarless candies and cholinergic agonist like pilocarpine.
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Clearance , residual saliva and oral dryness

The mouth is a receptacle into which , for about 14 hrs of

the day ,there is an influx, distribution and efflux of about
350 ml of resting saliva, additionally about 2hrs of the day
variety of solids and liquids and about 250ml of stimulated
saliva , enter or placed in the oral cavity. The process
whereby substances are removed is known as salivary
clearance. Central to this process are the act of swallowing
and the flow of saliva.

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Following deglutition there is progressive influx of
unstimulated saliva. This is distributed throughout the
mouth, where it mixes with and dilutes it contents, and
coats the oral mucous membrane. As the volume of saliva
increase it soon reaches a maximum volume, at which
point another swallow occurs and the process starts all
over again.
A small amount of saliva , as well as the substances
contained within it remain in the mouth. This is referred
to as residual saliva-it sticks as a thin film to the mucous
membrane and surfaces of the teeth and flows into the
interstices between teeth.

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Some of the substances dissolved in this residual saliva,
enzymes antibacterial peptides, antibodies, are protective to
the oral cavity. Others like sugar and carbohydrates are
potentially harmful.
The clearance process is described as similar to tidal
exchange where following the ebb tide, there remains tidal
pools and the ecosystem contained within them. Whichever
analogy is used ,it should be clear that, with exception of
substances wanted to be retained in the mouth-fluoride and
chlorhexidine, fast clearance favors health; and slow rates
favors disease.
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The volume of residual saliva was largely dependent on the
max volume V max before swallowing- mean value –
1.07ml and the resting flow rate of whole saliva.The mean
volume of residual saliva -0.77ml.
Average thickness of the residual saliva film on oral
tissues= Vmax
total surface area of the oral tissues.
=0.036to 0.05mm.
Because of the variation in the distribution of saliva the
shape of the teeth and their disposition in the maxilla or
the mandible the thickness of the film varies.

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Palate and the upper lip were the driest and covered with
least amount of saliva; floor of the mouth and dorsum of
the tongue were wettest.
Dryness is alleged ,is dependent on the volume of saliva
present on the oral mucous membrane and the rate of its
evaporation from them. Hard palate – fewer glands, far
away from the orifices of major glands and is the area of
high evaporation.
it is proposed that the thickness of the film of residual
saliva on the hard palate is a valid indicator of the degree of
oral wetness and xerostomia.

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 XEROSTOMIA

It is a subjective sensation of a dry mouth, frequently but

not always associated with salivary gland hypofunction.

Dryness of mouth is one of the oldest symptoms recorded

by man.

Ancient records describe the use of rice tests to determine

guilt or innocence: if innocent-ingestion of rice will
stimulate the flow of saliva, if guilty mouth will be dry and
swallowing difficult or even impossible.

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PREVALANCE

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HOW DOES THE SENSATION OF ORAL DRYNESS
CORRELATE WITH THE FLOW OF SALIVA?

Fox et al. Concluded that oral dryness was not a valid

indicator of salivary hypofunction.
Sreebny &validini also showed that dry mouth per se was not
a valid indicator of salivary hypofunction.Their findings –
slightly more than half (54%)of the subjects who complained
of xerostomia had resting whole saliva flow rates abnormally
low (0.1ml/min)
Xerostomia is rarely a solitary symptom. Accompanying it is
a wide variety of other oral and non oral complaints.
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CAUSES OF XEROSTOMIA

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Overall the most common cause of decreased salivary
output is the intake of drugs.
A wide variety of medications referred to as Xerogenic
drugs induce oral dryness.
Prevalence of xerostomia is not only related to drugs that
are xerogenic but to the total number of drugs taken. As a
general rule the drying and hyposalivatory effects of drugs
are transient.
Anticholinergic, antidepressants , antihistamines,
antipsycotic, antihypertensives, sedatives, diuretics and
analgesics.
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Diagnosis of xerostomia

Clinically
• Medical history, H/o radiation chemotherapy, oral
infections, questionnaire.
• Dentists should provide the patients with a dry mouth
questionnaire-
• Do you sip liquids to aid the swallowing of foods?
• Does your mouth feel dry when eating?
• Do you have difficulties swallowing any foods?
• Does your mouth usually become dry when you speak?

Lab tests: flow rate tests , sialometry ,etc.

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MANAGEMENT
 Reassurance, symptomatic and supportive care.

Patient education- to compensate for the oral dryness

patient may stop chewing & prefer a liquid or a semisolid
diet rich in fermentable carbohydrates.

 Because decreased mastication worsens the condition ,

patients should undergo nutritional counseling to limit
the harmful effects of reactionary diet modifications.

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 Patient should be reminded to chew , as periodontal
mechanoreceptors & mechanical stimulation of the tongue
& oral mucosa are vital stimuli for salivation. Sugar free
candies & chewing gum are recommended .
 Use of medication before bed time should be discouraged
as this time of the day coincides with lowest salivary flow
rate.
 Should sip cool water throughout the day and drink milk
with their meals.

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 Water is a poor mucosal wetting agent, lacks buffering
capacity, lubricating mucins. Whole milk may serve as a
better substitute. Citrus fruits, caffeine and alcohol,
alcohol containing mouth washes cause dehydration &
must be avoided.
 sleep on the side to reduce mouth breathing,
 Apply petrolatum –based lubricants to lips during the
day & bedtime
 Cool air humidifier be placed in the room.
Medication -capable of stimulating salivary glands-
pilocarpine -5 to 10 mg ,3 or 4 times daily, 30 min before
meals administered.

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ARTIFICIAL SALIVA SUBSTITUTES

Commercially available products contain

 Carboxy methylcellulose –lubrication,
 Animal mucins –to increase viscosity,
 Parabens- inhibit bacterial growth,
 Sugar free agents- xylitol, sorbitol- sweetners, mineral
salts- simulate electrolyte content,
 Flouride- reminaralisation.
 Trade names: salivart(spray), mouthkote (spray),
oral balance (gel).
 The oral mucous and the intaglio surface of prosthesis can
be sprayed throughout the day with artificial saliva .
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 Electrical stimulation- SALITRON-.battery operated
devices which deliver an electrical stimulus to the tongue
and palate for saliva production.

Acupuncture.

Future aspects:
 gene therapy

 tissue engineering.

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Therapeutic irradiation of the head and neck
 Xerostomia and salivary gland hypofunction are almost
inevitably seen in patients whose salivary glands are
irradiated for head and neck cancer.
 Sensation of oral dryness occurs early in the course of
radiation. It has been shown that 24 hrs after
administration of only 2.25 Gy(225Rads) there is already a
50% decrease in flow of the parotid saliva.
 When exposure exceeds 50Gy (5000Rads) the reduction in
flow is profound &for the most part permanent , the
decrease amounts to >90%.
 Parotid glands are the most sensitive to ionising radiation
the other glands in the decreasing order of sensitivity-
submandibular, sublingual and the minor glands.
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 In Preventive therapy: maintain impeccable oral hygiene,
schedule frequent recalls , use topical flouride regime.
Prosthodontic management:
 Thorough case history
 Elastomeric impression materials preferred.
 In the partially and fully edentulous patient, susceptibility
to mucosal ulcerations & fungal infections- patient should
be made aware of the well fitting denture & minimize
denture use at times when salivary flow is noted.
 Patient should be made aware of a well fitting denture and
minimize denture use at times when decreaesed salivary
flow is noted.
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Artificial saliva reservoir
Fabrication of intra oral reservoirs

 Construct the maxillary denture with an accepted

technique. provide the maximum inter arch space
possible with an acceptable vertical dimension of
occlusion.
 thicken the external palatal surface of the trial denture
with wax.
 soften the wax and contour its surface with functional
movements of the tongue (swallowing, speech ,
mastication).
 Complete the wax up, ,invest it , and boil out the wax.

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 Construct a chrome cobalt palatal plate on a duplicate cast
cover the palate to the palatal portion of the alveolar
process & beginning of the post palatal seal. Post palatal
seal not included in the metal to decrease the weight of the
denture & to prevent premature loss of the artificial saliva
due to leakage between metal and acrylic resin parts of the
denture. The metal palate is 0.45mm thick at the center &
1mm thick where it joins the acrylic base.

 Drill two filling holes 1.5mm in the metal base one anterior
and one posterior to the midline.
 Glue the metal base to the flasked cast.
 Fill the maximum space available for the reservoir with
optosil which is then glued to the metal base .
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 space for acrylic resin must remain between the filler and
the investment
 Pack and cure the acrylic resins into the flask in the usual
manner.
 Remove the metal base and the filler from the denture
and reattach the metal base into the denture. The border
of the metal base interlocks with the acrylic resins
internal surface of the palate .
 Drill a saliva release hole (0.1 to 0.2) in the reservoir at
the midline of the denture 5mm palatal to the anterior
teeth.
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 SIALORRHEA

Excessive salivation often experienced by the individual

and experienced by the individual & noticed by the
operator.

Prosthodontic management
Impression making: mouth irrigated with an astringent.
Mouth washed prior to investing impression material.
Fast setting impression material is used.
Anti sialagogues administered 1to 2 days before treatment
Dummy dentures are fabricated & given.

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Prosthodontic Considerations

 From the prosthodontists point of view, salivary glands

are of great importance both anatomically and
physiologically.
Extension of denture base:
 Stensens duct- it is rare for a maxillary denture to cause
obstruction to this duct.
 whartons duct-extension of the lingual flange in this
region can lead to obstruction – patient complains of
swelling under the tongue while eating.
 Sublingual- it is rare for a denture to cause any
significant obstruction.

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Amount of saliva
Will effect the denture construction process & quality of
the final product.
If a mouth is dry . Retention of the denture –affected+
increased potential for soreness.
Excess saliva- complicates denture construction-
impression making.
When new dentures are first inserted increased
salivation due to temporary increase in salivary flow is a
natural response to foreign object & in time will subside.
Patients need assurance about this.
Deglutition will be necessary to evacuate the excess -
advised not to rinse and spit as this – unsettling of the
denture bases.

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Consistency
 Best to work with a serous type of saliva.
 Presence of thick saliva may create a problem for
maxillary complete denture retention,-create hydrostatic
pressure in the area anterior to the post palatal seal area-
downward dislodging force exerted upon the denture
base.
 In an effort to alleviate this problem, a cupids bow can be
scribed on the master cast .
 Watt and macgregor feel that extension of the posterior
palatal seal line will contain the thick mucous in the
posterior part of the denture to provide a seal even if the
posterior portion of the denture base is slightly out of
contact with the palatal tissues.

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Thick saliva also complicates impression making by
forming voids in the impression surface while the
impression sets- palatal surface should be wiped free of
saliva & the mucous glands massaged with a piece of
gauze just before the final impression is made to
eliminate as much as mucous as possible.

It may also be factor for the patient to gag while

impressions are made and after the placement of new
dentures.

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 Role of saliva in denture retention

 Saliva is considered as a major factor in evaluating the

physical influences that contribute to the denture
retention .
The physical forces in which saliva is involved are:
 Adhesion
 cohesion
 atmospheric pressure
 capillary attraction
 peripheral seal
 Viscosity of saliva & Surface tension.

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Adhesion
Adhesion is the physical attraction of unlike molecules
for each other.
It acts when saliva sticks and wets to the basal surface of
the dentures & at the same time to the mucous membrane
of the basal seat. A watery saliva is quite effective ,
provided the denture base material can be wetted.
Saliva that is thick ropy adheres well to both the denture
base and the mucosa; but since much of it is produced by
the palatal glands under the maxillary denture base it
builds up & pushes the denture out of position. The forces
of adhesion still act on them but the hydraulic pressure
produced by the thick mucus secretion over power them.
The amount of retention provided by adhesion is directly
proportional to the area covered by the denture

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Cohesion

Retentive force as it occurs in the layer of saliva between

the denture base & the mucosa. Since saliva is a liquid
the layer should be thin if it is to be effective.

Interfacial surface tension

Is the resistance to separation possessed by the film of

liquid between two well adapted surfaces. It again found
in the thin film of saliva – similar in its action to
cohesion and to capillary attraction.

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Capillary Attraction

 Is a force that causes the surface of a liquid to become

elevated or depressed when it is in contact with a solid.

Peripheral Seal:
 Developed with the proper extension of the denture into
the vestibule.
 Denture border merging against the mucosal border
assembled by a thin film of saliva provides border seal as
it prevents ingress of air , thus enabling the denture to be
in their position.

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VISCOSITY OF SALIVA:

 Analogies are usually drawn between the clinical

situation & the two circular parallel plates separated by
the liquid. Under these conditions Stephens law can be
applied :

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 Relationship expressed in equation 2 shows that the force
required to displace a denture is proportional to the viscosity
of saliva fluid film & the square of area of the denture &
inversely proportional to the square of the distance separating
denture from the supporting tissues & the time of force
application .

Degree of retention possessed by the denture depends critically

on the area of its
 fitting surface & hence the requirement to extend the denture
base to the maximum allowed by the muscle insertion.
 degree of closeness of fit.
 Viscosity of the saliva:
The glycoprotiens & the proteoglycans dissolved in the saliva
not only increase the viscosity but provide it with

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 pseudo plastic properties. When low shear stress is
encountered in the mouth when mastication is not taking
place , saliva acts as a semisolid.
equation 1. and 2. are valid if we assume that the circular
parallel plates are completely immersed in the liquid. In
mouth the dentures are not immersed all the time ,
hence a meniscus can form at the periphery and surface
tension can be included as a factor.
Laplace formula:

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  Any positive effect that
surface tension has must
depend on their being an
intact saliva/air interface at
the periphery of the denture, a
condition which could exist
only during speech. When
eating and drinking the
integrity of any peripheral
saliva/air interface would be
destroyed and the effect of
surface tension becomes
negligible.Therefore emphasis
is placed on close fit and
accurate impression technique

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 SALIVA AS A DIAGNOSTIC TOOL
 Saliva is not widely used as a indicator of health &. disease.
However salivary testing is becoming more common as
clinicians have begun to appreciate its advantages &
investigators defined its worth.
 Salivary levels of drugs detected following therapeutic
medications.
 Saliva drug testing kits are commercially available. Included
in these are the tests for alcohol, cocaine HLA typing,
HIV1 ,HIV2 ,DNA, etc
 Salivary cortisol is an indicator of hypothalamic pituitary
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 adrenal axis function- used to quantify the human stress
& to determine the effect of treatment on it.
 to detect antibodies-hepatitis A, rubella virus, etc
 to diagnose systemic disease after salivary gland
dysfunction- sjogrens syndrome, alzheimers disease,
cystic fibrosis,etc.
 Forensic odontology
 Salivary pH assessment using telemetry:
Device called telemetry system is incorporated in the
denture which has a radiosensitive diode, oscillator, ph
sensor, and a computer analyzer.

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 CONCLUSION
 The multi factorial role of salivary components continue
to represent a focused area of dental research.
 The knowledge of normal salivary composition, flow &
function is extremely important on a daily basis when
treating patients.
 Dental health professionals spend untold hours removing
this precious natural resource to perform therapy, with
little regard to its value until flow is significantly reduced.
 Whether saliva occurs in quantities large or small ,
recognition should be given to the many contributions it
makes to the preservation & maintenance of oral &
systemic health.

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