*Balarabe

Musa EL- HUSSAIN

Dental Therapy Department Federal School of Dental Technology & Therapy P.M.B 01473, Trans-Ekulu, Enugu state, Nigeria, WEST AFRICA.

INTODUCTION & GENERAL OVERVIEW In an attempt to make the understanding of oral physiology more simplified, interesting, easier & appreciative. It is important or pertinent that one should & also must have an understanding of the back ground knowledge of the history of physiology; origin of physiology; general classification of physiology; broad based subdivisions of physiology; relation of physiology to other sciences and human physiology. The History of Physiology In ancient times the earliest information on physiology was obtained from the empirical observations of naturalists and physicians and particularly through the dissection of animal and human cadavers. For many centuries the accepted views concerning the body and its functions were those of Hippocrates and Aristotle i.e. in the fifth and fourth centuries B.C., respectively. In the middle ages, advances in medicine stimulated the development of biology, and the overall progress achieved in the sciences during the Renaissance contributed to the development of physiology. However, Physiology as a science founded by an English physician W. Harvey, with his discovery of blood circulation in 1628, which in the words of F. Engels another scholar in physiology, was what made the science of the physiology of man and animals a very significant tool in medicine and other allied fields; of which the dental therapy arm in the field of dentistry is never an exception or rather in isolation. Physiology however became an independent field as it was removed or distinguished from anatomy in the 19th century, due to the developmental advancements in organic chemistry; the discovery of the laws of the conservation and transformation of energy and of the cellular structure of the body; as well as the formulation of the theory of evolution of organic life. This is because, it was in the early 19th century that it was believed established that the chemical compounds in the living organism were fundamentally different from inorganic substances and could not be produced outside the body: and this believe is what ushered in a new stage in the development of physiology that began in the 20th century , when the earlier, narrowly analytic view of the bodys vital processes gave way to a synthetic view. Origin of Physiology The term physiology is derived from two Greek words, physis --- meaning nature and logos -- meaning word. Physiology is a field of science that involves studying various functions of the component /structural parts of living organisms. It is a critically important basic science because it is the foundation upon which we build our knowledge of what normal functioning is, how disease states are developed and how to treat them, and how to best cope with stresses encountered by our bodies due to the changes in our environment. The study of human physiology was stimulated by the development of medicine, and it embraces many chemical and physical principles. This is because physiological processes are dynamic; just as cells contained in the human body do change their primary functions i.e. into secondary function in response to changes in the composition of their local environment. Meanwhile, as living organisms responds to alterations in both their external and internal environment, the resultant effects are consequently registered/denoted/classified/categorized/identified/named & or regarded as physiological reactions significantly aimed at preserving a constant/neutral physical & or chemical internal environment homeostasis.

Relative to living organisms vizviz plants & animals mammals and man or humans inclusive, physiology is being described as the branch of science that deals with the life functioning processes of individual systems, organs & tissues as contained in a specified identifiable or rather distinguishable living organism. It is also being described as the field of scientific study of all regulatory functional processes involving the interaction of various structural components both microscopic & macroscopic in a living organism, either within the living organisms internal structures or in between the living organisms internal structures and the immediate external environment. Branches of Physiology Physiology as one of the most important i.e. vital or significant branch of biology/biological science as well as medical science, it is however interwoven with a large number of independent or interdependent allied fields or disciplines because of the existing close relationship shared amongst other various identifiable arms i.e. the fields of biological sciences or medical sciences. Generally & from a broader point of view, physiology is classified into: a) General physiology b) Applied physiology
c)

Physiology of specific structures here belongs Oral Physiology.

General physiology: This is a branch of physiology centered about the general studies & understanding of the physiological interactive or reactionary principles common i.e. exhibited amongst different species of living organisms; as well as the processes involved in the excitation and inhibition of mechanisms, relative to how the different species of living organisms respond to certain stimuli; and is further subdivided into: Comparative, Developmental, Ecological physiology & & Evolutionary etc.

Comparative physiology: ----This is a sub-discipline of physiology that

studies as well exploits the existing diversity of functional characteristics of various kinds of living organisms.

Developmental physiology: ----Studies the formation and development of

physiological functions in the course of ontogeny, from the fertilization processes in living organisms until death, and is closely associated with

evolutionary physiology.

Ecological physiology (Environmental physiology): --- It is a sub-discipline

in physiologic-biological science which studies the functioning of physiological systems in living organisms relative to their adaptation ability as regards their basic surrounding habitat & immediate environmental conditions.

Evolutionary physiology:----This is a sub-discipline of physiological science

aimed at studying, identifying & understanding the manner in which the functional characteristics of variety of individual living organisms & or their structural component parts (i.e. in a population of different living organisms or
amongst various structural component parts in a living organism) do respond to

selection across multiple generations during the history of the population.

Applied physiology: It is a branch of physiology centered about how the study, understanding and knowledge of how the biological systems and other various structural component parts of systems as contained in the body of living organisms can be applied into practice in order to help resolve any physiological functional deficiencies i.e. functional anomalies that may arise from abnormal functioning; as well as the best possible steps applicable in practice. This involves the application of the knowledge of physiological properties to restore stability, which differs from clinical practice. Thus, applied physiology is often than not being described as a branch of physiology concerned with the studies of the general and specific principles that control the functioning of living organisms, in relation to various aspects of life. Other sub-divisions of applied

physiology include the physiology of labor, sports physiology, the physiology of

nutrition, aviation physiology, space physiology, underwater physiology, High altitude physiology and exercise physiology etc.
Physiology of specific structures: The physiology of specific structures is aimed at investigating the life & functional processes in individual structural groups of tissue component parts in living organisms or specific tissues i.e. specialized tissues component parts in living organisms in order to study, evaluates, understands as well as appreciates the properties of such group of specialized tissues or specific individualized tissue and the ways in which these structural tissue component parts help form specialized functional systems that play significant role in the maintenance of complete & total body integrity of a living organism.

Broad Based Divisions of Physiology Physiology is also subdivided into: a) Normal physiology b) Pathological physiology Normal physiology:

Primarily studies the functioning of the healthy organism, its interaction with the environment, and the mechanisms by which it resists and adapts to a variety of factors.
Pathological physiology:

Studies altered functions of the diseased organism, the processes of compensation and adaptation in disease, and the mechanisms of recovery and rehabilitation. A branch of pathological physiology is clinical physiology, which studies the origin and activity of such functions as blood circulation, digestion, and higher nervous activity during disease in animals and man.
Relationship of Physiology to other sciences Physiology as a branch of biological science is closely related to such morphological sciences as anatomy, histology, and cytology; however physiology & morphology are significantly closely interdependent. Furthermore, physiology as a branch of both biological & medical science also utilizes extensive use of the principles and methods of physics, chemistry, cybernetics, and mathematics in which the chemical and physical processes occurring in the organism are studied in conjunction with biochemistry, biophysics, bionics, evolutionary laws that are studied in conjunction with embryology. More so, whereas the physiology of higher nervous activity is associated with ethology, psychology, physiological psychology, and pedagogy; however the physiology of farm animals has direct significance for livestock breeding, zootechny, and veterinary science. Conclusively & from a general point of view, physiology is generally accepted to be most closely associated with medicine, of which it plays significant i.e. vital role in the diagnoses, prognoses, management involving prevention & or treatment of variety of diseases affecting living organisms. In which Clinical medicine is what in turn, provides physiology with significant new areas of investigation, as the data established by physiological studies are what constitute part of the foundation of the natural sciences and are widely used in philosophy to substantiate the materialist world outlook.

HUMAN PHYSIOLOGY The study of human physiology dates back to at least 420 B.C. and the time of Hippocrates, the father of medicine. Physiology was first recognized in the early 1960s, due to the critical thinking of Aristotle and his emphasis on the relationship between structure and function which marked the beginning of physiology in Ancient Greece. However, it was Claudius Galenus (c. 126-199 A.D.), known as Galen, who first use experiments to probe the function of the body (otherwise called experimental physiology). The medical world moved on from Galenism only with the appearance of Andreas Vesalius and William Harvey during the middle ages, in which the ancient Greek and Indian medical traditions were further developed by Muslim physicians. Following from the middle ages, the renaissance brought an increase of physiological research in the western world that triggered the modern study of anatomy and physiology. It was in the 19th century, that physiological knowledge began to accumulate at a rapid rate, due to the advent of cell theory, concepts of cell environment & homeostasis. These were what made biologists in the 20th century, to become more interested in how organisms other than human beings function; which eventually brought about the existence of other fields of physiology such as comparative physiology, ecophysiology & evolutionary physiology as distinct sub-disciplines. Thus today, in Human Physiology we have molecular physiology, cell physiology, endocrine physiology, cardiovascular physiology, respiratory physiology, oral physiology and etc. ORAL PHYSIOLOGY

Oral Physiology is a branch of oral biological science that deals with the study of the health and diseases of the oral cavity in the context of its proper biologic function . Thus, it is often described as the physiology related to clinical manifestations in the normal and abnormal behavior of oral structures, that deals with the scientific study of an human's oral cavity vital functions, including growth & development, the absorption & processing of nutrients, the synthesis & distribution of proteins and other organic molecules, as well as the functioning of different tissues, organs & other anatomic structures that make up the oro-facial complex apparatus in humans. Of which the principal clinical functions in which the oral structures participate are deglutition, mastication, respiration, speech, and head posture. Summarily, it can be said that oral physiology is a branch of biology that studies the normal mechanical, physical, and biochemical processes of the functions of the structural components of the mouth.

INTODUCTION & GENERAL OVERVIEW The oral cavity is derived from two Latin words Oralis --- i.e. pertaining to the mouth, and Cavum --- i.e. referring to the cavity proper. The oral cavity is the space within the mouth, which is the 1st portion of the alimentary canal, containing the tongue, teeth & other masticatory structures. It is also the 1st portion of the mouth that which received food and begins food digestion by breaking up food particles into smaller pieces while mixing them with saliva. It can as well be described as the opening or hollow part of the mouth through which food is taken in; & vocalizations emerge, which comprises of an externally visible part on the face and the system of organs surrounding the orofacial opening. Furthermore, the oral cavity can also be described as the part of the mouth behind the teeth and gums that is bounded above by the hard and soft palates and below by the tongue and the mucous membrane connecting it with the inner part of the mandible. More so, it is often described as the first space of the mouth, bounded laterally and in front by the alveolar arches (containing the teeth), and posteriorily by the isthmus of the fauces. The oral cavity is also known as an opening through which food is swallowed, that then goes down the esophagus & finally into the stomach. Besides, it can also be described as a nearly an oval shaped

hollow compartment in which food mastication takes place and is generally made up of two basic anatomic parts that influences its significant physiologic functions. These basic component parts are: a) The vestibule oris i.e. oral vestibule. b) Cavum oris proprium i.e. oral cavity proper.

Oral vestibule: This is what forms the outer smaller portion of the oral cavity. It is a slit like aperture bounded in front and laterally by the lips & cheeks; behind and internally by the gums & teeth; above and below by the mucous membrane reflection from the lips & cheeks to the gum covering the upper and lower alveolar arches. The oral vestibule receives secretion from the parotid glands and communicates with cavum oris proprium when the jaws are closed by an aperture on each side behind the wisdom teeth. Cavum oris proprium: This is what forms the inner larger portion of the oral cavity, bounded laterally and in front by the alveolar arch with their contained teeth; behind it communicates with the pharynx by a constricted aperture (i.e. isthmus faucium). It is roofed by the hard & soft palate, while the greater part of the floor is formed by the tongue & mucous membrane reflection from the sides and under surface of the tongue to the gum lining the inner aspect of the mandible. It receives secretions from both sub maxillary and sublingual glands.

CONTENTS OF THE ORAL CAVITY The oral cavity is an important component structural part of the human body; which from the basic for assessing & evaluating various significant physiologic processes involved in mastication up to the initial diagnosis of systemic diseases. The oral cavity also serves as an important indicator i.e. a significant diagnostic parameter to the proper assessment & evaluation of overall human general health. The structural component parts of the oral cavity are thus, the: a) Lips. b) Cheeks. c) Teeth. d) Jaws maxillae and mandible. e) Gums i.e. gingivae. f) Tongue. g) Palate. h) Salivary glands. i) Jaw joint i.e. temporomandibular joint.

Basic Physiologic & Morphologic component structures of the human oral cavity

The lips: It is a muscular skeleton forming two fleshy folds surrounding the orifice of the mouth. The lips are connected in the midline to the gingivae by a mucous membrane fold (freanum labii superioris and inferioris). It also has red free margins (vermillion). The lips are what outline the cavity externally and are the only visible external part of the oral cavity, serving as an upper seal to the digestive tract. Covered with skin on the outside and mucosa on the inner side, together they are the gateway to the oral cavity.

Basic Physiologic & Morphologic component structures of the human lips

Oral Physiologic actions/functions: These include: Guiding food and water intake. Helping in articulation of speech. Helping mouth to chew and close on food i.e. by sealing the mouth Assisting in speech and non- verbal communication. Marking the transition from skin to mucous membrane Enhancing judgment on temperature & texture as it contains many sensory receptors Aiding in exploring unknown object especially in babies & toddlers as a tactile organ Playing crucial role in kissing & other acts of intimacy as an erogenous zone Serving as a symbolic meaning for sensuality & sexuality

The cheeks: Are what forms the sides of the face and are continuous in front with the lips. The cheeks has a nonkeratinized mucosa tightly attached to the buccinators muscles, reflected above and below upon the gum which continue behind with the lining membrane of the soft palate.
Oral Physiologic actions/functions: These include: Preventing food from escaping chewing action of the teeth Helping in maintaining the teeth in positions

The Teeth: They are derived from the embryonic dental organ, when the embryo is about 3-4 weeks old in utero. They contain four significant tissues (enamel, dentine,

cementum and pulp). The enamel, cementum and dentine are hard tissues while
pulp is a soft tissue. Teeth are generally contained in the alveoli (teeth sockets) of the alveolar bone. In overall human dentition, there are two different sets of teeth (deciduous/milk/primary/babys teeth and adult/permanent/secondary teeth).

Secondary dentition of the human adult

Primary teeth: --- Are the 1st sets of teeth formed. They are 20 in number,
grouped from A-E on either side of the dental arches [upper and lower], with the dental formulae of I- 2/2; C-1/1; M- 2/2. These set of teeth are replaced by secondary teeth. Physiologic eruption of these teeth into the oral cavity begins in the mandibular arch with central incisors at the age of 6th-9th month after birth. Unlike the secondary successors, primary teeth lack premolars.

Secondary teeth: --- Are the 2nd group of human dentition, about 32 in
number arranged from 1-8 on either side of the midline of upper and lower arches, with a dental formulae of I-2/2; C-I/1; Pm- 2/2; M-3/3. They are set of teeth replacing the deciduous/primary teeth. Physiologic eruption of these teeth in to the oral cavity begins in the mandibular region with the central incisors at the age of 6-7yrs.

Oral Physiologic actions/functions: These include: Improving esthetics, speech &mastication or mechanical breakdown of food ( involving tearing, cutting and grinding of food) Helping in deglutition Providing protection for other internal oral cavity components Helping to preserve & maintain the physiologic functional integrity of the oral cavity.

The Jaws: The jaws in the oral cavity are two viz-a-viz upper and lower jaws representing the upper and lower dental arches in the oral cavity.

Mandible jaw: --- It is also called inferior maxillary bone & is the largest and

strongest facial bone, which houses the lower teeth. It comprises of a body (curved horizontal portion) and rami (two perpendicular portions) that joins the body nearly at right angles. This bone also articulates with temporal bones through the gleinoid fossa as well as gives attachment to other facial and masticatory muscles.

The mandibular jaw

Morphologic features enhancing physiologic functions of the mandibular jaw

Mandible body:--- It is convex in general outline presenting

somewhat horse shoe shape with external and internal surfaces, in which the external surface is concave from side to side, while the internal surface is concave from side to side too.

Mandible rami: --- These are quadrilateral in form with two surfaces
(external and internal) and two processes (coronoid and condyle) marked with ridges.

The Maxillae jaw: --- Are also called superior maxillary bones. They are the

most prominent bones of the face from a physiologic surgical point of view on account of the number of diseases to which some of its parts are liable to. Each of the maxillae bone does assist in the formation of three cavities ( i.e.

the roof of the mouth; floor and outer walls of nasal fossae; and the floor of

the orbit). It also enters in to the formation of zygomatic and sphenomaxillary

fossae as well as sphenomaxillary and pterygomaxillary fissures. The maxillae are somewhat cuboidal and hollowed out to form a large cavity antrum of

Highmore.

Morphologic features enhancing physiologic functions of the maxillae jaw

Morphologic features enhancing physiologic functions of the maxillae jaw

Oral Physiologic actions/functions: These include: Providing for articulation with other facial bones Providing for attachment to other facial and masticatory muscles.

The gum/gingivae: It is the mucous membrane lining the lower part of the alveolus, closely connected to the periosteum of the alveolar process. It is a specialized portion of

mucosa that surrounds the necks of the teeth; covered by smooth and vascular mucous membrane remarkable for its limited sensibility. The gum presents different colours owing to its keratinization types as well as its proximity to underlying blood vessels surface.

Morphologic features enhancing physiologic functions of the human gingivae gum

Oral Physiologic actions/functions: These include: Helping in connecting each tooth at the neck and extends over the root and supporting bone. Serving to anchors the teeth in position Acting as a shock absorber to dissipate the forces of chewing

The Tongue: This is an organ of special sense (taste), made of mainly skeletal muscle situated in the floor of the mouth and in the intervals between two lateral portions of the body of the lower jaw. The tongue is a muscular organ (highly mobile,

flexible, and a muscular structure attached to the floor of oral cavity at one end and free at the other projecting upwards from the floor of the mouth), partly invested by
mucous membrane and a sub mucous fibrous layer, consisting of two symmetrical halves viz-a-viz an upper surface anterior 2/3rd and a lower surface posterior

1/3rd.

Morphologic features enhancing physiologic functions of the human tongue

Anterior 2/3rd :--- This is also divided into two, i.e. the oral part-- that which
lies in the oral cavity and covered by tiny projections called papillae where the four significant taste buds viz-a-viz sweet, salty, sour and bitter are located; and the pharyngeal part -- that faces backward to the oropharynx.

Posterior 1/3rd:--- This is the lower tongue surface covered with a smooth
mucous membrane that forms part of the pharynx (tongue root). It is nonkeratinized and tightly bound to the underlying muscles. This portion of the tongue contains such structures as frenelum linguae (freanum), sulcus terminalis, freanum caecum and epiglottis and it is separated from the anterior 2/3rd in the midline by a V-shaped groove fibrous septum.

Oral Physiologic actions/functions: These include: Helping in speech production. Aiding in the formation of food bolus and swallowing of food (i.e. aiding food mastication) Facilitating taste sensation, perception & appreciation of food Helping in oral hygiene maintenance Enhancing in esthetics and gesture Serving as a sensory organ in babies

The palate: It forms the ceiling or roof of the oral cavity, consisting of two portions viz-a-viz the hard palate (in front) and soft palate (behind). In which the front portion of the palate is constructed of bone (specifically two bones called the

maxilla and the palatine) covered with a mucous membrane. Together these form
the hard palate. While further back in the mouth, behind the hard palate, lays the soft palate. The hard and soft palate separates the oral cavity from the nasal cavity.

Morphologic features enhancing physiologic functions of the human palatemouth roof

Hard palate: It is the anterior part of the palate, consisting of the bony
plate covered above by the mucous membrane of the nose. Below this by the mucoperiosteum the roof of the mouth, which constitutes an immovable portion of the palate, with a bony skeleton bounded in front and at the sides by the alveolar arches and gum/gingivae, while it continuous behind with the soft palate. The hard palate is also furnished with palatal glands lying between the mucous membrane and surface of the bone. On the hard palate is a found linear ridge/raphe (palatine rugae); series of mucosa ridges and irregular folds.

Soft palate: --- Continuous with the hard palate, lays the soft palate. It is also
called Velum pendulum palati, a movable fold suspended from the posterior border of the hard palate that forms an incomplete septum between the mouth and the pharynx. It also has a thin but firm fibrous layer attached above to the posterior border of the hard palate. The soft palate is made up of muscular tissue that is covered by epithelial tissue, and a projection of tissue known as the (uvula).

Morphologic features enhancing physiologic functions of the human palatemouth roof

Oral Physiologic actions/functions: These include: Aiding breathing and chewing at the same time Aiding speaking and singing

The Oral mucosa: It is a mucous membrane lining the oral cavity, composed of connective tissues covered with stratified squamous epithelium. The oral mucosa is heavier and more resistant to injuries than the mucous membrane of other more protected cavities. It can withstand wear and tear of ordinary oral functions as well as resist bacterial irritation or infection. The oral mucosa is made of three significant portions viz-a-viz lining, masticatory and specialized (sensory) mucosae.

Lining oral mucosa: ----

It is a nonkeratinized mucosa, containing larger

blood vessels, nerves and lymphatics that cover the inner surfaces of the cheeks, lips, floor of the mouth, ventral tongue surface, soft palate and alveolar mucosa. The lining oral mucosa is not firmly attached to underlying tissues.

Masticatory oral mucosa: --- It is tough epithelial surface membrane highly

keratinized to withstand masticatory forces/stress covering the hard palate and the gingivae/gum. It is firmly attached to underneath tissues except on the marginal gingivae.

Specialized (sensory) gingivae: ---- It is keratinized epithelium that covers the

upper surface or dorsum of the tongue contributing to the special function of taste sensation.

Oral Physiologic actions/functions: This includes: Helping in protecting the oral cavity against the daily wear and tear caused by eating

The salivary glands: These glands are found in and around your mouth and throat. There are three pairs of major salivary glands (the parotid glands, the sub-mandibular glands

and the sub lingual glands). The parotid gland is the largest among the three major
glands followed by sub-mandibular and sub-lingual.

Sub maxillary salivary glands: --- They are situated below the jaw in the
anterior part of the sub maxillary triangle of the neck. It is irregular in form, covered by integuments, platysma, deep cervical fascia and the body of the lower jaw. Its secretions get into the oral cavity via the Whartons duct under the tongue.

Submandibular/sublingual salivary glands: --- Are the smallest salivary

glands situated beneath the mucus membrane of the floor of the mouth at the side of the freanum linguae in contact with the inner surface of the lower jaw, close to the symphysis. Its secretions get into the oral cavity via the duct of Rivini, though few others do join to open into the Whartons duct via the duct of Bartholin.

Parotid salivary glands: --- Are the largest salivary glands placed near the
ear, lying upon the side of the face immediately below and in front of the external ear. Its secretions get into the oral cavity via a dense, thick canal about the size of a crow-quill the Stensons duct on the inner aspect of the cheeks, near the upper teeth.

The human salivary glands

Oral Physiologic actions/functions: These include: Producing the saliva used to moisten (lubricate) the mouth, initiate digestion i.e. the physical and chemical break down of food by solubulizing dry food in the mouth Helping in protecting the teeth from decay by providing alkaline buffering action

The temporomandibular joint (TMJ): The TMJ is complex & flexible joint, composed of muscles, tendons and bones. It connects the lower jaw (mandible) to the temporal bone at the side of the head.

Morphologic features enhancing physiologic functions of the human TMJ

Oral Physiologic actions/functions: These include: Providing for smooth up & down movement of the jaws Providing for smooth side-to-side movement of the jaws Enhancing chewing i.e. masticatory actions Aiding in speech & yawning Providing for muscles attachment to & from the surrounding joint Helping in controlling the mouth precise position & movement

Summary on the oral cavity

The oral cavity i.e. mouth is an important part of the body that has variety of oral physiologic actions or functions, of which some of these actions or functions are vital, social and or asocial. However, in order to effectively fulfill these functions, the oral cavity is made up of a number of structures that perform specific functions. These varieties of physiologic oral actions or functions are as summarily charted below:-

INTODUCTION & GENERAL OVERVIEW

The human saliva though referred to in various contexts as either spit, spittle, drivel, drool, or slobber; is a component of oral fluid & a watery substance produced in the mouths of humans and most animals. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands, which are the parotid, sublingual, submandibular glands as well as from hundreds of other minor salivary glands, referred to as the accessory salivary glands. NOTE: Saliva just like the blood also serves like a bloodstream to the mouth, whose chemical nature evolves along with the oral flora & the teeth. Thus as does blood, saliva as well helps in building & maintaining the health of the soft and hard tissues. It also helps in removing waste products as well as providing disease-fighting substances throughout the mouth, thereby offering first line protection against microbial invasion or overgrowth that might lead to disease. The secretion of saliva is under control of the autonomic nervous system, which controls both the volume and type of saliva secreted. This is because all the salivary glands are innervated by both sympathetic & parasympathetic nerve fibers, in which various neurotransmitters and hormones stimulate different receptors, different salivary glands, and different responses. However, the parasympathetic stimulation from the brain is what results in greatly enhanced secretion, as well as increased blood flow to the salivary glands. While the salivary secretion is regulated by a reflex arch under influence of higher centers in the brain comprising of afferent receptors and nerves that which carry or convey impulses as induced by actions on gustation and or on mastication, via a central connection i.e. salivation center, and an efferent part consisting of parasympathetic and sympathetic autonomic nerve bundles that separately innervate the glands. Daily salivary output

A considerable volume of saliva is produced over a day. About 0.5 or 0.75 to 1.5 liter of fluid is usually secreted in a day (which drops to almost zero during

sleep).This represents about 1/5 of the total plasma volume. This fluid is not lost as
most of it is swallowed and reabsorbed by the gut. However, the relative proportion contributed to the whole saliva by each of the gland pairs depends on the degree of stimulation. Thus:

Under resting conditions: --- The submandibular glands contribute 69%, the
parotid glands 26%, and the sublingual glands 5% mean values of the total secretion derived from these three major gland pairs.

Under conditions of increased exogenous stimulation:--- The submandibular

glands again account for the largest and the sublingual glands for the smallest fraction of the total secretion from the major glands, but the relative proportion of the total secretion contributed by the parotid glands increases. Thus, the submandibular glands contribute 63.7%, the parotid glands 34%, and the sublingual glands only 2.8%.

NOTE: Salivary flow can vary between 800mililiters and 2 liters, but this is regulated by a number of factor especially nervous control by the brain stem. It has also been established that the mucosal and labial glands in the oral cavity make some contribution to the total volume of saliva under stimulated conditions.

Salivary secretion

As food is broken up by the teeth, it is lubricated with salivary secretions saliva, in order It helps get food to the right consistency to be swallowed. Salivary secretion is a combination of a serous and mucoid fluid.

The serous fluid:

Is watery and contains the enzyme ptyalin which the starts the digestion of carbohydrates. It is secreted by all three paired salivary glands parotid, submandibular and sublingual.

The mucoid fluid:

Is viscous or thick secreted throughout the day to moisturize the lining of the mouth which increases during eating to lubricate the food in the mouth and assist with swallowing. It also contains ptyalin high in potassium & bicarbonate ions. It is secreted by the buccal glands of the mouth as well as the sublingual and submandibular glands.
Characteristics of normal saliva

Amongst the characteristics of normal saliva are:

Saliva is rich in proteins Due to the serous salivary cells it contains. Saliva is hypotonic Due to the less solute contents it has, that drives the
osmotic pressure of water into the cytoplasm of its mucosal cells for hydration of oral

tissues.

Saliva has a resting pH 6.7-7.4 Due to its ability of keeping oral environment
pH neutral to avoid dental erosion.
Physiologic classification of saliva

Saliva is broadly classified into three and these are atomar, molecular & normal saliva.

Atomar saliva saliva atomaris---- It gives rise to molecular saliva.

Molecular saliva saliva molecularis----It is derived from atomar saliva and gives rise to normal saliva. Normal saliva saliva normalis--- Derived from molecular saliva.
Composition of saliva

Though the composition of saliva is subject to individual variations, however, saliva is widely accepted to consist of the compositions:
a) b)

Water (99.5%). Dissolved substances (0.5%)

The dissolved substances contained in saliva are made up of: Organic substances i.e. major and minor salivary proteins. Inorganic substances i.e. ions & electrolytes. Organic Saliva Substances i.e. Components:

The organic substances or components in saliva are salivary proteins comprising of antibacterial compounds & enzymes which are classified into two as: Major Organic Substances. Minor organic substances. The Major Salivary Organic Substances:
They include such organic substances as Mucin i.e. Glyoproteins; Proline-rich proteins; Amylase; Lipase; Peroxidase; Lysozyme; Lactoferrin; sIgA; Histatins; Statherins; Epidermal growth factor or EGF; Opiorphin a newly researched pain-killing substance found in human saliva; Blood group substances; sugars; steroid hormones; amino acids; ammonia & urea. Glycoproteins (mucoids): They are protein core with many oligosaccharide side

chains. They are more than 40% carbohydrates and are hydrophillic, entraining water (ie resists dehydration). They have unique rheological properties (e.g. high

elasticity, adhesiveness, and low solubility). The two major glycoproteins in saliva
are mucoglycoprotein 1(MG1) & mucoglycoprotein 2 (MG 2).
Oral Physiologic Action/Functions: These include: 1) Helping in oral tissues coating: By

Providing a protective coating about hard and soft tissues. Playing primary role in formation of acquired pellicle. Facilitating concentrates of anti-microbial molecules at mucosal interface.

2)

Helping in oral tissues lubrication: By


3)

Increasing lubricating qualities (i.e. providing film strength). Enhancing bacterial adherence to mucins. Inhibiting mucin-coated bacteria from being attached to oral mucosa surface.

Helping in aggregation of bacterial cells: By

4)

Helping in encourages bacterial adhesion: By

Reacting with bacterial adhesins, thereby blocking bacteria from being attached to oral mucosa surface.

Amylases: Though there are several salivary isoenzymes, however, alpha-Amylase

is the major digestive salivary digestive enzyme. Of which about 70% -- 80% is synthesized by the parotid salivary glands; while 20%-- 30% is derived from the sub-mandibular glands, in which 60-120mg/100ml is found in the parotid saliva, while 25mg/100ml is from the submandibular saliva, with molecular weights ranging from 5457kDa, depending on the degree of salivary glycosylation.
Oral Physiologic Action/Functions: These include: 1) Helping in digestive function: By

Conversion of starch to maltose. Hydrolyzing starches into either amylose ,amylopectin, maltose & or glucose,

2)

Helping in the production of other bodily fluids: By

Producing tears. Producing serum. Producing bronchial secretions. Producing male & female urogenital secretions.

3)

Helping in modulating bacterial adherence.

Lingual Lipase: This is a highly hydrophilic salivary enzyme that readily enters fat

globules. It is secreted by the sublingual and parotid salivary glands & it is significantly involved in the first phase of digestion as well as in the hydrolysis of medium triglycerides into long-chain triglycerides.
Oral Physiologic Action/Functions: It is important in: 1) Infants digestion: By

Enhancing proper digestion of milk fat in new-born.

 Lactoferrins: They are Iron-binding proteins found in saliva providing nutritional immunity against iron starvation. Lactoferrin with or without iron can be degraded by some bacterial proteases.
Oral Physiologic Action/Functions: They are important in: 1) Providing anti-bacterial effects: By

Their ability to bind to salivary ferric ions & produce an antibacterial effect.

Lysozomes (muramidase): They are present in numerous organs and most body

fluids and are also called muramidase. They hydrolyses b (1-4) bond between Nacetylmuramic acid (MurNAc) and N-acetylglucosamine (GlcNAc, or NAG) in the peptidoglycan layer of bacteria.
Oral Physiologic Action/Functions: These include: 1) Attacking & destroying bacteria cell walls to protect the oral cavity from invading pathogens: By

Inhibiting bacterial adhesion to tooth surfaces. Inhibiting glucose uptake and acid production. Lysing of peptidoglycan layer.

Lactoperoxidase: There are two major types of lactoperoxidase produced in the

saliva called salivary peroxidase systems. These are the sialoperoxidase (SP) produced in the parotid glands & submandibular gland acinar cells which is readily adsorbed to
various surfaces of the oral cavity, including the enamel, salivary sediment, bacteria and dental plaque; & myeloperoxidase (MP) derived from leukocytes entering via gingival crevice in the oral cavity. Oral Physiologic Action/Functions: They are important in: 1) Controlling established oral flora: By

Controlling bacterial metabolism.

Histatins: They are groups of small, histidine-rich, cationic salivary peptides

comprising of HIS 1; HIS 2 & HTN 3 contained in human saliva which are either antibacterial and or antifungal; due to their ability to either bind to a receptor on either the cell wall membrane of a bacteria or a fungal cell &

consequently be transported across the cytoplasm of affected cells & unto the mitochondrion of the cells concerned.
Oral Physiologic Action/Functions: These include: 1) Controlling bacterial & fungal infections: By

Inhibiting bacterial & fungal growth.

Statherins: They are produced by acinar cells in salivary glands as Calcium

Phosphate salts of dental enamel, & which are soluble under typical conditions of pH and ionic strength.
Oral Physiologic Action/Functions: This includes: 1) Maintenance of tooth enamel integrity: By

Preventing or inhibiting the precipitation & or crystallization of supersaturated calcium phosphate in ductal saliva and oral fluid. Lubricating the oral mucosa.

Cystatins: They are ubiquitous in many human body fluids and are inhibitors of

cysteine-proteases that have an effect on calcium phosphate precipitation.

Oral Physiologic Action/Functions: This includes: 1) Protecting unwanted proteolysis such as bacterial proteases & lysed leucocytes: By

Inhibiting proteases in periodontal tissues.

Proline-rich proteins (PRPs): They constitute a significant fraction of the total

salivary protein though possess important biological activities, and are subdivided into three groups as: - 45% Acidic prolines; 30% Basic prolines; & 25% Glycosylated prolines.
Oral Physiologic Action/Functions: This includes: 1) Inhibiting the growth of calcium phosphate crystals: By

Encouraging adhesion of selected bacteria to the tooth surfaces. immunoglobulins: They are a group of predominantly large

Salivary

heterogeneous proteins i.e. glycoproteins secreted by salivary blood plasma cells which comprises of such immunoglobulins as: IgA, IgD, IgE, IgG, & IgM. However, the IgA category that comprises of IgA1 & IgA2 subclasses are the

most commonly identified in human saliva; of which IgA1 is the most predominant.
Oral Physiologic Action/Functions: This includes:
1)

Prevention of oral infections: By Producing human body antibodies.

The major component parts of saliva and their respective oral physiologic actions/functions

The Minor Salivary Organic Substances: Salivary acid phosphatases A+B: Are types of enzyme, used to free attached phosphate groups from other molecules during digestion. It is basically a phosphomonoesterase stored in lysosomes and functions when these fuse with endosomes, which are acidified while they function; therefore, it has an acid pH optimum.
NAD (P) H dehydrogenase (quinone): It is an enzyme that catalyzes the

removal of hydrogen from a substrate and the transfer of the hydrogen to an

acceptor in an oxidation-reduction reaction. A NAD (P) H dehydrogenase (quinone) is an enzyme that participates in biosynthesis of steroids. NAD (P) H + H+ + a quinone hydroquinone
Superoxide dismutase: Are enzymes that catalyze the dismutation of superoxide

NAD (P)

+ a

into oxygen and hydrogen peroxide. Thus, they are an important antioxidant defense in nearly all cells exposed to oxygen. One of the exceedingly rare exceptions is Lactobacillus plantarum and related lactobacilli, which use a different mechanism.
Glutathione transferase (GST): Are composed of many cytosolic, mitochondrial,

and microsomal (now designated as MAPEG) proteins. GSTs are present in eukaryotes and in prokaryotes, where they catalyze a variety of reactions and accept endogenous and xenobiotic substrates.
Glucose-6-phosphate

isomerase:

Alternatively

known

as

phosphoglucose

isomerase or phosphohexose isomerase, is an enzyme that catalyzes the

conversion of glucose-6-phosphate into fructose 6-phosphate in the second step of glycolysis.
Tissue Kallikreins: Are a subgroup of serine proteases enzymes capable of

cleaving peptide bonds in proteins. Kallikreins are responsible for the coordination of various physiological functions including blood pressure, semen liquefaction and skin desquamation. They act on blood vessels and capillaries of salivary glands to generate vasodilatations and increased capillary permeability, thus resulting in increased production of more saliva due increased blood flow

to the salivary glands.

NOTE: - All these enzymes play a role in preventing infections in the mouth by destroying microorganisms and digesting any food particles that are stuck between the teeth and which may be used by the bacteria as a food source. Inorganic Saliva Substances i.e. Components:

The major inorganic saliva substances include the Calcium ions (Ca++); Phosphate ions (PO4 ); Hydrogen Carbonate ions (HCO3 ); Hydrogen ions (H ); Fluoride ions (F ); and Thiocyanate ions etc. Calcium ions (Ca++): About 50% of Calcium ions are present in saliva, with a pH of less than 4; in which about 1,4mmol/l to about 1,7mmol/l is contained in stimulated saliva, and it is higher in sublingual saliva that in submandibular saliva, while the parotid saliva contains less of calcium ions in its secretion. The Calcium ions, serve to:
Help to prevent dissolution of dental enamel. Contributes to solubility product of calcium phosphate, which is crucial in maintaining tooth structure. important as a buffer an essential nutrient for oral microflora for metabolic pathways Maintain the integrity of teeth by providing minerals for newly erupted teeth which helps with the post-eruptive maturation of enamel and prevents tooth dissolution by enhancing the remineralisation of enamel.

Phosphate ions (PO4 ): There is about 90% (ie 6mmol/l) of phosphate ions in the overal human saliva (in form of hydroxyapaptites), out of which about 4mmol/l is due to stimulated saliva secretion, which is unlikely to dissolve at a pH around 6. However increase in the pH can lead to the precipitation of calcium salts and subsequent formation of dental calculus.
NOTE: The inorganic phosphate ions in saliva are basically found as conjugates of phosphoric acid (H3PO4), which include H2PO4 , HPO4,2 and PO4,3 whose concentrations are affected by salivary flow rate as well as salivary pH, and also to a smaller extent compared to calcium i.e. circadian rhythm: Also, the concentrations of each ionic type is dependent on salivary pH just as decreased pH leads to decreased concentration of the tertiary ions, while increased flow rate decreases total inorganic phosphate concentration. Depending on pH, inorganic phosphate can be complexed to inorganic ions or proteins.

Hydrogen Carbonate i.e. Bicarbonate or Hydroxidodioxidocarbonate ions (HCO3 ): It is an intermediate anion from the deprotonation of carbonic acid. It is derived actively from CO2 by carbonic anhydrase, and it is low in unstimulated saliva, but increases with flow rate. Bicarbonate generally serves a crucial biochemical role in the physiological pH buffering system, as it helps:

Neutralizes acid produce in the mouth by plaque bacteria when carbohydrate is fermented. Maintain the pH in the mouth to near neutral (i.e. 6.3) for normal tooth maintenance.

Hydrogen Ions (H+): Hydrogen ions are derived from secretions via salivary

glands, oral microbiota owing to the intake of acidic drinks into the oral cavity by individuals and Hydrogen ability to complex with many substances, whose resultant effect is seen or observed as making the saliva acid-base balance a complex & mutable process.
NOTE: The concentration of H+ in saliva has the greatest influence on the chemical reactions in the oral cavity: By Facilitating the equilibria between calcium phosphate in dental hard tissue and surrounding liquid phase solubility, as well as activity, of important salivary enzymes Fluoride Ions: The concentration of fluoride in saliva depends on fluoride in the

environment, such as fluoridated drinking water and dental products used for caries prophylaxis. Basal concentration of fluoride is less than 1 micromol per liter, but can be much higher in places where levels of fluoride in drinking water are high. Fluoride also enters saliva via facilitated transport over membranes of salivary gland tissue. Clearance rate of inorganic phosphate is dependent on salivary flow rate.
Thiocyanate: This is an antibacterial (oxidated to hypothiocyanite OSCN- by

active oxygen produced from bacterial peroxides by lactoperoxidase). Higher concentration of this substance in saliva results in decreased or lower incidence of dental caries. Its concentration is higher in the saliva of smokers than that of non-smokers.
Others: Other inorganic substances in saliva are contained in small amounts, and

they include the followings. Magnesium; Iodine & Copper.

Glands of saliva secretion

Sodium; Potassium; Chloride; Lead; Cadmium;

There are three major glands and other numerous minor glands responsible for the production of saliva. The major glands are made up of large glands with longer excretory ducts. They are paired and symmetrical, distributed along the body and ramus of the mandible. This group includes the parotid, sub-

mandibular and sublingual glands. The minor glands are formed of numerous, small,
mucosal or sub-mucosal glands with short excretory ducts. They are classified according to their location into labial, zygomatic, palatine and lingual.
NOTE: 1)

The major and minor salivary glands secrete their products into the oral cavity. The saliva from the parotid gland is a rather thin, watery fluid. The saliva from the sublingual and the submandibular glands are much thicker due to mucus content.
Structure of the salivary glands

2) 3)

The salivary glands are solid structures composed of millions of secretory cells. Between the cells run tiny ducts which collect the saliva and channel it into a single, much larger, duct. This large duct carries the saliva away from the gland and into the mouth. The position of each of the three pairs of large major salivary glands is indicated by their names.

Parotid means "near the ears". Sublingual means "under the tongue". Submandibular means "under the mandible" (i.e. under the jaw-bone).

Relative locations for the 3 major human salivary glands

Major Salivary Glands

There three major salivary glands contained in the human oral cavity mouth & they are:

The parotid salivary glands The submandibular salivary glands The sublingual sub-maxillary salivary glands

The Parotid Salivary Glands glandula parotidea:

They are the largest paired salivary glands, found wrapped around the mandibular ramus, lying just under beneath the skin & one in front of each human ear; whose duct orifice opening is located i.e. situated on the inside of the cheek, just opposite the crown of the upper second molar tooth. The saliva secreted by the parotid glands is mainly serous i.e. thin, watery & amylase-rich fluid. On stimulation, the parotid salivary glands accounts for up to 50% of the mouth volume of saliva, whereas under un-stimulated conditions, they contributes much less 20% i.e. when the glands are at rest. The parotid gland saliva secretion is carried to the mouth in a small vessel called Stensons duct, and are usually felt by individuals as it is in the upper neck and feels like a rounded ball.

The human parotid salivary glands

The submandibular gland

glandula submandibularis:

The submandibular glands are a smaller pair of glands i.e. smaller than

parotid glands located beneath the lower jaws, superior to the digastrics muscles,
whose saliva secretion is mixed i.e. a mixture of both serous fluid and mucus. About 65% - 70% of the total saliva in the human mouth secreted by the submandibular salivary glands is as a result of un-stimulated conditions i.e. at rest; while about 30% -35% of the saliva fluid in human mouth is derived under stimulated conditions. Each submandibular gland has a duct which runs forward through the structures in the floor of the mouth, and opens by an easily seen orifice at the base of the frenelum of the tongue. The paired submandibular glands enter the oral cavity via Wharton's ducts.

The human submandibular salivary glands

The sublingual gland glandula sublingualis:

The sublingual glands are a pair of glands located beneath the tongue, anterior to the submandibular glands. Which contribute only about 1% 2% volume

of the un-stimulated saliva secreted i.e. at rest & produces approximately about 5% volume of whole stimulated saliva secreted in the human mouth. The sublingual saliva secretion is mainly mucous in nature.

The human sublingual salivary glands

The human sublingual salivary glands

Minor Salivary Glands

The minor glands are distributed throughout the oral mucosa (including the

labial, buccal, lingual, palatinal mucosa). These are mixed glands largely comprising
mucous acinar cells. However, the palatinal glands are strictly mucous, whereas the lingual von Ebners glands are strictly serous. They produce less than 10% of the total volume of saliva rich in lingual lipase--even in the absence of local stimuli); which play an important role in lubricating the mucosa.
Physiologic processes of saliva secretion

The process of saliva secretion from the salivary glands into the oral cavity is divided into three stages, which include the following:

Stimuli to secretion Formation of initial acinar fluid

Ductal modification of acinar secretion

Stimuli to secretion:

The stimulation to saliva secretion stage occurs in three phases, which include

Cephalic; Intra-organ and Inter-organ phases.

Cephalic phase------- This phase is brought about by the following factors:a) b) c)

Psychological phase (thinking of food). Visual phase (sight of food). Olfactory phase (smelling food).

Intra-organ phase------- This phase is the most important phase of saliva

secretion and it is enhanced by the following:a)

Mechanical

stimulation---

Involves

stimulation

of

touches

&

pressure receptors leading to mandibular movement and activation of masticatory muscles.

b)

Chemical stimulation ----Involve stimulation of taste receptors and it is more effective than mechanical stimulation, especially with acids. Direct olfactory stimulation----- In which smell receptors are directly stimulated.

c)

Inter-organ phase------- This is the third phase of saliva secretion that may

result from irritation to the oesophagus or vomiting reflex.

Formation of initial acinar fluid:

The formation of initial acinar fluid for saliva secretion is initiated, controlled and enhanced by parasympathetic and sympathetic stimulations.

Parasympathetic stimulation------ This involves cascade of biochemical reactions

leading to release of calcium from calcium stores. The intracellular calcium so released has three basic functions, and these are to:a)

Open basal Potassium (K) channels--- for outward diffusion of Potassium (K). This initiates outward Open apical Chlorine (Cl) channels--- for inward diffusion of Chlorine (Cl).

b)

c)

Facilitate movements of secretory granules towards the apical membrane & exocytosis protein and mucoprotein. of biochemical

Sympathetic stimulation------- This also involves cascade

reactions that would lead to mobilization of Calcium (Ca) ions. A proportion of intracellular increase in Calcium (Ca) ions so mobilized is due to opening of Calcium (Ca) channels as well as rapid opening of Potassium (K) channels. This is what initiates the salivary fluid secretion. Major result of sympathetic stimulation is secretion of protein & mucoprotein that gives thick viscous saliva.
NOTE: Outward diffusion of Potassium (K) is characterized by initial high Potassium (K) content in the 1st few drops of saliva collected after stimulation. And as the Potassium content (K) is raised in basal extracellular fluids, there is activation of Sodium-Potassium-Chlorine (Na-K-Cl) transporter that carries these ions intracellularly in the ratio of 2K & 3Cl ions: 1Na ion. With Potassium (K) influx, it replaces the Potassium (K) lost by outward diffusion. Further increase in intracellular Chlorine (Cl) brings is what brings water down in an osmotic gradient and make the cell swells. The Sodium (Na) is however excreted from the cell by Sodium-Potassium (Na-K) pump, while the Chlorine (Cl) in acinar lumen dragged Sodium (Na) to the acinar lumen to balance the negative charge of Chlorine (Cl). Ductal modification of acinar secretion:

At this stage, there is modification of intercalated ducts in which IgA from lymphoid plasma cell follicles become depressed throughout the salivary glands stroma, proteins and Kallikreins are secreted. Lysozymes, lactoferrins, carbonic anhydrase, serum albumin, salivary amylase, some addition of potassium Composition of primary acinar fluid.
Physiologic stages of salivary secretion

Salivary fluid secretion appears to be a two-stage process, involving:

Primary secretion stage. Secondary secretion stage.

First stage primary secretion:

At this stage saliva is initially formed as a near isotonic plasma-like primary secretion in the acinar lumen upon stimulation. The acinar cells forming the secretory end piece of the salivary gland actively pump sodium ions from the blood into the lumen of the end piece. The resulting osmotic pressure difference between

the blood and the fluid in the end piece causes water to flow from the blood, through the tight junctions between the acinar cells, and into the lumen of the end piece. Thus, the primary secretion as it leaves the end piece is thought to be almost isotonic with plasma.
Second stage secondary secretion:

It commences when the fluid in the first stage passes along through the duct system it is modified by selective and energy-dependent reabsorption of sodium and chloride without water, as the salivary ducts are impermeable to water and secretion of potassium and bicarbonate the latter especially occurring under stimulated conditions. The resulting saliva becomes increasingly hypotonic as it moves down the ductal system: the final saliva secreted to the oral cavity contains concentrations of sodium and chloride much below that of primary saliva.
Control of salivary secretion

The control of salivary secretion is ensured in two basic ways, which include:

Non-hormonal control Neural control

Non-hormonal Control:

This is due to increased circulation of aldosterone in the human body.

Neural:

The neural control of saliva secretion is under control of the autonomic nervous

system, comprising of sympathetic & parasympathetic nerves which controls both

the volume and type of saliva secreted as stimulation of one receptor often enhances and complements another receptor. Besides, the salivary glands are innervated by both sympathetic and parasympathetic nerve fibers. In which various neurotransmitters and hormones stimulate different receptors, different salivary glands, and different responses. And as the various parasympathetic impulses travel from the salivatory nuclei in the brain stem salivation centers, to reach the salivary glands via the facial and glossopharyngeal nerves, saliva production and flow is stimulated. Amongst the impulses that stimulate the salivation centers are:

Impulses from the higher brain example thinking of food that one finds

delectable.

Impulses from the mouth and throat taste sensations (sour and umami) and tactile

sensations (smooth objects in the mouth stimulate flow while rough objects inhibit salivation).

Impulses from the stomach and proximal part of the small intestine irritation of the

lining of these parts of the alimentary tract. None-the-less the impulses that stimulate salivary secretion, there are three types of specific triggers to the stimulation of the impulses. And these triggers include:

Mechanical--- Example the act of chewing. Gustatory ---The most stimulating trigger for sweet and or the least stimulating

trigger for bitter.

Olfactory ---- A surprisingly poor stimulus. Others--- Such as psychic factors e.g. pain, certain types of medication, and

various local or systemic diseases affecting the glands themselves.

NOTE: The parasympathetic stimulation from the brain results in greatly enhanced secretion, as well as increased blood flow to the salivary glands. Also, stimulated saliva is what contributes to as much as 80% to 90% of the average daily salivary production. As parasympathetic stimulation increases salivation, it also increases blood flow to the salivary glands. Conversely, increased blood flow to the gland, for reasons other than parasympathetic stimulation of the gland, also increases salivation. The production of saliva is stimulated both by the sympathetic nervous system and the parasympathetic. The saliva stimulated by sympathetic innervations is thicker, and saliva stimulated parasympathetically is more watery. Sympathetic stimulation of saliva is to facilitate respiration, whereas parasympathetic stimulation is to facilitate digestion. Regulation of salivary secretion

Salivary secretion is regulated by a reflex arch involving conditioned &

unconditioned reflexes comprising afferent receptors and nerves carrying impulses

induced by actions on gustation and mastication, a central connection (salivation center), and an efferent part consisting of parasympathetic and sympathetic autonomic nerve bundles that separately innervate the glands. The secretory reflex

arch is also under influence of higher centers in the brain. Saliva may be secreted in the absence of exogenous stimuli referred to as the resting or un-stimulated salivary flow. The regulation of salivary secretion is achieved by two basic means as:

Initiation of salivation by unconditioned reflex. Initiation of salivation by a conditioned reflex.

Initiation of salivation by an unconditioned reflex:

Here the afferent part is activated by stimulation of various sensory receptors including chemoreceptors in the taste buds and mechanoreceptors in the periodontal ligament. The afferent nerves carrying impulses to the salivary nuclei (salivation center) in the medulla oblongata are the facial, glossopharyngeal and vagal nerves (taste) and the trigeminal nerve (chewing). Olfaction and stretch of the stomach are other afferent inputs that can initiate formation of saliva.

Initiation of salivation by a conditioned reflex:

In this reflex, the sight and thought of food may lead to some formation of saliva. The salivary nuclei also receive impulses from other centers of the brain resulting in facilatory or inhibitory effects on salivation depending on, for example, the emotional state.
NOTE: The release of neurotransmitters from postganglionic neurons of both branches of the autonomic nervous system is what elicits secretion of saliva to the oral cavity. In which the facial nerve provides parasympathetic control of the submandibular, sublingual, and minor glands (except von Ebners gland), whereas the glossopharyngeal nerves control the parotid glands. Higher control of salivation

These include:

Excitement or inhibition. Control of hypothalamus.

Excitement or inhibition:

Due to patterned reflexes i.e. preparatory stimulation of salivatory flow before

vomiting; Stimulation of regional parts of the cortex due to increased flow;

Decreased salivation during sleep and progressive reduction in unstimulated flow rate especially of infants between birth 5 years.
Control of hypothalamus:

Due to an over-riding control and direct connection with sympathetic system, for example in such conditions like fear, rage, excitement, dryness of the mouth and excess salivation in certain circumstances.
Normal physiologic variation in salivary composition

The normal physiologic variation in salivary composition occurs in relation to such conditions as:
Flow during sleep:

Submandibular glands produce (72%). Sublingual glands+ minor glands produce (14%). No measurable secretion from Parotid glands. Submandibular glands produce (70%). Parotid glands produce (20%). Minor/accessory glands produce (7%). Sublingual glands produce (<2%) in stimulated or unstimulated flow. Parotid glands (45%). Submandibular glands (45%). Parotid glands (60%). Submandibular glands (30%).

Unstimulated flow:

Acid stimulation:

Chewing stimulation:

Factors affecting saliva composition

The factors affecting influencing saliva composition include:

Source of saliva Flow rate Duration of stimulation Nature of stimulus Time of day

Source of saliva :

This determines the concentration of main electrolytes in human saliva which are sodium, potassium, calcium, chloride, bicarbonate, and inorganic phosphate, because the saliva secreted from different salivary glands have differences in composition; For instance, parotid saliva is relatively low in calcium and high in phosphate as compared with submandibular and sublingual secretions. Types of proteins and their concentrations are different in the different secretions, eg, most of the salivary amylase is derived from the parotid glands.
Flow rate:

Flow rate has a decided influence on salivary composition, because as the flow rate is increased slightly above the unstimulated rate, the concentration & pH of some electrolytes such as sodium and bicarbonate increases, whereas the concentrations of other electrolytes like potassium, calcium, phosphate, chloride,

urea, and protein decreases.

Sodium (Na) & Chlorine (Cl) concentration. Bicarbonate (HCO3) raises in high flow rates. Amylase raises in high flow rates (esp. stimulated). Urea, IgA fall in high flow rates. Diffused through the ductal system

Duration of stimulation:

When flow rate of stimulated saliva is maintained constant for several minutes, the composition of the saliva tends to change considerably with duration of stimulation. For instance, there is an increase in the total concentrations of protein,

calcium, and bicarbonate, also pH do increases with duration of stimulation, whereas the chloride concentration decreases in proportion to the rise in bicarbonate concentration.

Flow rate falls slightly with time. Protein content falls. Slow synthesis. Bicarbonate (HCO3) rises and Chlorine (Cl) falls.

Nature of stimulus:

Recent studies have shown that the nature of the stimulus decidedly influenced the total concentration of electrolytes in saliva because the salivary glands respond differently to electric, pharmacologic & or gustatory stimuli.
Time of day:

The time of day can have a decided influence on both salivary flow rate and composition.

Early morning 4-6 am (lowest) Afternoon 16-20 pm (peak) Late afternoon (highest protein)

Stimuli responsible for saliva production

Various stimuli can trigger or increase the production of copious amounts of saliva, which is not due to any disease process (pathological). This includes:

Thinking of foods that one finds tasty. Smelling, seeing or tasting delectable foods especially when hungry. Smooth objects in the mouth. Nervousness, anxiety, excitement. Chewing gum or tobacco. Teething. Pregnancy.
Relationship between adult saliva & infant saliva

These include the followings:

Unstimulated rate in infants is higher than in adults Ca, Mg, K are higher in infants Phosphate are low in infants but rises to adult level over the first year Rate of parotid gland is not significantly affected by age Sublingual glands secretion + Submandibular glands secretion show some decreased flow with age.
Relationship between unstimulated and stimulated Saliva

The unstimulated saliva:

Basal production. Confers most protection. Importance of minor and submandibular output. Low output during sleeping hours.

The stimulated saliva:

Protection during mastication. Assists in deglutition. Importance of parotid output.

Functions of saliva

Although, there are so many interrelated functions of the saliva is to protect the oral cavity. However, these numerous salivary functions can be organized into 5 major categories that serve to maintain oral health and create an appropriate ecologic balance:

Lubrication and protection, Buffering action and clearance, Maintenance of tooth integrity, Antibacterial and antifungal activity, Taste and digestion.

NOTE: - Salivary components work in concert in overlapping, multifunctioning roles, which can be simultaneously beneficial and detrimental.

 Lubrication & protection:

The lubricating and protective functions of saliva are seen in the following ways:

The seromucous coating of saliva lubricates and protects oral tissues, acting as a barrier against irritants. These irritants include, but are not limited to, proteolytic and hydrolytic enzymes produced in plaque, potential carcinogens from smoking and exogenous chemicals, and desiccation from mouth breathing.
NOTE: - The best lubricating components of saliva are mucins ---- they have the

properties of low solubility, high viscosity, high elasticity, and strong adhesiveness. Mastication, speech, and swallowing all are aided by the lubricating effects of mucins.

Mucins also perform an antibacterial function by selectively modulating the adhesion of microorganisms to oral tissue surfaces, which contributes to the control of bacterial and fungal colonization. Mucins as a part of the enamel pellicle, help initiate bacterial colonization by promoting the growth of benign commensals oral flora, forming a protective barrier and lubrication against excessive wear, providing a diffusion barrier against acid penetration, and limiting mineral egress from the tooth surface.

Buffering action & clearance:

The buffering and clearance functions of saliva are seen in the following ways:

Saliva dilutes and removes substances (oral debris, noxious agents) from the oral cavity which is referred to as salivary or oral clearance. Both the act of swallowing and the salivary flow rate are important to this process, and these are the principal ways by which oral bacteria and injurious, noxious agents are eliminated from the mouth. Saliva also clears dietary acids and thereby protects the teeth against erosion. The higher the flow rate, the faster the clearance and the higher the buffer capacity. Dental caries is probably the most common consequence of hyposalivation.

The buffer capacity of both unstimulated and stimulated saliva involves three major buffer systems: the bicarbonate (HCO3), the phosphate, and the protein buffer systems. These systems have different pH ranges of maximal buffer capacity, the bicarbonate and phosphate systems having pK values of 6.1-6.3 and 6.8-7.0, respectively.

Maintenance of tooth integrity:

The maintenance of tooth integrity is facilitated by saliva in the following ways:

Demineralization occurs when acids diffuse through plaque and the pellicle into the liquid phase of enamel between enamel crystals. Dissolved minerals subsequently diffuse out of the tooth structure and into the saliva surrounding the tooth. The buffering capacity of saliva greatly influences the pH of plaque surrounding the enamel, thereby inhibiting caries progression. Remineralization is the process of replacing lost minerals through the organic matrix of the enamel to the crystals. Super saturation of minerals in saliva is critical to this process. Human salivary secretions are supersaturated with respect to calcium and phosphate, but spontaneous precipitation from saliva to dental enamel does not normally occur.

Antibacterial & antifungal activity:

The antibacterial/antifungal activity of saliva is due to:

Its fluid contains immunologic and nonimmunologic agents for the protection of teeth and mucosal surfaces. Immunologic and nonimmunologic antibacterial salivary content come from two different sources namely, plasma and ductal

cells with different responses to stimulation and different content levels.

Taste & digestion:

The saliva enhances taste and begins the digestive process in the following ways:

The sense of taste is activated during the initial stage of ingestion of food particles allowing for identification of essential nutrients and of harmful and potentially toxic compounds. Taste is a main stimulant for formation of saliva. On the other hand, presence of saliva in the oral cavity is also essential for taste perception, first of all because food particles need to be in solution in order to stimulate taste receptor cells in the taste buds within the lingual papillae (fungiform, foliate, and vallate papillae). The hypotonicity of saliva enhances the tasting capacity of salty foods and nutrient sources. Saliva has an early, limited role in total digestion by beginning the breakdown of starch with amylase, a major component of parotid saliva that initially dissolves sugar. The contribution of saliva to starch breakdown is limited because most of the digestion of starch results from pancreatic amylase, not salivary amylase. Salivary enzymes also initiate fat digestion. More importantly, saliva serves to lubricate the food bolus, which aids in swallowing. Summary of saliva functions Summarized below are the concise functions of saliva in the mouth.

Amongst these functions are:

Cleansing function:

By cleansing action on the teeth. By lubricating the mouth lining during mastication. By moistening the mucosa of the mouth. By physical protection of oral mucosa. By dissolving certain molecules so that food can be tasted. By producing antibodies eg IgA-produced by saliva plasma cells especially against bacteria, thereby avoiding mouth infections or slowing decay in a tooth cavity.

Lubrication function:

Protection function:

Taste sensation & perception function:

Antibacterial and immunity function:

Digestion function:

By producing chemical digestive enzymes eg amylase that begins the digestion of starches breaking it down polysaccharides into disaccharides. By moistening & lubricating food during mastication & swallowing. By producing minerals & electrolytes that help maintains optimum pH value in the mouth. By helping in maintaining the integrity of enamel. By producing Epidermal Growth Factor secreted by the submandibular salivary glands. By producing blood coagulation factors.

Buffering function:

Wound healing and maintenance of upper GI mucosal integrity function:

Abnormal Saliva Conditions in the Mouth

Although saliva is drained out of the mouth cavity by swallowing as it passes down the throat and esophagus and into the stomach. However, when this sequence is disrupted it results in abnormal saliva presence in the mouth. There are two major abnormalities in the quantity and quality of saliva present in the mouth and they are either:

Hypersalivation i.e. Sialorrhea Hyposalivation i.e. xerostomia

Hypersalivation Sialorrhea: Hypersalivation also called driveling, drooling, slobbering,

ptyalism,

sialorrhea, hyperactive salivary flow, polysialia, and sialism, is a condition of

excessive production of saliva. It can be defined as salivary incontinence or the involuntary spillage of saliva over the lower lip i.e. saliva beyond the margin of the

lip, due to increased amount of saliva in the mouth, which may also be caused by
decreased clearance of saliva. It is a condition characterized by the secretion of drool in the resting state, which is often the result of open-mouth posture.

Hypersalivation could be caused by excessive production of saliva, inability to retain saliva within the mouth, or problems with swallowing.

Patients with hypersalivation

NOTE: - This condition is normal in infants but usually stops by 15 to 18 months of age. Sialorrhea after four years of age generally is considered to be pathologic which could lead to functional and clinical consequences for patients, families, and care-givers. Pathophysiology of hypersalivation

Pathophysiology of hypersalivation is multifactorial, due to either:

o o

Psychological factors. Local factors. Systemic factors.

Psychological factors: Pregnancy Local factors: These include:

1)

Oral inflammation

2) 3) 4) 5)

Teething Infection Oral cavity infection Dental caries Dental prosthetics Such as new and ill-fitting implants, bridges & dentures Mouth pains (i.e. stomatodynia). TMJ dysfunction Bruxism Tonsillitis Peritonsillar abscess Poor head control Constant open mouth Infrequent swallowing Inefficient swallowing Retropharyngeal abscess Epiglottitis Mumps Problems with jaw i.e. fracture or dislocation

6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18)

Systemic factors: These include:

1)

Toxin

exposure-

Pesticides,

Insecticides,

Mercury,

Capsaicin,

Snake

poisoning & Copper etc.

2)

Medication Such as Tranquilizers, Anticonvulsants, Anticholinesterases & Lithium etc. NeuromuscularSuch as Cerebral palsy, Parkinsons disease, Motor neuron disease, Bulbar/ pseudobulbar palsy, Bilateral facial nerve palsy i.e. Bells palsy, Hypoglossal nerve palsy, Trigeminal neuralgia & Geniculate neuralgia etc. Stroke Infection- Such as Rabies Gastric- Such as Gastroesophageal reflux Dental malocclusion

3)

4) 5) 6)

7) 8) 9) 10) 11) 12)

Decreased tactile sensation Macroglossia Nasal obstruction Poor lip control Disorganized tongue mobility Lack of awareness of saliva build up in the mouth

Side effects of hypersalivation:

The side effects of hypersalivation are most noticeable when hypersalivation is left untreated; and these effects are also referred to as complications which are classified into two major groups as:
o

Physical complications Psychosocial complications

Physical complications: They include

1) 2) 3) 4) 5) 6) 7) 8)

Perioral chapping i.e. skin cracking Maceration of skin around the mouth with secondary infection Dehydration Foul odour Aspiration pneumonia Speech disturbance impairment Interference with feeding Increased risk of inhaling saliva, food, or fluids into the lungs especially when body's normal reflex mechanisms, such as gagging and coughing are also impaired. General difficulties to perform oral motor activities during eating and speech with repercussion in quality of life

9)

Psychosocial complications: They include

1) 2) 3)

Isolation Barriers to education damage to books or electronic devices Increased dependency & level intensity of care

4) 5) 6)

Decreased self esteem Difficult social interaction i.e. impairment of social integration Social stigmatization

Management for hypersalivation:

Hypersalivation is a challenging oral condition to manage. However, successful management of sialorrhea can alleviate the associated hygienic problems, improve appearance, enhance self-esteem, and significantly reduce the nursing care time of these sufferers, bearing in mind that the goal of managing hypersalivation is a reduction in excessive salivary flow, while maintaining a moist and healthy oral cavity as well as putting measures in place to help avoid the onset of xerostomia i.e. dry mouth in affected patients. However, because of the numerous approaches that could be utilized in the management of hypersalivation, which ranges from conservative including observation, postural changes, medication & biofeedback to more aggressive measures such as surgical & radiation therapy; there is no single approach that is totally accepted as being most effective in the management of hypersalivation. None-the-less, a combination of two major approaches is being widely accepted in an effort to help manage hypersalivation in patients and these are:
o

Non invasive modalities e.g. oral motor therapy, pharmacological therapy Invasive modalities e.g. surgery and radiotherapy

Non invasive modalities: These modalities are centered about the first step in management of

hypersalivation which is achieved by the correction of reversible causes. These modalities are less invasive & are reversible methods that utilize the use of oral motor therapy & medication comprising of such techniques as: Patients good positioning Oral facial facilitation Speech therapy Behaviour therapy

 Use of oral prosthetic devices Pharmacologic method Improvement of eating & drinking skills

Patients good positioning:

Good posture with proper trunk and head control

provides the basis for improving oral control of hypersalivation and swallowing. Thus patients suffering from hypersalivation should be encouraged to maintain good posture.

Oral facial facilitation: This technique will help to improve oral motor control, sensory awareness and frequency of swallowing, because it improves muscle tone and saliva control and can be practiced easily, with no side effects as well as can be ceased if no benefits are noted. Oral facilitation techniques involve:
o

Icing effect usually last up to 5-30 minutes. Improves tone, swallow

reflex.

Brushing- as effect can be seen up to 20- 30 minutes, suggested to

undertake before meals.

o o

Vibration- improves tone in high tone muscles Manipulation like tapping, stroking, patting, firm pressure directly to
muscles using fingertips known to improve oral awareness.

Oral motor sensory exercise - includes lip and tongue exercises.

Speech therapy: The goal is to improve jaw stability and closure, to increase tongue mobility, strength and positioning, to improve lip closure (especially during swallowing) and to decrease nasal regurgitation during swallowing, which should be started early to obtain good results.

Behaviour therapy: this uses a combination of cueing, overcorrection, positive & negative reinforcement to help manage hypersalivation. Suggested behaviours, like swallowing and mouth wiping are encouraged, whereas open mouth and thumb sucking are discouraged. Behavior modification is useful to achieve;
o

Increased awareness of the mouth and its functions

o o

Increased frequency of swallowing Increased swallowing skills.

NOTE: Behaviour interventions are useful prior and after medical management such as botulinum toxin or surgery. This can be done by family members and friends in order to help improve quality of life of patients suffering from hypersalivation.

Use of oral prosthetic devices: Variety of prosthetic devices can be beneficial, and are utilized in management of hypersalivation e.g. chin cup and dental appliances in order to achieve mandibular stability, better lip closure, tongue position and swallowing. However, it is important to note that patients cooperation and comfort is highly essential in order to achieve better results.

Pharmacologic method: The use of anticholinergics drugs, such as Glycopyrrolate, Scopolamine Benztropine, Glycopyrrolate, Benzhexol Hydrochloride & Injection of Botulinum toxin type A are very effective in the treatment of hypersalivation. However, the uses of these drugs do have adverse side-effects and though none of the drugs has been identified as superior, yet the injection of botulinum toxin type A into the salivary glands is considered safer & more effective in managing hypersalivation, but its effects might take several months to fade, while a repeat of injections are also necessary to achieve good result.

Improvement of eating & drinking skills: Because hypersalivation can be exacerbated by poor eating skills, special attention and developing better techniques in lip closure, tongue movement and swallowing should be encouraged amongst patients suffering from hypersalivation as doing this may lead to improvements of some extent. Besides patients suffering from hypersalivation should also be encouraged to avoid acidic fruits & alcohol, because the consumption or intake of these substances stimulate further saliva production, so avoiding them will help to control hypersalivation.

Invasive modalities: These modalities are centered about the second steps employed in the

management of hypersalivation which is achieved by the correction of irreversible

causes. These modalities are more invasive & are often irreversible methods that utilize the use of such techniques as: Surgical therapy Radiation therapy

Surgical therapy: This is centered about surgical interventions performed on the salivary glands and ducts which might involve the entire surgical removal of salivary glands i.e. salivary glands excision; surgical therapy performed to ligate the salivary glands i.e. ligation of salivary glands; or to reroute salivary gland ducts i.e. rerouting of salivary glands ducts and surgery to denervate the salivary glands, i.e. interrupting parasympathetic nerve supply to salivary glands, which is performed through the middle ear, where the tympanic plexus and chorda tympani travel before entering the major salivary glands. The procedure is relatively simple and fast, and does not require general anesthesia.

NOTE:Though denervation of the salivary glands is what seems to provide the most effective & permanent treatment of significant hypersalivation in order to help greatly improve the quality of life of patients & that of their families or care-givers. Unfortunately, however, salivary function returns within 6 to 18 months, when nerve fibers regenerate.

Radiation therapy: Radiation to the salivary glands is a reasonable management option of hypersalivation in the elderly patients who are not candidates for

surgery and cannot tolerate medical therapy. Administration of about 6000 rad
in doses or more to major salivary glands is effective in management of hypersalivation. However, one of its common side effects include onset of xerostomia that could lasts months to years, mucositis, dental caries, osteoradionecrosis, thus the use of radiation therapy as a means of managing hypersalivation may be limited.
NOTE: Malignancies induced by radiation therapy typically do not occur until 10 to 15 years after treatment and, therefore, are less of a concern in patients who are elderly and debilitated.

Summary
Hypersalivation is salivary incontinence or the involuntary spillage of saliva over the lower lip due to either excessive production of saliva in the mouth, inability to retain saliva within the mouth, or problems associated with swallowing. It can lead to functional and clinical consequences for patients, families, and caregivers. The physical and psychosocial complication of hypersalivation includes maceration of skin around the mouth, secondary bacterial infection, bad odour, dehydration and social stigmatization, amongst others. People with hypersalivation problems are also at increased risk of inhaling saliva, food, or fluids into the lungs especially when body's normal reflex mechanisms, such as gagging & coughing are also impaired. Though hypersalivation is normal in infants but usually stops by 15 to 18

months of age. However, if the condition prevails after four years of age, it
generally is considered to be pathologic, which is more prevalently higher in the chronic neurological patients with impairment of social integration and difficulties to perform oral motor activities during eating and speech. This is characterized with consequent repercussion in quality of life amongst people suffering from hypersalivation. It is important to note that though chronic hypersalivation can be difficult to manage, but never-the-less, the successful management of hypersalivation can be significantly achieved by employing such modalities i.e. techniques geared towards alleviating the associated hygienic problems & improving sufferers appearance, as well as enhancing sufferers self-esteem, that will ensure a significantly reduce nursing care time of these sufferers. Key messages: Hypersalivation is mainly due to neurological disturbance, which under normal circumstances persons are able to compensate for increased salivation by swallowing. However, sensory dysfunction may decrease a persons ability to recognize the onset of hypersalivation. Besides, anatomic or motor dysfunction of swallowing may as well impede the ability to manage increased saliva secretion in some affected persons. Thus, it can be summarily deduced that:

Chronic hypersalivation can pose difficulty in management

Early involvement of Multidisciplinary team is the key. Combination of approach works better Always start with noninvasive, reversible, least destructive approach Surgical and destructive methods should be reserved as the last resort. Hypersalivation is optimally treated by treating or avoiding the underlying cause. Mouthwash and tooth brushing may have drying effects.

Hyposalivation Asialorrhea:

Hyposalivation that is sometimes colloquially called pasties, cottonmouth,

drooth & or dough mouth, is a decreased flow of saliva, also referred to as

asialorrhea which simply means abnormally decreased salivation. It is a symptom that reflects both the end result of the process of inflow of pure saliva,

evaporation, adsorption to the oral mucosa & outflow of saliva. Though decreased
saliva production can often than not be mistaken and be called xerostomia i.e. dry

mouth, however, in actual sense it is not, because it should rather be seen as a

decreased or insufficient saliva production that could as well lead to the condition xerostomia or dry mouth. This is because xerostomia is the medical term for the subjective complaint of dry mouth which may or may not be associated with a lack of saliva,

NOTE: Though hyposalivation is not a disease but a symptom of some diseases that are often than not most common in old people, yet it can also occur in all age groups especially when an individual is

exposed to certain conditions that could contribute to the secretion of lesser amount of saliva in the mouth. Pathophysiology of hyposalivation

The pathophysiology of hyposalivation just like as it is in the case of

hypersalivation is multifactorial, resulting due to either such factors as:

o

Psychological factors. Local factors. Systemic factors.

Psychological factors: Including:

1) 2) 3) 4)

Menopause hormonal changes i.e. pregnancy hormonal changes Pains controlling salivary glands i.e. when controlling salivary gland hurts Stress Anxiety

Local factors: Comprising of:

1)

Bad oral habits,

such as snoring and breathing with the mouth open,

smoking or use of chewing tobacco and intake of alcoholic beverages

2) 3) 4) 5) 6) 7) 8)

Thirst Working hard i.e. exhaustion Excessive perspiration i.e. sweating a lot Sleeping Keeping mouth opened longer than necessary Dry mouth. Physical trauma

that could result from such conditions as salivary glands

nerve damage from head & neck surgery as well as extended activities like eg extended exercise on a hot day,
9) 10) 11) 12) 13) 14)

Ageing though not common, but due to the like hood of older people having increased rate of medication intake, ageing can is considered as phsychosial factor

Cavities/tooth decay Nasal polyps Cushing's syndrome Scleroderma Various forms of parotitis & inflammation or infection of the salivary glands

Systemic factors: These include:

1)

Use of medications such as anti-allergy, antihypertensive, anti-diabetic, anti-depressant,

anti-worry, anti-diuretic,

antihistamines, decongestants, anti-diarrheal, muscle

relaxants, drugs for urinary incontinence, anorectics, antipsychotics, weight loss drugs,
2)

anti-depressants & drugs to either reduce or stimulate appetite etc.

Radio therapeutic treatment of head and neck tumors i.e. use of

chemotherapeutic irradiation, for treatment of certain cancers of the head and neck with radiation therapy drugs
3) 4) 5) 6)

Salivary gland diseases Snuffles Gastroesophageal reflux Vitamins deficiency

Side effects of hyposalivation:

The reason that hyposalivation is such a significant medical condition is because of the vast number or functions saliva performs. As saliva contains valuable enzymes that initiates digestive processes in human, it is also richly endowed with antimicrobial components that are highly essential in mediating taste sensation within the taste buds in order to enable it perceive taste relative the constituents contained in food substance. However, for sensing, perceiving & interpreting the texture, constituency and taste of food substance i.e. when placed in the oral

cavity, such food substance must first be dissolved in saliva. Besides there must be
sufficient saliva flow in the oral cavity, so as to help maintain the proper pH of the oral cavity, which consequently contributes in helping to maintain the integrity of both the teeth and oral mucosa in a healthy mouth. Therefore, amongst the side effects of reduction in saliva production hyposalivation is:

Difficulty in speech and eating & halitosis Dramatic rise in the number of cavities, as the protective effect of saliva's remineralizing the enamel is no longer present, and can make the mucosa and periodontal tissue of the mouth more vulnerable to infection Tight clenching of the jaw, bruxism i.e. compulsive grinding of the teeth

Repetitive chewing movement as if the user were chewing, but without food in the mouth. A sore tongue i.e. burning mouth Difficulties with swallowing, and fungal infections Loss of diminution of the sense of taste i.e. dysphagia Difficulties with mastication i.e. lack of the ability to properly chew food and deglutition i.e. lack of ability to swallow food Difficulties in wearing and removal of removable intra oral prosthesis.

Interventions for xerostomia:

Amongst the intervention regimens for hyposalivation are:

Increase fluid intake. Increased hydration of tissues. Use of sugarless candies or gum. Use of saliva substitutes & use of lubricants. Proper mouth care & dietary modification. Use of therapeutic drugs (e.g. pilocarpine hydrochloride).

INTODUCTION & GENERAL OVERVIEW Halitosis is the medical term for bad breath also often referred to as oral malodour that occurs when noticeably unpleasant odours are exhaled in breathing. Even though it's a

comparatively minor health problem, bad breath can be distressing and a bit of a social handicap. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease. In most cases 8590%, bad breath originates in the mouth itself. The intensity of bad breath differs during the day, due to eating certain foods such as garlic, onions, meat, fish, and cheese, obesity, smoking, and alcohol consumption. Since the mouth is exposed to less oxygen and is inactive during the night, the odor is usually worse upon awakening " morning breath".

NOTE: Bad breath may be transient, often disappearing following eating, brushing one's teeth, flossing, or rinsing with specialized mouthwash. Bad breath may also be persistent chronic bad breath, which is a more serious condition, affecting some 25% of the population in varying degrees. Bad breath is not, however, a modern affliction. Records mentioning bad breath have been discovered dating to 1550 B.C. of which a mouthwash of wine and herbs was once a recommended way of solving the problem. Classification

Halitosis has been classified by location of the cause of the malodour and by aetiology. The primary subdivision is between:

Genuine halitosis Pseudo halitosis

NOTE: Where halitosis is genuine, this can be subdivided according to location, for example intra-oral halitosis within the mouth & extra-oral halitosis outside the mouth. Intraoral halitosis is what accounts for some 80-90% of genuine halitosis cases. Genuine halitosis can also be thought of as either physiological, or pathological.

Genuine Halitosis:

This category refers to bad breath that can be readily detected by organoleptic testing i.e. smelling the person's breath or by the use of a scientific testing apparatus designed to detect the compounds typically associated with bad breath

i.e. volatile sulphur compounds. Genuine halitosis is further sub-divided into two as:

Physiologic halitosis i.e. transient halitosis Pathologic halitosis

Physiologic halitosis Transient Halitosis: This category refers to those situations where the person's malodour is attributable to putrefactive processes taking place in the oral cavity. Usually these processes are taking place within the whitecoloured coating found on the posterior portion of the tongue. In most cases the person's breath problems can be resolved simply by improving their oral home care, especially their tongue cleaning habits. This type of halitosis is transient, in the sense that its presence comes and goes as determined by temporary

localized conditions in the mouth and that it can be easily resolved. Examples
include:
o o

Morning breath Bad breath associated with speaking.

NOTE: The bad breath experienced in both of these situations is caused by the dry oral conditions that develop during sleep or when we speak for extended periods of time.

Pathologic halitosis: This classification recognizes a person's bad breath as being a symptom of a disease, or other pathologic condition, or aggravated by it. The "pathologic" halitosis category is further subdivided into subcategories based on the location of the disease process that is associated with the breath problem. These categories include:

o o

Oral Pathologic Halitosis Extra oral Pathologic Halitosis

Oral Pathologic Halitosis: This category includes breath problems that are caused or aggravated by disease or other pathologic condition associated with the tissues of the mouth. As an example, problems with bad breath are often caused by the presence of periodontal disease i.e. gum diseases. The dental professional treating this type of case will need to provide the patient with instructions outlining proper oral hygiene, especially tongue cleaning. They will also need to provide treatment for the diseased oral tissues. In most cases this will start with a thorough professional dental cleaning.
Extra oral Pathologic Halitosis: With this classification, the person's breath malodour

originates from a disease or a pathologic condition involving body tissues other than in the mouth. For instance, the odour may originate from:
The nasal or laryngeal areas i.e. upper respiratory tract. The lower respiratory tract i.e. lungs or upper digestive tract. Disorders anywhere else in the body. In these cases, compounds produced by

the disease process are blood borne and a state of breath malodour is created when they are exhaled from the lungs. These disorders can include diabetes, liver cirrhosis, uremia & internal bleeding etc. Pseudo halitosis Psychosomatic halitosis This classification refers to categories of psychosomatic halitosis in which a patient's perception of a breath problem continues to exist & patients complain of the existence of halitosis, which is not offensive.
NOTE: - Though psychosomatic halitosis is out of the treatment realm of dental practitioners, patients with this condition will still seek help from a dental practitioner. They often only receive treatment for genuine halitosis without referral to a psychological specialist. However, if these psychosomatic halitosis patients are incorrectly managed, the psychological condition might become worse than before the visit. Pseudo halitosis is subdivided into:

Delusional halitosis Olfactory hallucinations/neurosensory disturbance Halitophobia

Delusional halitosis: This classification refers to a situation where an oral malodour problem does not exist i.e. cannot be detected by smell or scientific

apparatus testing but the patient still feels that they have bad breath. Since no
real breath problem exists, treatment consists of counseling the patient about their misconception.

Olfactory hallucinations/neurosensory disturbance Halitophobia: A situation where a patient's perception of a breath problem continues to exist despite the successful treatment of their genuine halitosis condition or, in the case of pseudo-halitosis, after receiving counseling. At this point, treatment for the patient's condition needs to be referred to a medical professional who can provide appropriate psychological counseling.
NOTE:o o

Both Delusional halitosis and Halitophobia patients complain of the existence of halitosis, which is not offensive. Both Delusional halitosis & Halitophobia patients cannot be treated by dental practitioners, and must be referred to psychological specialists.

Classification Summary Halitosis: Is classified into:

Genuine Halitosis
Oral malodour intra-oral halitosis Extra oral halitosis

Extra-oral Blood borne halitosis Extra-oral non-blood borne halitosis

o o o

Upper respiratory tract ENT causes Lower respiratory tract causes Gastrointestinal halitosis

Pseudohalitosis
Delusional halitosis Olfactory hallucinations/neurosensory disturbance

Causes of Halitosis bad breath

Everybody has halitosis i.e. bad breath from time to time, especially first thing in the morning, when one is hungry or starved i.e. hunger breath, when one is dieting, or after one must have eaten foods with a strong odour, as well as when one is suffering from certain ailments i.e. diseases, There are just as many causes of bad breath as there are sources of bacteria in the mouth. Some of these sources are considered as either contributing factors or risk factors; while others are classified as external or internal factors. However, in most cases, this classification is interwoven, because persistent or chronic bad breath is due to the construction of excessive bacteria in the mouth, of the mouth & of the tongue due to food debris accumulation, plaque retention & onset of gum disease.

Contributing factors; Amongst the identified contributing factors to halitosis are:

Poor oral hygiene i.e. lack of oral hygiene: People who do not practice or maintain good oral hygiene regimen are more

likely to have halitosis, because of the accumulation of bacteria in the mouth. This could also lead to the accumulation of plaque very adherent coating on enamel

consisting of food waste, dead cells & bacteria. The lack of oral hygiene is probably
one of the most common contributing factors to halitosis. However, this can be solved easily by an individual sufferer getting back on track with proper dental care

which must include brushing, flossing, rinsing the mouth & tongue cleaning as well as visiting a dentist twice a year for routine dental appointments.
NOTE: - Lack of proper dental care can as well lead to dental plaque formation, gum diseases, dental calculus deposition, tooth decay & terminal or eventual loss of teeth.

Certain medications: Certain medications like antidepressants, diuretics, aspirin insulin, inhaled

anesthetics & paraldehyde can lead to decreased production of saliva in the mouth,
causing dry mouth, a condition known as xerostomia. The saliva is the bodys natural mouthwash that helps clean and reduce bacteria in the mouth, hence, a lack of its sufficient production in the mouth would results in the production of an offensive odour i.e. bad breath. Also, in other rare cases, bad breath can also cause health or other medical problems, such as inflammation of the respiratory tract, chronic sinusitis, bronchitis, chronic inflammation, diabetes, throat or tonsils, gastrointestinal disorders, liver or kidney disease.
NOTE: - Dry mouth is a good environment for bacteria to grow and cause bad breath. Morning breath is an example of the party and bacteria multiplication in the mouth when the salivary glands slow down its work.

Inflammations: Such inflammations as airway inflammation in individuals with a throat

infection, cough and runny nose may lend credence to the accumulation of mucus that is trapped in the nose or fistulas. When this occurs, it can as well result in the production of halitosis due to bad breath.

Medical conditions: Such conditions as:o

Gastrointestinal disorder--

Digestive

disorders

resulting

from

indigestion,

constipation can contribute to bad breath smell as the odour is released from the gas in the stomach become expelled through the mouth.
o

Respiratory tract infections--- Such infections like nasal infection, windpipe

infection, lungs infections, chronic bronchitis, postnasal drip & chronic

sinusitis can cause bacteria accumulation in the back of the throat, which can
cause bad breath odour expelled through the mouth.
o

Diabetes---In the case of diabetes, a fruity breath odour is a sign of

Ketoacidosis, which can be life-threatening, and this odour is a bad breath which could be expelled through the mouth too.
o

Renal disorders --- Renal disorders could result in bowel obstruction & even

prolonged vomiting, producing a fecal breath odour that is often expelled through the mouth.
o

Liver & Kidney disorder---Chronic kidney failure may produce a breath odour that

is described as smelling like ammonia, urine or fish. Risk Factors: Although it is often than not difficult to have a clear demarcation between either the risk factors of halitosis; contributing factors of halitosis; external factors & internal factors of halitosis due to the existing interwoven characteristic &

similarities of effects shared amongst both. However, the commonly identified risk
factors of halitosis are said to be those conditions that help aggravate the initial onset of halitosis bad breath. Amongst which are mainly those conditions associated or resulting from numerous dental problems.

Dental Problems: They usually facilitate the accumulation of excess protein in the diet which

increases the pH in the mouth & consequently the production of chemical molecules containing volatile sulphur compounds, which are produced when bacteria that live in the mouth breaks or putrefies decomposes or rotten saliva and excess food debris protein in the mouth, thereby producing offensive odour expelled through the mouth. These include such dental problems as:
o o o o

Gum diseases gingivitis Dental caries tooth decay Periodontitis Coated tongue

o o o o o

Mouth ulcer Abscessed tooth Impacted tooth Mouth breathing Oral thrush candidiasis

External factors: These comprises of certain substance taken from outside the body system and introduced into the body systems, whose resultant effect is the production of volatile gases within the body system that are subsequently expelled from the body system through the mouth. They include:

Certain Food Types: People who eat spicy or odorous foods in nature such as garlic, coffee,

cabbage, milk & onions, and those with low carbohydrates in their diet are more
prone to experiencing bad breath. This is so, because long as these foods are removed from the body, they will continue to contribute to bad breath while washing and rinsing the mouth to cover the odour will only remain a temporarily measure, because these category of food contains odour-causing volatile sulphur

compounds that is greatly responsible for halitosis. None-the-less however, eating a

well-balanced diet can help reduce bad breath caused by dieting.

Tobacco & Alcohol products: Tobacco and alcohol intake consumption, just like with the food one eats,

has strong odours associated with these substances can cause halitosis, for as long as they remain in the body system of an individual. Besides, they could also lead to

drying of the mouth which also provides an ideal environment for bacteria

multiplication whose resultant end result is production of halitosis an offensive odour in the mouth.
NOTE:- In addition to causing halitosis, these substances can as well stains the teeth & also increase the likelihood of developing gum diseases & or oral cancer as well as leading to digestive problems.

Improper cleaning of denture: Dentures that are not cleaned properly may be collecting bacteria, fungi, and

remaining food particles, which cause bad breath. Internal factors: These include oral factors that can affect the whole body. Bacteria can accumulate and grow on the tongue. Most odour-causing bacteria produce substances that cause bad breath, and are mostly situated on the back part of the tongue.
Symptoms of halitosis

The features of halitosis can include:

A white coating on the tongue especially at the back of the tongue Dry mouth Build up around teeth Post-nasal drip, or mucous Morning bad breath and a burning tongue Thick saliva and a constant need to clear your throat Constant sour, bitter metallic taste.

Management of halitosis

Having halitosis can have a major impact on a person, because bad breath can make other people back away or turn their heads at you. This can cause a loss

of confidence & self-esteem. Though there is no one most effective treatment for halitosis, however, the treatment will depend on what is causing the problem. Besides, understanding the causes of halitosis will actually give one ideas on how to deal with the problem, especially for those with identified case of persistent halitosis that cannot be eliminated by application of simple measures such as cleaning the

mouth, it is imperative that one consults a dentist. Thus, halitosis can be efficiently
managed in the following ways:

Home remedies i.e. personal good oral hygiene practice Professional care i.e. management regimen by the dentist

Home remedies/Personal care:

Home remedies for effective management of halitosis are centered about individual personal efforts toward maintaining good oral hygiene regimen that individuals suffering from the menace of offensive malodour i.e. halitosis, fowl

breath or bad breath, could employ in order to manage the problem of halitosis on
their own based on their personal effort.

Amongst these home remedies that a dentist should advice & encourage halitosis patient to practice, keep & maintain are:

Gentle cleaning of the tongue surface before bedtime by scraping with a plastic tongue cleaner or brushing gently. Eating regularly to prevent hunger breath by avoiding skipping meals. Chewing sugarless citric gum or lemons to stimulate adequate saliva flow Brushing the teeth regularly at least 3 times daily.

Flossing regularly & at least once a day to remove rotting food debris & bacterial plaques especially from between the teeth. Rinsing properly by frequently gargling the mouth with water. Eating more fibrous foods & chewing fibrous vegetables to stimulate adequate saliva flow. Drinking at least 8 glasses of water daily to keep the mouth moist and to help rinse away odour-forming bacteria. Decreasing alcohol and coffee intake. Keeping the nose & sinuses clean regularly. Cleaning dentures properly by soaking it in antibacterial solution unless otherwise advised by a dentist Avoiding the use of mouthwash, because its result is only temporary. Ensuring periodic visits to dentists & dental therapists i.e. dental hygienists for oral health counseling. overnight

Professional care:

Proper personal care of the mouth & teeth by practicing & maintaining regular tooth brushing, dental flossing, mouth rinsing & tongue scraping are important enough for an individual person suffering from halitosis to be able to manage the problem. However, it is not most effective enough to be considered as ways for efficient management of halitosis. This is because halitosis could sometimes be caused due to underlying illnesses such as lung disease, impaired emptying of

the stomach, liver failure, or kidney failure; and in this case, managing & treating
the underlying conditions is very imperative in order to help avert further complications that may arise. Hence the need not for individual suffers of halitosis, not to significantly rely on home remedies for controlling mouth malodour; rather it is advisable that they are encouraged to seek for professional medical assistance.

This not withstanding however, professional oral health care givers dentist &

dental therapist can as well help guide halitosis patients manage their problems
based on the following considerable factors:

The health of the mouth The cause or origin of the condition The extent of the condition Individual tolerance for specific medications, procedures, or therapies Individual opinion or preference Lastly, the successful management of halitosis is significantly dependant on

managing the primary causes of the condition, for instance as contained in the table below.
Cause Poor oral health care Possible Management/Treatment Protocol

If the halitosis is of oral origin i.e. improper oral health

care, in most cases dentists should device management

regimen to help treat the cause of the problem.
Gum disease

If the cause of the halitosis is an underlying gum disease, the condition may be managed & treated by the dentist, or the dentist may refer a patient to an oral specialist i.e.

in most cases, a periodontist.

However, a periodontal cleaning by the dentist can often help to remove the bacteria and calculus that has accumulated and which must have been the chief cause of

inflammation at the gum line that must have been a contributing factor to the halitosis malodour or bad

breath.
Extensive plaque buildup

If the halitosis is as a result of extensive dental plaque buildup, the dentist or periodontist may recommend an antimicrobial mouthrinse i.e. a therapeutic mouthrinse, as first line of management/treatment regimen. Also, the dentist should instruct individual sufferers to brush their tongue gently each time they brush their teeth, in order to ensure that excess plaque & bacteria are efficiently reduced or completely removed.

Summary

Halitosis or bad breath commonly known is a common problem that affects many people from all walks of life, caused by sulphur-producing bacteria that live within the surface of the tongue and in the throat. The breath is the air emitted during exhalation through the mouth and nose. It may be transient due to changes in the oral environment, or a pseudo-halitosis in which patients are wrongly convinced to have bad breath and use products to hide; it can as well be a symptom of a local or general disease. The worst form of halitosis is usually found in people who neither know nor care, and neglect important factors such as dental hygiene. While good oral hygiene may eliminate some cases of bad breath, chronic cases can be difficult to treat because the causes of halitosis in these cases may be deeper than the improper cleaning of the mouth and teeth. However, the general treatment for halitosis depends on the underlying cause. Hence, understanding the various causes of halitosis gives good ideas on how to get rid of this condition. It also helps prevent and help evaluate whether one have an explosion of accounts or a common chronic disease.

INTODUCTION & GENERAL OVERVIEW

This is a collective term referring to a variety of deposits and or stains (intrinsic & extrinsic) that accumulate on the teeth and on appliances in the mouth. These deposits include acquired pellicle, materia alba, food debris, dental plaque, dental stains and dental calculus. Classification of dental deposits The deposits found in the mouth are classified into soft and hard deposits.

Soft depositsComprising of acquired dental pellicle, materia alba, food debris and dental plaque (dental biofilm). Hard deposits-- Dental calculus is the only hard deposit found in the mouth.

NOTE: - Dental stains are neither a classified as a soft or hard deposit.

Soft Deposits: The soft deposits found in the human oral cavity include the following:

Acquired pellicle i.e. Dental pellicle Materia alba Food debris

Dental Plaque i.e. Dental biofilm

Dental Pellicles: Dental pellicle is also referred to as acquired pellicle, salivary acquired

pellicle & or enamel pellicle. It is a protein film that forms on the surface enamel by
selective binding of glycoproteins from saliva that prevents continuous deposition of salivary calcium phosphate. It forms in seconds after a tooth is cleaned. It is also protective to the tooth from the acids produced by oral microorganisms after consuming the available carbohydrates. This is clear, insoluble, appears thin and pale pink with disclosing solution-can take on extrinsic stains.

Examining a patients mouth for dental pellicle presence

Dental pellicles are not alive, and do not respond to bacteria. This makes it likely that bacteria latch onto them by feeding, which may account for the ridges, or a scalloped appearance, in the pellicles. In extreme cases, bacteria can consume all of the pellicles a patient has on his or her teeth. Though firmly attached to the teeth, dental pellicles may be removed through abrasion. However normal tooth brushing will normally not cause enough abrasion to remove a dental pellicle and even after removal, usually dental pellicles will simply reform within two hours. Normally very thin, dental pellicles may occasionally be thick in some places. Subject to wear and tear, they are typically thinnest on the occlusal surfaces of the teeth where grinding and chewing occur. As a clear coating typically beneath plaque, a pellicle is not visible to the naked eye; however, it can still be seen as a light stain on the surface of the patient's teeth i.e. when patients use a solution

composed of disclosing materials to make it visible.

NOTE: - In physiology of mouth, pellicles are created from the selective absorption of salivary
tissues. Composition of a dental pellicle:

elements onto the surface of the teeth. It is a biofilm free of bacteria, covering oral hard and soft

Though, the exact composition and structure of dental pellicle is still not certain. But it is found that they comprise mainly of protein components comprising of glycoproteins, enzymes & salivary mucin. Amongst which are:

Magnified dental pellicle on a tooth surface

Amylase (1-4- -D-glucan glucanohydrolase) :

Origin---Salivary glands, mainly parotids Physiologic role: --- Starch and malto-oligosaccharide digestion

Carbonic anhydrase VI, I, II

Origin: -- Serous acinar cells from salivary glands Physiologic role-- Maintenance of pH homeostasis by catalyzing the reaction of CO2 and H2O to HCO 3 & H+

Lysozyme/muraminidase (mucopeptide N-acetylmuramoyl hydrolase):

Origin: -- Salivary glands, mainly sublingual and submandibular glands Physiologic role: --- Hydrolysis of peptidoglycans in bacterial cell walls

Neuraminidase/sialidase (acyl neuraminyl hydrolase):

Origin: -- Micro-organisms but also lysosomes and plasma membranes of human cells Physiologic role: --- Variable Release of glycosidically linked sialic acids from sialyl oligosaccharides and sialyl conjugates

Glucosyltransferases Transglutaminase (protein-glutamine- -glutamyltransferase):

Origin: -- Streptococcal species Oral mucosal cells Physiologic role: --- Glucan synthesis from disaccharides Glutamine cross linking

Peroxidases (hydrogen peroxide oxidoreductase):

Origin: -- salivary glands Physiologic role: --- Reduction of peroxides and oxidation of Thiocyanate
NOTE:-Dental pellicle enzymes are the structural elements of the dental pellicle, which exhibit antibacterial properties but can also facilitate bacterial colonization of the dental hard tissues in the oral cavity. Clinical significance of dental pellicle:

The dental pellicles are gift of nature. As such their clinical significance includes:

Providing natural protection of the teeth---- Their natural development is intended to

protect the teeth from acids. They form in just few seconds after brushing the teeth.

Lubricating dental surface---Preventing tooth wear as well as forms an anti-erosion

barrier and buffer to the teeth.

Serving as means for bacteria to latch onto the teeth----Adhering to the dental pellicle

rather than attaching to minerals within the teeth structures.

Providing conduciveness--- Provides conducive climate for dental plaque creation or

deposition and formation.

Providing reservoir---- Serves as a reservoir for remineralizing electrolytes. Enhancing anti-microbial activity--- Mediating in non-specific and selective adherence

of micro organisms to teeth surfaces.

Removal of dental pellicle:

Though the pellicle is firmly attached to the teeth, it may be removed through abrasion. A thorough polishing or using a dental burr can remove the pellicle. Normal tooth brushing will normally not cause enough abrasion to remove a pellicle. Materia Alba: This is a white or cream colored, cheesy mass composed of food debris, mucin, and bacteria. Materia alba is a soft white deposit around the necks of the teeth, usually associated with poor oral hygiene; composed of food debris, dead tissue elements, and purulent matter; serves as a medium for bacterial growth. In

some cases materia alba is a grayish white or yellowish soft, sticky deposit and is somewhat less adherent than plaque. It lacks a regular internal pattern seen in plaque. It can be seen clearly without the help of any disclosing agent. It is seen on restorations, calculus and gingivae. It tends to accumulate on the gingival third of the teeth and malposed teeth. It can form very quickly even after an ultrasound scaling. It can be easily flushed away with water spray but mechanical cleansing is required to ensure complete removal.
NOTE:- Materia alba can be considered a type of biofilms and it is subtly distinguished from the protective dental pellicle. Aetiology: Poor oral hygiene. Clinical features: It presents as a soft, whitish plaque that is easily detached after

slight pressure.
Composition of materia alba:

It is a concentration of microorganisms, desquamated epithelial cells, leucocytes and a mixture of salivary proteins and lipids. It may have few or no food particles.

Materia alba as seen in a human mouth

NOTE: - The irritating effect of materia alba is caused by bacteria and their products. In which the accumulations of micro flora that lead to pathological plaque and calculus which cause periodontal diseases.

Food Debris: This is particles of food remaining in the mouth after eating which collect in tooth crevices and between the teeth and may contribute to the formation of dental caries. Food debris is rapidly formed in the mouth by bacterial enzymes and cleared from the oral cavity within 5 minutes after eating but some remains on the teeth and mucosa. The formation of food debris is accelerated by increased chewing activity and the low viscosity of saliva.

Food debris accumulation in the mouth

NOTE: - Dental plaque is not a derivative of food debris. Food debris is white small particles on the teeth- easily rinsed off, in which the rate of clearance from the oral cavity varies with the type of food and the individual. Removal of food debris:

The following practices are significant for the removal of food debris from the teeth surfaces and the mouth at large.
1. 2. 3.

Brushing is necessary after eating such food. If brush is not available just rinse your mouth. Use tap water instead of bottled water because it contains fluoride which is best for teeth. Visit your dentist once in a month. Chew sugar free gum.

4. 5.

NOTE: Liquids are cleared more easily than solids. Sticky foods such as figs, bread, toffee and caramel may adhere to tooth surfaces for more than 1 hour whereas coarse foods such as raw carrots and apples are quickly cleared. Plain bread is cleared faster than bread with butter. Brown rye is cleared faster than white. Cold foods are removed faster than hot.

Dental Plaque: Dental plaque i.e. Dental biofilm can be defined as the soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable and fixed restorations. It is a sticky, colorless film of bacteria and sugars that constantly forms on our teeth. Plaque is a biofilm composed of several different kinds of bacteria and their products that develop over the enamel

on a layer known as pellicle. It is the main cause of cavities and gum disease and can harden into calculus if not removed daily.
Classification of dental plaque:

Dental plaque is classified in several ways. Amongst the basic classifications are:

Supra gingival and sub gingival dental plaque. Attached and unattached dental plaque. Health-associated and disease-associated dental plaque.

Supra & sub gingival dental plaque:

This classification is based on dental plaque position in relation to the gingivae in the oral cavity.
Supragingival dental plaque---- Is found at or above the gingival margin, on the

tooth surface It is also called marginal plaque and is important in the development of gingivitis.
Sub gingival dental plaque--- is found below the gingival margin between the

tooth and the gingival sulcular tissue. This plaque is important in the oral soft tissue destruction, characteristic of different forms of periodontitis.
NOTE: - The supra gingival and sub gingival plaque are critical in calculus formation and root caries. Attached & unattached dental plaque:

This classification is based on dental plaque position in relation to the tooth surfaces in the oral cavity.
Attached dental plaque--- It is related to the supra gingival dental plaque found

on the tooth surface without any link or association with the gingivae.
Unattached dental plaque---- It is closely associated with the walls of the sub

gingival tissues in the oral cavity.

Health-associated & disease-associated dental plaque:

This classification is based on dental plaque relation to deceases, referring to differences in the composition of dental plaque in health and versus diseases.
Composition of Dental Plaque:

The dental plaque is composed of organized mass of microorganism in a sticky matrix,

75-80% water 15- 20% organic 5% inorganic solids mainly microorganisms

Magnified structural composition of dental plaque

Organic constituents---- These includes

1. 2. 3. 4.

Glycoproteins from saliva. Polysaccharides especially dextran---from bacteria. Albuminfrom crevicular fluid. Lipids debris---from disrupted epithelial cell membranes.

Inorganic constituents---These are

1. 2. 3. 4.

Calcium Phosphorus Sodium Potassium & Fluorides from fluoridated toothpaste and mouth rinses.

Microorganisms in dental plaque---These include the following:

1.

Gram positive microorganism--- Such as facultative Streptococcus mutans, Streptococcus sanguis & Actinomyces viscosus Gram negative microorganisms--- Such as Actinocetemcomitans, Capnocytophyp species, facultative Actinobacillus, Eikerella corrodens &

2.

Anaerobic Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Bacteroides forsythus, Campylobacteria rectus
3.

Spirochetes microorganismsSuch as treponema species

Treponema denticola & Other

Dental plaque formation:

Plaque formation occurs in three phases, which include:

Attachment of bacteria to a solid surface. Formation of micro-colonies on the surface. Formation of a mature sub-gingival dental plaque.

Attachment of bacteria to a solid surface: The initial attachment of bacteria begins with pellicle formation, of which attachment, growth, removal and reattachment of bacteria to the tooth surface is a continuous and dynamic process. The pellicle is a thin coating of salivary proteins that attach to the tooth surface within minutes after a professional cleaning. It acts like double-sided adhesive tape, adhering to the tooth surface on one side and on the other side, providing a sticky surface that facilitates bacterial attachment to the tooth surface. Following pellicle formation, bacteria begin to attach to the outer surface of the pellicle. Once they stick, the bacteria begin producing substances that stimulate other free floating bacteria to join the community.
NOTE: - In this phase of dental plaque formation, the thin layer of pellicle formed on the surface of the enamel is usually 0.1-0.2 thick. Also, the pellicle so formed consists of different glycoproteins and immunoglobulins. Saliva from the sub-mandibular and sublingual glands are more likely to precipitate than saliva from the parotid gland. Sub-mandibular saliva also gets spread over the surfaces of all teeth, thereby providing the medium of pellicle formation.

Formation of micro-colonies on the surface: Micro-colony formation begins once the surface of the tooth has been covered with attached bacteria. The biofilm grows primarily through cell division of the adherent bacteria, rather than through the attachment of new bacteria. Next, the proliferating bacteria begin to grow away from the tooth as dental plaque doubling times are rapid in early development and slower in more mature biofilms. This result

in other bacterial colonizers adheres to bacteria already attached to the dental pellicle earlier formed. Formation of mature sub-gingival dental plaque: Now with the adherence of other bacterial colonizers to bacteria that are already attached to the pellicle, there is further co-aggregation of the new bacterial colonizers to adhere to the previously attached cells and together they form sessile, mushroom-shaped micro colonies that are attached to the tooth surface at a narrow base. The result of the co-aggregation is the formation of a complex array of different bacteria linked to one another. Following a few days of undisturbed biofilm formation, the biofilm now extends into the sub-gingival region and flourishes in this protected environment, resulting in the formation of a mature sub-gingival plaque biofilm.
NOTE: - The mechanism of dental plaque formation can be summarized as follows:
1.

Absorption of salivary proteins and glycoproteins, together with some bacterial molecules, to the tooth surface to form a conditioning film the acquired

pellicle.
2.

Irreversible adhesion can occur if specific inter-molecular interactions take place between adhesions on the cell surface and receptors in the acquired pellicle. Secondary or late- colonizers attach to primary colonizers co-aggregation, also by specific inter-molecular interactions. Cell division of the attached cells to produce confluent growth, and a bio film.

3.

4.

Process of dental plaque formation:

This comprise of three basic stages as:

Primary stage initial formation. Secondary stage bacterial colonization. Tertiary stage complete accumulation & maturation.

Primary stage: This is the first stage in which Dental plaque formation starts almost immediately after tooth brushing i.e. some seconds or minutes after tooth brushing

is completed. It begins with the attachment i.e. adherence of saliva derived glycoprotein deposits to cover the tooth surface with protein film coating otherwise called dental pellicle". Thus, formation of dental pellicle is the first stage in dental plaque formation process. Secondary stage: This stage commences 1-3 days following the adherence of dental pellicle on the tooth surface. At this stage the adhered dental pellicle is colonized by numerous bacteria, which in turns multiply and expands in order to accommodate more new species of bacteria.
NOTE: - However, the first species to adhere to the immature dental pellicle are the gram-positive bacteria such as Streptococcus sanguis, Streptococcus mutans & Actinomyces viscosus .

Tertiary stage: This stage begins a week after new species of bacteria colonies are established in the adhered dental pellicle. It resulted from bacteria cells interaction with the adhered dental pellicle, thus making the dental pellicle stickier & viscous becoming what is known as dental plaque. In this stage of dental plaque formation process, the new bacteria colonies are chiefly Gram-negative organisms such as Porphyromonas gingivalis, Campylobacter rectus, Eikenella corrodens, Actinobacillus

actinomycetemcomitans, and oral spirochetes Treponema species. Besides, while

the dental plaque maturation continues, the Gram-positive species are increasingly replaced by the Gram-negative species as the later become dominant over the former.
NOTE: - The overgrowth of Gram-negative anaerobic bacteria is considered as one of the main causative factors of gingivitis and periodontitis. Cause dental plaque: Poor oral hygiene Clinical significance of dental plaque:

The clinical significance of dental plaque is related to lack of its removal from the mouth regularly, which can lead to:

Demineralization of adjacent tooth surface --- resulting in tooth decay and dental cavities caries.

Irritation of the gums around the teeth---resulting in inflammation leading to periodontal problems such as gingivitis and periodontitis & final tooth loss. Calculus formation--- due to excessive dental plaque buildup.

Control of dental plaque:

This can be achieved with the removal of microbial plaque & the prevention of its accumulation on the teeth and adjacent gingival tissues i.e. prevention is better

than cure. Generally there are two basic means of controlling dental plaque
accumulation on the teeth surfaces. They include:

Mechanical means i.e. techniques Chemical means i.e. techniques

NOTE: - Dental plaque removal & control is an essential step for maintaining good and proper healthy oral environment as well as improving generally good oral health.

Mechanical means of dental plaque control: This is centered about the use of various oral hygiene materials for the maintenance of good oral hygiene. Amongst which includes the use of:
1.

Toothbrushes including manual & electric tooth brushes--- for brushing the teeth regularly and most importantly using proper tooth brushing techniques after each meal & or at least twice in the day i.e. in the morning after breakfast

& last at night before retiring to bed.

2.

Dentifrices & antiseptic mouthwashesusing fluoride rich toothpaste while tooth brushing and also using fluoride antiseptic mouthwashes when necessary. Interdental cleaning aids ---- for regular & proper interdental flossing at least

3.

once a day & regular interdental massage, examples dental floss, super floss,
perio-aids, interdental brushes etc
4.

Gingival stimulation aids ---for proper stimulation of blood flow around the gingivae, examples rubber tip stimulator, balsa wood edge tooth pick & tooth pick in special holder etc. Oral irrigation aids---- for adequate flushing of food debris lodged at the gingival crevices and sulcus areas, examples pipe cleansers & water irrigation devices etc.

5.

6.

Aids for Completely or Partially Edentulous Patients--- for ensuring adequate cleaning of fixed and removable dentures, examples full & partial denture clasp brushes, denture cleansing solutions etc.

Chemical means of dental plaque control: This is centered on the use of various chemical agents that can act on the dental plaque ultra structurally in order to prevent i.e. thwart or avert its onset formation. These chemical agents are however classified into three categories, which are:
o o o

First generation anti plaque agents. Second generation anti plaque agents. Third generation anti plaque agents.

First Generation Anti Plaque Agents---- Agents in this category are capable of reducing if not preventing dental plaque accumulation up to 20-50 %, though they exhibit poor retention within the mouth, eg antibiotics, phenols, quaternary ammonium compounds & sanguanarine etc. Second Generation Anti Plaque Agents----They produce an overall plaque reduction of about 70-90% and these are better retained than those of the first generation. These exhibit better retention by oral tissues and show slow release properties, eg Bis-biguanides such as Chlorhexidine. Third Generation Anti Plaque Agents----These classes of agents can completely block microorganisms from binding to the tooth or to each other, yet they have a short coming in poor retention capacity when compared to the second generation Chlorhexidine, eg Delmopinol.

Hard dental deposit:

Dental calculus is the only hard deposit found in the mouth. Dental Calculus: It is a hard, yellowish, brownish or darkish mineral deposit on the teeth surfaces created by hardened calcified dental plaque. It is an adherent calcified or calcifying mass that forms on the surface of natural teeth and dental prostheses, and bridges over the gingival margin following the festooning shape of the dentition. The dental calculus can only be removed by scaling.

Dental calculus as seen in the mouth

Composition of dental calculus:

The composition of dental calculus is influenced by the location of its formation as well as its age. However, it is generally accepted that dental calculus is composed of:

70%-90% inorganic mainly minerals 10%-30% organic materials

Inorganic components (70%-90%): These are a mixture of different calcium phosphate (Ca-P) compounds out of which:

75.9% is Calcium Phosphates 3.5% is Calcium Carbonate 0.6% is traces of Magnesium Sulphate & other metals.

Comprehensively, however the major inorganic components in dental calculus by % composition are:
1. 2. 3.

9% Brushite or Dicalcium Phosphate Dihydrate (CDCPD): CaHPO4.2H2O 12% Octacalcium Phosphate (OCP):Ca8H2 (PO4)6.5H2O 21% Magnesium substituted Tricalcium Phosphate or Whitelockite (_TCMP): (Ca.Mg) 3(PO4)2 58% Carbonate Hydroxyapatite (CHA): (Ca.Na.X) 30(PO4.HPO4.CO3)6 (OH.Cl) 2

4.

NOTE: Other inorganic components are:

1.9% Carbon IV Oxide 0.8% Magnesium 0.2% traces elements such as Sodium, Zinc, Strontium, Copper, Aluminium,

Manganese, Silicon, Iron, Tungsten, and Gold & Fluorine.

Organic components (10-30%): These are mixture of protein-polysaccharide complexes, desquamated epithelial cells, Leukocyte and various micro organisms. However, the most significant organic components are the protein-polysaccharides out of which:

1.9-9.1% is carbohydrates -- consisting of galactose, glucose, rhamnose, mannose, glucuronic acid, galactosamine, arubinose, galacturonic acid, glucosamine, oxalic acid, porphyrins, osteopontin & calproteotin etc. 5.9-8.2% is salivary protein---mostly amino acids. 0.2% is lipids ---In forms of neutral fats; free fatty acids, cholesterol, cholesterol esters & phospholipids.

Morphology of dental calculus

This refers to the different manners in which dental calculus is attached to the tooth surface in the oral cavity. There are four basic morphological modes in which dental calculus attachment to the tooth surface is enhanced in the oral cavity. These are:

Attachment by means of an organic pellicle.

Mechanical locking into surface irregularities e.g. resorption lacunae & caries

sites.

Penetration of dental calculus bacteria in cementum. Close adaptation of dental calculus undersurface depressions to the gently sloping mounds of the unaltered cementum surface.

NOTE: - Dental calculus embedded deeply in cementum a) May appear morphologically similar to cementum and is called calculocementum. b) A difference in the manner in which dental calculus is attached to the tooth surface also affects the relative ease or difficulty encountered in its removal. Classification of dental calculus

From a topographical point of view, dental calculus is classified according to its relationship to the gingival margin in the oral cavity into two, as:

Supra-gingival calculus i.e. salivary or extra gingival calculus Sub-gingival calculus i.e. serumal calculus

Supra-gingival calculus: It is also referred to as salivary calculus or extra gingival calculus. This is the dental calculus found located above or coronal to the gum margin. It is the most common and less harmful type & it is visible that can be easily detected. This is because supra-gingival calculus is always present on the clinical crown of the tooth & above the gingival margin.

Supra-gingival calculus as seen in the oral cavity

Sub-gingival calculus:

Also called serumal calculus. It is the class of dental calculus formed below the gums i.e. below the crest of the marginal gingivae. Sub-gingival calculus is always present on the clinical crown below the gingival margin, however unlike the supra-gingival counterpart; this type of dental calculus is not visible in the oral cavity and can only be visualized or identified with the help of dental a dental instrument i.e. dental calculus explorer probes.

Sub-gingival calculus as seen in the oral cavity

Formation of dental calculus

Formation and development of dental calculus is a complex processes that involve numerous calcium phosphate phases as well as the interaction of these ions with the organic molecules of dental plaque, as the formed dental plaque undergoes mineralization within 4-8 hours after its deposition i.e. formation.

NOTE: - Dental calculus in the oral cavity is formed in layers that are parallel to the tooth surface, of which the layers are separated by line that appears to be pellicle & which later undergoes subsequent mineralization. These lines are called incremental lines.

However, it is widely accepted that dental calculus is formed in three basic phases which include:

Dental calculus initiation following dental pellicle formation Dental calculus facilitation following dental plaque maturation Dental calculus enhancement following dental plaque mineralization

Dental calculus initiation: This is the first stage of dental calculus formation that commences immediately i.e. seconds after successful formation of dental pellicle in the oral cavity, with the selective binding of glycoproteins on to the enamel surfaces of the teeth, especially in a mouth with poor oral hygiene. Dental plaque maturation: This is stage begins 24-72 hours after glycoproteins are been selectively bounded to the enamel tooth surfaces. It began with production of acids as a metabolic by-product of anaerobic dental pellicle bacteria, thereby creating acidic environment in the mouth causing the loss of calcium from the tooth enamel demineralization and resultant dental plaque formation close to the underlying

tooth surfaces. And as the dental plaque grow large enough, they come in contact and unite, thereby having increase in its inorganic material content to at least about 2-20 times more than that of saliva level and becoming matured.
NOTE: - Maturation of the soft dental plaque formed is achieved by precipitation of mineral salts and this occurs between the 1st-14th days of dental plaque formation.

Dental plaque mineralization: This is the last and final stage of dental calculus formation in which the matured dental plaque deposited becomes more mineralized and subsequently hardened. The average time for this to occur is from 2 days in which 50% of the

soft dental plaque become mineralized to 12 days in which about 60%-90% of the soft dental plaque is mineralized. Its main ingredient is calcium phosphate, a hard
insoluble material that adheres to the tooth enamel.
NOTE: - Dental plaque that absorbs Calcium & Phosphate out of saliva is what results in supragingival calculus. Dental plaque that absorbs Calcium & phosphate out of crevicular fluid is what forms the sub-gingival calculus. Factors initiating dental plaque mineralization

Calcification mineralization of dental plaque entails the binding of Calcium ions in saliva into the carbohydrate-protein complexes of the organic matrix & the subsequent precipitation of crystalline Calcium Phosphate salts, which begins at the inner surface of the supra-gingival plaque & in the attached components of subgingival plaque adjacent to the tooth in separate foci that increase in size and coalesce to form solid mass of dental calculus. This process is being initiated by certain factors, which are classified into three:

Endogenous factors Exogenous factors Sensitivity factors

Endogenous factors: They include

Level of salivary mineral ions Presence of salivary proteins and lipids.

Exogenous factors: They comprise of

Dietary components--- that promotes mineral nucleation mineralization in dental plaque eg Silicon Bacterial by-products---that serves as a nucleating center i.e. dental plaque mineralizing centers. Dental plaque mineralization inhibitors--- adsorbing constituents at active sites on the crystalline surfaces of dental plaque mineralization, eg salivary phosphoproteins; saliva pyrophosphates; plaque lipoteichoic acid; saliva statherins & proline-rich proteins. Dental plaque enzyme systems----that serves to degrade the salivary protective inhibitor species, e.g. Phosphatases & proteases

Sensitivity factors: The salivary factors of dental plaque mineralization are relative to specific bacteria and bacterial proteolipid membrane components to mineralization
Clinical Implication of dental calculus

The clinical implication or significance of dental calculus is relative to its location & disposition in the oral cavity. Amongst these implications, however are:

Direct participation in advance periodontal case especially with supra-gingival

calculus.

Loss of periodontal attachment & pocket formations especially with sub-gingival

calculus.

Development & progression of early onset of periodontitis & early periodontal breakdown especially with sub-gingival calculus. Irritation & progression of periodontal lesions especially with sub-gingival

calculus.

Formation of gingival recession in adjacent tissues especially with sub-gingival

calculus.

Risk of developing tooth decay i.e. dental caries. Difficulty in removing dental plaque with brushing and flossing of the teeth.

Accumulation of stains in the porous dental calculus material and thereby make teeth look unattractive.
Table of comparison between supra-gingival and sub-gingival calculus

Character

Dental calculus type Supra-gingival calculus Sub-gingival calculus

Origin Location

Saliva. extends up to the bottom of the pocket.

Blood serum or gingival fluid.

Coronal to the gingival margin Below the crest of gingival margin.

Appearance Chalky white;

Greenish-black & Dark-brown May be stained from by blood pigments pockets. to conform to diseased

Whitish-yellow & Grayish Can be stained by tobacco and other food pigments.

Shape

Amorphous bulky & gross at Flattened the inter-proximal bridge

pressure from the pocket wall or ring like

between adjacent teeth which Crusty, spiny, or nodular; ledge may extend over the margin of gingivae. As determined Thin, smooth veneers by:-tooth anatomy; gingival Finger-and fern like.

margin contour; pressure of the tongue, cheeks & lips.

Structure

Homogenous with areas of Homogenous with areas of noncalcified micro-organisms. calcified micro-organisms.

Consistency Clay like & texture

Brittle Flint like covered with dental plaque.

Moderately hard Porous plaque. & surface with non-mineralized dental

covered Harder and denser & surface

Character

Dental calculus type Supra-gingival calculus Sub-gingival calculus

Removal

Easily removed mechanically but Difficult to remove mechanically & recur dont recur aspect of maxillary Surfaces Stensons base of below pockets the in gingival chronic opposite margin extending nearly to the conditions but doesnt reach the junctional epithelium.

Distribution Buccal molars

duct opening

Lingual aspect of mandibular incisors opposite Whartons duct opening

Size quantity

& Direct

relationship

to

oral Related to pocket depth

hygiene care

Increased amount related to age Related to diet, oral care related to the development & progression of periodontal disease

Character of diet users

Increased amount in tobacco Primarily

Limitation

Coronal gingivae

to

the

marginal Apical to the gingival margin

Extends to the bottom of the pocket and follows the contour of the attachment & limited to root surfaces of the teeth

May cover a large portion of the crown, enamel surface & cementum or form a thin line at the margin Symmetrical except when

affected by malposed teeth, poor oral hygiene, abrasion from food Attachment Detection Loosely attached to the teeth

Firmly attached to the teeth

Easily seen in the oral cavity. Can mirror be seen with directly the or indirectly Visual mouth be

Cant be seen easily, but may as well be seen just beneath the gingival loosely margin adapted, because of inflamed

detection

must

marginal tissues

accompanied exploring

by

air

and May also reflect through thin marginal tissues

With the use of light through Air can also aid in deflecting the anterior teeth during tissue use mirror, probe light for and explorer detection Generalized on proximal surfaces of teeth proper trans-illumination, shadow calculus Must

can be seen as an opaque

Disposition

May be localized or generalized

NOTE: - Both supra and sub-gingival calculus can occur together, but also one may as well be present without the other. The initial deposits of supra-gingival calculus are what create conditions for the formation of sub-gingival calculus. But this does not mean that supra-gingival calculus formation is a pre-requisite for sub-gingival calculus formation.

Relationship of dental calculus to dental plaque and periodontal pocket

The relationship between dental calculus, dental plaque & periodontal pockets is as shown in the table summarized below. Dental plaque

Periodontal pockets

It is mineralized dental plaque that becomes a dental calculus.

Dental calculus is always covered with active dental plaque and it is in direct contact with periodontal pocket epithelium i.e. dental plaque bacteria is

Dental caculus

Also upon

dental dental

calculus depends plaque

prevention

what initiate gingivitis & periodontitis.

Dental calculus is formed due to

control.

calcification of dental plaque on subgingival tooth surface thus sub-gingival

calculus

is

secondary
is

to

periodontal
cause

pockets formation.
Dental calculus what inflammation of periodontal pockets wall due to the presence of bacterial plaque on the surface of the dental calculus.
Management of dental calculus

The management of dental calculus is centered about:

Prevention Treatment

Prevention: Prevention of dental calculus formation is achieved by the following means:

o

Proper brushing and flossing to reduce dental plaque and dental calculus buildup. Regular dental cleaning visits to the dentist. Preventive debridement or dental scaling once a year, if the teeth tend to accumulate dental calculus. Use of dental calculus control toothpastes. Entirely eliminating its source (i.e. dental plaque accumulation). This can be achieved by: Avoiding sugary snacks Healthy eating will minimize the production of dental plaque. Getting a dental checkup A dental exam and cleaning will remove dental calculus to better prepare the mouth for an at-home care program. Continued visiting the dentist at least twice a year will help keep dental calculus buildup in control.

o o

o o

Practicing excellent oral hygiene Brushing at least twice daily, and flossing at least once daily. Brushing after every meal is effective in keeping dental plaque and dental calculus from rapid accumulation. Treatment: These are means of removing dental calculus attaches itself to teeth, mare tooth brushing. The means of treating dental calculus is by:
o

because it cant be removed with Full Mouth Debridement-FMD--- which can be ensured by: Scaling and root planning Where a dentist dislodge calculus even from under the gum line using hand instrumentation involving special sharp instruments i.e. dental scalers & curettes. Ultrasonic dental cleaning---In which power driven devices that

combines ultrasonic vibration & irrigation are used to blast away large
deposits of dental calculus from the teeth surfaces. Dental Stains Dental stains are pigmented deposits on the tooth surface that result from acquired dental coatings by chromogenic bacteria, foods and chemicals. They vary in colour and composition and in the firmness with which they adhere to the tooth surface. Dental stains are discolouration of the teeth and are caused by a variety of things that adhere to the tooth structure, dental plaque and calculus or may be part of the internal structure of the tooth.
Causes of dental stains

Causes of dental stains in the oral cavity are classified into:

Exogenous causes Endogenous causes These are topical substances taken from outside the mouth

Exogenous causes:

which contains chromogenic deposits that resulted in discolouration of the teeth. Such substances include:
o o

Foods and drinks eg coffee, tea, cola; wines, apples, potatoes etc. Tobacco use eg smoking or chewing tobacco etc.

o o o o o o

Dental materials used in prosthesis Metals Certain drugs or medications eg tetracycline Trauma Poor oral hygiene Environment

Endogenous causes: These include substances from within the body whose effects results in staining the teeth. Examples are:
o o o o o o o o

Diseases eg amelogenesis imperfect; dentinogenesis imperfect etc. Pregnancy Bacteria Head & neck radiation & chemotherapy Advancing age Genetics Imperfect development of the tooth Excess fluoride in drinking water.

Classification of dental stains

There are three ways of classifying dental stains, which can either be classified according to its:

Location Origin Nature

Classification by location: According to location, dental stain is classified into two as:
o o

Extrinsici.e. on the tooth structure Intrinsic---i.e. in the tooth structure

Classification by origin: According to origin, dental stain is also classified into two as:

o o

Exogenous i.e. from within a tooth structure Endogenous---i.e. from outside a tooth structure

Classification by nature: This classification is based on:

o

Age-related dental stains--- encompassing both extrinsic & intrinsic dental

stains
NOTE: - The extrinsic stains are also referred to as exogenous stains; while the intrinsic stains are as well called endogenous stains. However, the age-related dental stains encompass both the extrinsic and intrinsic stains. This is because both the extrinsic & intrinsic stains could be as a result to age related changes in the mouth. Extrinsic stains also called exogenous stains:

They are discolorations located on the outer surface of the tooth structure and caused by topical or extrinsic agents or predisposing factors and other factors. Extrinsic stains occur when the outer layer of the tooth i.e. enamel is discoloured, causing superficial colour changes, by the adherence of coloured substances on tooth or plaque surfaces. Causes of extrinsic stains: Examples of common causes of extrinsic stains are:
Coloured compounds found in foods and drinks such as coffee, tea, red wine,

colas & curries etc.

Tobacco/cigarette smoking. Poor oral hygiene

Predisposing factors of extrinsic stains: These include the following.

o o

Dental Plaque & dental calculus --- gives teeth yellow appearance. Foods & beverages---- due to acidic contents in them that open up enamel pores thereby exposing it to deposition of tannins especially in tea, coffee

etc that result in teeth surface discolouration. Besides, beverages can easily
be affected by a change in temperature while in the mouth thereby making teeth to expand & contract making it possible for stains to permeate.
o

Tobacco----- due to accumulation stain-producing agents eg nicotine, causing dark & deep discolouration.

Poor oral practices---- due to inadequate or inefficient tooth brushing or flossing frequently, thereby leading to faster build up & accumulation of plaque & dental calculus that can also cause stain teeth. Chromogenic bacteria---due to bacteria action and iron in saliva and gingival exudates. Metallic compounds---- due to interaction of metal with dental plaque to produce surface stain. Topical medications--- such as using Chlorhexidine mouth wash for a prolonged period of time. Enamel defects---- due to presence of rough surfaces that make teeth susceptible to accumulation of stain-producing foods. Salivary dysfunction-----due to diminished salivary output or decrease in saliva caused by some disease conditions.

NOTE:-Extrinsic stains are of exogenous origin that which do not involve the tooth structures itself; and are relatively easy to manage with the use of regular oral dentifrices and can be removed by scaling and polishing i.e. scale clean or micro abrasion can be carried out. Types of extrinsic stains and their relative causes

The various common categories of extrinsic stains and their causes include:
o

Brown or black stain--- mostly caused by Dental plaque, Dental calculus & Food particles. Dark brown & black stains on cervical 1/3rd to of a tooth mostly caused by Tobacco Red-black stains on teeth, gingivae & oral mucosa---mostly caused by pan chewing Blue-green stains--- mostly caused by Mercury & Lead metals. Black stains on gingival margins mostly caused by Actinomyces bacteria species. Green stains --- mostly caused by Penicillium & Aspergillus bacteria species Orange stains--- mostly caused by flavobacterium lutescens Brown stains Chlorhexidine rinse--- mostly caused by Stannous fluoride, Tannins in tea, coffee & other food

o o

o o o

beverages
o

Black stains mostly caused by Iron containing oral solution, Silver nitrate, Manganese & Silver. Violet-black stainsmostly caused by Potassium permanganate mouthwash Red stains mostly caused by Chewing pan

o o

Intrinsic stains also called endogenous stains:

These are discolourations inside the tooth structure and are mostly permanent. The intrinsic stains occur when the inner structure of the tooth i.e. dentin darkens or gets a yellow tint. Intrinsic staining reflects structural changes within the tooth itself involving enamel, dentine & pulp. The distribution of intrinsic stains varies from localized to a regional or even a generalized involvement of primary and secondary dentition. Its origin can be:

Endogenous i.e. from inside the tooth--- type of intrinsic stains are referred to as endogenous intrinsic stains. Exogenous i.e. from outside the tooth--- type of intrinsic stains are referred to as exogenous intrinsic stains.

Classification of intrinsic stains:

They are classified into two as:o o

Pre-eruptive intrinsic stains. Post-eruptive intrinsic stains.

Pre-eruptive stains: - Are discolourations usually caused by disturbances occurring during the development of tooth/teeth which includes any prenatal influence, i.e. changes during mothers pregnancy. The pre-eruptive discoloration on teeth varies depending on the causing agent but it usually has more severe effects, ranging from tolerable yellow shades to brown red colors. This is the main cause behind yellow teeth in children. Pre-eruptive discoloration tends to be generalized, i.e. affecting

the same teeth bilaterally and it has a symmetrical appearance.

Contributing agents of pre-eruptive stains: They include:

o

Metabolic or systemic problems such as alkaptonuria, amelogenesis

imperfecta & congenital hyperbilirubinaemia etc.

o o o

Drugs - mostly pre- or post natal tetracycline administration Chemicals such as ingestion of excessive fluoride etc. Trauma from falling over & blow to facial regions etc.

Post eruptive stains: Are discolourations involving oral influences occurring after the tooth/teeth have erupted into the dentition. These tend to be less severe, depending on the causing agent, and are generally localized. Contributing agents of post-eruptive stains: These include:
o o o

Drugs such as Tetracycline & oral contraceptives etc Chemicals such as prolonged usage of Chlorhexidine mouth rinse etc Trauma due to pulpal haemorrhage remnants & internal root resorption etc

Causes

of

intrinsic

stains:

Examples

of

the

common

causes

of

intrinsic

discolourations are:

Natural aging. Trauma to teeth. Dental caries. Infections. Nutritional deficiencies. Tooth decay (caries) Genetic factors/defects e.g. congenital erythropoietic porphyria, congenital

hyperbilirubinaemia, Amelogenesis imperfecta & Dentinogenesis imperfecta etc.

Hereditary diseases. Medication/chemicals e.g. tetracycline & fluoride (when taken during the tooth

formative years) etc.

NOTE: - Intrinsic stains are much harder to manage than extrinsic stains. Only some intrinsic stains can be removed by bleaching, or managed by porcelain veneers and dental crowns i.e. capping.

 Age-related dental stains:

The age-related dental stains do result from a combination of extrinsic and intrinsic factors, in which dentin naturally yellows over time. The origin of agerelated dental stains can as well be either endogenous i.e. from inside the tooth or exogenous i.e. from outside the tooth. Relative to age-related discolourations, the enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Besides, certain foods and smoking also can stain teeth as people get older. Finally, chips or other injuries also can discolour a tooth, especially when the pulp has been damaged. Contributing factors: These include:
o o o

Thinning of enamel Accumulation of dentine deposition stains Changes in the saliva composition

Management of dental stains

The management of dental stains is centered about:

Prevention Treatment

Prevention: Preventive means of managing dental stains formation are more efficient in controlling extrinsic discolourations on the teeth i.e. stains located on the tooth surfaces, but

not incorporated into the tooth structures. This can be achieved by the following means:
o

Proper & regular tooth brushing and flossing to get rid of dental plaque, reduce dental calculus buildup & stains accumulation. Avoiding diets that are highly rich in sugar. Eating more fiber-rich vegetables & self-cleansing fruits which helps cleanses the mouth. Quitting smoking Avoid consumption of beverages that contains chromogenic substances.

o o

o o

Minimize acidic foods that can contribute to teeth discolourations eg citrus fruits. Regular dental visit for professional scaling & ultrasonic dental cleaning Minimizing the rate of mouthwash usage. Drinking lots of water regularly to help wash away chromogenic bacteria colonies. root planing involving

o o

Treatment: These are means of managing intrinsic discolourations within the teeth i.e. most tenacious dental stains that

are incorporated into the teeth structures, because it cant be removed

with mare tooth brushing & all the other measures used for the extrinsic stains. These means include:
o o o

Tooth bleaching. Application of porcelain veneers. Use of dental crowns i.e. capping.

INTODUCTION & GENERAL OVERVIEW Gnathology is the study of masticatory system including its physiology, functional disturbances and treatment. The oral cavity or the mouth is an important part of the human body, which serves the basic function of mastication as well as provides an initial place for the diagnosis

of systemic diseases. Mastication is the chewing or grinding of food in the mouth into a soft, warm mush called a bolus, which can be easily swallowed. It is important to understand that proper mastication is not only a means of fully exploiting the nutritious value of food, but it also helps the mouth and teeth stay clean. Besides, the cycles of jaw and tongue movement during feeding produce not only the breakage of food but its intra-oral transport; which activity predominates depends upon the physical characteristics of the food, and tooth-food-tooth contact made during jaw closure, that produces two clearly different phases of closure. Conversely, in cycles with a mainly transport function (eating soft food), the pattern of jaw movement during closing and during opening consequently varies with food consistency. However the basic plan of movement in mastication is produced by the activity of a brainstem pattern generator which receives input from both cerebro-cortical and peripheral sources. NOTE: Mastication is the first step of digestion in mammals that breaks down food into simple carbohydrates that can be converted into energy or stored for later use, which requires that the jaw muscles, tongue, and teeth work together to push food around the mouth in a rhythmic motion. The actions in mastication are what increase the surface area of food that enables the digestive enzymes in saliva to work efficiently so as to kill bacteria and begin digestion. Mastication

Mastication refers to the cyclic movement produced by the elevation and depression of the mandible as well as the concerted reflex actions sequences of other oral structure as food is sheared and formed into a bolus in preparation for its onward transfer from the mouth i.e. oral cavity into the stomach. The processes involve in mastication includes biting and tearing of food into manageable pieces, in which food is moistened and mixed with saliva; In all these processes, there is the involvement of a complex and coordinated physiologic mechanism.
NOTE: - Mastication usually involves using the teeth including the incisors and cuspids teeth for tearing; the molars & premolarsfor grinding.

Significance of Mastication: Amongst some of the significances of mastication are to enhance:

o o o o o o

Mixing of ingested food with secretions from the salivary glands Bolus formation i.e. mashed up food ball Easier transport of ingested food along the digestive tract Increased in surface area available for enzymatic digestion Beginning of starch digestion through the enzymes present in saliva Stimulating mucosal circulation & keratinization of mucosa

o o

Increase in the thickness of periodontal ligament Stimulation of alveolar bone growth The word mastication is derived from the Latin masticre, which translates

Mastication Chewing:

as "to chew." Mastication of food is the initial stage in the process of digestion in which large pieces of food are reduced for swallowing. At this digestive process stage, and during the mastication process, the food is positioned between the teeth for grinding by the cheek and tongue. While, as chewing continues, the food is made softer and warmer, & the salivary enzymes begin to break down carbohydrates in the food. After chewing, the food now called a bolus enters being swallowed into the esophagus via peristalsis & continues on to the stomach, where the next step of digestion occurs. Generally, the ability to masticate evolved, so that mammals including humans could take advantage of a wider variety of foods. For instance,
Carnivores---- have jaws and teeth that enable them to tear meat and

swallow with little chewing

Herbivores---- such as cud-chewing cows, almost continuously masticate

high-fiber diets. Thus, mastication is generally a factor in the bodys ability to feel satisfied after a meal. Because, thorough chewing of food is what enables the tongue to sense & appreciate the basic tastes as contained in different food varieties i.e.

sweet, sour, salty & bitter. However, it is important to note that, slow chewing is
what draws more nutrients from food and signals the rest of the digestive system to start juices flowing to digest the meal that is en route.
Physiologic Control of Mastication i.e. Mastication Motor Program:

Mastication is an unconscious act, generally controlled by higher conscious input in the brain stem of the body, in which this input in continuously being monitored, controlled & also regulated to adapt to changes in relation to the various types of food placed in ones oral cavity; as well as the type of occlusion in ones oral cavity. Thus is important to note that:

The motor program for mastication is a hypothesized central nervous system function by which the complex patterns governing mastication are created and controlled. The feedback from proprioceptive nerves in the teeth & the temporomandibular joints are what govern the creation of neural pathways, which in turn determine the duration & force of individual masticatory muscle activation (and in some cases muscle fiber groups as in the masseter and temporalis). Conscious mediation is important in the limitation of parafunctional habits as most commonly, the motor program can be excessively engaged during periods of sleep and times of stress, just as excessive input to the motor program from myofascial pain or occlusal imbalance can contribute to parafunctional habits. Mastication as controlled by the brain stem of the body, is a learned skill centered about two separate recognizable acts in the chewing process: First is a combination of prehension and incision in which the food is secured by the lips and bitten by the front teeth. Second is mastication, the major activity during which the food is mashed between the back teeth. Chewing mastication in humans as an unconscious act is actually asymmetrical and unilateral, in which at the: Working side: - It possesses the greatest adductor force, but articular eminence is less substantially loaded. Balancing side: -- It possesses the less adductor force and the articular eminence is substantially loaded. Initial action: - Contraction of inferior head of lateral pterygoid muscle occurs to initiate mandibular deviation to working side. The total physiologic masticatory chewing cycle motor control occurs through three phases including: Opening stroke during which the mandible is lowered. Beginning closing stroke during which the mandible is rapidly raised until the entrapped food is felt

Power stroke, in which the food is compressed, punctured, crushed and sheared.
o

Much of the chewing masticatory process motor control is caused by chewi ng reflexes that brings about the rhythmic opposition & separation of the jaws with the involvement of the teeth, lips, cheeks & tongue for chewing of food in order to prepare it for swallowing & digestion.
Physiologic Masticatory Forces

Physiologic masticatory forces are often referred to as masticatory bite forces and are the forces generated on biting on a food substance. These forces are exerted during mastication with various variations in regions, persons, age, sex, food habits & races. The physiologic masticatory forces are derived as a result masticatory muscles physiologic contractions & relaxation, whose resultant effect yields to the production of forces for mastication. Influencing Factors of Masticatory Bite Forces: These factors include the following: --

Dietary consistency Degree of chronic periodontal disease Particular tooth Jaw separation Tooth-cusp configuration Natural/artificial teeth Biting practice

Physiologic Phases of Masticatory cycle

The masticatory cycle is what enhances the repetitive sequence of jaw opening and closing with a profile in the vertical plane i.e. chewing cycle in mastication. It is the significant physiologic pathway in which the mandible is

moved during chewing which is characterized by opening, closing, retrusive, protrusive & lateral jaw movements. Although, there are about 15 chews chewing cycle in a series from the time of food entry into the mouth, until swallowing, yet

the most significant masticatory cycle during physiologic masticatory process are three, which include:
o

Opening phase --- where mandible depression

the mouth is opened & it is characterized with

Closing phase--- here the mouth is closed & it is characterized with mandible elevation i.e. raising the mandible

towards the maxilla

o

Occlusal/intercuspal phase--- where the mandible become stationary as the teeth from both upper and lower jaw approximate

Opening Phase: It lasts from the time of intake of bolus into the mouth i.e. when the

mouth opens by reflex inhibition of elevators to when the mouth closes i.e. by isotonic contraction of depressor muscles. This phase is characterized by significant
physiologic forwards and backwards movement of the mandibular condyle. Closing Phase: In this phase there is an initial physiologic isotonic contraction & a final physiologic isometric contraction by elevator muscles-masseter action, characterized by precedential & sequential gradual transition from isotonic contraction to isometric contraction, in which the condyle on the working end move almost backward in a horizontal pattern and while on the balancing side, it moves upwards & backwards in a reverse direction. Intercuspal Phase: This is the phase that brings about a significant physiologic tooth to tooth contact, in which the path of the mandibular closure is determined by the physiologic slide of the mandibular teeth along the cuspal inclination of the maxillary counterparts, as characterized by slow penetration of food particles and tooth contact as well as the sudden breakage of food particles that leads to the subsequent unloading reflex and separation of occluding surfaces of the teeth.

Physiologic Masticatory Reflexes

These are otherwise called jaw reflexes that which involves highly stereotyped & automated physiologic responses to specific physiologic masticatory stimulus. They are type of stretch reflexes brought about by physiologic activation of muscle spindles within the masticatory muscles.
Types of Masticatory Reflexes

There five basic physiologic masticatory reflexes types which include:

o o o o o

Jaw closing jaw jerk reflexes Jaw opening reflexes Jaw unloading reflexes Tooth contact reflexes Horizontal reflexes.

Jaw Closing Reflex jaw jerk reflex: It is a physiologic masticatory stretch reflex that lasts 7-12 minutes & is generated by stretching muscle spindles in the masseter muscle. It is characterized by a sharp downward tap on the chin when the mandible is held loosely in the rest position with the resultant effect as contraction of the muscle that subsequently brings the teeth into occlusion during mastication. Jaw Opening Reflex: This type of physiologic masticatory reflex results from mechanical or electrical stimulation of the lips, oral mucosa or the teeth, leading to a slight opening movement of the mouth due to the inhibition of mandibular elevator muscles activity and it is characterized by physiologic simultaneous contractions of the depressor masticatory muscles. Jaw Unloading Reflex protective physiologic reflex: This occurs when the jaw is suddenly unloaded, on sudden encounter with the hard object, mastication become seized or stopped abruptly, due to reflex inhibition of masticatory elevator muscles and simultaneous excitement of jaw masticatory

depressor muscles e.g. sudden mastication of a stone alongside with food inside

the mouth during mastication. This physiologic masticatory reflex is what serves to
protect the teeth from sudden masticatory damage. Tooth Contact Reflex: It is a physiologic masticatory reflex change that occurs in the masticatory elevator muscles when the upper and lower teeth are abruptly napped together. It is a transient physiologic masticatory action followed by a silent and then a phase of increased and decreased activity in the masticatory elevator muscles, without any resultant side effect on the masticatory depressor muscles. Horizontal Jaw Reflexes: These are the lateral, protrusive & retrusive reflexes of the mandibular reflexes.
Masticatory Apparatus

Chewing food i.e. mastication is a complex technique that which cannot be effectively accomplished not without the significant roles played by certain structures in and around the oral cavity i.e. the mouth. Some examples of these structures include:
o o o o o o o

Teeth Gum i.e. gingivae Lips Tongue Cheeks Palate Floor of the mouth

The teeth: The teeth are one of the hard, white structures in the mouth used to chew food, i.e. to break up and crush food so it can be swallowed i.e. pushed down

into the stomach. Some animals also use teeth as a weapon. Children have 20 teeth
and are the first teeth "i.e. primary teeth" that come through the skin of the jaw

when a baby is 5-10 months old. By the age of 11-12yrs most children do have 28 adult teeth; while the last 4 teeth, called wisdom teeth or third molars come in by age 17-21 in most people. However, some people many a times never grow wisdom teeth, or they may have only 2 instead of 4. The teeth are set into sockets alveolus in the maxilla i.e. upper jaw, and in the mandibular i.e. lower jaw. Teeth on the right tend to mirror those on the left side.

Mastication in mammals especially humans is characterized by large vertical movements of the lower jaw usually on one side of the dentition, because humans teeth are admirably designed for chewing, and these teeth are:

The anterior teeth comprising of central, lateral incisors & the canines. The posterior teeth made up of the premolars & molars.

The first frontal teeth are the incisors, immediately followed by lateral incisors, then a single canine, preceded by the first and second premolar only in

adult as children dont have premolars, and finally the three molars at the posterior extremities of each arch.
NOTE: - Each tooth comprises of four tissues and these are:

Enamela highly mineralized structure made of Hydroxyapatite crystals. Dentine--- a mineralized structure to some extent that constitutes the bulkiness of the tooth structure containing nerve vasculature network. Cementum---located atop root region dentine that also containing substantial amount of nerves, blood vessel & lymphatics Pulp ---a highly endowed vascular structure, richly containing nerves, blood vessels and lymphatics

Four basic tissues of the tooth

The anterior teeth incisors: Are the front teeth, very harp & shaped like a chisel.

Human Permanent Anterior Incisors

Masticatory functions of incisors:

Used for cutting food and a little bit of tearing action.

The anterior teeth canines cuspids: Are sharp teeth on either side of lateral incisors i.e. at the corner

edges of the jaws.

Human Permanent Anterior Canines

Masticatory functions of canines:

Work together with incisors to tear & bite food. Serve to hold food firmly in order to tear it apart.

The posterior teeth premolars bicuspids: They are smaller than the molar teeth.

Human Permanent Posterior Premolars

Masticatory functions of premolars:

Used for tearing and crushing food i.e. grinding action during mastication.

The posterior teeth molars: These are large and most complex of teeth, with wide flat surfaces.

Human Permanent Posterior Molars

Masticatory functions of molars:

For biting, chewing & grinding food during mastication.

NOTE: - Wisdom teeth are a set of teeth in a person's mouth. Most people get them late in their teenage years or in their early twenties. Many people have to have surgery to get rid of them because they often grow in a crooked way.

The gum gingivae: The gingivae are the soft tissues in the mouth known as the gums that covers the bone holding the teeth in place. Gingivae consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth, which surrounds the teeth and covers the jaw bone. It is tightly bound to the underlying bone.

Masticatory functions: Provides a seal around the mouth, and creates a protective barrier which helps resist the friction of food passing over the teeth. The Lips: Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be erogenous when used in kissing and other acts of intimacy. Masticatory functions: They serve to guide and hold food or to get it in the mouth. In addition, lips serve to close the mouth airtight shut, to hold food and drink inside, and to keep out unwanted objects.
NOTE: - Of all the organs in the human body, the lips are among the most mobile. In addition, the lips are very sensitive and have numerous receptors on their surface to help determine temperature and texture of food during mastication.

The tongue: The tongue is a muscular organ in the mouth, covered with moist, pink tissue mucosa, tiny bumps papillae--- that gives its rough texture, and thousands of taste buds i.e. a collection of nerve-like cells--covering the surfaces of the papillae. The tongue is anchored to the mouth by webs of tough tissue and mucosa. The tether holding down the front of the tongue is called the freanum. In the back of the mouth, the tongue is anchored into the hyoid bone. Masticatory functions: The tongue is vital for tasting i.e. the primary organ of taste gustation; chewing, digesting and swallowing food, as well as for speech. In humans a secondary function of the tongue is phonetic articulation. The tongue also serves as a natural means of cleaning one's teeth.
Comprehensively, the tongue serves to maneuver food within the oral cavity (i.e. during opening phase of mastication); initiating its physiologic and mechanical break down as it pushes food to occlusal surfaces of the teeth, as it helps repositions the crushed food and divides it into portions that require more chewing and portions that are to be swallowed. While after eating, the tongue sweeps the teeth to remove any food residue that has been trapped in the oral cavity. And with the help of the cheeks, it guides food to be chewed by the teeth so it can be properly swallowed and digested.

The cheeks: The cheeks form the sides of the mouth and continue along the front of the face to the lips. The cheeks are composed of subcutaneous fat, with the outside layer covered by skin and the inside consisting of a mucous membrane. Cheeks are fleshy in humans and other mammals, the skin being suspended by the chin and the jaws, and forming the lateral wall of the human mouth, visibly touching the cheekbone below the eye. Masticatory functions: During mastication i.e. chewing and digestion, the cheeks muscles especially

the buccinators and tongue between them serve to keep the food between the
teeth, as it help compresses and keeps food in the oral cavity. The palate: The palate is the roof of the mouth in humans and other mammals, which separates the oral cavity from the nasal cavity. It is divided into two parts, anterior

bony part ----hard palate; and posterior fleshy part ---- soft palate, muscular palate
or velum. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone. Masticatory functions: Separates the nasal cavity and nasopharynx from the posterior part of the oral cavity and oral portion of the pharynx; provides a posterior seal in conjunction with the posterior superior surface of the tongue as it occludes the oral cavity from the oropharynx. Prevents the unwanted escape of fluid and food up through the nose and while the tongue allows fluid and food to collect in the mouth until swallowed. However, when food is not being swallowed this passage is left open, making it possible to breathe through the mouth and through the nose.
NOTE:- Palate is what makes it possible to breathe and chew at the same time and also functions in speaking and singing as it directs and resonates sound.

The Floor of the Mouth:

The floor of the mouth contains largely of the tongue. It is formed by mucous membranes that extend inward from both sides of the lower jawbone and from the tongue to the gum line, forming a crescent shape. The floor of the mouth can be seen only when the tongue is raised. In the midline is a prominent, elevated fold of mucous membrane frenelum that binds each lip to the gums and on each side of this is a slight fold called a sublingual papilla, from which the ducts of the submandibular salivary glands open. Running outward and backward from each sublingual papilla is a ridge plica sublingualis that marks the upper edge of the sublingual under the tongue salivary gland and onto which most of the ducts of that gland open.
NOTE: - Within the floor of the mouth are glands, portions of the muscles of the tongue and nerves. And these are the structures in conjunction with other the teeth, cheeks, lips and tongue facilitates mastication and swallowing.
The Masticatory Muscles

There are about 639 muscles, composed of 6 billion muscle fibers in the human body. Each fiber has 1000 fibrils, which means that there are 6000 billion fibrils at work at one time or another. Masticatory muscles are otherwise called muscles of mastication & are the group of muscles that help in movement of the mandible when one chews or bites on food substances i.e. they are muscles

required mainly to control the jaws during mastication. These muscles generally
serve to control the opening & closing the mouth as well as playing significant roles in the configuration of face.

Classification of masticatory muscles: The masticatory muscles are classified into two major groups as:

Primary basic muscles Accessory muscles

Primary muscles of mastication

The primary muscles of mastication are of four types, & are the basic masticatory muscles that move the mandible and are involve in chewing. They comprise of:

Masseter muscles

Temporalis muscles Lateral pterygoid muscles Medial pterygoid muscles

NOTE: - The masseter, temporalis & medial pterygoid are powerful closers of the joint and account for the strength of the bite. Whereas the medial and lateral pterygoids move the mandible from side to side and also protrudes the mandible.

Masseter musculus masseter: This is the most powerful muscle of mastication & most efficient masticatory muscle useful for the physiologic movement of the jaw as well as for applying good bite force for mastication. It consists of three overlapping layers i.e. the superficial, middle & deep layers. The origin of the whole muscle is mainly from the zygomatic process.

Location of masseter muscles location in human skull

Masticatory Action:

Elevates mandible as in closing of the mouth Enhances lateral movement of the mandible for efficient chewing & grinding

of food

Improves unilateral chewing and retraction of the mandible, with minimal electric activity in resting position Close the jaws and exerts pressure on the teeth, particularly in the molar region.

Temporalis musculus temporalis:

It is the largest extensively fan shaped masticatory muscle in appearance which covers the temporal area of the skull & can easily be seen or felt during the closure of the mandible. It has deep head containing anterior, middle & posterior fibers, and a much smaller superficial head. Its origin is the floor of temporal fossa & deep surface of temporal fascia; while its insertion point is the tip and medial surface of coronoid process & anterior border of mandibular ramus. It is richly supplied by the temporal branches of mandibular nerve (CN V3).

Location of the temporalis muscles in human skull

Masticatory Action:

Elevates mandible and so closes the mouth & approximates the teeth. Retracts the mandible, while crushing of food between the molars as its

fibers draws backward and forward the mandible after it has been protruded

Closes the jaws after protrusion. Contributes to the side to side grinding movement of the mandible when it has been protruded.

Lateral Pterygoid musculus pterygoideus lateralis & musculus pterygoideus externus: It is a short, conically thick muscle with two heads a superior head & an

inferior head , whose apex points posteriorily. The superior head originates from
infra-temporal surface & infra-temporal crest of the greater wing of the sphenoid bone, while the inferior head comes from the lateral surface of lateral Pterygoid plate. Its insertion is on the neck of the mandible, articular disc & capsule of the

temporomandibular joint, while it is richly innervated by mandibular nerve via Pterygoid nerve from the anterior division, which enters its deep surface.

Location of the lateral pterygoid muscles in human skull

Masticatory Action:

Depresses the mandible chin and helps protrude it forward for a naturally smooth opening of the jaw if acting together with medial pterygoid . Serves to effect side-to-side rotational movements of the mandible when

acting alone or alternatively with medial pterygoid .

Helps in opening the jaw during closing the backward gliding of the articular disc & mandibular condyle.

Medial Pterygoid musculus pterygoideus medialis or musculus pterygoideus internus: This is a thicker, quadrilateral muscle located deep to the mandibular ramus that also has two heads deep head---from the medial surface of lateral pterygoid plate & pyramidal palatine bone process as well as superficial headfrom the maxillary tuberosity which embraces the inferior head of the lateral pterygoid muscle. Its innervations are derived from the mandibular nerve via pterygoid nerve.

Location of the medial pterygoid muscles in human skull

Masticatory Actions:

Assisting in the elevation of the mandible Closure of the jaws Produces side to side movement of the jaw used to triturate food Protrudes the mandible especially the chin if acting together with the lateral

pterygoid muscle

Protrudes sides of jaws only when acting alone Produces masticatory grinding motion while acting alternately with lateral

pterygoids
NOTE: - If the pterygoideus internus and externus of one side act in the same direction, the corresponding side of the mandible is physiologically drawn forward while the opposite condyle remains comparatively fixed and side-to-side movements, such as occur during the trituration of food.

Accessory Muscles of Mastication Though there are numerous accessory muscles of mastication, otherwise referred to as masticatory assisting muscle. However, this presentation is centered about such muscles as the:

The buccinators The digastricus Mylohyoid Geniohyoid The orbicularis oris

 Buccinators musculus buccinators: The buccinators otherwise

called

trumpeter

muscles

are

thin

quadrilateral muscle, occupying the interval between the maxilla and the mandible in the cheek at the side of the face. The buccinators are attached to the outer surfaces of the alveolar processes of the maxilla and mandible opposite the molar teeth, and, behind, to the anterior border of the pterygomandibular raphe which separates the muscle from the superior constrictor of the pharynx.

Location of the buccinators muscles in human skull

Masticatory Action;

Compresses the cheeks against the teeth & gums thus moving food between

the teeth during grinding.

Assists the tongue in directing food between the grinding molar teeth Serves to expel air between the lips i.e. act of blowing when cheeks are distended with air

Digastricus anterior belly musculus digastricus:

The digastricus muscle is a small muscle located under the jaw. It lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. The anterior belly arises from digastrics fossa (mandible); posterior belly from mastoid process of temporal bone. It is inserted into the intermediate tendon (hyoid bone).

Location of the digastricus muscles in human skull

Masticatory Actions:

Elevates hyoid bone when the digastrics muscle contracts Depress the mandible i.e. open the mouth when the masseter and the temporalis are relaxed.

Mylohyoid musculus mylohyoideus:

The mylohyoid muscle is a muscle running from the mandible to the hyoid bone, forming the floor of the oral cavity. The mylohyoid muscle is flat and triangular, and is situated immediately above the anterior belly of the digastrics muscle. It forms, with its fellow of the opposite side, a muscular floor for the cavity of the mouth.

Location of the mylohyoid muscles in human skull

Masticatory Action:

Depresses the mandible

Elevates the hyoid, the floor of the oral cavity, and the tongue. This is particularly important during swallowing and speaking.

Geniohyoid musculus geniohyoideus:

The Geniohyoid muscle is a narrow muscle situated superior to the medial border of the mylohyoid muscle. It is named for its passage from the chin ("genio -" is a standard prefix for "chin") to the hyoid bone.

Location of the geniohyoid muscles in human skull

Masticatory Actions:

Carry hyoid bone and the tongue upward during deglutition Serves to drive down mass of food from the mouth into the pharynx during the first act of deglutition Assists in depressing the mandible.

Orbicularis oris musculus orbicularis oris:

It is the sphincter muscle around the mouth. Orbicularis Oris is a complex of muscles in the lips that encircle the mouth; until recently it was misinterpreted as a sphincter, or circular muscle, but it is actually composed of four independent quadrants that interlace and give only an appearance of circularity. It is also one of the muscles used in the playing of all brass instruments and some woodwind

instruments. It is sometimes known as the kissing muscle because it is used to pucker the lips, when it contracts.

Location of the orbicularis oris muscles in human skull

Masticatory Action:

Compresses mouth Purse lips

Summary
The physiologic pattern of masticatory muscles activities is centered about significant contraction of muscles which serves to control the jaw during mastication. The pattern of activity is determined by a number of factors which include:

The species of organisms masticating Type of food masticated Degree of food breakdown Individual factors.

And the general pattern of activity as seen in the chewing cycle or masticatory cycles comprise of:

Inactivation of closing muscles during jaw opening. Slow & steady increase in jaw closing muscles as the teeth begin to interdigitate or rather as soon as food is encountered between the teeth.

Amongst the unique physiologic features of masticatory muscles are:

Possession of shorter contraction times than other body muscles. Incorporation of more muscle spindles to monitor their activities. Lack of golgi tendon organs to monitor tension. Possession of predominantly white fibres which perform fast twitching. Ability to withstand stress without getting fatigued so easily. Psychological stress increases the activity of jaw closing muscles. Occlusal interferences cause a hypertonic synchronous muscle activity. Closing movement also determined by the height of the teeth.

There are four basic masticatory muscles known as primary muscles of mastication and are:
S/n Muscle Origin Insertion Action

Elevates, retracts & laterally moves mandible

1

when

Masseter

zygomatic arch

Mandible chewing/swallowing/talking

to

effectively grind food.

Elevates Mandible mandible mandible when & Retracts

Temporalis

Temporal frontal bones

&

grinding

food

between the molars.

Elevates, moves mandible side to side, closing the jaws & sideways Pulls down mandible to opens jaws, moving the jaws

Medial pterygoid

Sphenoid (Lateral pterygoid plate)

Mandible

Lateral pterygoid

Sphenoid (Lateral pterygoid plate)

Mandible

protrudes mandible & moves the mandible side to side

There are also four groups of assisting masticatory muscles known as accessory muscles of mastication and are:
S/n Muscle Origin Insertion Action

Buccinators

Maxilla Mandible Mandible

& Orbicularis oris Hyoid bone Hyoid chin &

Compresses cheeks to prevent

accumulation of excess food in the vestibule of mouth.

Depresses the mandible. Supports the floor of the mouth during depression of mandible like in swallowing. Depresses the mandible when swallowing and talking. Compresses, purses lips to aid in

Digastric

(digastrics fossa)

Mylohyoid

Mandible (internal) Inferior genial

Geniohyoid

tubercle

Hyoid bone

Orbicularis oris

Maxillary bone and mandible

Lips

opening of the mouth; shutting of the mouth & controlling the movements of lips and cheeks.

INTODUCTION & GENERAL OVERVIEW Even if early digestion begins in the mouth with some enzymes, it is the stomach that does the major work. With acid secretions and muscle contractions, the stomach breaks the tissue and cell membranes of food. But before the food (the food bolus) arrives in the stomach, one must swallow it. This process is called swallowing or deglutition. It is important to coordinate the deglutition so it

does not interfere with respiration and vocalization. Otherwise food or water could reach the trachea and provoke coughing or even choking. This is because; the basic plan of movement in

swallowing is produced by a succession of muscular contractions from above downward or NOTE:

While Mastication is the first step of digestion in mammals that breaks down food into simple carbohydrates that can be converted into energy or stored for later use, which requires that the jaw muscles, tongue, and teeth work together to push food around the mouth in a rhythmic motion. Swallowing is a process, whose action is generally initiated at the lips, and precedes back through the oral cavity mouth & the food is subsequently moved automatically along the dorsum of the tongue. While the actions in mastication are what increase the surface area of food that enable the digestive enzymes in saliva to work efficiently so as to kill bacteria and begin digestion. The actions in swallowing are what keeps food out of the larynx & dilates the esophageal opening so that food is passed quickly towards the stomach by significant physiologic peristaltic contraction.

Swallowing or deglutition involves the subsequent passage of the food earlier masticated or chewed in to the stomach. In which, there is the involvement of a more complex and organized coordinated patterns of physiologic mechanism.
Swallowing

Swallowing is a succession of muscular contractions from above downward or from the front backward; that propels food from the oral cavity towards the stomach. It is often referred to as deglutition i.e. the act or process of swallowing. In deglutition, the tongue pushes the bolus toward the pharynx throat and into the esophagus, a muscular tube that leads from the throat to the stomach. To prevent food or liquid from entering the trachea windpipe, the epiglottis a small flap of

tissue closes over the opening of the larynx voice box during deglutition.

Structures involve in deglutition

Upon entering the esophagus, peristalsis wave-like contractions of smooth muscle carries the bolus toward the stomach. Two layers of smooth muscle, the outer longitudinal lengthwise and inner circular, contract rhythmically to

squeeze food through the esophagus. Throughout the digestive tract, smooth muscle peristalsis aids in transporting food. From the esophagus, the bolus passes through a sphincter muscular ring into the stomach. All sphincters located in the digestive tract help move the digested material in one direction. When the stomach is empty, the walls are folded into rugae stomach folds, which allow the stomach to expand as more food fills it. Significant of swallowing

Ensuring adequate nutritional supply to the general body in order to improve physiological well being

Types of swallowing

Swallowing can be classified according to how the mandible is braced and stabilized by the tongue pushing forwards between the arches and against the anterior part of the palate. In this sequence there are two basic types of swallowing as:

Somatic i.e. adult swallow Visceral i.e. infantile swallow

Somatic Adult swallow --- Is a type of swallowing pattern seen in adults in

which the teeth are used to stabilize the mandible.

Visceral Infantile swallow --- Is a type of swallowing pattern seen in infants. In

this pattern the tongue is being thrusted between gum pads to obtain the seal during swallowing.
NOTE: - Visceral type of swallowing does change to mature swallowing when incisors erupt. If retained even after teething i.e. retained infantile swallow; its resultant physiologic effect is malocclusion. Stages of swallowing

Swallowing deglutition is physiologically divided into three phases, which includes:

Oral phase-- the first phase of swallowing which is voluntary that initiates swallowing process

Pharyngeal phase ---Pharyngeal reflexes that runs for 1-2 seconds which is

involuntary that pushes the bolus

into the eosophagus

Eosophageal phase ---Eosophageal contractions which is involuntary that pushes the bolus towards the stomach

Oral Phase This is a voluntary stage in which small amount of food bolus is trapped between the tongue & the palate, which is then pushed towards the pharynx where the swallowing reflex is triggered, thereby initiating involuntary pharyngeal phase of swallowing.

Voluntary oral phase of swallowing

Pharyngeal Phase This is a physiologic swallowing involuntary process that cannot be stopped. The involuntary swallowing reflex is initiated at the entrance of the pharynx, where the bolus stimulates ciliary cells swallowing receptors, sending information to sensory centers in the brain stem medulla. In response to this stimulus, the brain triggers a series of muscle contractions that propel the bolus into the esophagus, in these sequences:

First, the soft palate rises and blocks the entrance to the nasal cavity, preventing reflux of food into the nose. Then, the palato-pharyngeal folds toward the center in order to limit the passage only to the smaller pieces of food. Because, the presence of

larger pieces can inhibit swallowing, and push the bolus back to the mouth.

When the bolus reaches the pharynx, the epiglottis closes the entrance of the trachea to prevent food from entering the respiratory tract. The next step is, using hyoid muscles, to move the pharynx forward and upward to fully open the entrance of the esophagus. Finally, the upper part of the esophagus relaxes and forms a funnel to receive food, and a series of contractions pushes the bolus into the esophagus.

Involuntary pharyngeal phase of swallowing

Eosophageal Phase This is the stage in which the bolus is being pushed through the eosophagus into the stomach. This is done by a wave of contractions i.e. physiologic peristaltic. It takes about 5 to 10 seconds for the wave to travel along the eosophagus and the bolus to reach the stomach.
NOTE: - This peristaltic reflex is initiated by the presence of food itself, which stimulates some afferences of the vagus nerve. The signal travels to the medulla, and returns by vagal efferents, hence the esophageal contraction.

Involuntary eosophageal phase of swallowing

Physiologic nervous coordination & control of swallowing:

Swallowing i.e. deglutition is a complex neuromuscular activities consisting essentially of three phases, an oral, pharyngeal & eosophageal phase. Thus, coordination & control of swallowing is determine by the various stages or phases involved in swallowing in relation to the effect of nervous system on these stages, because each phase of swallowing is being controlled by a different neurological mechanism. Oral phase coordination and control: The physiologic coordination & control of swallowing deglutition at the oral phase involve sequences of events aimed at ensuring normal & necessary physiologic actions to form a food bolus i.e. the state of food in which it is ready to

be swallowed. Thus:

Control of oral phase: This is ensured by the medial temporal lobes & limbic system of the

cerebral cortex, with contributions from motor cortex & other cortical areas.

Coordination of oral phase: This is achieved by initial depression of the mandible, while lips are

abducted i.e. to allow passage of food into the oral cavity & subsequent elevation of the mandible, while the lips become adducted as food gain entry into cavity i.e. to assist in oral containment of food and liquid.
NOTE: - Physiologic nervous coordination & control of activities in the oral phase of

the oral

swallowing is characterized by:

1) 2) 3) 4)

Moistening Mastication Trough formation Posterior movement of food bolus Moistening-- Due to parasympathetic coordination in which food is moistened by saliva from the salivary glands. Mastication-- Here food is mechanically broken down by the action of the teeth as controlled by:

Masticatory muscles acting on the temporomandibular joint, in which food

bolus is moved from one side of the oral cavity to the other by the tongue.

Buccinators muscles (VII) helping to contain the food against the occlusal
surfaces of the teeth.

Chorda tympani (VII) & lesser petrosal (IX) that stimulate mucous saliva
secretions which helps hold bolus together ready for swallowing. Lingual nerve of the tongue (Vc) that sensed any food that is too dry to form a bolus will not be swallowed.

Trough formation-- a preparatory phase, in which food bolus is been formed at the back of the tongue by:

Intrinsic muscles of the tongue (XII) that obliterates against the hard
palate from front to back forcing the bolus to the back of the tongue.

Mylohyoid nerve elevating the tongue to the roof of the mouth. Genioglossus, styloglossus & hyoglossus contracts and moves the tongue
such that it slopes downwards posteriorly in order to enable the bolus pass on to the eosophagus.

Posterior movement of the bolus -- Here the food bolus already formed at the end of the oral preparatory phase is ready to be propelled posteriorily into the pharynx. This anterior to posterior transit of the bolus is facilitated by:

Orbicularis oris contraction & lips adduction to form a tight seal of the
oral cavity. Next, the superior

Longitudinal muscle elevating the apex of the tongue to make contact

with the hard palate and the bolus is propelled to the posterior portion of the oral cavity.

Pharyngeal phase coordination & control: The coordination & control of pharyngeal swallowing phase is started by the stimuli from the receptors of oral phase that provoke the pharyngeal phase; and subsequently is co-ordinated by the swallowing center in the medulla oblongata and pons. In which the reflex is initiated by touch receptors in the pharynx as a bolus of food is pushed to the back of the mouth by the tongue.
NOTE: - This makes swallowing a complex mechanism in which both skeletal muscle tongue and smooth muscles of the pharynx and esophagus are effectively utilized. Besides for the pharyngeal phase to work properly all other egress from the pharynx must be occluded, which includes the nasopharynx and the larynx; and when the pharyngeal phase begins, other activities such as chewing, breathing, coughing and vomiting are concomitantly inhibited. THUS: - Physiologic nervous coordination & control of activities in the pharyngeal

phase is characterized by:

1) 2) 3) 4) 5) 6) 7)

Nasopharynx closure Pharynx prepares to receive food bolus Auditory tune opens Oropharynx closes Larynx closes laryngeal closure Hyoid elevates Food bolus transits Nasopharynx closure This is ensured by:

Tensor palati muscles that enhances tensing of the soft palate. Levator palati muscles of pharyngeal plexus (IX & X) that elevates the soft
palate to close nasopharynx.

Palatopharyngeus

muscles

of

pharyngeal

plexus

(IX

&

X)

that

simultaneously approximates the walls of the pharynx to the posterior free border of the soft palate. Pharynx prepares to receive food bolusby the actions of:

Suprahyoid & longitudinal pharyngeal branches of stylopharyngeus (IX); Salpingopharyngeus branches of pharyngeal plexus (IX & X) that pulled
pharynx upwards and forwards to receive the bolus, in which the palatopharyngeal folds on each side of the pharynx are brought close together through the superior constrictor muscles, so that only a small bolus can pass.

Auditory tube opens by the actions of:

Levator palati branch of pharyngeal plexus (IX & X); tensor palati (Vc) & salpingopharyngeus branch of pharyngeal plexus (IX & X) which close the
nasopharynx & elevate the pharynx to open the auditory tube, that also equalizes the pressure between the nasopharynx and the middle ear.

NOTE: - This does not contribute to swallowing, but happens as a consequence of it.

Oropharynx closes --The oropharynx is kept closed by:

Palatoglossus branch of pharyngeal plexus (IX & X); intrinsic muscles of

tongue (XII) & styloglossus (XII).

Larynx closesit is a vocal fold closure & a primary laryngopharyngeal protective mechanism to prevent aspiration during swallowing. This is effected by:

Laryngeal branches of vagus nerve that adducts the true vocal cords folds
by contracting the lateral cricoarytenoids, muscles during the swallow. the oblique & transverse arytenoids

Stylopharyngeus (IX), salpingopharyngeus branches of pharyngeal plexus

(IX & X), palatopharyngeus branches of pharyngeal plexus (IX & X) & inferior constrictor branches of pharyngeal plexus (IX & X) serve to pull up the larynx with the pharynx under the tongue.

Vagus cranial nerves branches (V & X), accessory nerve (XI) & hypoglossal nerve (XII) passively control the
reflexivity involved.

While, the swallowing center finally inhibits the respiratory center of the medulla for a brief time that it takes to swallow i.e. to prevent mixing

swallowing with breathing.

NOTE: - This means that it is briefly impossible to breathe during this phase of swallowing and the moment where breathing is prevented is known as deglutition apnea.

Hyoid elevatesThis is coordinated & controlled during swallowing by:

Digastric branches (V & VII) & stylohyoid nerve (VII), which lifts the
pharynx & larynx up even further.

Food bolus transits pharynx--The bolus moves down towards the esophagus by pharyngeal peristalsis which takes place by sequential contraction of:

Superior, middle & inferior pharyngeal constrictor branches of pharyngeal plexus (IX & X), in which the lower part of the inferior constrictor i.e.
cricopharyngeus is normally closed & only opens for the advancing bolus.

NOTE: - Gravity plays only a small part in the upright position, because, it is possible to swallow solid food even when standing on ones head. While, the velocity through the pharynx depends on a number of factors such as: Viscosity of the bolus Volume of the bolus

Esophageal phase coordination & control: The esophageal phase of swallowing is coordinated by the autonomic nervous system (ANS). Like the pharyngeal phase of swallowing, the esophageal phase of swallowing is under involuntary neuromuscular control that encompasses two significant steps, which include:
1) 2)

Eosophageal peristalsis Relaxation

Esophageal peristalsisinvolves a much slower propagation of the food bolus than how it was when in the pharynx as the bolus enters the esophagus & becomes propelled downwards by:

Striated muscle branch of recurrent laryngeal (X) Smooth muscle (X) at a rate of 3 5 cm/sec.

NOTE:- In this step of eosophageal swallow, the upper eosophageal sphincter relaxes in order to let food pass across, after which various striated constrictor muscles of the pharynx as well as peristalsis and relaxation of the lower esophageal sphincter sequentially push the bolus of food through the esophagus into the stomach.

Relaxation phasethis is the final stage of swallowing in which the larynx & pharynx finally move down with the hyoid mostly by elastic recoil. Then the larynx and pharynx move down from the hyoid to their relaxed positions by elastic recoil.
NOTE: - Here, swallowing therefore depends on coordinated interplay between many various muscles, and although the initial part of swallowing is under voluntary control, once the deglutition process is started, it is quite hard to stop it. Swallowing reflex

This is the process in the human or animal body that makes something pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. If this fails and the object goes through the trachea, then choking or

pulmonary aspiration can occur. In the human body, its control begins as soon as the ingested bolus approaches the entry to the pharynx. In a series of swallowing reflex actions: breathing is halted, the soft palate elevates and closes the entrance to the nasal cavities, the tongue is clamped into the fauces, closing the exit from the pharynx back into the mouth, the epiglottis closes off the larynx, the pharynx contracts and forces the bolus into the eosophagus, peristalsis-like movements in the eosophagus carry the food to the cardia which relaxes and allows the food to be propelled into the stomach, also referred to as palatal reflex.
Clinical significance of swallowing

Swallowing is a great concern for the elderly since strokes and Alzheimer's disease can interfere with the autonomic nervous system. Speech therapy is commonly used to correct this condition since the speech process uses the same neuromuscular structures as swallowing. In terminally ill patients, a failure of the reflex to swallow can leads to a build-up of mucus or saliva in the throat and airways, producing a noise known as a death rattle (not to be confused with agonal

respiration, which is an abnormal pattern of breathing due to cerebral ischemia or hypoxia).

Abnormalities of the pharynx and or oral cavity may lead to oropharyngeal dysphagia, while abnormalities of the eosophagus may lead to eosophageal dysphagia. The failure of the lower eosophagus sphincter to respond properly to swallowing is called achalasia.

INTODUCTION & GENERAL OVERVIEW The sense of taste affords an animal including human beings the ability to evaluate what it eats and drinks. However, it is pertinently important to know that at the most basic level, this evaluation is what serves to promote ingestion of nutritious substances as well as prevention of consumption of potential poisons or toxins. Besides, ones ability to taste food should be seen as a life-and-death matter. This is so, because, failure to recognise food with a high enough caloric content could mean a slow death from malnutrition; so also failure to detect a poison could result in near-instant expiration. And now, as researchers begin to understand some of the nuts and bolts of taste perception; it has become very significant that the sense of taste may also have more subtle effects on health. The sense of taste is mediated by groups of cells i.e. taste buds. In most animals, including humans, taste buds are most prevalent on small pegs of epithelium on the tongue i.e. papillae, of which the taste buds themselves are too small to be seen without a microscope, but none-the-less the papillae are readily observable by close inspection of ones tongue's surface. Once taste signals are transmitted to the brain, several efferent neural pathways are activated that are important to digestive function. For instance, tasting food is followed rapidly by increased salivation and by low level secretory activity in the stomach. Among humans, there is substantial difference in taste sensitivity. Such differences are heritable that which may as well reflect differences in the number of fungi form papillae on the dorsum of an individuals tongue surface. In addition to signal transduction by taste receptor cells, it is also clear that the sense of smell profoundly affects the sensation of taste. NOTE:Think about how tastes are blunted and sometimes different when ones sense of smell is disrupted due to a cold. Taste

Though taste is etymologically referred to as the sense of perceiving different flavours in soluble substances that contact the tongue and which must have been triggered by nerve impulses to special taste centers located in the cortex & thalamus of the brain. However, taste can still be defined in a variety of ways & forms, of which all are correct, hence, the choice of definition lies on an individual prerogative. Amongst these varieties of definitions are, taste is:

The sense by which the chemical qualities of food in the mouth are distinguished by the brain, based on information provided by the taste buds.

The sense by which the qualities and flavour of a substance are distinguished by the taste buds The sensation of flavor perceived in the mouth and throat on contact with a substance. The special sense that perceives and distinguishes the sweet, sour, bitter, or salty quality of a dissolved substance and is mediated by taste buds on the tongue The objective sweet, sour, bitter, or salty quality of a dissolved substance as perceived by the sense of taste. A sensation obtained from a substance in the mouth that is typically produced by the stimulation of the sense of taste combined with those of touch and smell i.e. flavour None-the-less, from a general point of view, tastes sensations can only be

caused by the contact of soluble substances with the tongue; in which impulses relating to taste must be conducted by the cranial nerves i.e. components of facial

nerves to the anterior part of the tongue & or by the glossopharyngeal nerve to
the posterior part of the tongue.
Conclusively, it can be said that taste is the sensation produced when a substance in the mouth reacts chemically with receptors of taste buds.

NOTE: Taste, along with smell i.e. olfaction and trigeminal nerve stimulation with

touch for texture, also pain, and temperature, are what determines flavours, the sensory impressions of food or other substances.

As taste senses both harmful and beneficial things, all basic tastes are classified as either aversive or appetitive, depending upon the effect the things they sense have on our bodies. Sweetness tastes helps to identify energy-rich foods, while bitterness tastes serves as a warning sign of poisons.
Taste organ i.e. organon gustus

The principal oral structure that contain organs of taste is the tongue which carries such tiny structures made of bundles of slender cells with hair like

branches i.e. taste buds or gustatory calyculi that are packed together in groups to form projections i.e. papillae at various places on the tongue. Though taste buds are found mostly concentrated on top of the tongue, however few other taste buds are also located on the roof of the mouth, sides & back of the mouth, throat & near the pharynx. The taste organs are able to detect five basic tastes that include salty,

sweet, bitter, sour & umami i.e. savory tastes respectively.

NOTE: - The human tongue is generally divided into two major portions as: Posterior 1/3rd--- The non-keratinized lower portion of tongue surface, tightly bounded to underlying muscles. Anterior 2/3rd--- The keratinized upper portion of the tongue covered by four significant taste buds ie papillae projections.

The human tongue

Tongue papillae i.e. taste papillae: Taste papillae can be seen on the human tongue as little red dots, or raised bumps, particularly at the front of the tongue because they look like little button mushrooms. The human tongue comprise of four basic papillae, which include:

Fungi form papilla Foliate papilla Circumvallate papillae Filiform papilla

Various papillae found on a human tongue

Foliate papilla --- Made up the taste buds located mainly on the posterior lateral edges of the tongue & it is most sensitive to sour flavors. Fungi form papilla --- Made up the mushroom-shaped taste bud occurring in large numbers at the apex & on the sides of the tongue that which reacts mainly to sweet and salty flavors. Circumvallate papilla --- Made up the large taste buds that forms a lingual V at the back of the body of the tongue ensuring the taste functions of mostly perceiving sour & bitter flavors.

Filiform papilla --- Made up the non-gustatory cone-shaped taste buds covering the rear of the tongue; its function is solely tactile as it gives the tongue its velvety appearance. Taste buds: Taste buds are defined as specialized structure made up of taste receptor cells &
supporting cells that form the smallest functional unit of the sensing portion of the gustatory system.

Taste buds are the primary oval sensory end organ of taste found on the tongue surface that when in contact with saliva, detect flavors and transmit them to the brain in the form of nerve impulses. The taste buds are collections of sensory cells on the papillae of the tongue & cannot be seen by the naked eye. They are specialized, and each responds only to the kind of basic taste i.e. either aversive or

appetitive that which must have been is its specialty. The taste buds are
approximately 10,000 made up of between 50-150 receptor cells that occupy nests in the stratified epithelium, and are present in large numbers on the sides of the papillae vallate & to a less extent on their opposed walls. They are also found on the fungi form papillae over the back part and sides of the tongue, and in the general epithelial covering of the same areas. They are very plentiful over the fimbriae linguae, and are also present on the under surface of the soft palate, and on the posterior surface of the epiglottis.

Taste bud--- primary organ of taste

Generally, the taste buds are interwoven & wrapped around its base by a network of nerve fibers which stimulates receptor cell triggers that send impulses to nearby nerve fibers which is subsequently transmitted into the brain for interpretation as taste sensations. More so, the number of taste buds do varies

substantially from individual to individual, but greater numbers of taste buds on the tongue do as well increase sensitivity. Women, in general, have a greater number of taste buds than men. As in the case of color blindness, some people are insensitive to some tastes.
NOTE: o The taste receptor cells are sensory receptor cells that transduce a tastant into a neural signal and transmit gustatory information to the brain o The senses of taste can only functions in coordination with the sense of smell o A watery fluid must be secreted by the salivary glands before a particular chemical can be tasted o Solid substances must be dissolved in the watery fluid for its taste to be appreciated. o Food molecules must bind to receptors and the pattern must generate a sensory impulse on nearby nerve fibers before for its interpreted as a particular taste sensation.

Major structural features of a Taste bud: The bud is formed by two kinds of cells, which are:

Supporting cells i.e. sustentacular cells ----- are mostly arranged like the staves of a cask, and form an outer envelope for the bud. Some, however, are found in the interior of the bud between the gustatory cells. Gustatory receptor cells i.e. taste cells --- are epithelial chemoreceptor cell that detect taste, and occupying the central portion of the bud that which activate sensory fibers of the facial nerve or the glossopharyngeal nerve & or vagus nerve. They are spindle-shaped, and each possesses a large spherical nucleus near the middle of the cell. Gustatory hairs ---- spindle-like protrusions extending from taste pores, mingling with food molecules as introduced by saliva, that comes into contact with the outside environment, in which the peripheral end of gustatory cells terminates Taste pores--- small openings on the surfaces of tongue epithelium where the taste cell is exposed to the contents of the mouth. Microvilli--- thin extensions at the apical end of taste bud that project into small opening on the surface of the tongue Apical end----- small membrane margin of a taste receptor that is the most chemically sensitive part of a taste receptor cell near the surface of the tongue.

Taste receptor cells:

The taste receptors are not neurons, but they do form synapses with the endings of the gustatory afferent axons near the bottom of the taste bud; and can make both electrical and chemical synapses onto some of the basal cells. The taste cells may last for only about 2 weeks but then regenerate. This process depends on an influence of the sensory nerve; for instance if the nerve is cut the cell will die . Each receptor in a taste bud responds best to one of the basic tastes. There are three basic types of taste receptor cells and they are:

Supporting cells - contain microvilli; appear to secrete substances into lumen of taste bud. Sensory receptor cell modified ends of sensory neurons that have peg-like extensions projecting into lumen. These contain the sites of sensory transduction, modified to deal with specific types of stimulus Basal cells - these differentiate into new receptor cells. They are derived from surrounding epithelium. The cells are continuously renewed every 10 days or so.

A typical taste receptor cell structure

NOTE: - Though a receptor can respond to the other tastes, however but its response is only strongest to a particular taste. Classification of taste sensations

Taste refers to the ability to detect the flavour of substances such as food, certain minerals & poisons, etc. The sensation of taste is traditionally broken into five as:
o o

Sweetness Bitterness

o o o

Sourness Saltiness Umami.

NOTE: - These basic tastes only partially contribute to the sensation and flavour of food in the mouth; because others factors must also be present in order to appreciate taste. These other factors include: Smell as detected by the olfactory epithelium of the nose Texture as detected through a variety of mechanoreceptors, muscle nerves, etc. Temperature as detected by thermoreceptors.

However, the taste senses can as well be either harmful or beneficial depending upon the effect of those sensed things on the human bodies. None-theless, however, all the basic tastes are broadly classified into two as:
o o

Aversive tastes Appetitive tastes Although most parts of the tongue are receptive to all the basic tastes,

however the tongue map breaks the tongue down into regions of sensation, thereby making some regions more sensitive to a given taste. These regions of taste are as illustrated below:

Typical taste sites in human tongue

Aversive tastes:---Comprise of:

Bitterness Sourness

Bitter taste:

Bitter taste are poison receptors and the most sensitive of the tastes, and many perceive it as unpleasant, sharp, or disagreeable, but it is sometimes desirable and intentionally added via various bittering agents. Common bitter foods and beverages include coffee, unsweetened cocoa, marmalade, bitter gourd, olives,

citrus peel, dandelion greens, wild chicory & quinine etc.

Bitter taste region--- Across the back of the tongue

Physiologic function/action: -- Bitter taste helps prevent ingestion of toxic substances i.e. the ability to detect
bitter-tasting substances at low thresholds is considered to provide an important protective function because many toxins taste bitter.

Sour taste:

Sour taste is detected by a small subset of cells that are distributed across all taste buds in the tongue. The most common food group that contains naturally sour foods is fruit, such as lemon, grape, orange, tamarind & sometimes melon etc. Sourness is acidity, and, like salt, it is a taste sensed using ion channels in which Hydrogen ion channels detect the concentration of hydronium ions that are formed from acids and water.

Sour taste region---- On the sides closest to the back of the tongue

Physiologic function/action: -- Sour taste serves to wards off the ingestion of harmful substances into the body.
Appetitive tastes:-- Comprise of:

Saltiness Sweetness Umami

Salty taste:

Saltiness is the taste of salt that drives the urge for consumption of salt as it suppresses bitterness. It is a taste produced best by the presence of cations such as (Na+, K+ or Li+) & like sour, it is tasted using ion channels. Other monovalent cations e.g. ammonium, (NH4+) and divalent cations of the alkali earth metal group of the periodic table e.g. calcium, (Ca2+) ions, in general, elicit a bitter rather than a salty taste even though they, too, can pass directly through ion channels in the tongue.

Salty taste On sides more rostral than sour i.e. front edge of the tongue

NOTE: - Other ions of the alkali metals group also taste salty, but the less sodium-like the ion is, the less salty the sensation.

Physiologic functions/actions: --- It is commonly added to chocolates, fruits and desserts to intensify their sweetness.

Sweet taste:

Sweetness, usually regarded as a pleasurable sensation, is produced by the presence of sugars, some proteins, and a few other substances. It is often connected to aldehydes and ketones, which contain a carbonyl group. Sweetness is detected by a variety of G protein coupled receptors coupled to the G protein found on the taste buds that acts as intermediary in the communication between taste bud and brain, gustducin. These receptors are heterodimer (T1R2+3) & homodimer (T1R3), which account for sweet sensing in humans and other animals.

Sweet taste region---Across the front i.e. at the tip of the tongue

Physiologic functions/actions: --- Sweetness rewards the consumption of energyrich sugars.

Umami taste:

This is a savory or meaty taste & can be tasted in cheese and soy sauce. It is also found in many other fermented & aged foods, tomatoes, grains & beans. Physiologic functions/actions: --- facilitates ingestion of protein-rich food, and it is variously described as savory, brothy or meaty taste.
Further taste sensations

The tongue can also feel other sensations not generally included in the basic tastes, of which these are largely detected by the somatosensory system. Amongst these tastes sensations are:
o o o o o o o

Calcium sensation Coolness sensation Dryness sensation Fattiness sensation Numbness sensation Prickliness or hotness sensation Temperature sensation

Calcium taste sensation:

This was discovered by geneticists in 2008, as CaSR calcium receptor on the tongues of mice. The CaSR receptor is also commonly found in the gastrointestinal tract, kidneys, and brain, in which along with the "sweet" T1R3 receptor, the CaSR receptor can detect calcium as a taste. However, whether is mice genes closely related are to humans genes, it is still believed that this phenomenon do also exists in humans as well is unknown.
Coolness taste sensation:

Some substances activate cold trigeminal receptors even when not at low temperatures. This "fresh" or "minty" sensation can be tasted in spearmint, menthol, ethanol, and camphor, due to the activation of some mechanism that signals cold, TRPM8 ion channels on nerve cells. NOTE: - Unlike the actual change in temperature
described for sugar substitutes, this coolness is only a perceived phenomenon. Dryness taste sensation:

Some foods, such as unripe fruits, contain tannins or calcium oxalates that cause an astringent or rough sensation of the mucous membrane of the mouth. Examples include tea, red wine, rhubarb, unripe persimmons & bananas.
NOTE: Less exact terms for the astringent sensation are "dry", "rough", "harsh" (especially for wine), "tart" (normally referring to sourness), "rubbery", "hard" or "styptic". When referring to wine, dry is the opposite of sweet, and does not refer to astringency. Wines that contain tannins and so cause an astringent sensation are not necessarily classified as "dry" & "dry" wines are not necessarily astringent.

Fattiness taste sensation:

Recent research reveals a potential taste receptor called the CD36 receptor that reacts to fat i.e. fatty acids more specifically. This receptor was found in mice, but can as well be applicable to humans.
Heartiness i.e. kokumi taste sensation:

Some Japanese researchers refer to the kokumi as foods laden with alcohol and thiol-groups in their amino acid extracts, and this sensation has also been described as mouth feel.
Numbness taste sensation:

These sensations though not tastes fall into a category of chemesthesis, yet they include a cooking tingling numbness caused by such spices as Sichuan pepper & chili pepper.
Temperature taste sensation:

Temperature can be an essential element of the taste experience, because food & drink that which in a given culture is traditionally served hot is often considered distasteful if cold, and vice versa. For example, alcoholic beverages, with a few exceptions, are usually thought best when served cold, but soups again, with exceptions are usually only eaten hot.
Prickliness or hotness taste sensation:

These sensations are centered about pungency. For instance substances such as ethanol & capsaicin can cause a burning sensation by inducing a trigeminal nerve reaction together with normal taste reception. However, the sensation of heat is caused by the food's activating nerves that express TRPV1 & TRPA1 receptors.
NOTE: This particular sensation, is called Chemesthesis, and is not a taste in the technical sense, because the sensation does not arise from taste buds and a different set of nerve fibers carry it to the brain. However, it arises from foods like chili peppers that activate nerve fibers directly; while the sensation interpreted as "hot" results from the stimulation of somatosensory pain/temperature fibers on the tongue. Besides many other parts of the body with exposed membranes but no taste sensors such as the nasal cavity, under the fingernails, surface of the eye & or even a wound would have produced a similar sensation of heat when exposed to hotness agents. Taste Sensations/perceptions

These are sensations that results when taste buds in the tongue and throat convey information about the chemical composition of a soluble stimulus. Though the sensation of taste is equivalent to the excitation of taste receptors, of which receptors for a large number of specific chemicals have been identified that contribute to the reception of taste. Yet, despite this complexity, five types of tastes are commonly recognized by humans. These include:

The sweet taste ---- usually indicates energy rich nutrients The umami taste ---- taste of amino acids e.g. meat broth or aged cheese The salty taste ---- that which allows modulating diet for electrolyte balance The sour taste ---- typically the taste of acids The bitter taste ---- that which allows sensing of diverse natural toxins

The taste sensations/perceptions are influenced by:

o o o

Thermal stimulation of the tongue. Warming the front of the tongue Cooling of the tongue

NOTE: - None of these tastes are elicited by a single chemical. Besides, there are also thresholds for detection of taste that differ among chemicals that which might taste the same i.e. similar. In other words, within a taste bud, some taste receptor cells can sense sweetness, while others have receptors for bitterness, sourness, salty and or umami tastes. For instance:1)

Pleasant tastes such as sweet & umami are mediated by a family of three T1R receptors that assemble in pairs. Furthermore, there are diverse molecules that could lead to a sensation of sweet which at the same time are either bounded to a receptor formed from T1R2 & or T1R3 subunits. For instance the receptor formed as a complex of T1R1 and T1R3 that binds L-glutamate and L-amino

acids, whose resultant effect is the experience of an umami taste.

2)

Unpleasant taste such as bitter taste can result from binding of diverse molecules to a family of about 30 T2R receptors. While sour tasting itself must involve the activation of a type of TRP i.e.

3)

transient receptor potential channels.

4)

Surprisingly, the molecular mechanisms of salt taste reception are poorly characterized relative to the other tastes

Physiology of taste sensation/perception

The sense of taste is mediated by taste receptor cells which are bundled in clusters called taste buds. Taste receptor cells sample oral concentrations of a large number of small molecules and report a sensation of taste to centers in the brainstem. When a taste cell is activated by a certain taste, it will either depolarize or hyperpolarize, resulting in an action potential due to a shift in voltage called receptor potential, that is ultimately transmitted to the brain. Depolarization of the membrane causes the influx of Ca2+, triggering the release of transmitter molecules. More than 90% of receptor cells respond to two or more of the basic tastes. Each of the gustatory has a bias as to which chemicals they respond to. This has to do with the particular transduction methods of each cell. One interesting aspect of this nerve transmission is that it rapidly adapts - after the initial stimulus, a strong discharge is seen in the taste nerve fibers but within a few seconds.
NOTE: - Taste buds are able to differentiate between different tastes through detecting interaction with different molecules or ions. For instance:
1)

Sweet, umami, and bitter tastes are triggered by the binding of molecules to G protein-coupled receptors on the cell membranes of taste buds. Saltiness and sourness are perceived when alkali metal or hydrogen ions enter taste buds, respectively.

2)

Mechanisms of Taste Transduction (Gustatory Transduction) i.e. taste as a form

of chemoreception:

Taste transduction is the process by which an environmental stimulus causes an electrical response in a sensory receptor cell. Each receptor has a different
manner of sensory transduction by which it detects the presence of a certain compound and starting an action potential which ultimately alerts the brain. However, no single neuron type alone is capable of discriminating among stimuli or different qualities, because a given cell can respond the same way to disparate stimuli. None-the-less, the nature of the transduction mechanism is what determines

the specific sensitivity of a sensory system relative to the five basic tastes that which must undergo the following basic process:

When taste receptor is activated by the appropriate chemical, its membrane potential changes receptor potential. Depolarizing receptor potential cause Ca++ to enter the cytoplasm triggers the release of NT Taste stimuli may:
a. b. c. d.

&

Pass directly through an ion channel for salt & sour taste Bind to and block ion channels for sour & bitter taste Bind to and open ion channels for some sweet amino acids. Bind to membrane receptors that activate 2nd messenger systems that in turn open or close ion channels for sweet & bitter taste

Taste Transduction i.e. Gustatory Transduction

 Central Taste Pathway

This is the pathway responsible for the main flow of taste information , in
which two cranial nerves that innervate the tongue & a third cranial nerve that innervate areas around the throat comprising of the glottis, epiglottis & pharynx played significant role in taste perception. These nerves are:

The facial nerve i.e. cranial nerve VII innervates the anterior 2/3rd i.e. front of the tongue The glossopharyngeal nerve i.e. cranial nerve IX --- innervates that posterior 1/3rd i.e. back of the tongue The vagus nerve i.e. cranial nerve X --- innervates areas around the throat & carries taste information from the back part of the mouth. These cranial nerves are what carry taste information into the brain i.e. a part of

the brain stem called the nucleus of the solitary tract; & from the nucleus of the solitary tract, the taste information goes to the thalamus of the brain, then to the cerebral cortex and finally into the limbic system i.e. hypothalamus & amygdale. Taste buds Cerebral cortex
NOTE: - Another cranial nerve (the trigeminal nerve, V) also innervates the tongue, but is not used for taste. Rather, the trigeminal nerve carries information related to touch, pressure, temperature and pain.

Primary gustatory axons

Brain stem

Thalamus

Cranial nerves responsible for taste sensation

Taste Nerve Pathway

The Neural Coding of Taste

This involves neurons of the gustatory nucleus that receive synapses from many axons of different taste specificities. It revolves around the theory of how the
brain decides what one taste is called i.e. population coding, in which the responses of a large number of broadly tuned neurons, rather than a small number of specific neurons, are used to specify the properties of a particular taste. For instance one food type may activates a certain subset of neurons, with some of them firing very strongly, some moderately, and some not at all or perhaps even inhibited below their spontaneous firing rates. It happens because all of the nerves and axons enter the brain stem and synapse within the gustatory nucleus, i.e. part

of the solitary nucleus in the medulla.

More so, as neurons on the gustatory nucleus synapse on a subset of small neurons in the ventral posterior medial (VPM) nucleus, that is the portion of the thalamus that deals with sensory information. The ventral posterior medial nucleus sends axons to the primary gustatory cortex, in which the taste pathways are

generally ipsi-lateral to the cranial nerves that supply them, thereby being able to encode specific tastes. However, the process of coding tastes is achieved in the under listed sequence or mechanisms:

NT release from taste cells causes an AP in the gustatory afferent axon. Three different cranial nerves (VII, IX & X) innervate the taste buds and carry taste information from the tongue, palate, epiglottis and eosophagus to efferent target i.e. gustatory nucleus in the medulla. Information is relayed to the thalamus i.e. VPM--ventral posterior medial

nucleus

Information then goes to the primary gustatory cortex i.e. parietal lobe

Neural taste coding pathway

NOTE: - In neural coding of taste, every gustatory receptor cell has a spindly protrusion i.e. gustatory or taste hair that reaches the outside environment through an opening taste pore. And as molecules mix with saliva, it enters the taste pore and interacts with the gustatory hairs, thereby stimulating the sensation of taste. Once stimuli activates the gustatory impulse, the receptor cells in turns synapse with neurons and pass on electrical impulses to the gustatory area of the cerebral cortex. It is these impulses that the brain interprets as the sensations of taste. Gustation i.e. taste & Olfaction i.e. smell; any relationship..?

Though taste & smell are separate sense with their own receptor organs, yet they are intimately entwined. However, most of people dont think of it in this way, that the related senses of taste and smell help humans interpret the chemical world. As taste begins with sensation in the form of electrical impulses, tastants, i.e. chemicals in foods, are detected by taste buds, which consist of special sensory cells. And when stimulated, these cells are what send signals to specific areas of the brain, which make humans conscious of the perception of taste. Similarly, it is the specialized cells in the nose that helps pick up odourants, i.e.

airborne odour molecules which stimulate receptor proteins found on hair like cilia
at the tips of the nose sensory cells, thereby initiating a neural response process of which ultimately, messages about taste and smell converge are being interpreted, thus allowing humans to detect the flavors of food. Therefore, tastes and smells are the perception of chemicals in the air or in our food.

Relationship between smell & taste perception

This close relationship is most apparent however in humans, because though different stimuli can activate different sensory receptors, however, it is only chemical stimuli that can activate the chemoreceptors responsible for gustatory & olfactory perceptions, being that both taste & smell are reactions to the chemical makeup of solutions, thus the two senses are closely related. For instance, as anyone with a head cold cannot attest that food tastes different when the sense of smell is impaired; but what is actually being affected here is the taste not flavor of the food, which is the combination of taste & smell. Thats because only the food odours can be detected, not the taste. we eat.
NOTE: - In some species, however, the two chemical senses are practically one. Invertebrates like worms do not have distinctions between gustatory and olfactory receptors. They instead differentiate between volatile and nonvolatile chemicals.

None-the-less however, it is the interactions

between the senses of taste & smell that enhances humans perceptions of the foods

Comparison between Gustation & Olfaction Taste gustation & olfaction smell have similar tasks, which include:

Detection of environmental chemicals. Both are required to perceive flavour.

Both have strong and direct connections to human most basic needs such as thirst, hunger, emotion, sex, & certain forms of memory. Though the systems are separate and different, yet they merge at higher levels of cortical functions by: a. Having different chemoreceptors. b. Using different transduction pathways. c. Having separate connections to the brain. d. Having different effects on behaviour.
How taste sensation or perception works?

The following conditions must be met as a pre-requisite for taste sensation or perception to work:

Chemical must dissolve in watery fluid around taste buds. If it is not liquid when it enters the mouth, then it must melt or chewed and become mixed with saliva. Its molecules must enter the pores of the tongue papillae and stimulate the taste buds directly. Food molecules must combine with specific receptor sites on taste hairs The combination must cause generation of sensory impulses on nearby nerve fibers.

Clinical significance of gustatory system

Amongst the numerous importance of the gustatory system are:

It serves to guide & allow humans to distinguish between safe and harmful food. It helps humans distinguish & appreciate that bitter & sour foods are unpleasant. It helps humans distinguish & appreciate that salty, sweet, and meaty tasting foods generally provide a pleasurable sensation. It aids humans detect, in different ways, the presence of sodium chloride in the mouth that which serves critical role in ion & water homeostasis in the human

body.

It helps facilitate passive re-uptake of water into the blood intake of

osmotically active compounds in the mammalian kidney.

It helps elicits pleasant taste in most humans, eg the intake of salt elicits a pleasant taste in most humans. It helps serve a last-line warning system before an unpleasant compound that can do damage is ingested. It helps triggers pleasurable responses and thus encourages the intake of peptides & proteins.
Function of taste

The main functions of taste are:

Helps humans to identify toxins & maintain nutrition. Helps protect humans from unsafe foods, for instance if one ate poisonous or

rotten foods, one would probably spit them out immediately, because they usually taste revolting, this way, one must have succeeded in stopping them from entering the stomach .

Helps one maintain a consistent chemical balance in the body, for instance liking

sugar and salt helps satisfies ones body's need for carbohydrates & minerals.
Similarly, eating sour foods such as oranges & lemons supplies the body with

essential vitamins.
Taste disorders

The major disorders of taste gustation are three:

Ageusia--- The complete inability to taste Hypogeusia---the reduced ability to taste Hypergeusia---the enhanced ability to taste However, ageusia is a rare disorder, because there are three different nerves

that carry taste information to the brain. Besides, older people have a reduced sense of taste because their taste buds are not replaced as fast those in younger people. Taste disorders can also be caused by drugs used to treat epilepsy, Parkinson's disease, diabetes and high blood pressure. Damage to the areas of the brain such as the brain stem, thalamus and cerebral cortex may also cause taste problems.

Taste summary
Though taste is etymologically referred to as the sense of perceiving different flavours in soluble substances that contact the tongue and which must have been triggered by nerve impulses to special taste centers located in the cortex & thalamus of the brain. However, from a general point of view, tastes sensations in humans, can only be transduced by taste buds and must only be conveyed via three of the twelve cranial nerves, which are the:

Cranial nerve VII i.e. facial nerve--- that carries taste sensations from the anterior two thirds of the tongue (excluding the circumvallate papillae, see lingual papilla) & soft palate.

Cranial nerve IX i.e. glossopharyngeal nerve--- that carries taste sensations from the posterior one third of the tongue (including the circumvallate papillae). Cranial nerve V i.e. a branch of the vagus nerve--- that carries some taste sensations from the back of the oral cavity (i.e. pharynx and epiglottis). However, information from these cranial nerves is processed by the

gustatory system. Though there are small differences in sensation, which can be measured with highly specific instruments, all taste buds can respond to all types of taste, of which sensitivity to all tastes is distributed across the whole tongue and indeed to other regions of the mouth where there are taste buds (epiglottis, soft palate).

Basic structures involve in taste sensation

Taste Signal Processing In humans, as the sense of taste is transmitted to the brain via three cranial nerves. The gustatory cortex is the brain structure responsible for the perception of taste. It consists of the anterior insula on the insular lobe and the frontal operculum on the inferior frontal gyrus of the frontal lobe. Neurons in the gustatory cortex respond to the five main tastes. While the taste cells synapse with primary sensory axons of the mentioned cranial nerves, the central axons of these neurons in the respective cranial nerve ganglia are projected to the rostral and lateral regions of the nucleus of the solitary tract in the medulla. However, the axons from the rostral i.e.

gustatory part of the solitary nucleus are also projected to the ventral posterior
complex of the thalamus, where they terminate in the medial half of the ventral

posterior medial nucleus. This nucleus is what projects to several regions of the neocortex, which include the gustatory cortex, inducing the gustatory cortex neurons to exhibit complex responses to changes in concentration of tastant.

Taste signal processing sequence

Taste disorders

The most common taste disorders are either complete or partial loss of taste i.e. ageusia which often sometimes can be accompanied by the loss of smell; and abnormal taste ies dysgeusia an alteration in the perception associated with the sense of taste, whose cause can be associated with neurologic disorders.
Conclusion

The senses of gustation i.e. taste are under the category of chemoreception, in which specialized cells act as receptors for certain chemical compounds. And as these compounds react with the receptors, an impulse is sent to the brain which is registered as a certain taste. Gustation generally involves the interpretation of chemical senses by the brain because the gustatory receptors contained are sensitive to the molecules in the food we eat, along with the air we breathe. Taste is also known as gustation, of which its receptors are classified as chemoreceptors because they respond to chemicals such as the food dissolved in saliva. Though there are no significant differences amongst the taste buds responsible for sensation of taste, five

basic qualities of taste sweet, sour, salty, bitter & umami (deliciousness or

savouriness) have been identified.