Saliva and Its Prosthodontic Implications / orthodontic courses by Indian dental academy

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  SALIVA AND ITS PROSTHODONTIC IMPLICATIONS INTRODUCTION The secretions of the major and minor salivary glands, together with gingival crevicular fluid constitute oral fluid which  provides chemical milieu of the teeth and oral soft tissue.The environment of the oral cavity is to a large degree created and regulated by saliva. The fact that the teeth are in constant contact with and bathed by the saliva would suggest that this environmental agent could profoundly influence the state of oral health of a person. Saliva has manifold functions in protecting the integrity of the oral mucosa. Most often, the dentist is called upon to treat patients in whom he finds out a few of the symptoms and clinical signs of abnormal salivary secretions and function. Hence the knowledge of salivary glands, secretion and function is important in diagnosis, treatment planning, treatment and in  predicting the prognosis.1  Sources of saliva Saliva is a comple miture of fluids with contributions from the major salivary glands !parotid, submandibular and sublingual , the minor # accessory glands and the crevicular fluid. $dditionally it contains a high population of bacteria normally resident in the mouth, des%uamated epithelial cells and transient residues of food or drink following their ingestion. &hen referring to the fluid normally present in the mouth the term whole saliva is commonly used, as distinct from 'direct saliva( which is that flowing from individual glands. Formation of saliva Saliva is formed in two stages) a primary secretion occurs in the acini, then modified as it passes through the ducts. The primary secretion is formed actively by the movement of sodium and chloride ions into the lumen, creating an osmotic gradient which leads to the passive movement of water. *ther acinar components are added here before the fluid enters the ducts, where sodium ions +  are actively reabsorbed !chloride ions follow passively to maintain electrical e%uilibrium and potassium and bicarbonate ions secreted.The macromolecular components !amylase mucous glycoproteins etc. are formed in the usual way in the acinar cell endoplasmic reticulum, processed into secretory vesicles in the golgi apparatus and are eported from the cell by eocytosis. Sinal trans!uction &hen the nerve to the salivary gland is stimulated, the transduction of this signal to increase the formation of saliva is first brought about by the release of a neurotransmitter substance. These include noradrenaline and acetyl holine, substance  and vasointestinal polypeptide !parasymphathetics . &hen the neurotransmitter arises at a secretory cell membrane it binds to and activates a receptor !which may be stimulatory or inhibitory on the eternal surface of the membrane. This activates an intermediate %uanine nucleotide-dependent membrane protein known as '( /   protein which in turn activates a regulatory en0yme on the inner cytoplasmic surface of the cell. The regulator en0yme may be a  phospholipase  or adenyl cyclase. hospholipase  is activated on  binding of acetyl choline at mucoarinic receptors and it controls the intracellular pathway leading to the secretion of water and electrolytes. $drenyl cyclase is activated when noradrenaline binds to β -adrenergic acinar receptors. $ctivation leads to ceocylosis of secretory proteins. 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.The nerve supply to the major glands is derived from both sympathetic and parasympathetic branches of the autonomous nervous system. The sympathetic supply is trophic, the stimulation of which leads to the release of secretory proteins such as amylase 2
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