Transcript Saliva and Oral Health

Saliva and Oral Health
Part 1
Maintaining Oral Health
Preventing Dental Disease
A CPD Module for Dental Professionals
1 Hour Verifiable CPD
Saliva and Oral Health
Overview
Saliva
- Production - Composition - Function
Biofilm New Insights
- Composition - Activity - Fluoride resistance
Chewing Gum and Saliva
- Flow rate - Clearance - Buffering
Caries
- Plaque pH - Demineralisation-Remineralisation
Erosion
- Prevalence - Causes - Aetiology- Management
Clinical Assessment
- Examination - Chair side Tests - Recommendations
(CRA BEWE)
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Saliva and Oral Health
Saliva
Major Salivary Glands
-
Parotid
Sublingual
Submandibular
Minor Salivary Glands
-
Lips, tongue, cheek, palate
Saliva Secretion
- Parotid
- Sublingual
- Submandibular
Serous saliva
Mucous saliva
Mixed saliva
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Saliva and Oral Health
Saliva
Salivary Acini
Basic secretory units
Mixed Salivary Acinus
End piece
Serous Cell
of salivary glands.
Serous Cells
- Stain darkly.
- Wedge shaped with round
nucleus.
Intercalated duct
-Tight spherical formation.
Mucous Cells
Serous Demilune
Basement membrane
Mucous Cell
- Stain lightly.
- Tubular shaped with flattened
nucleus.
- Open formation larger central
lumen.
Salivary duct
(secretory)
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Saliva and Oral Health
Saliva
Histology varies by gland type
Serous Acini
Mucous Acini
Parotid
Sublingual
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Mixed Acini
Submandibular
Saliva and Oral Health
Saliva
Saliva Formation Stage One: Primary Saliva
Local Vasculature
©Reeves 2013
ACINI- water and ions
derived from plasma
Saliva formed in acini flows down
DUCTS to empty into the oral
cavity
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Saliva and Oral Health
Saliva
Saliva Formation Stage Two: Final Saliva
Proteins
Na+& Cl-
K+
Hypotonic
Concentration
Gradient
Concentration
Gradient
Final Saliva
©Reeves 2013
Water and
electrolytes
Isotonic
H2O
Primary Saliva
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Saliva and Oral Health
The Composition of Saliva
Saliva
99.4 % Water
0.2 % Soluble inorganic substances:
sodium, potassium, calcium, chloride,
bicarbonate, phosphate, fluoride
0.3%
Soluble organic substances:
proteins, digestive enzyme (amylase), mucins,
antibodies (immunoglobulins), urea, peroxidases,
antioxidant enzymes (SOD catalase gluathione)
0.1 % insoluble substances
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Saliva and Oral Health
The Composition of Saliva
Saliva
Water and Electrolytes
Composition
K+
Stimulated
Water
99.55%
99.53%
Solids
0.45%
0.47%
Flow Rate(ml/min)
0.32  0.23
2.08  0.84
pH
7.04  0.28
7.61  0.17
5.76  3.43
20.67  11.74
Potassium
19.47  2.18
13.62  2.70
Bicarbonate
5.47  2.46
16.03  5.06
Phosphate
5.69  1.91
2.70  0.55
Chloride
16.40 ± 2.08
18.09  7.38
Calcium
1.32 ± 0.24
1.47 ± 0.35
Sodium
Na+& Cl-
Unstimulated
(mmol/L)
Saliva and Oral Health Edgar M, Dawes C, O’Mullane D Eds. 4th Ed 2012
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Saliva and Oral Health
The Composition of Saliva
Saliva
Water and Electrolytes
Na+& ClK+
Dawes, C. JADA 2008;139:suppl 2:18S-24S
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Saliva and Oral Health
Saliva
Unstimulated
Stimulated
Water
99.55 %
99.53%
Solids
0.45%
0.47%
Flow Rate
pH
0.32 ± 0.23
7.04 ± 0.28
2.08 ± 0.84
7.61 ± 0.17
Organic
Total
1630 ± 720
1350 ± 290
protein
830 ± 480
460 ± 200
MUC5B
440 ± 520
320 ± 330
MUC7
317 ± 290
453 ± 390
Amylase
8.4 ± 10.3
5.5 ± 4.7
Lactoferrin
4.93 ± 0.61
Statherin
51.2 ± 49.0
60.9 ± 53.0
Albumin
79.4 ± 33.3
32.4 ± 27.1
Glucose
0.20 ± 0.24
0.22 ± 0.17
Lactate
3.57 ± 1.26
2.65 ± 0.92
Urea
6.86
2.57 ± 1.64
Saliva and Oral Health, Edgar M. Dawes C., O’Mullane, D. Eds. 4 th Ed, 2012
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Saliva and Oral Health
The Functions of Saliva
Saliva
Resting Saliva
Oral Protection System
Secretion
-Submandibular - 60%
-Parotid
- 25%
-Sublingual
~ 7-8%
- Secretion rate: 0.3-0.4 mls/min
-Minor glands
~ 7-8%
- Texture: Viscous (mucus)
- Rich in mucins
- pH value 5.7-7.1
- Functions: Coating of the teeth: salivary pellicle
- Lubrication of oral mucosa
Stimulated Saliva
Oral Repair System
Secretion
-Parotid
60%
-Submandibular
30%
-Sublingual
~ 10%
- Secretion rate: 1-3mls/min
and minor glands
- Consistency: Thin (serous)
- Rich in minerals
- pH value: 7.0-7.8
- Functions: Clearance, buffer system,
remineralisation
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Saliva and Oral Health
Saliva
The Multiple Functions of Saliva
QuickTime™ and a
decompressor
are needed to see this picture.
Salivary
Functions
Figure adapted from M.J. Levine. 1993
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Saliva and Oral Health
Saliva
Digestion & Taste
• Dissolve solids
• Starch digestion
(amylase)
• Gustatory sensation
• Facilitate chewing
• Swallowing
• Bolus formation
The Major Functions of Saliva
Protection
• Buffer -
plaque acids
(foods)
extrinsic acids
(reflux)
intrinsic acids
• Antibacterial
Manipulation
• Attachment Saliva proteins coat
enamel surface and allow
specific absorption of
primary colonisers
Oral ecology balance
• Food -
Pathogen defence
Saliva may act as a
carbon source and select
for healthy bacterial
balance
• Mouth clearance/rinsing
Food and bacteria
• Prevent demineralisation
• Aid remineralisation
• Hydrates mucous
membrane
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Saliva and Oral Health
Biofilm
Bacterial Microcolonies
Streamers
Fluid
Channels
Flow
Pellicle
©Reeves2013
Biofilm: a well organized, cooperating community of microorganisms.
- A complex community of highly organised bacterial colonies.
- Each community contains a mix of microorganisms.
- Arranged in micro-colonies surrounded by a protective matrix.
- With a communication system of fluid channels: Quorum sensing
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Tooth
Surface
Saliva and Oral Health
Biofilm
1st Phase: immediately to approximately 4 hours
Formation of aquired pellicle from salivary glycoproteins and
maturation. Early colonisation from initial bacteria mainly
Streptococcus strains.
2nd Phase: 4 to 48 hours
Colonisation of predilection sites, i.e. fissures, iatrogenic retention
factors (restorations/overhangs/ortho brackets) and white spots.
3rd Phase: 3 to 7 days
Aerobic bacterial metabolic products compromise the hard dental
tissues; anaerobic bacterial metabolic products compromise the
soft tissues.
(König 1987)
4th Phase: 7 to 14 days
Mature plaque biofilm is established that consists of sessile bacteria
firmly attached to the hard dental tissues and planktonic (floating)
bacteria.
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Saliva and Oral Health
The Formation of Biofilm
Quorum sensing
Biofilm
Fl-
AA
Late
Colonizers
C.gingivalis
A.oris
Strep. oralis
Flresistance
Statherin
Strep. mitis
Proline-rich protein
Salivary Pellicle
Enamel Surface
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Early
Colonizers
Saliva and Oral Health
Sugar-Free Gum
Salivary Flow Rate
Saliva flow rates under stimulation
Saliva flow (ml in 20 min)
- Chewing gum increases the
saliva flow rate up to 10
times.
- “Empty” chewing, without
flavor additive (e.g.,
paraffin), only stimulates
up to 5 times.
Un-stimulated
saliva
Stimulated saliva
Stimulated saliva
after chewing
after chewing sugarparaffin
free gum
- Chewing sugar-free gum
with flavor additive
improves flushing and
accelerates the removal of
soluble compounds.
(Edgar 1993)
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Saliva and Oral Health
Sugar-Free Gum
Salivary Flow Rate
Polyol-sweetened gum stimulates the production of saliva by two
mechanisms:
-
Gustatory stimulation (taste buds)
-
Masticatory action (periodontal mechanoreceptors)
(Dawes and Macpherson. 1992)
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Saliva and Oral Health
Sugar-Free Gum
-
Salivary Flow Rate
Salivary stimulation lasts more than 2 hours with SF gum.
Flavour and chewing increase salivary flow.
Unstimulated flow rates of less than 0.1 mL/minute are considered evidence of hypo-salivation
(Dawes, C., et al. Arch Oral Biol 2004, 49, 665-669.)
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Saliva and Oral Health
Sugar-Free Gum
Salivary Flow Rate and Xerostomia*
Sugar-free gum may have benefits in older and medically-compromised patients
-
Chewing sorbitol gum increased saliva flow rates and neutralized plaque pH
drop from sucrose in subjects with xerostomia.1,2
- 69% of cancer patients with xerostomia preferred chewing gum to artificial
saliva3; 60% of hemodialysis patients preferred gum to saliva substitutes.4
- Gum chewing (12 months, 2x/day) increased stimulated saliva flow rates in
111 frail older people.5
-
1.
2.
3.
4.
5.
6.
A 6 month study in 186 older (community-dwelling) adults showed
significant improvements in plaque and gingival indices, but not saliva flow6;
self-perceived oral health status improved significantly in the gum group.
Markovic N; Abelson DC; Mandel ID (1988): Gerodont. 7: 71-75
Abelson DC, Barton J, Mandel ID (1990): J Clin Dent 2: 3-5
Davies AN (2000): Palliat Med 14: 197-203
Bots CP, Brand HS, et al (2005): Palliat Med 19: 202-207
Simons D, Brailsford SR, Kidd EAM, Beighton D (2002): J Am Geriatr Soc 50: 1348-1354
Al-Haboubi M, Zoitopoulos L, Beighton D, Gallagher JE (2012): Community Dent Oral Epidemiol 40: 415-424
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* Module Two
Saliva and Oral Health
Oral Clearance
Halftime(min)
Sugar-Free Gum
15
- Relies on swallowing and flow
rate.
10
- Higher salivary flow rate =
increased clearance.
- Unstimulated flow rate <
0.2ml/min = prolonged
clearance.
5
0
0.2
0.4
0.6
0.8
0
Unstimulated Flow Rate UNSTFR(ml/min)
1.0
- Prolonged clearance = greater
risk of caries.
- Greater risk of acid erosion.
Effect of changes in the UNSTFR
on the clearance halftime of sucrose
Saliva and Oral Health, Edgar M. Dawes C., O’Mullane, D. Eds. 4 th Ed, 2012
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Saliva and Oral Health
Buffering Capacity
Sugar-Free Gum
Fast flowing saliva neutralises plaque (pH value increases).
Saliva stimulation and buffering of acids by chewing gum
Chewing gum with sugar
substitute
Buffer capacity is the ability to
neutralise acids (buffering).
-
The pH value is raised due to the
increased concentration of
bicarbonate in stimulated saliva.
(Bicarbonate increases from 5.47
unstimulated to 16.03mmol/L in
stimulated saliva).
-
Increased flow rate exposes hard
tissues to low pH for a shorter
period.
(Flow rate increases from 0.32
ml/min unstimulated to 2.08ml/min
in stimulated saliva).
pH value
10% sugar
solution
-
Time in minutes
(Stoesser 1996)
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Saliva and Oral Health
Plaque pH
Caries
Saliva stimulation from chewing gum helps to neutralise plaque acids
Factors affecting plaque acids
- Fermentable carbohydrates.
7.0
- Oral bacteria produce:
6.5
- Extracellular polysaccharides in
the presence of excess sucrose.
6.0
- Glucans increase plaque
adhesion and thickness.
5.5
5.0
- Fructans produce acid
metabolites.
4.5
4.0
Chew ing Gum
3.5
Non-Chew ing Gum
3.0
0
5
10
15
20
25
30
35
40
45
50
55
60
65
80
- Intracellular polysaccharide
stores provide ongoing acid
production in resting plaque.
Time (min)
Manning RH, Edgar WM (1993) Brit Dent J 174: 241-4
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Saliva and Oral Health
Plaque pH
Caries
Plaque buffering systems
Bicarbonate diffuses
from saliva and
neutralises plaque
acids
Plaque acids diffuse out
and are neutralised by
bicarbonate in saliva
- Bicarbonate is the most important
buffering system.
- Bicarbonate concentration
increases with salivary flow.
- Directly increases plaque pH.
Urea from saliva
diffuses into
plaque
Ammonia increases
plaque pH
- Urea from saliva is converted to
ammonia by bacteria in plaque with
urease activity.
- Ammonia is highly alkaline and
neutralises plaque pH.
Plaque bacteria convert
urea to ammonia
Calcium
phosphate
in plaque
- The intrinsic buffering capacity of
plaque.
Increases buffering
capacity in plaque
- Calcium phosphate crystals in
plaque dissolve in acid conditions.
- Increasing buffering capacity.
©Reeves2013
Dissolves in acid conditions
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Saliva and Oral Health
Demineralisation-Remineralisation
Caries
- A dynamic equilibrium exists between demineralization and remineralisation.
- A neutral pH value promotes remineralisation.
- When the pH value is <5.5
- Calcium
and Phosphate
3
(PO4 -) are withdrawn from the
dental enamel.
Demineralisation
(Ca2+)
H+
Low pH
Ca
++
H+
Ca++
F-
PO4-
Demineralisation
H+
Remineralisation
Increased pH
- When the pH value is >6.5
- Calcium (Ca2+) and Phosphate
(PO43-) migrate back into the dental
enamel.
PO4-
H+
F-
Ca++
FCa++
PO4-
Remineralisation
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FFPO4©Reeves 2014
Saliva and Oral Health
Caries
Demineralisation- Remineralisation
- Demineralisation shifts to remineralisation by the use of fluoridation and saliva
activation. Saliva provides the medium for remineralisation.
- Supersaturation of saliva with ionic Ca and Pi, can effectively help remineralise incipient
caries lesions.
- Fluoride inhibits demineralisation by
penetrating and coating enamel
crystals to prevent dissolution.
- Enhancing remineralization resulting in
enamel with a higher Fl content and lower
acid solubility.
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Saliva and Oral Health
Caries
Demineralisation - Remineralisation
At a pH value < 5.5-5.7 demineralisation begins.
Reversible caries = early enamel lesions
- Plaque-coated.
- Frequent fall in pH value below 5.5-5.7.
- Beginning of demineralisation of the
enamel.
- White spots; surface “pseudo-intact”
Image Courtesy Dr F Goulbourn
Irreversible caries = dentine caries
- Prolonged acid attack.
- No remineralisation.
- Established lesion (manifest
caries).
- Breach of the enamel surface.
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©Goulbourn 2012
Saliva and Oral Health
Caries
THE CARIES BALANCE
PATHOLOGiCAL FACTORS
- Acid producing bacteria
- Frequent eating/drinking of fermentable
carbohydrates
- Subnormal saliva flow and function
PROTECTIVE FACTORS
- Saliva flow and components- Fluoride-remineralisation
with calcium and phosphate
- Antibacterials: chlorhexidine, xylitol
CARIES
NO CARIES
Redrawn from Featherstone BMC Oral Health 2006 6(Suppl 1):S8
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Saliva and Oral Health
Caries
Reduction Studies
Chewing SF gum reduces caries in prospective 2-3 year clinical trials.
- Three year study in children with high caries prevalence
showed caries-protective benefit of sugar-free gum
(Beiswanger et al. 1998)

Three year study, Puerto Rico

N = 1402 subjects, age 8-13

Chewed gum 3 x/day for 20 min after meals

7.9% fewer DMFS in all subjects and 11.0
fewer in high-caries subjects.
- Another two year study confirmed caries-protective
benefit in lower-caries prevalence population (Szöke
et al, 2001)

Two year study, Hungary

n = 547 subjects, age 8-13

Chewed gum 3 x/day for 20 min after meals or
no gum

Results show 38.7% reduction in DMFS
increment after 2 years
INCREMENTAL DMFS
Clinical Caries Studies
2.91
3.0
2.5
GUM
NO GUM
1.95
2.0
1.5
1.0
1.33
0.81
0.5
0.0
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Radike Criteria
WHO criteria
Saliva and Oral Health
Reduction Studies
Caries
Tabulated Summary of Data from Pertinent Human Intervention Studies
Study
Intervention (n/N)
Control (n/N)
Reduction of Caries
Incidence (%)
Möller 1973
Sorbitol gum 3x/day after meals. 161/313
No gum. 152/313
10%
Glass 1983
Sorbitol gum 2x/day. 269/540
No gum. 271/540
2%
Kandelman 1990
15% Xylitol gum 90/274
No gum. 97/274
61%
Kandelman 1990
65% Xylitol gum 87/274
No gum. 97/274
66%
Mäkinen 1995a
Sorbitol gum pellets 2x1.3g, 5x/day
129/1135
No gum. 121/1135
17%
Mäkinen 1995a
3:2 xylitol/sorbitol pellets, 5x/day 120/1135
No gum. 121/1135
44%
Mäkinen 1996
Sorbitol stick, 1, 5x/day. 63/471
No gum. 86/471
28%
Beiswanger 1998
Sorbitol gum, 3x/day after meals. High risk
subjects, intention to treat, 607/1256
No gum. 649/1256
12%
Szöke 2001
Sorbitol stick, 3x/day after meals. Including
white spots, 269/547
No gum. 278/547
33%
Peng 2004
Sorbitol/xylitol/carbamide gum, 4x/day.
363/733
No gum. 370/733
42%
Machiulskiene 2001
Sorbitol gum, 5x/day after meals. 68/432
No gum. 80/320
25%
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Saliva and Oral Health
Caries
Reduction Studies
Caries Reduction and Gum - Conclusions
-Multiple studies support the anti-caries
benefits of sugar-free gum chewed
after eating.
-The majority showed reductions in the
range 20-60%.
-Systematic reviews have also
supported this position.
(eg Mickenautsch et al, 2007;
Deshpande and Jadad , 2008)
- Studies have been reviewed by
expert panels resulting in supporting
reviews and statements from
regulatory and authoritative bodies
(FDA, FDI, ADA, EFSA, etc).
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Saliva and Oral Health
Erosion
The loss of hard tissue as a result of direct decalcification from acids of non bacterial origin.
©Image Courtesy Dr F Goulbourn
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Saliva and Oral Health
Erosion
Sources
Extrinsic
Intrinsic
-
Acidic foods (pH < 5)*
-
Acidic medications (pH < 5)
-
Diet (e.g., frequent acidic
food/drink intake.
-
Particularly in the presence
lower saliva flow.
-
Environmental factors (e.g.,
occupational exposure to
acids)
* Exception: Yogurt (pH = 4) is not
erosive.
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-Gastroesophageal reflux
(GERD:backflow of gastric
acid into the oral cavity).
-Vomiting due to:
-Chronic alcohol abuse
-Bulimia
- Central nervous disorders
Saliva and Oral Health
Erosion
Sources
Often seen in those striving for a healthy lifestyle
©Goulbourn 2012
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Saliva and Oral Health
Erosion
Prevalence
ESCARCEL Study
- Prevalence growing steadily.
- Europe has a prevalence rate of
29.4% of young adults having erosive tooth
wear.
- 41.9% demonstrating dentine hypersensitivity.
- The increasing prevalence of dentine
hypersensitivity due to:
- The longevity of healthy dentition.
- More frequent daily dietary acid challenges to
the tooth surface.
- Tooth wear risk factors:
- Associated with frequent acidic food with
increased levels of damage.
©Goulbourn 2012
Image courtesy Dr F Goulbourn
Bourgeois D, et al ;FDI Annual World Dental Congress, 28-31 August
2013, Istanbul, Turkey.
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Saliva and Oral Health
Erosion
Aetiology
Appearance of erosions:
- Dish-shaped, shallow, rounded edges.
- Molar cupping.
- On buccal, palatal or incisal dental
surfaces.
Progress of erosions:
©Goulbourn 2012
-
Pain-free onset.
Initially in dental enamel.
Leads to exposed dentine.
Hypersensitivities.
Erosive wear, abfraction.
Opacity to incisal edges.
Image Courtesy Dr F Goulbourn
©Goulbourn 2012
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Saliva and Oral Health
Erosion
Remineralisation
Sugar free gum may help prevent erosion and erosive tooth wear*
- Exogenous dietary acids occur at much lower pH values in comparison to
plaque acids.
- Saliva stimulation from chewing gum:
- Increases the rate of mouth clearance from acidic food or drink1.
- Stimulates saliva production2.
- Increases levels of bicarbonate and calcium ions in saliva3.
- Aids in more rapid remineralisation of the enamel surface following an
acid challenge4.
*Initial study suggests salivary stimulation may help5.
*Direct clinical evidence pending
1.Trlolo P et al:J Dent Res 1990:69(1Suppl);136
2.Dawes C et al:Arch Oral Biol 2004;49(8):665-669.
3.Dawes C et al: Arch Oral Biol. 1995;40:699-705.
4.Wefel JS et al:J Dent Res 1989;68(1supp):214.
5. Rios D et al: Caries Res 2006;40:218-23.
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Saliva and Oral Health
Clinical Assessment
Examination
Review Medical History
- Drugs, medicines.
- Conditions: Acid reflux, diabetes, vomiting, heartburn, hiatus hernia,
- Autoimmune diseases (e.g. Sjögren’s syndrome), radiotherapy
Soft Tissue Examination
- Oral hygiene.
- Periodontal conditions: BOP, pocketing.
- Soft tissue loss: previous periodontal therapy, surgical/non surgical.
- Dry/ friable mucus membrane.
- Lack of saliva pooling.
Hard Tissue Examination
- Exposed root surfaces.
- Attrition
- Erosion
- Abfraction
- Abrasion
- Loss of enamel characteristics : shiny,flat surfaces.
- Caries rate: root surface, proximal.
- Demineralisation bands.
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Saliva and Oral Health
Clinical Assessment
Examination
Diet
- Acids : Food, drinks and frequency.
- Sugars: Added, hidden and frequency.
- Timing: Avoid before bed time - reduced salivary
flow.
Oral Hygiene
- Tooth brushing technique, bristle type.
- Toothpaste abrasives.
- Bacterial acids, plaque scores, demineralisation.
Fluoride Exposure
- Frequency
- Age appropriate fluoridation
Saliva
- Quality: serous, mucoid, frothy.
- Quantity: adequate and reaches all areas of the
mouth.
- Buffering capacity.
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Saliva and Oral Health
Clinical Assessment
Risk Assessment Tools
Caries
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Saliva and Oral Health
Risk Assessment Tools
Clinical Assessment
Basic Erosive Wear Examination
0
No surface loss
1
Initial loss of enamel surface texture
2*
Distinct defect, hard tissue loss less
than 50%of the surface area
3*
Hard tissue loss more than 50% of the
surface area
*Dentine is often involved
BEWE: a new scoring system for scientific and clinical needs. Clin Oral Investig. 2008 March;
12(Suppl 1): 65–68.
BEWE Index
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Saliva and Oral Health
Chairside Testing
Saliva
1. Measuring the saliva flow rate (ml/min)
Saliva categories
Normal flow rate
Reduced saliva flow rate
Mouth dryness (xerostomia)
Saliva flow rates (ml/min)
1-3
0.5 - 0.8
<0.5
2. Consistency
Visual inspection
Categories
Strongly increased viscosity
Increased viscosity
Normal viscosity
Characteristics
Sticky frothy saliva
Frothy bubbly saliva
Watery clear saliva
3. Measuring the buffer capacity
The change in color on the test strip is compared with
the sample card and this indicates the buffer capacity:
Low
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Medium
High
Saliva and Oral Health
Recommendations
- Continuous recall with oral hygiene, caries,
gingivitis,bleeding index.
- Regular fluoridation building up a stable
fluoride reservoir.
H+
H+
Ca++
- Use a less abrasive toothpaste.
F-
H+
PO4-
H+
- Only take acidic medications (pH < 5.7) with
water.
F-
FCa++
- Diet with a low erosive potential, e.g.,
vegetables, milk, hard cheese.
FF-
PO4©Reeves 2014
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Saliva and Oral Health
Recommendations
Sugar Free Gum
- Chew SFG for 20mins after sugar or acid
challenge.
- Encourage regular saliva stimulation in
between meals.
-Chew sugar free gum, to increase the
saliva flow rate.
- Dental care on the go: chewing sugar free gum
can:
-
Provide mouth clearance
Help prevent plaque accumulation.
Increase saliva buffering capacity.
Decrease plaque pH.
Decrease caries and erosive potential.
www.wrigleyoralhealthcare.co.uk
Saliva and Oral Health
Conclusions
 Saliva is the most important part of the body’s
own protective systems for maintaining oral
health.
 Reduced saliva quantity and quality increase
the risk of caries, erosion, xerostomia and
interfere with the ecological balance in the
mouth.
 Informing the patient and activating the
saliva’s protective function for the mouth and
teeth is the basis of a modern, preventionoriented treatment strategy.
 It has been scientifically proven: saliva
stimulation by chewing sugar free gum helps to
increase the saliva flow-rate up to tenfold,
which can reduce the risk of caries by up to
40%.
www.wrigleyoralhealthcare.co.uk
Saliva and Oral Health
Thank you!
Thank You!
47
www.wrigleyoralhealthcare.co.uk