Introduction to the Salivary Glands
description
Transcript of Introduction to the Salivary Glands
Introduction to the Introduction to the Salivary GlandsSalivary Glands
Dennis E. Lopatin, Ph.DDennis E. Lopatin, Ph.DDept. of Biologic & Materials SciencesDept. of Biologic & Materials Sciences
Even Science Even Science Fiction Has Fiction Has
Discovered the Discovered the Importance of Importance of
Saliva!Saliva!
Saliva in Oral Health: Protective Saliva in Oral Health: Protective FunctionsFunctions
LubricationLubrication
• Mucins, proline-rich glycoproteins, waterMucins, proline-rich glycoproteins, water AntimicrobialAntimicrobial
• Amylase, complement, defensins, lysozyme, Amylase, complement, defensins, lysozyme, lactoferrin, lactoperoxidase, mucins, cystatins, lactoferrin, lactoperoxidase, mucins, cystatins, proline-rich glycoproteins, secretory IgA, proline-rich glycoproteins, secretory IgA, secretory leukocyte protease inhibitor, statherin, secretory leukocyte protease inhibitor, statherin, thrombospondinthrombospondin
Saliva in Oral Health: Protective Saliva in Oral Health: Protective Functions (cont’d)Functions (cont’d)
Growth FactorsGrowth Factors
• Epidermal growth factor (EGF), transforming growth Epidermal growth factor (EGF), transforming growth factor-alpha (TGF-factor-alpha (TGF-), transforming growth factor-), transforming growth factor-alpha (TGF-alpha (TGF-), fibroblast growth factor (FGF), ), fibroblast growth factor (FGF), insulin-like growth factor (IGF-I & IGF-II), nerve insulin-like growth factor (IGF-I & IGF-II), nerve growth factor (NGF)growth factor (NGF)
Mucosal IntegrityMucosal Integrity
• Mucins, electrolytes, waterMucins, electrolytes, water
Saliva in Oral Health: Protective Saliva in Oral Health: Protective Functions (cont’d)Functions (cont’d)
Lavage/cleansingLavage/cleansing
• WaterWater BufferingBuffering
• Bicarbonate, phosphate ions, proteinsBicarbonate, phosphate ions, proteins RemineralizationRemineralization
• Calcium, phosphate, statherin, anionic proline-Calcium, phosphate, statherin, anionic proline-rich proteinsrich proteins
Saliva in Oral Health: Food and Saliva in Oral Health: Food and Speech-related functionsSpeech-related functions
Food PreparationFood Preparation• Water, mucinsWater, mucins
DigestionDigestion• Amylases, lipase, ribonuclease, proteases, water Amylases, lipase, ribonuclease, proteases, water
mucinsmucins TasteTaste
• Water, gustinWater, gustin SpeechSpeech
• Water, mucinsWater, mucins
Salivary Gland AnatomySalivary Gland Anatomy
Parotid GlandParotid Gland Submandibular GlandSubmandibular Gland Sublingual GlandSublingual Gland Minor GlandsMinor Glands
Major Salivary Major Salivary GlandsGlands
Parotid Parotid GlandsGlands
Submandibular Submandibular GlandsGlands
Structure Structure of the of the DuctsDucts
Salivary ConstituentsSalivary Constituents
Water & electrolytesWater & electrolytes ProteinsProteins Non-electrolytesNon-electrolytes Non-glandular Non-glandular
proteinsproteins
Components of Whole SalivaComponents of Whole Saliva Salivary glandsSalivary glands
• Water, proteins, electrolytes, small organic moleculesWater, proteins, electrolytes, small organic molecules Blood and blood derivativesBlood and blood derivatives
• Intraoral bleeding, gingival crevicular fluid (serum & Intraoral bleeding, gingival crevicular fluid (serum & inflammatory cells)inflammatory cells)
Extrinsic substancesExtrinsic substances• Food debris, toothpaste and mouth rinseFood debris, toothpaste and mouth rinse
Other fluidsOther fluids• Bronchial and nasal secretionsBronchial and nasal secretions
Lining cellsLining cells• Epithelial keratinsEpithelial keratins
MicrobiotaMicrobiota
Factors Contributing to Saliva ContentFactors Contributing to Saliva Content
Normal Human VariabilityNormal Human Variability Unstimulated vs. stimulated salivaUnstimulated vs. stimulated saliva AgingAging MedicationsMedications DiseaseDisease Circadian rhythmsCircadian rhythms Objective vs. subjective Objective vs. subjective
determinationsdeterminations
Human VariationsHuman Variations
Large range defines “normality”Large range defines “normality” A little goes a long wayA little goes a long way Changes over timeChanges over time
Normal Variations in Saliva OutputNormal Variations in Saliva Output
Unstimulated vs. Stimulated SalivaUnstimulated vs. Stimulated Saliva
UnstimulatedUnstimulated
• Basal productionBasal production
• Confers most protectionConfers most protection
• Importance of minor and submandibular outputImportance of minor and submandibular output
• Low output during sleeping hoursLow output during sleeping hours StimulatedStimulated
• Protection during masticationProtection during mastication
• Assists in deglutitionAssists in deglutition
• Importance of parotid outputImportance of parotid output
Circadian RhythmCircadian Rhythm
Effects of Aging on SalivaEffects of Aging on Saliva
QuantityQuantity
• No significant changes in major secretionsNo significant changes in major secretions
• No significant changes in minor secretionsNo significant changes in minor secretions QualityQuality
• No general changesNo general changes
Stimulated Parotid Flow Over TimeStimulated Parotid Flow Over Time
Assessment of Salivary FlowAssessment of Salivary Flow
Objective measures (Clinical tests)Objective measures (Clinical tests)
• Major gland secretionsMajor gland secretions
• Minor gland secretionsMinor gland secretions
• Whole salivaWhole saliva Subjective measures (Patient perceptions)Subjective measures (Patient perceptions)
• Xerostomia Xerostomia (Do you have a dry mouth?)(Do you have a dry mouth?)
• Questionnaires Questionnaires (Dry mouth, trouble swallowing?)(Dry mouth, trouble swallowing?)
• Thirst Thirst (Are you often thirsty?)(Are you often thirsty?)
Factors Affecting Salivary ProductionFactors Affecting Salivary Production
Local diseasesLocal diseases Systemic diseasesSystemic diseases MedicationsMedications Head and neck radiationHead and neck radiation ChemotherapyChemotherapy
Local Factors Affecting SalivaLocal Factors Affecting Saliva
Obstructive DiseasesObstructive Diseases
• Neoplasms, mucous plugs, calculiNeoplasms, mucous plugs, calculi Inflammatory DiseasesInflammatory Diseases
• Acute viral sialadenitis (myxovirus of mumps)Acute viral sialadenitis (myxovirus of mumps)
• Acute suppurative bacterial sialadenitisAcute suppurative bacterial sialadenitis
• Chronic recurrent sialadenitisChronic recurrent sialadenitis
• Allergic parotiditisAllergic parotiditis Head and Neck IrradiationHead and Neck Irradiation DietDiet
Sialadenitis: Inflammation of the Salivary GlandSialadenitis: Inflammation of the Salivary Gland
Bacterial Parotiditis: Inflammation of the Parotid GlandBacterial Parotiditis: Inflammation of the Parotid Gland
Medications Influence SalivaMedications Influence Saliva
Anti-cholinergicsAnti-cholinergics Anti-histaminesAnti-histamines Anti-depressants, antipsychoticsAnti-depressants, antipsychotics Sedative and hypnotic agentsSedative and hypnotic agents Anti-hypertensivesAnti-hypertensives Anti-Parkinson drugsAnti-Parkinson drugs
Oral Side-Effects of Prescribed DrugsOral Side-Effects of Prescribed Drugs
RG Smith & AP Burtner, 1994RG Smith & AP Burtner, 1994
Xerostomia - Dry mouthXerostomia - Dry mouth
Dysgeusia - Impairment of tasteDysgeusia - Impairment of taste
Stomatitis - Inflammation of oral mucous Stomatitis - Inflammation of oral mucous membranesmembranes
Glossitis - Inflammation of tongueGlossitis - Inflammation of tongue
Systemic Diseases That Influence SalivaSystemic Diseases That Influence Saliva
Sjögren’s syndromeSjögren’s syndrome Sarcoidosis Sarcoidosis (a systemic granulomatous disease, (a systemic granulomatous disease,
especially of lungs, but affecting many other organs, especially of lungs, but affecting many other organs, including parotid glands)including parotid glands)
Cystic fibrosisCystic fibrosis DiabetesDiabetes Alzheimer’s diseaseAlzheimer’s disease AIDSAIDS DehydrationDehydration
Submandibular Duct Obstruction 2° to InfectionSubmandibular Duct Obstruction 2° to Infection
Head and Neck RadiationHead and Neck Radiation
Parotid vs. SubmandibularParotid vs. Submandibular Dysfunction is dose- and field-dependentDysfunction is dose- and field-dependent Threshold of permanent destruction: 2100-Threshold of permanent destruction: 2100-
4000 cGy4000 cGy
Salivary Flow Following Radiation Salivary Flow Following Radiation TherapyTherapy
ChemotherapyChemotherapy
Alters salivary constituentsAlters salivary constituents Normal function returnsNormal function returns Bone marrow transplantation: graft vs. host Bone marrow transplantation: graft vs. host
diseasedisease
Salivary Dysfunction and Oral SequelaeSalivary Dysfunction and Oral Sequelae
CariesCaries MucositisMucositis Oral ulcerationOral ulceration TasteTaste SwallowingSwallowing DenturesDentures InfectionsInfections
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: CariesCaries
Incipient decayIncipient decay Recurrent decayRecurrent decay Root vs. coronal decayRoot vs. coronal decay
Extensive Caries in a post-radiation patientExtensive Caries in a post-radiation patient
Caries in a xerostomic individualCaries in a xerostomic individual
GlossitisGlossitis
MucositisMucositis
CariesCaries
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: MucositisMucositis
PainPain InfectionsInfections DysphagiaDysphagia Impaired nutritionImpaired nutrition DehydrationDehydration
MucositisMucositis
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: Oral UlcerationOral Ulceration
Wound healingWound healing Lichen planusLichen planus Recurrent aphthous ulcers Recurrent aphthous ulcers PainPain Secondary infection (Candidiasis)Secondary infection (Candidiasis)
Xerostomia: Dry Fissured TongueXerostomia: Dry Fissured Tongue
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: TasteTaste
Reduced enjoyment of eatingReduced enjoyment of eating Altered supra-threshold and threshold Altered supra-threshold and threshold
performanceperformance
• Sucrose, sodium chlorideSucrose, sodium chloride
• Citric acid, quinine sulfateCitric acid, quinine sulfate
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: SwallowingSwallowing
Subjective complaints of dysphagiaSubjective complaints of dysphagia Increased duration in oral swallow Increased duration in oral swallow
timestimes
• Dry swallowsDry swallows
• Wet swallowsWet swallows
Salivary Dysfunction and Oral Sequelae: Salivary Dysfunction and Oral Sequelae: DenturesDentures
Decreased retention and stabilityDecreased retention and stability Increased complaintsIncreased complaints Greater likelihood for Greater likelihood for CandidaCandida infections infections
Salivary Dysfunction and Oral Salivary Dysfunction and Oral Sequelae: InfectionsSequelae: Infections
CandidiasisCandidiasis CariesCaries GingivitisGingivitis Viral infectionsViral infections BacteremiasBacteremias Aspiration Aspiration
pneumoniapneumonia
Candida 7th Week Following Tonsil Candida 7th Week Following Tonsil Radiation TreatmentRadiation Treatment
Candida/Denture StomatitisCandida/Denture Stomatitis
Saliva and Oral health: ConclusionsSaliva and Oral health: Conclusions
Saliva in healthSaliva in health Saliva in diseaseSaliva in disease Prevention of diseasePrevention of disease Treatment of diseaseTreatment of disease
Saliva deficientSaliva deficient