Research articles

Salivary Flow Assessment In Denture Wearers

Authors Dr. Akanksha Maheshwari
Modern Dental College and Hospital Indore., India

Dr. Bharat Maheshwari
Gverment college of dentistry, India

Dr. Vishal Khandelwal
Pedodontics, Modern Dental College ,Indore, India 452001
Corresponding Author Dr. Vishal Khandelwal
Pedodontics, Modern Dental College ,Indore, - India 452001
Submitting Author Dr. Vishal Khandelwal
Pedodontics, Modern Dental College ,Indore, India 452001

Plus Speciality:

BIOCHEMISTRY

Keywords:

Edentulism, Denture, Saliva, Salivary flow rate.

How to cite the article:

Maheshwari A, Maheshwari B, Khandelwal V. Salivary Flow Assessment In Denture Wearers. WebmedCentral plus BIOCHEMISTRY 2013;4(11):WMCPLS00103
doi: 10.9754/journal.wplus.2013.00103

Copyright:

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Submitted on: 22 May 2013 06:15 AM
Accepted on: 26 Oct 2013 10:26 AM
Published on: 12 Nov 2013 05:31 AM

Abstract


Introduction: Some of the common problems of the elderly people that leave a significant impact on their life are edentulism, xerostomia, and salivary gland hypofunction. In the denture wearing population, salivary wetting mechanisms are necessary to create adhesion, cohesion, and surface tension that ultimately lead to increased retention of the prosthesis. Salivary flow rate is thus an important aspect contributing to the retentive properties of complete denture. An in-vivo study was thus planned from a comprehensive perspective to assess resting and stimulated whole salivary flow rate and pH and to correlate them before and after complete denture placement in different age groups.

Materials and Methods: The participants were 50 edentulous individuals aged from 40-75 years requiring complete denture prostheses. The participants were divided into three groups based on their age groups. The procedure selected for this study was spitting method for collecting resting (unstimulated) and stimulated whole saliva. The flow rates and pH of resting and stimulated saliva were measured at different intervals.

Results: There were significant differences in resting and stimulated whole salivary flow rates obtained before, immediately after, and after 2-3 months of complete denture placement. There were significant differences in pH of resting and stimulated whole saliva determined before , immediately after, and after 2-3 months of complete denture placement.

Conclusion: The salivary factors like salivary flow rate and pH are to be better analysed for their potential to add benefits to the oral health in particular and overall health in general of an individual.

Introduction


The dawn of 21st century has seen an advent of revolution in the field of medical science which has lead to increase in the average life expectancy of the people. Among some of the common problems of the elderly people that leave a significant impact on their life are edentulism, xerostomia , and salivary gland hypo function.1 Examination of saliva output in healthy persons have suggested that there is no generalized age related deterioration in gland function ,but some specific alterations do occur (Baum,1981)

Saliva plays a major role in regulating oral health. In the denture wearing population, salivary wetting mechanisms are necessary to create adhesion, cohesion, and surface tension that ultimately lead to increased retention of the prosthesis. The lack of saliva and lubrication in denture mucosal interface can produce denture sores, mucosal candidiasis, and traumatic ulcerations of mucosa, etc.2

Saliva is said to be ‘unstimulated’ when no exogenous stimulation is present and is termed ‘stimulated’ when secretion is promoted by mechanical or pharmacological agents. The collection period of saliva is generally 5 minutes. Various methods of collection include draining method, spitting method, suction method, Swab method. Navazesh & Cristensen (1982) concluded that the spitting method appeared to be the most reproducible.   The purpose of this study was to assess resting and stimulated whole salivary flow rate and pH and to correlate them before and after complete denture placement in different age groups.

Materials And Methods


The participants for the study were selected from the Out Patient Department of Department of Prosthodontics, Modern Dental College and Research Centre, Indore. The 50 subjects who participated in the study were healthy, unmedicated and ranged in age from 40 to 75 years.

The participants were divided into three groups:

Group 1: Subjects aged ≤ 50 years (n=15)

Group 2: Subjects aged between 51 years and 65 years (n=18)

Group 3: Subjects aged 66 years and above (n=17)

The procedures selected for this study were (i) spitting method for collecting unstimulaed saliva, and (ii) the mechanical method for stimulated saliva (paraffin wax).

Saliva collection

Whole saliva was collected under clinical conditions between 08:00 to 11:00 hours. The subjects were instructed not to eat or drink for 2 hours preceding the experiment. They were seated comfortably on the dental chair, with eyes open and head tilted forward.

The subjects were asked to rinse their mouths for 5 seconds with 10mL of distilled water. Following the spitting out of the water and initial swallow, whole saliva was collected by spitting into a graduated measuring jar after every 30 seconds. The participants were asked to chew paraffin wax (mechanical method) for stimulating whole saliva and the sample collection was done in the similar way. The experiment was carried out until 5mL of whole saliva was collected. Collection times were recorded by using stop watch.

The flow rates of resting (unstimulated) and stimulated whole saliva and pH were measured at three different stages:

i. Before complete denture placement;

ii. Immediately after complete denture placement ; and

iii. After 2 to 3 months of complete denture placement.

Flow rate was calculated as collected volume/collection time. pH was determined by using a digital pH meter.

Results


The data were analysed using paired t-test and one way ANOVA. The mean and standard deviation of resting and stimulated salivary flow rate (mL/min) and pH is shown in Table I and Table II respectively. No statistically significant difference was observed in the resting and stimulated whole salivary flow rates between the age groups 1, 2 and 3. There were significant differences in resting and stimulated whole salivary flow rates obtained before , immediately after, and after 2-3 months of complete denture placement.(p

Discussion


Saliva is critical for the maintenance and function of all the tissues in the mouth.3 It fosters and protects the integrity of soft and hard oral tissues and supports important oral function.4 Situation that disturbs saliva production or its composition have broad negative sequelae in the mouth and may result in systemic complications.5 Various studies have suggested that saliva plays a pivotal role in the retention of complete denture.6,7 Reduced salivary production is thought to be related to the aging process. This thought has been supported by other studies. However, few others have found no age related decrease in salivary flow rates. 8,9

In our study, we found that there is significant difference in the resting and stimulated salivay flow rate before and after denture placement. This signifies that complete denture acts as a mechanical stimulant and continues to be even after 2-3 months thus increasing the salivary flow rate. However from this study, salivary flow rate appears to be independent of age in healthy, non medicated subjects. It can be nearly correlated with the other studies. 10,11

There were significant differences found in the pH determined between resting and stimulated whole saliva, but no significant age group related variations were observed in the subjects. The results obtained are consistent with studies done by others.12

Conclusion


The salivary factors like salivary flow rate and pH are to be better analysed for their potential to add benefits to the oral health in particular and overall health in general of an individual.

References


1. Turner M, Jahangiri L, and Ship JA. Hyposalivation, xerostomia and the complete denture: A systematic review. J Am Dent Assoc 2008;139:146-50.
2. Turner M and Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc 2007;138:15S-20S.
3. Samarawickrama DYD. Saliva substitutes: how effective and safe are they?. Oral Diseases 2002;8:177-79.
4. Shern RJ, Fox PC, Cain JL, and Li SH. A method for measuring the flow of saliva from the minor salivary glands. J Dent Res 1990;69:1146-49.
5. Ferguson DB.Current diagnostic uses of saliva. J Dent Res 1987;66:420-24.
6. Pederson AM, Bardow A, Jensen SB, and Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Diseases 2002;8:117- 29.
7. Edgerton M, Tabak LA, and Levine MJ. Saliva: A significant factor in removable prosthodontic treatment. J Prosthet Dent 1987;57:57- 66.
8. Gandara BK, Izutsu KT, Truelove EL, Ensign WY, and Sommers EE. Age related salivary flow rate changes in controls and patients with oral lichen planus.  J Dent Res 1985;64:1149-51.
9. Tylender CA, Ship JA, Fox PC, and Baum BJ. Evaluation of submandibular salivary flow rate in different age groups. J Dent Res 1988; 67:1225-28.
10. Baum BJ. Evaluation of stimulated parotid saliva flow rate in different age groups. J Dent Res 1981;60:1292-96.
11. Percival RS, Challacombe SJ, and Marsh PD. Flow rates of resting Whole and stimulated parotid in relation to age and gender. J Dent Res 1994;73:1416- 20.
12. Mandel ID. Relation of saliva and plaque to caries. J Dent Res 1974;53:246-66.

Source(s) of Funding


None

Competing Interests


None

Prepublication Reviews

   The pap...
Posted by Anonymous reviewer on 18 Oct 2013 04:33:37 PM GMT

This study is concis...
Posted by Dr. S.Omer S Sheriff on 29 Jun 2013 12:39:28 AM GMT

dear sir

\n

thanks for the positive note on my article. 

... View more
Responded by Dr. Vishal Khandelwal on 01 Jan 1970 12:00:00 AM GMT

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WebmedCentral Plus Article: Salivary Flow Assessment In Denture Wearers