SALIVA

Saliva

Saliva is the best natural defence against decay.

Acid from bacteria can be neutralised by saliva. A reduced flow of saliva (dry mouth) can increase your risk of decay. Causes of reduced saliva might include:

• Medications (especially neurological medications) that you may be taking that may have a drying effect in the mouth
• Excessive intake of caffeine. Caffeine is found in coffee, tea, chocolate and cola drinks. It draws fluid from the body and reduces saliva.
• Working in a dry environment and not rehydrating often enough
• Some specific diseases or conditions such as Sjogren's syndrome
• Medical conditions that reduce the amount of saliva produced by salivary glands , particularly the submandibular gland and parotid gland , are likely to lead to widespread tooth decay. Examples include Sjögren's syndrome,diabetes mellitus, diabetes insipidus, and sarcoidosis.[36]

Medications, such as antihistamines and antidepressants, can also impair salivary flow. Stimulants, most notoriously methylamphetamine , also occlude the flow of saliva to an extreme degree. Abusers of stimulants tend to have poor oral hygiene. Tetrahydrocannabinol, the active chemical substance in cannabis, also causes a nearly complete occlusion of salivation, known colloquially as "cotton mouth". Moreover, sixty-three percent of the most commonly prescribed medications in the United States list dry mouth as a known side effect. [36]

Saliva (also referred to as spit, spittle, drool or slobber) is the watery and usually frothy substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. Saliva is produced in and secreted from one of the three salivary glands. Human saliva is composed of 98% water, while the other 2% consists of other compounds such as electrolytes, mucus, antibacterial compounds, and various enzymes.[1] As part of the initial process of food digestion, the enzymes in the saliva break down some of the starch and fat in the food at the molecular level. Saliva also breaks down food caught in the teeth, protecting them from bacteria that cause decay. Furthermore, saliva lubricates and protects the teeth, the tongue, and the tender tissues inside the mouth. Saliva also plays an important role in tasting food, by trapping thiol produced from odourless food compounds by anaerobic bacteria living in the mouth. [2]

Various species have evolved special uses for saliva that go beyond predigestion. Some swifts use their gummy saliva to build nests. Aerodramus nests are prized for use in bird's nest soup.[3] Cobras, vipers, and certain other members of the venom clade hunt with venomous saliva injected by fangs. Some arthropods, such as spiders and caterpillars, create thread from salivary glands. The digestive functions of saliva include moistening food and helping to create a food bolus, so it can be swallowed easily. Saliva contains the enzyme amylase (also called ptyalin) that breaks up starch into sugar. Thus, digestion of food begins in the mouth. Salivary glands also secrete salivary lipase (a more potent form of lipase) to start fat digestion. Lipase plays a large role in fat digestion in new-borns as their pancreatic lipase still has some time to develop.[4] It also has a protective function, helping to prevent bacterial build-up on the teeth and washing away adhered food particles.

A common belief is that saliva contained in the mouth has natural disinfectants, which leads people to believe it is beneficial to "lick their wounds". Researchers at the University of Florida at Gainesville have discovered a protein called nerve growth factor (NGF) in the saliva of mice. Wounds doused with NGF healed twice as fast as untreated and unlocked wounds; therefore, saliva can help to heal wounds in some species. NGF has not been found in human saliva; however, researchers find human saliva contains such antibacterial agents as secretory IgA, lactoferrin, lysozyme and peroxidase.[5] It has not been shown that human licking of wounds disinfects them, but licking is likely to help clean the wound by removing larger contaminants such as dirt and may help to directly remove infective bodies by brushing them away. Therefore, licking would be a way of wiping off pathogens, useful if clean water is not available to the animal or person.

The mouth of animals is the habitat of many bacteria, some pathogenic. Some diseases, such as herpes, can be transmitted through the mouth. Animal (including human) bites are routinely treated with systemic antibiotics because of the risk of septicemia.

Recent research suggests that the saliva of birds is a better indicator of avian influenza than are faecal samples.[6]

Saliva secretes Gustin hormone which is thought to play a role in the development of taste buds.

Non-physiological use

Saliva has anti-fog functions. Scuba divers commonly smear a thin layer of saliva on the inside surface of their goggles to prevent fogging.[7] Saliva is an effective cleaning agent used in art conservation. Cotton swabs coated with saliva are rolled across a painting's surface to delicately remove thin layers of dirt that may accumulate.[8]

Iodine in salivary glands and oral health

The trophic, antioxidant and apoptosis-inductor actions and the presumed anti-tumour activity of iodide might also be important for prevention of oral and salivary glands diseases.

Stimulation

The production of saliva is stimulated both by the sympathetic nervous system and the parasympathetic.[9] The saliva stimulated by sympathetic innervation is thicker, and saliva stimulated parasympathetically is more watery. Parasympathetic stimulation leads to acetylcholine (ACh) release onto the salivary acinar cells. ACh binds to muscarinic receptors and causes an increased intracellular calcium ion concentration (through the IP3/DAG second messenger system). Increased calcium causes vesicles within the cells to fuse with the apical cell membrane leading to secretion formation. ACh also causes the salivary gland to release kallikrein, an enzyme that converts kininogen to lysyl-bradykinin. Lysyl-bradykinin acts upons blood vessels and capillaries of the salivary gland to generate vasodilation and increased capillary permeability respectively. The resulting increased blood flow to the acinar allows production of more saliva. Lastly, both parasympathetic and sympathetic nervous stimulation can lead to myoepithelium contraction which causes the expulsion of secretions from the secretory acinus into the ducts and eventually to the oral cavity. Saliva production may also be pharmacologically stimulated by so called sialagogues. It can also be suppressed by so called antisialagogues.

Daily salivary output

There is much debate about the amount of saliva that is produced in a healthy person per day; estimates range from 0.75 to 1.5 litres per day while it is generally accepted that during sleep the amount drops to almost zero. In humans, the sub-mandibular gland contributes around 70-75% of secretion, while the parotid gland secretes about 20-25 % and small amounts are secreted from the other salivary glands. Produced in salivary glands, human saliva is 98% water, but it contains many important substances, including electrolytes,mucus, antibacterial compounds and various enzymes.[1]

It is a fluid containing:

• Water
• Electrolytes:
• 2-21 mmol/L sodium (lower than blood plasma)
• 10-36 mmol/L potassium (higher than plasma)
• 1.2-2.8 mmol/L calcium (similar to plasma)
• 0.08-0.5 mmol/L magnesium
• 5-40 mmol/L chloride (lower than plasma)
• 25 mmol/L bicarbonate (higher than plasma)
• 1.4-39 mmol/L phosphate
• Iodine (mmol/L usually higher than plasma, but dependent variable according to dietary iodine intake)
• Mucus. Mucus in saliva mainly consists of mucopolysaccharides and glycoproteins;
• Antibacterial compounds (thiocyanate, hydrogen peroxide, and secretory immunoglobulin A)
• Epidermal growth factor or EGF
• Various enzymes. There are three major enzymes found in saliva.
• α-amylase (EC3.2.1.1). Amylase starts the digestion of starch and lipase fat before the food is even swallowed. It has a pH optima of 7.4.
• Lingual lipase. Lingual lipase has a pH optimum ~4.0 so it is not activated until entering the acidic environment of the stomach.
• Antimicrobial enzymes that kill bacteria.
• Lysozyme
• Salivary lactoperoxidase
• Lactoferrin[10]
• Immunoglobulin A[10]
• Proline-rich proteins (function in enamel formation, Ca2+-binding, microbe killing and lubrication)[10]
• Minor enzymes include salivary acid phosphatases A+B, N-acetylmuramoyl-L-alanine amidase, NAD(P)H dehydrogenase (quinone), superoxide dismutase, glutathione transferase, class 3 aldehyde dehydrogenase,glucose-6-phosphate isomerase, and tissue kallikrein (function unknown).[10]
• Cells: Possibly as much as 8 million human and 500 million bacterial cells per mL. The presence of bacterial products (small organic acids, amines, and thiols) causes saliva to sometimes exhibit foul odour.
• Opiorphin, a newly researched pain-killing substance found in human saliva.

Question

What happens when my saliva is not adequate?

Answer

In the mouth, there is a constant demineralisation (tooth being dissolved by acids) and remineralisation (tooth being re-deposited on the teeth from saliva). If your demineralisation is happening at a greater rate than remineralisation, you get loss of tooth substance.

If your mouth is acidic a good deal of the day from, say, excessive and constant intake of acidic soft drinks or constant sugar intake, then the demineralisation wins and you have problems.

If you are careful with the diet, then your saliva is more neutral and you will get good remineralisation to constantly repair the teeth.

Sensitivity

See Tooth Sensitivity

Shared Planning

The dentist has a long-term view of your dental health - with a plan that you arrived at together, including seeing you regularly to help maintain optimal health?

Sleep Apnea

See www.snoreaustralia.com.au

Smiles



To achieve that natural, great smile make an appointment for a consultation, assessment and treatment plan at SAS and we can discuss with you want is most suitable for our patient. It is Dr Shouha’s passion to positively his patient’s life.



Confidenece

Smoking




Most people are becoming aware that smoking poses a problem to general health.

It contributes to Heart Disease, Stroke, and to a third of all cancer deaths, to name just a few conditions. In 1992 it was estimated that almost five thousand deaths in Victoria resulted from smoking.

What is less well known is the effect it has in the mouth.

The main damage is to the gums and mucosa, or lining of the mouth. Smokers develop more oral cancers than non-smokers (about five times more) and invariably suffer some degree of gum or, periodontal disease.

Other than staining, smoking does not affect the teeth. However, it also has a profound effect on the Saliva, promoting the formation of the thicker ‘mucous’ form of saliva at the expense of the thinner watery ‘serous’ saliva.. There is a reduction in the acid-buffering capacity of their saliva.

This effect of nicotine explains why some heavy smokers get decay even if they are brushing well

Snoring

See Sleep Apnea

Soft Drinks

One can of Coke has 10 teaspoons of sugar (now corn syrup) or 39 grams

Soft drinks contain high fructose corn syrup

Diet drinks usually contain Aspartame

Coca Cola is a very addictive soft drink. It has a universal double thumbs up like no other product

1. Nutritional content is zero
2. Drinking one can a day:
1. increases your risk of obesity 1.5 times
2. makes you 83% more likely to developing type 2 diabetes
3. Linked to weakness in bones and osteoporosis
4. Dissolve the tooth enamel (Phosphoric, Carbonic, Ascorbic and sometimes Citric Acids)making teeth weaker and more sensitive
5. Responsible for doubling or tripling tooth decay.
   The acidity can dissolve the mineral content of the enamel, making the teeth weaker, more sensitive and more susceptible to tooth decay. The acid in soft drinks makes it even worse for teeth than the sugar in lollies or chocolate. Dentist still urge patients not to eat or drink any of the above especially not in between meals
6. Soft drinks can cause kidney stones The acidity and radical minerals imbalances in cola drinks your body must buffer the acidity of soft drinks with calcium from your own bones As the calcium is passed through your urine it slowly forms kidney stones
7. Increased blood pressures
8. Metabolic Syndrome Risk Factor
   Soft drink consumption is a risk factor MSRF a combination of the symptoms such as high bp obesity, high glucose and insulin resistance

Staining

See Tooth Discolouration

Sterilization

We have been sterilizing instruments according to recommended Australian Dental Association protocols since starting up in 1989. The Practice now has as Practice Manager Sue Shouha who with over twenty years’ experience at Westmead Centre for Oral Health is able to maintain very high standards in Universal Precautions/ Infection Control. We are currently one of the pioneer dental clinics being used to trial Accreditation of dental practices in NSW.

Do you re use your instruments ?

• The average dentist spends ???? $ 35 ???? to set up the dental chair for one person to sit on it much of this going on disposables such as
• We do reuse our instruments that are autoclavable.

But when we do they must first be decontaminated in an ultrasonic bath and then rinsed, dried and sealed before sterilizing in a class B autoclave.

• In the autoclave instrument are heated to a temp of 134 ?????degrees at high pressure. This kills all possible microorganisms.

Sugar



Sugary Foods and Drinks

Drinking sugared soda pop provides double-trouble when it comes to dental health. The refined syrupy sugars feed the bacteria and the phosphoric acid in pop (both diet and sugared), further contributes.

Systemic Illness Links

• It is now widely accepted that a link exists between poor oral hygiene, gum disease and serious systemic diseases, such as:

  • Cardiovascular Disease(Atherosclerosis,Heart attack and Stroke) Beck et al (2001) Relationship of Periodontal Disease to Carotid Artery Intima-Media Wall Thickness : The Atherosclerosis Risk in Communities (ARIC) Study Arteriosclerosis, Thrombosis, and Vascular Biology 21 (21): 1816–1822
    Ford et al (2007) Anti-P.gingivalis response correlates with atherosclerosis J Dent Res. 86(1):35-40
    Scannapieco et al (2003) Associations Between Periodontal Disease and Risk for Atherosclerosis,Cardiovascular Disease, and Stroke A Systematic Review Annals of Periodontology 8 (1): 38–53
    Pussinen et al (2004) High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction. Eur J Cardiovasc Prev Rehabil. 11(5):408-11
    Elter et al (2004) Relationship of Periodontal Disease and Tooth Loss to Prevalence of Coronary Heart Disease Journal of Periodontology 75 (6): 782–790
    Beck et al (2005) Periodontal Disease and Coronary Heart Disease: A Reappraisal of the Exposure Circulation 112 (112): 19–24
    Humphrey et al (2008) Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis Journal of General Internal Medicine 23 (12): 2079–2086
    Wu et al (2000)Periodontal Disease and Risk of Cerebrovascular Disease: The First National Health and Nutrition Examination Survey and Its Follow-up Study Archives of International Medicine (160): 2749–2755
    Pussinen et al (2004) Antibodies to periodontal pathogens and stroke risk. Stroke. 35(9):2020-3
    Pussinen et al (2007) Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis. 193(1):222-8

  • Diabetes
  • Osteoporosis
  • Cancer risk Michaud et al (2008). "Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study.". Lancet Oncology. 9 (6): 550–8
  • Mental Impairment

  Noble et al (2009) Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-IIIJ Neurol Neurosurg Psychiatry. 80(11):1206–11
  Kaye et al (2010) Tooth Loss and Periodontal Disease Predict Poor Cognitive Function in Older Men Journal of the American Geriatrics Society 58 (4): 713–718

  • Low Birth Weight/Extreme High Birth Weight
  • Bacterial Pneumonia, Chronic Bronchitis and Pulmonary Fibrosis
• It has been shown that a direct link exists between gum disease and inflammation in the body. Elevated levels of oral bacteria leads to inflammation in the mouth (gingivitis and periodontitis). This inflammation in the mouth revs up inflammation throughout the body, including in the arteries, where it can lead to the illnesses mentioned in point #1.This condition is seen with raised levels of:
  • C-reactive protein

  Paraskevas et al (2008) A systematic review and meta-analyses on C-reactive protein in relation to periodontitis Journal of Clinical Periodontology 35 (4): 277–290
  D'Aiuto et al (2004) Periodontal disease and C-reactive protein-associated cardiovascular risk Journal of Periodontal Research 39 (4): 236–241

  • Interleukin-6

  D'Aiuto et al (2004) Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers J Dent Res 83 (2): 156–160
  Nibali et al (2007) Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case-control study Journal of Clinical Periodontology 34 (11): 931–937

• Another direct cause may be the result of bacterial entry into the bloodstream. Bacteria such as Streptococci may then interact with platelets and cause them to clump together to form clots that can partially block blood vessels. These clumps can also “protect” the bacteria from antibiotics. (according to current research by Kerrigan, Jenkinson and others at the University of Bristol). Therefore, good oral hygiene is a necessity because bacteria easily get into the bloodstream from the mouth even from routine activities such as chewing and tooth brushing
• It also may be argued that persons likely to develop gum disease are also likely to develop these diseases through genetic susceptibility. This is an indirect correlation and is important in that:
  
  • A. Persons with gum disease should screen themselves for the diseases mentioned
  • B. Persons with any of the above diseases should be particularly aware of oral hygiene measures to avoid direct exacerbation
• Some evidence also exists to link snoring with disturbed oxygen delivery to vital organs and blood vessels leading to vascular disease (see Sleep Apnea)