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1

Saliva Buffering Capacity

____ helps to stabilize the pH and resist fluctuation.

The buffering capacity is a _______

High buffering capacity resists pH changes and keeps the mouth stable.

Buffering capacity indicates how well the saliva can moderate __________

Bicarbonate helps to stabilize the pH and resist fluctuation.

The buffering capacity is a measurement of the bicarbonate concentration.

High buffering capacity resists pH changes and keeps the mouth stable.

Buffering capacity indicates how well the saliva can moderate plaque pH changes.

2

Saliva parameters

Normal saliva flow

  • Resting pH
  • Stimulated flow rate
  • Stimulated pH
  • buffering capacity 

Abnormal saliva flow

  • Resting pH 
  • Stimulated flow rate 
  • Stimulated 
  • buffering capacity 

Normal saliva flow

Resting pH >6.8, Stimulated flow rate >.7 mL/min,

Stimulated pH >7, buffering capacity >10

Abnormal saliva flow

Resting pH<6.8, stimulated flow rate <.7 ml>

Stimulated pH<7, buffering capacity <10

3

Calculus and caries? Rarely….

 


A ____  environment results in __________ and ________
Mouths with high levels of calculus tend to have _____ salivary pH
Patients with ___ failure tend to develop more calculus due to the high content of ____ in their saliva
l

  


A basic environment results in precipitation of ions and calcification of plaque
lMouths with high levels of calculus tend to have high salivary pH
Patients with renal failure tend to develop more calculus due to the high content of urea in their saliva
l

  

4

3.2.1 Digestive Enzymes & Amylase

The enzymes found in saliva are essential in beginning the process of digestion of dietary ___ and ____.

These enzymes also play a role in_________, _____.

Furthermore, saliva serves a lubricative function, wetting food and permitting the initiation of swallowing, and protecting the mucosal surfaces of the oral cavity from desiccation.

The enzymes found in saliva are essential in beginning the process of digestion of dietary starches and fats. These enzymes also play a role in breaking down food particles entrapped within dental crevices, protecting teeth from bacterial decay. Furthermore, saliva serves a lubricative function, wetting food and permitting the initiation of swallowing, and protecting the mucosal surfaces of the oral cavity from desiccation.

5

Amylase

Amylase, an enzyme of___structure, plays an active role in the digestive system. Foods such as rice, wheat, corn, potatoes, beans, nuts etc. initiate digestion in the oral cavity. 

In animals, it is a major digestive enzyme, and its optimum pH is____ In human physiology, both the salivary and pancreatic amylases are ___-amylases. It will break ____ ____ ____molecules into ____ starches (amylodextrin, erythrodextrin and achrodextrin), producing successively ____ starches and ultimately ____.

Most Importantly
•Hydrolyzes_____ bonds of starches such as___ and ____
•___ is the major end-product (___ is glucose)

Amylase, an enzyme of protein structure, plays an active role in the digestive system. Foods such as rice, wheat, corn, potatoes, beans, nuts etc. initiate digestion in the oral cavity. 

In animals, it is a major digestive enzyme, and its optimum pH is 6.7-7.0. In human physiology, both the salivary and pancreatic amylases are α-amylases. It will break large, insoluble starch molecules into soluble starches (amylodextrin, erythrodextrin and achrodextrin), producing successively smaller starches and ultimately maltose.

Most Importantly
•Hydrolyzes a(1-4) bonds of starches such as amylose and amylopectin
•Maltose is the major end-product (20% is glucose)

6

3.2.1 Digestive Enzymes - lipase

Salivary glands also secrete salivary ____ (a more potent form of lipase) to begin ___ digestion.

Salivary lipase plays a large role in fat digestion in ______ as their ____lipase still needs some time to develop.

It also has a protective function, helping to _____________

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.

It also has a protective function, helping to prevent bacterial build-up on the teeth and washing away adhered food particles.

7

Lingual Lipase

Secreted by ________ of tongue

Involved in first phase of fat digestion.

Hydrolyzes ____________

Important in digestion of ____ in new-borns.

Unlike other mammalian lipases, it is highly ____ and readily_________

Secreted by von Ebner’s glands of tongue Involved in first phase of fat digestion.

Hydrolyzes medium- to long-chain triglycerides.

Important in digestion of milk fat in new-borns.

Unlike other mammalian lipases, it is highly hydrophobic and readily enters fat globules

8

Calcium & Phosphorus

Some loss of ____ inevitably occurs at ____, as the cariogenic bacteria in the biofilm on the surface of the tooth _______________________.

This creates a ____ pH  that is capable of driving ________

Between meals, the saliva __________________________ when the Calcium ions can __________

If there is not enough time for sufficient remin, then there is an overall ____________ from the tooth, the __________ may develop, bacteria __________ and the cavitation process commences.

Some loss of Calcium inevitably occurs at mealtimes, as the cariogenic bacteria in the biofilm on the surface of the tooth metabolizes the sugars in the diet via glycolysis. 

This creates a low pH or acidic environment that is capable of driving demineralization.  Between meals, the saliva brings the pH back to safe levels (above pH 5.5) when the Calcium ions can return to the tooth (remin).  If there is not enough time for sufficient remin, then there is an overall loss of Calcium from the tooth, the subsurface lesion may develop, bacteria enter the tooth material and the cavitation process commences.

9

Dietary Prevention

To prevent the occurrence of caries in your patients, it is important to include information about foods that lead to _______ in oral health counseling, and note that saliva needs time between food intakes to restore any loss of calcium by sugar-containing foods and beverages.  Foods _________ and that _______ are very beneficial at the end of any meal. Examples would be yogurt, cheese, or milk (super-saturated with calcium) or a sugar-free chewing gum. 

To prevent the occurrence of caries in your patients, it is important to include information about foods that lead to demineralization in oral health counseling, and note that saliva needs time between food intakes to restore any loss of calcium by sugar-containing foods and beverages.  Foods rich in calcium and that stimulate saliva flow are very beneficial at the end of any meal. Examples would be yogurt, cheese, or milk (super-saturated with calcium) or a sugar-free chewing gum. 

10

Statherin
Statherin - a PRP that _________ and allows for__________

A _____ binding protein from ___ and _____ saliva.

______inhibits ____________ __________.

__________ inhibits ________ __________ ( _____ _____)

Known to promote the_______ of Actinomyces viscosus  and Streptococcus gordonii to ______.

Statherin is responsible for saliva’s unique ability to stabilize calcium and phosphate. Although the saliva is ________with respect to _____ and _____, this protein prevents the ____________________. 

Statherin - a PRP that stabilizes inorganic ions and allows for super-saturation

A calcium binding protein from parotid and submandibular saliva.

Entire molecule inhibits primary precipitation.

Amino-terminal hexapeptide inhibits secondary precipitation (crystal growth).

Known to promote the adhesion of Actinomyces viscosus  and Streptococcus gordonii to tooth surfaces

Although the saliva is supersaturated with respect to calcium and phosphate, this protein prevents the precipitation from saliva to dental enamel. 

11

~ PAROTID GLAND ~

The gland is _________

The ___ _____ _____communicates with the oral cavity. The opening is called _______ duct and is located ___________.

 

The parotid is the _____ of the salivary glands.

The gland is entirely serous.

The main secretory duct communicates with the oral cavity. The opening is called Stenson’s duct and is located opposite the second molar.

 

The parotid is the largest of the salivary glands.

12

~ PAROTID ANATOMY ~

Resembles an ______

Approximately ___ cms in length _____ cms in width and weighs _____ grams.

Located ____ and ____ to the external acoustic meatus, _____ to the zygomatic arch, _____ to the ramus of the mandible and the masseter muscle and _____ to the styloid process.

Resembles an inverted pyramid.

Approximately 6 cms in length 3 - 4 cms in width and weighs 15 - 30 grams.

Located anterior and inferior to the external acoustic meatus, inferior to the zygomatic arch, posterior to the ramus of the mandible and the masseter muscle and lateral to the styloid process.

13

~ PAROTID BLOOD SUPPLY ~

The arterial blood supply to the parotid is provided by ______________________________.

These arteries are: _____, ____, ______, ______ and_____ 

Blood return is provided by the __________.

The arterial blood supply to the parotid is provided by glandular branches from several arteries.

These arteries are: external carotid, posterior auricular, superficial temporal, transverse facial and maxillary arteries.

Blood return is provided by the retromandibular vein.

14

~ PAROTID LYMPHATICS ~

The lymphatic vessels of the gland drain into the ______________ embedded deep within the gland and to the_______________

The lymphatic vessels of the gland drain into the deep parotid nodes embedded deep within the gland and to the superficial and deep cervical nodes.

15

Parotid gland Micro-Anatomy

____ has ____ cells.

_____ cells _____________and _________

Acinar epithelium secretes ___ and ____ filtrate

Acinus has acinar cells.

Myoepithelial cells constrict intercalated duct and squirt saliva into striated duct.

Acinar epithelium secretes proteins and isotonic filtrate

16

~ SUBMANDIBULAR GLAND ~

The submandibular is a mixed salivary gland; however, it is predominately ____.

The __________ are of the same type as the parotid.

Ducts are _______ and generally ______ than those of the parotid gland.

The mucous alveoli are capped with ___ _____.

The submandibular is a mixed salivary gland; however, it is predominately serous. (It is also mucosal. )

The intralobular ducts are of the same type as the parotid.

Ducts are more numerous and generally longer than those of the parotid gland.

The mucous alveoli are capped with serous demilunes.

17

-SUBMANDIBULAR GLAND

The gland is roughly ____shaped ____ cms long and weighs ___ gms.

It is located in the _____________________ on the ____ surface of the body of the _____ below the _____.

The ____ or recess also includes the ____ and _____ muscles medially and superiorly.

The gland is roughly egg-shaped 4 – 5 cms long and weighs 7 – 19 gms.

It is located in the submandibular fossa on the medial surface of the body of the mandible below the mylohyoid line.

The bed or recess also includes the mylohyoid and hypoglossus muscles medially and superiorly.

18

~ BLOOD SUPPLY ~

The_____ and____ arteries supply the gland.

The veins of the gland are ____ to the___ and ____ veins.

The facial and lingual arteries supply the gland.

The veins of the gland are tributary to the submental and facial veins.

19

~ LYMPHATICS ~

The lymphatic drainage is to the nearby ____ nodes.

The lymphatic drainage is to the nearby submandibular nodes.

20

 ~ SUBLINGUAL GLAND ~

It is a mixed gland, but its secretions are predominately ______

The _____ of the three glands.

Similar to the submandibular gland, the sublingual gland empties into the oral cavity at the side of the ____ of the tongue, near the opening of ________ duct. 

It is a mixed gland, but its secretions are predominately mucous.

The smallest of the three glands.

Similar to the submandibular gland, the sublingual gland empties into the oral cavity at the side of the frenum of the tongue, near the opening of Wharton’s duct. 

21

Sublingual Gland

It is an elongated ______________ shaped  gland about ____ cms in length and weighs ____

The gland is located between the________ and the body of the mandible where it occupies the _______ _______of the mandible superior to the _____ line. 

The main body of the gland produces numerous ducts called the ______ ducts.

The ducts join together to form the duct of _____, which then joins the ________ duct near the ________. 

It is an elongated “almond-shaped” gland about 3 – 4  cms in length and weighs 2 – 3 grams.

The gland is located between the genioglossus muscle and the body of the mandible where it occupies the sublingual fossa of the mandible superior to the mylohyoid line. 

The main body of the gland produces numerous ducts called the “Ravinus” ducts.

The ducts join together to form the duct of Bartholin, which then joins the submandibular duct near the sublingual papilla. 

22

 Sublingual Gland

The arteries to the gland are branches of the ____ and _____ arteries.

These arteries empty into tributaries of the ___ _____ _____ _____and _____ vein.

 

The lymphatic drainage is to the____________.

The arteries to the gland are branches of the submental and sublingual arteries.

These arteries empty into tributaries of the vena comitans nervi hypoglossi and facial vein.

 

The lymphatic drainage is to the superior deep cervical nodes.

23

~ Minor Salivary Glands ~


•Minor salivary glands are on the ___ ____ ___ & _____ mucosa.
•They are____ and produce ____ secretions with ____ buffering capacity.
•The von Ebner’s glands of the tongue, however, are ____!
•They are located at the _______________.
 


•Minor salivary glands are on the tongue, palate, buccal and labial mucosa.
•They are monoductal and produce mucous secretions with little buffering capacity.
•The von Ebner’s glands of the tongue, however, are serous!
•They are located at the base of the circumvallate papilla of the tongue.
 

24

Von Ebner’s Glands

These glands are serous.

25

MASTICATION

The ___ nerve (the ____ cranial nerve, also called the ______, or simply ___ or ___). It is a nerve responsible for _________ and certain________ such as ____ ____ _____.

The trigeminal nerve (the fifth cranial nerve, also called the fifth nerve, or simply CNV or CN5). It is a nerve responsible for sensation in the face and certain motor functions such as biting, chewing, and swallowing. 

26

Parasympathetic control:

_______ _____ (  ) innervates _____ and _____ glands

________ (___) innervates____ gland with some fibers from the _______ ______(  ).

Parasympathetic stimulation ______salivary secretion:

basal rate = _____ ml/min, stimulate rate = ____ ml/min

Total volume about 1.5 L/day produced  

Flow is modulated by _____ and____________ drugs. 

Facial nerve (VII) innervates sublingual and submandibular glands

Glossopharyngeal (IX) innervates parotid gland with some fibers from the Trigeminal Nerve (V).

Parasympathetic stimulation increases salivary secretion:

basal rate = 0.5 ml/min, stimulate rate = 1.5+ ml/min

Total volume about 1.5 L/day produced  

Flow is modulated by cholinergic and anti-cholinergic drugs. 

27

Sympathetic control

 

_____ _____in secretion.

Blood flow initially _____(___-_____) then _____ due to _____ ______ and ____ of ______.

Stimulates_____________________.

It also ________ protein content in the saliva.

 

Weaker increase in secretion. Blood flow initially decreased (alpha-adrenergic) then increases due to increased metabolism and release of metabolites. Stimulates myoepithelial cell contraction. It also increases protein content in the saliva.

 

28

~ Parasympathetic Innervation ~

CLINICAL NOTE

The ____ nerve courses through the body of the ___ gland making surgery difficult to perform.

Great care must be given during the course of surgical dissection as paresthesia may result if the nervous tissue is damaged.

CLINICAL NOTE

The facial nerve courses through the body of the parotid gland making surgery difficult to perform.

Great care must be given during the course of surgical dissection as paresthesia may result if the nervous tissue is damaged.

29

Salivary Gland Secretion

Stimulation comes to _____ cells, comes down to ____ and ___ is removed

When saliva is in aciner cells : it is ____ (same as Na)

After Na removed (in mouth) ,secretions are ___

Acinus secretes an ____ of plasma driven by _____ ______

____ _____ actively ____ NaCl

____ of K+ and HCO3- by ducts ___ than salt absorption

______________ leads to greater salt absorption than water and a ______ saliva

Stimulation comes to aciner cells, comes down to striated ducts and Na is removed

When saliva is in aciner cells : it is isotonic (same as Na)

After Na removed (in mouth) ,secretions are hypotonic 

Acinus secretes an ultrafiltrate of plasma driven by chloride secretion

Ductal epithelium actively absorbs NaCl

Excretion of K+ and HCO3- by ducts less than salt absorption

Low water permeability leads to greater salt absorption than water and a hypotonic saliva

30

Salivary Secretion
•At low flow rates the saliva is ____ and rich in ____
•At high flow rates, its ion composition approaches ____ that of ____ (300 mosmole/L)
•Reduced time for ___ _____in ducts at high flow rates.


•At low flow rates the saliva is hypotonic and rich in K+.
•At high flow rates, its ion composition approaches 70% that of plasma (300 mosmole/L)
•Reduced time for water reabsorption in ducts at high flow rates.