saliva and salivary gland DETAILS .pptx

BLOOD HAEMOSTASIS

1. Saliva and Salivary Glands Presented by : DR. HRITWIKA NAIK Post Graduate Student Dept. of Pediatric & Preventive Dentistry

2. 2 Contents

3. 3 Introduction

4. 4 Salivary flow facilitates :

5. 5 Serous Mucous Mixed Orbans Oral Histology and Embryology, 14 th Edition

6. 6

7. 7 Embryology David T. Wong Salivary Diagnostics, Wiley-Blackwell

8. 8 Development

9. LARGEST salivary gland. 20-25% of total saliva. Pyramidal in shape. Weighs around 14-28gms. Situated below the external acoustic meatus, between ramus of the mandible and the sternocleidomastoid. Main excretory duct - STENSON’S DUCT. 9 Parotid Gland BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

10. 10 Structures within the Parotid Gland BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

11. 11 BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

12. 12 Clinical Anatomy Parotid swellings are very painful due to unyielding nature of parotid fascia. Mumps is an infectious disease of the salivary glands caused by a specific virus. Viral parotitis or mumps characteristically does not suppurate. Its complications are orchitis and pancreatitis. Bell’s Palsy - Sudden paralysis of facial nerve at the stylomastoid foramen, results in asymmetry of corner of mouth, inability to close the eye, disappearance of nasolabial fold and loss of wrinkling of skin of forehead on the same side. BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

13. 13 Blood supply The parotid gland is supplied by the external carotid artery and its branches that arise within the gland. The veins drain into the external jugular vein and internal jugular vein . Nerve supply Lymphatic Drainage Lymph drains first to the parotid nodes and from there to the upper deep cervical nodes . BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

14. Measures 4–6 cm in length and 5 mm in diameter long. Runs forward across masseter muscle, turns inwards at the anterior border of masseter. Runs through the 3Bs- 1. Buccal pad of fat 2. Buccopharyngeal fascia 3. Buccinator Muscle Opens at a papilla opposite the second maxillary molar . 14 Stenson’s Duct BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

15. 15 Clinical Anatomy A parotid abscess may be caused by spread of infection from the opening of parotid duct in the oral cavity. The parotid calculi may get formed within the parotid gland or in its Stenson’s duct. These can be located by injecting a radio-opaque dye through its opening in the vestibule of the mouth. The procedure is called ‘Sialogram’. BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

16. 2nd Largest Salivary Gland. Also called the Submaxillary salivary gland . It weighs half the weight of parotid gland. 65-70% of total saliva. Located on the medial aspect of the body of the mandible in the submandibular triangle. Main excretory duct - Wharton’s duct . It is thin walled, and is about 5 cm long. Runs forward and opens into the mouth beneath the tongue, lateral to lingual frenum i.e. sublingual caruncle. 16 Submandibular Gland BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

17. 17 BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

18. 18 Sublingual Salivary Gland This is smallest of the three salivary glands. It is almond shaped and weighs about 3 to 4 gms . It lies above the mylohyoid, below the mucosa of the floor of the mouth, medial to the sublingual fossa of the mandible and lateral to the genioglossus. 2.5 % of total saliva. About 15 ducts emerge from the gland. Most of them open directly into the floor of the mouth on the summit of the sublingual fold. A few of them join the submandibular duct. The gland receives its blood supply from the lingual and submental arteries . The nerve supply is similar to that of the submandibular gland. BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

19. 19 Clinical Anatomy The chorda tympani nerve supplying secretomotor fibres to submandibular and sublingual salivary glands lies medial to the spine of sphenoid. Submandibular lymph nodes lie both within and outside the submandibular salivary gland. Secretion of submandibular gland is more viscous, so there are more chances of the gland getting calculi or small stones. Submandibular gland can be manually palpated by putting one finger within the mouth and one finger outside, in relation to the position of the gland. BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

20. 20 BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

21. 21 Structure of Salivary Glands Secretory unit consists of : Excretory duct Intercalated duct Mucous Acini Serous Acini Myoepithelial cells Striated duct BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain

22. 22 Formation of saliva The fluid formation occurs in the acini where : S erous C ells produce a watery seromucous secretion and M ucous C ells produce a viscous mucin-rich secretion . Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

23. 23 The formation occurs in 2 stages: Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

24. 24 Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

25. 25 Properties of saliva . Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

26. 26 Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

27. 27 FLOW RATE (ML/MIN) WHOLE SALIVA PAROTID GLAND SALIVA SUBLINGUAL GLAND & SUBMANDIBULAR GLAND SALIVA RESTING STATE 0.2 – 0.4 0.04 0.1 STIMULATED STATE 2.0 – 5.0 1.0 – 2.0 0.8 Flow rate ph pH WHOLE SALIVA PAROTID GLAND SALIVA SUBLINGUAL GLAND & SUBMANDIBULAR GLAND SALIVA 6.7 – 7.4 6.0 – 7.8 6.0 – 7.4 Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

28. 28 Specific gravity It ranges between 1.002 – 1.004. Saliva is hypotonic to plasma. Tonicity Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

29. 29 99.5% Composition Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

30. 30 Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

31. 31 Digestion The digestive functions of saliva include moistening food and helping to create a food bolus. The lubricative function of saliva allows the food bolus to be passed easily from the mouth into the oesophagus. Saliva contains the enzyme amylase , also called ptyalin , which is capable of breaking down starch into simpler sugars such as maltose and dextrin that can be further broken down in the small intestine. About 30% of starch digestion takes place in the oral cavity . Salivary glands also secrete salivary lipase (a more potent form of lipase) to begin fat digestion. Salivary lipase plays a large role in fat digestion in newborn infants as their pancreatic lipase still needs some time to develop. Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

32. 32 Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

33. 33 Lubricant Saliva coats the oral mucosa mechanically protecting it from trauma during eating, swallowing, and speaking. Mouth soreness is very common in people with reduced saliva (xerostomia) and food (especially dry food) sticks to the inside of the mouth. Protection Barrier against noxious stimuli, microbial toxins and minor traumas. Flushes away bacteria and debries . Formation of salivary pellicle and helps in tooth protection. Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

34. 34 Antibacterial Saliva contains a spectrum of immunologic and non-immunologic proteins with antibacterial properties. Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503.

35. 35 Buffer capacity Oral histology and embryology – orban’s . 12th edition

36. 36 Excretory function Oral histology and embryology – orban’s . 12th edition

37. 37 Heat Loss This is found mainly in animals. When they become hot and excited, more saliva is secreted causing greater heat loss. Oral histology and embryology – orban’s . 12th edition

38. 38 Tissue repair A tissue repair function attributed to saliva - since clinically the bleeding time of oral tissues appears to be shorter than other tissues. Experimental studies - wound contraction is significantly increased in the presence of saliva due to the epidermal growth factor - submandibular glands. Oral histology and embryology – orban’s . 12th edition

39. 39 Regulation of salivary secretion Saliva secretion is a continuous process but the quantity of saliva secreted varies depending upon the activity of mouth. The secretion of saliva is regulated by nervous mechanism, no hormonal or chemical mechanism is involved in the regulation of salivary secretion. Salivary glands are under the control of the autonomic nervous system and receives efferent nerve fibres from both parasympathetic and sympathetic divisions. Oral histology and embryology – orban’s . 12th edition

40. 40 Salivary gland disorder

41. 41 Hypersalivation Excess secretion of saliva. Hypersalivation in pathological condition is known as : Ptyalism, Sialorrhea , Sialism or Sialosis. Dentistry for child and adolescent-MC Donald and Avery-9th edition

42. 42 Occurs in the following conditions : Dentistry for child and adolescent-MC Donald and Avery-9th edition

43. 43 Sialorrhea / drooling Uncontrolled flow of saliva outside the mouth. Often called Ptyalism. Occurs because of excess production of saliva in association with inability to retain saliva within the mouth. Drooling in small children is a normal part of development. The saliva which is produce during drooling is designed to moisten and lubricate baby’s tender gums. Dentistry for child and adolescent-MC Donald and Avery-9th edition

44. 44 Chorda tympani syndrome Characterized by sweating while eating . During the regeneration some of these nerve fibres, which run along with chorda tympani branch of facial nerve may deviate and join with the nerve fibres supplying sweat glands. When the food is placed in the mouth, salivary secretion is associated with sweat secretion. Dentistry for child and adolescent- M C Donald and Avery-9th edition

45. 45 Frey’s syndrome / gustatory sweating Also known as : Baillarger’s syndrome, Dupuy’s syndrome, Auriculotemporal syndrome or Frey-Baillarger syndrome. It is a food related syndrome . Can be congenital or acquired . Symptoms of Frey's syndrome : Redness and sweating on the cheek area adjacent to the ear. They can appear when the affected person eats, sees, thinks about or talks about certain kinds of food which produce strong salivation. Dentistry for child and adolescent-MC Donald and Avery-9th edition

46. 46 Hyposalivation The reduction in the secretion of saliva. Dentistry for child and adolescent-MC Donald and Avery-9th edition

47. 47 Xerostomia A loss of salivary function or a reduction in the volume of secreted saliva may lead to the sensation of oral dryness. Dry mouth and oral dryness are general terms that encompasses 2 medical entities : Xerostomia (symptom) – subjective complaints Hyposalivation – objective reduction in salivary secretion Dentistry for child and adolescent-MC Donald and Avery-9th edition

48. 48 Causes Dentistry for child and adolescent-MC Donald and Avery-9th edition

49. 49 Clinical Features of Xerostomia : Dentistry for child and adolescent-MC Donald and Avery-9th edition

50. 50 Sjogren’s Syndrome Also called as Gouge rot Sjogren’s Syndrome / Sicca Syndrome. It is an Chronic Autoimmune Disorder described as a triad of : Keratoconjunctivitis sicca, Xerostomia & Rheumatoid arthritis . Two types: Primary & Secondary. Dentistry for child and adolescent-MC Donald and Avery-9th edition

51. 51 Dentistry for child and adolescent-MC Donald and Avery-9th edition

52. 52 Mumps Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

53. 53 Clinical Stages of Mumps Infection STAGE ONSET (days) MANIFESTATIONS 1 (Incubation) 16 – 18 None 2 (Prodrome) 1 – 2 Mild fever Anorexia Malaise Myalgia 3 (Parotitis) 1-2 Unilateral Parotitis 1-3 Bilateral Parotitis (70%) 4 (Resolution) 3-5 Systemic symptoms 7-10 Parotitis Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

54. 54 Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

55. 55 Mucocele It is a clinical term used to describe the swelling caused due to the pooling of saliva at the site of damaged salivary duct due to trauma . Most common site is the Lower lip followed by Floor Of the Mouth, tongue and palate. Results from the accumulation of mucous secretion due to trauma and lip biting habits or alteration of minor salivary glands. It is the most common minor salivary gland lesion in children and young adults. Two types:-Extravasation Type & Retention Type. Clinical Appearance: Characteristic soft and painless, usually a single bump with a slightly bluish or normal skin colour. It is varying in size from 0.5" to 1". Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

56. 56 Treatment Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

57. 57 Ranula Ranulas are extravasation mucoceles, arising from either the ruptured and then blocked main excretory duct of the sublingual gland, or the numerous subsidiary ducts or the acini. Blue/Purplish Red enlargement occurring unilateral or occupying the whole floor of the mouth. Located lateral to the midline . These lesions may already be present at birth. Treatment Marsupialisation or Surgical removal . Shafer's textbook of Oral pathology eighth edition - Sivapathasundharam

58. 58 Sjogren’s Syndrome Textbook of oral medicine third edition – Anil Govindrao Ghoms

59. 59 Sjogren’s syndrome is an autoimmune disease characterized by progressive lymphocytic and plasmocytic infiltration , mainly of the salivary glands and lacrimal glands . According to Vitali et al., there are six criteria for the diagnosis of Sjogren’s syndrome: ocular symptoms, oral symptoms, objective ocular signs (Schirmer’s test), histologically detectable lymphocytic infiltration, objectively verifiable findings in the salivary glands (<1.5 ml saliva/15 min, positive imaging) and autoantibodies. Sjogren’s syndrome is confirmed when at least four of these are present together with at least positive histology or serology. Juvenile Sjogren’s syndrome is rare or underdiagnosed . The treatment of juvenile Sjogren’s syndrome is largely symptomatic. Textbook of oral medicine third edition – Anil Govindrao Ghoms

60. 60 Pleomorphic Adenoma Textbook of oral medicine third edition – Anil Govindrao Ghoms

61. 61 Sialolithiasis In children, salivary gland calculi are uncommon. SYMPTOMS: The main complaint is unilateral swelling. Occurs predominantly in boys. The affected gland is almost exclusively the submandibular gland. DIAGNOSIS: Clinical examination. Endoscopic evaluation. TREATMENT: carbon dioxide laser sialo lithotomy. Textbook of oral medicine third edition – Anil Govindrao Ghoms

62. 62 Sialorrhea Textbook of oral medicine third edition – Anil Govindrao Ghoms

63. 63 Textbook of oral medicine third edition – Anil Govindrao Ghoms

64. 64 Saliva as a diagnostic tool Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

65. Salivary diagnostics is a dynamic and emerging field utilizing nanotechnology and molecular diagnostics to aid in the diagnosis of oral and systemic diseases and using the salivary biomarkers for disease detection. 65 Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

66. 66 Saliva is a clinically informative, biofluid that is useful for novel approaches to prognosis, laboratory or clinical diagnosis, and monitoring and management of patients with both oral and systemic diseases. Saliva is easily collected and stored and is ideal for early detection of disease, as it contains specific soluble biomarkers. Saliva, a multi constituent oral fluid, has high potential for the surveillance of general health and diseases. Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

67. 67 Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

68. 68 Analysis of saliva can be done for the diagnosis of following : Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

69. 69 Salivary Biomarkers The United Nations World Health Organization defines a biomarker as “Any substance, structure or process that can be measured in the body or its products and influences or predicts the incidence of outcome or disease.” The National Cancer Institute has defined “biomarker” as “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition of disease such as cancer”. Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

70. 70 Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

71. 71 A biomarker is an objective measure that has been evaluated and confirmed either as an indicator of physiologic health, a pathogenic process, or a pharmacologic response to a therapeutic intervention. Biomarkers are tell - tale molecules that could be used to monitor health status, disease onset, treatment response and outcome. Stress biomarkers in saliva : Salivary α- amylase and Chromogranin A are Biomarkers of acute stress. Candidiasis : Through the presence of candida species in saliva . Cystic fibrosis is a genetically transmitted disease of children and young adults, which is considered a generalized exocrinopathy. The abnormal secretions present in saliva was helpful for the diagnosis of the disease. In neonates the presence of Ig A is an excellent marker of Rota virus infection . HIV antibody detection is as precise in saliva as in serum and is both applicable in clinical and epidemiological studies. Saliva biomarkers are used in cancer detection. Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

72. 72 Conclusion

73. 73 "Saliva: The tiny liquid marvel that reminds us even the smallest things can make a big difference. Embrace your unique abilities like saliva does - keep flowing, keep fighting, and make your mark drop by drop and remember, you too can be a hero in your own way!” Javaid MA, Ahmed AS, Durand R, Tran SD. Saliva as a diagnostic tool for oral and systemic diseases. J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):66-75. doi: 10.1016/j.jobcr.2015.08.006. Epub 2015 Sep 9. PMID: 26937373; PMCID: PMC4756071.

74. Reference Stedman's Medical Dictionary 26th Edition. David T. Wong Salivary Diagnostics, Wiley-Blackwell. BD Chourasia's human anatomy regional and applied dissection and clinical head, neck and brain. Orbans oral histology and embryology,14 th edition Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009 Jul-Sep;2(3):303-7. PMID: 20112475; PMCID: PMC5052503 . 74

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