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Oral biology > Oral environment > Flashcards

Oral environment Flashcards

1
Q

What do oral fluids contain

A

Saliva​
-Major and minor salivary glands​

Gingival crevicular fluid​

Oral bacteria​

Food debris​

Epithelial cells

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2
Q

What are the functions of the oral fluids

A

Protective​
-Cleansing​
-Mucosal protection​
-Buffering​
-Remineralisation​
-Antimicrobial​

Digestive​
-Taste​
-Digestive enzymes​
-Lubricates bolus for chewing, swallowing​

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3
Q

How do the oral fluids provide mucosal protection

A

A dry mucosal surface is at a greater risk of infection

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4
Q

What is a symptom for patients with salivary gland disease

A

Xerostomia (dry mouth) lack of various protective components

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5
Q

What issues arise with reduced salivary flow

A

Increased incidences of dental caries

Caries present on buccal and labial surfaces

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6
Q

What type of glands are salivary glands

A

Exocrine

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7
Q

What are the major salivary glands

A

Parotid
Submandibular
Sublingual

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8
Q

Where can minor salivary glands be found

A

Buccal (mucous)
Labial (mucous)
Lingual (serous & mucous NOT MIXED)
Palatal (mucous)

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9
Q

What is the gingival crevicular (sulcular) fluid

A

Fluid from the epithelium lining the gingival crevice (sulcus)

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10
Q

What is the function of the Gingival Crevicular fluid

A

No ‘function’ as such but possibly acts as an Inflammatory exudate

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11
Q

When is GCF produced

A

There is little production from healthy gingivae, but flow increase with inflammation (gingivitis)

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12
Q

What is the daily salivary flow

A

Averages 500-700 ml

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13
Q

What glands contribute to the production of saliva

A

Parotid
Submandibular
Sublingual
Minor glands

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14
Q

When sleeping what is the percentage makeup of saliva by the different glands

A

Parotid - 0
Submandibular - 70%
Sublingual - 15%
Minor glands - 15%

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15
Q

What is the difference between the makeup of saliva from glands when resting and stimulated

A

Parotid - 20% , 50%
Submandibular - 72%, 40%
Sublingual - 4%, 2%
Minor glands - 4%, 8%

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16
Q

What factors affect unstimulated salivary flow rate

A

State of hydration
Previous stimulation
Circadian rhythms
Circannual rhythms
Medications
Salivary gland disease

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17
Q

What is saliva composed of

A

Inorganic:
Water (99.5%)
Ions (0.2%)

Organic:
Mainly proteins (0.3%)
Little carbohydrate or lipid

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18
Q

When does greater bicarbonate ion conc of saliva occur

A

At greater flow rates as it is important for buffering plaque acids

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19
Q

What is the function of Fluoride in saliva

A

Antibacterial
Forms fluorapatite
Promotes remineralisation

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20
Q

Why is thiocyanate present in saliva

A

Antibacterial agent

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21
Q

What purpose do bicarbonate and phosphates play in saliva

A

Buffering properties to limit acidic attack

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22
Q

What can calcium and phosphate be used for within saliva

A

Remineralisation

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23
Q

What buffers are present within saliva

A

Bicarbonate: effective at high flow rates, when [HCO3] is highest ​

Phosphates: important ‘at rest’ ​

Proteins: limited effect, as main buffering action occurs at pH <5 ​

Bacterial NH3 : some role in buffering plaque acid​

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24
Q

What are the balanced equations of the buffers within saliva
Bicarbonate
Phosphate
Ammonia

A

H20+CO2<–>H2CO3<–>H+ +HCO3-

H2PO4- <–> H+ + HPO4 (2-)

Urea ———-> CO2 + NH3
NH3 + H+ ——> NH4+

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25
Q

When is mucous secretion greatest

A

When sleeping (30%)

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26
Q

When is DNA most susceptible to radiation

A

When separated for translation and transcription to produce proteins

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27
Q

What is an example of previous stimulation

A

Chewing gum, eating etc

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28
Q

What natural body secretion can protect against radiation

A

Saliva

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29
Q

What are the main salivary proteins

A

Amylase​
Cystatin​
Gustin​
Histatin​
Immunoglobins​
Lactoferrin​
Lactoperoxidase​
Lipase​
Lysozyme​
Mucoproteins​
‘Plasma proteins’​
Proline-rich proteins​
Statherins​
​

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30
Q

Where could amylase be found

A

Mucosal gland secretions
Saliva

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31
Q

What is the function of lysozyme

A

Attacks bonds in bacterial cell walls, causing lysis
Involved in antibacterial and immune functions found in body secretions

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32
Q

What property does lactoperoxidase have and why

A

Antimicrobial effect due to oxidation of thiocyanate

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33
Q

What do cystatins do

A

Inhibit cysteine proteases, especially in bacteria
Antimicrobial function

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34
Q

What drug will impact the effects of Gustin

A

Erectile disfunction drug
Impacts taste

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35
Q

What are histatins

A

Histidine rich proteins
Inhibit CaPO4 precipitation
Antimicrobial
Inhibits:
-candida albicans
-streptococcus mutans

36
Q

What are immunoglobins

A

Antibodies

37
Q

What protein binds Fe3+ and possesses antimicrobial properties (especially against bacteria that require Fe)

A

Lactoferrin

38
Q

What secretes lipase

A

Von Ebner glands on tongue

39
Q

What does lipase do

A

Hydrolyses triglycerides
(may assist in digestion of milk)

40
Q

What is the purpose of mucoproteins

A

Bind to tooth and epithelial surfaces:
-protective role
-lubrication
-component of primary pellicle

Affects bacterial adhesion
Promotes bacterial aggregation - easier clearance from mouth

41
Q

What proteins resist acid attack
decrease mineral loss
regulate bacterial attachment

A

Proline-rich proteins

42
Q

What protein has anticalculus action

A

Statherins

43
Q

What are plasma-derived substances

A

Proteins e.g. albumins
Blood group substances
Immunoglobins
Hormones
Drugs

44
Q

Which salivary constituents have these functions:
(a) Antimicrobial​

(b) Buffering​

(c) Digestive​

(d) Lubrication​

(e) (Re)mineralising​

A

(a)Histatins, amylase?, Lysozyme, Lactoperoxidase, cystatins

(b)Bicarbonate

(c)Lipase

(d)Lubrication

(e)Proline rich proteins

45
Q

What are the mechanical and chemical unconditioned salivary stimuli

A

Mechanical
-pressure on PDL/oral mucosa

Chemical
-gustation
-olfaction
-common chemical sense

46
Q

How does mechanical stimuli work

A

Pressure on PDL (chewing) causes an increase in flow from ipsilateral glands

47
Q

What receptors and action brings about a gustation stimuli

A

Receptors on taste buds:
-tongue dorsum, palate and epiglottis

Different potencies (flavours)
-acid > umami > sweet > bitter

**adaption to constant stimulus

48
Q

What is stimulated during olfaction stimuli

A

Receptors in olfactory epithelium

Produces very weak stimulus in humans

49
Q

What is conditioned salivary stimuli

A

Learned responses to:
Psychic stimuli
Visual stimuli
Auditory stimuli

Requires regular enforcement to maintain responses

50
Q

How does the PSNS respond to salivation

A

Increased secretions, increases blood flow via vasodilation

51
Q

Where do the primary salivary secretions occur

A

Acinus

52
Q

What does primary secretion depend on

A

Acetylcholine

53
Q

Salivary secretion is a 2-stage mechanism what does the second stage involve

A

Reabsorption of sodium chloride
Secretion of potassium and bicarbonate

54
Q

Is saliva hypotonic

A

yes

55
Q

What volume of saliva is in the mouth

A

1.1ml (0.5-2.1ml)

56
Q

Where is film flow of saliva highest

A

Lower lingual region

57
Q

Where is saliva secretion slowest

A

Labial and buccal region

58
Q

Where are cariogenic sugars retained longest

A

In regions when flow is lowest

59
Q

What is clearance

A

The rate at which substances are removed from the mouth

60
Q

Where are caries less frequent

A

Lingual region due to greater saliva retention/flow

61
Q

What are important oral health aspects of clearance

A

Removal or ‘harmful’ materials
Retention of ‘beneficial’ materials

62
Q

What are the steps in clearance

A

Stimulus
Salivary flow
Accumulation in mouth
Swallow trigger
Residual volume

63
Q

What are some beneficial substances retained by slow clearance

A

Fluoride
Chlorhexidine

64
Q

How is sucrose removed from the mouth

A

Rapid clearance, increased by high salivary flow

65
Q

Why should fluoride preparations be tasteless and tablets should be sucked not chewed

A

Ensure slow clearance to retain more fluoride within the oral cavity increasing possibility of fluorapatite forming

66
Q

What is a stephan curve

A

A graph of the plaque pH change over time

67
Q

How does increased salivary flow neutralise plaque acid

A

Increased bicarbonate content of saliva

68
Q

How does dilution of plague acid affect the oral cavity

A

Very little effect within plaque

69
Q

What is the effect of chewing gum on saliva

A

Large initial increase in salivary flow rate
Flow subsides to just above normal flow
pH rises by 0.5 pH unit which persists for a long time

70
Q

When is there a much larger increase in salivary pH when chewing gum

A

When the gum contains bicarbonate

71
Q

Are the ‘sugar free gum aids oral health’ claims valid

A

Gum chewing does not remove plaque, but will increase salivary flow rate, although the increase is quite small​

The salivary pH is increased​

The stimulated saliva may promote remineralisation​

72
Q

What occurs below a pH of roughly 5.5

A

Demineralisation

73
Q

Why are alternative ‘sugar free’ sweeteners better for oral health

A

Can not be metabolised to acids by plaque bacteria

74
Q

What are examples of Bulk (cariogenic) sweeteners

A

Sucrose
Fructose
Glucose
Lactose

75
Q

What are low caloric sweeteners

A

Mannitol
Sorbitol
Xylitol

76
Q

What are some Non-caloric/high intensity sweeteners

A

Aspartame
Cyclamates
Saccharin
Sucralose

77
Q

When will patients complain of Xerostomia

A

When salivary flow rates fall below 50% of normal levels

78
Q

When will a reduction in flow to below 50% occur

A

As a result of loss of function of more than one major salivary
gland

79
Q

What are causes of decreased salivary flow

A

Side effect of drugs
Radiotherapy
Diseases:
-Specific salivary gland disease
-Systemic diseases that also affect salivary glands (Sjogren’s syndrome)
-General conditions e.g. fluid/ electrolyte loss

80
Q

How many drugs have decreased salivary flow as a side effect

A

> 400

81
Q

Which caries are associated with reduced salivary flow

A

Smooth surface caries (anterior teeth)

82
Q

What are the consequences of decreased salivary flow

A

Increased dental caries
Increase oral disease (stomatitis)
Dysesthesia
Impaired oral function
Diminished taste perception

83
Q

What is Dysaesthesia

A

‘Burning’ mouth

84
Q

Why are there consequences of decreased salivary flow

A

Decreased clearance leading to a loss of protective components such as:
-Antimicrobial agents
-Buffering
-Less remineralisation
-Mucins and other proteins
-Gustin
-Consumption of cariogenic confectionery in attempts to increase salivation

85
Q

Questions to determine a diagnosis of Sjogren’s disease

A

‘Does your mouth feel dry when eating a meal’
‘Do you have difficulty swallowing any foods’
‘Do you sip liquids to help you to swallow dry foods’
‘Does the amount of saliva in your mouth seem too little’

86
Q

What salivary substitutes can be used when no functioning gland tissue is present

A

Mucin based, cellulose based
(water alone is not very effective)

87
Q

What drug can increase/stimulate salivary flow

A

Sialogogues - drug that promotes secretion of saliva

Oral biology (9 decks)

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