Biochemistry of tooth tissues and Biochemistry of tooth tissues and salivasaliva:: biological role biological role, , physical-physical-

chemical propertieschemical properties and and biochemical content. Regulation and biochemical content. Regulation and

pathology of saliva formationpathology of saliva formation, , significance in the appearance of significance in the appearance of

dental diseasesdental diseases..

TeethTeeth

The role is to masticate (chew) food Humans have two sets of teeth

– Deciduous (baby or milk) teeth– 20 teeth are fully formed by age two

Permanent teeth– Replace deciduous teeth beginning

between the ages of 6 to 12– A full set is 32 teeth, but some people

do not have wisdom teeth

Tooth is a complex system of specialized tissues

•Dentin contains collagen and is similar in composition to bone

Teeth contain tooth enamel and dentin

A . TOOTH TISSUES

1. TOOTH ENAMEL, is the hardest part of the tooth Enamel acts as a protective tissue that covers the exposed part of a tooth, the crown. 

2. DENTIN , is the tissue that forms the mainl mass of a tooth. It supports the enamel and absorbs the pressure of eating.

3. DENTAL PULP, a soft connective tissue containing nerves and blood vessels, that nourish the tooth.

  4. CEMENTUM, covers the dentine outside of the

root (under the gum line) and it is attached to the bone of the jaw with little elastic fibers

Dentin Dentin is a mineralized

connective tissue with an organic matrix of collagenous proteins.

• dentin contain exclusively genetic Type I collagen

• The chain are high in glycine (Gly), proline (Pro) and hydroxyproline (Hyp) content.

Composed of mineralized calcium phosphate (specifically, the calcium phosphate phase called hydroxyapatite (HAP) Ca10(PO4)6(OH)2) within a matrix of collagen fibrils

The HAP of teeth is not compositionally pure– it’s composition can actually be better

represented as – (Ca, Sr, Mg, Na, H2O)10(PO4, HPO4,

CO3P2O7)6(OH, F, Cl, H2O)2

HAP is a ‘living mineral’ that is continually grown, dissolved & remodeled in response to signals of internal (e.g., pregnancy) and external (e.g., gravity, exercise) origin

Apatites of tooth tissuesApatites of tooth tissues CaCa10(10(POPO4)6(4)6(OHOH)2 )2

CaCa88HH2(2(POPO4)6 · 54)6 · 5HH22OO

CaCa10(10(POPO4)64)6COCO3 3 or or CaCa10(10(POPO4)54)5COCO3(3(OHOH)2)2

CaCa10(10(POPO4)64)6ClCl

SrCa9(SrCa9(POPO4)6(4)6(OHOH)2 )2

CaCa10(10(POPO4)64)6FF22

HydroxyappatiteHydroxyappatite

Enamel is 95% HAP

Enamel gains mechanical strength by interweaving HAP crystals

Enamel initially starts with a high protein content, but these are removed and the voids backfilled with HAP as the tooth matures

B. PERIODONTAL TISSUES 5. GUMS, the tough pink-

colored skin that covers the bone of the jaw and supports the tooth along with the alveolar bone.

HEALTHY GINGIVA CONTAINS HEALTHY GINGIVA CONTAINS MANY FIBROBLASTS AND A MANY FIBROBLASTS AND A FEW INFLAMMATORY CELLS FEW INFLAMMATORY CELLS SUCH AS SUCH AS MACROPHAGES ,NEUTROPHILMACROPHAGES ,NEUTROPHILS, PLASMA CELLS AND S, PLASMA CELLS AND LYMPHOCYTES.LYMPHOCYTES.

6. PERIODONTAL LIGAMENT, the tissue between the cementum and the alveolar bone. It consists of tough little elastic fibers that keep the tooth attached to the jaw.

7. ALVEOLAR BONE, the bone of the jaw that keeps the tooth in its place, it feeds and protects it.

 

Enamel is the hardest and most highly mineralized substance of the body, and with dentin, cementum, and dental pulp is one of the four major tissues which make up the tooth.

Ninety-six percent of enamel consists of mineral, with water and organic material composing the rest.

The formation of dentin - dentinogenesis. The porous, yellow-hued material is made up of

70% inorganic materials, 20% organic materials, 10% water.

Cementum Cementum is a specialized bony substance

covering the root of a tooth. 45% inorganic material (mainly hydroxyapatite), 33% organic material (mainly collagen) 22% water. Cementum is excreted by cementoblasts within the

root of the tooth and is thickest at the root apex.

Pulp The dental pulp is the part in the center of a tooth

made up of living soft tissue and cells called odontoblasts. Those include: Fibroblasts, Granulocites, Histiosites etc. It's commonly called 'the nerve', although it contains many other structures which are not nerves.

Biochemical composition of teeth tissues

Compounds pulp dentin enamel cementum

Waterg per 100 g tissue

30 - 40 13 2,5 3,2

Organic compounds

40 20 4 25

Inorganic compounds

20 - 30 69 96 70

Ca g per 100 g of ashes

30 35 36 35,5

Mg 0,8 1,2 0,5 0,9

Na 0,2 1,2 0,2 1,1

K 0,1 0,1 0,3 0,1

P 17,0 17,4 17,3 17,1

F 0,02 0,02 0,02 0,02

citrate - 1,0 0,3 -

Organic componentsOrganic components

Soluble proteinsSoluble proteins::

Albumins, globulinsAlbumins, globulins

EnzymesEnzymes:: Alkaline phosphataseAlkaline phosphatase Acidic phosphataseAcidic phosphatase GlycoproteinsGlycoproteins

No soluble proteinsNo soluble proteins:: CollagenCollagen EnamelinEnamelin

CarbohydratesCarbohydrates GlycogenGlycogen Glycosaminoglycans (GAG, Glycosaminoglycans (GAG,

mucopolysaccharides) are mucopolysaccharides) are long-chain compounds made long-chain compounds made up of hundreds repeating up of hundreds repeating disaccharide units. One of disaccharide units. One of the sugars in each the sugars in each disaccharide unit is a disaccharide unit is a hexosamine (glycosamine). hexosamine (glycosamine).

Many proteoglycans contain Many proteoglycans contain a core protein which links a core protein which links them to the cellular them to the cellular membrane. membrane.

ProteoglycansProteoglycans

Hyaluronic acid is Hyaluronic acid is an extremely long an extremely long and rigid and rigid glycosaminoglycanglycosaminoglycan

Chondroitin 6 Chondroitin 6 sulphatesulphate

Dental plaquePlaque is a biofilm consisting of large amounts

of various bacteria which forms on teeth. If not removed regularly, it can lead to dental cavities (caries) or periodontal problems (such as gingivitis).

Given time, plaque can mineralize along the gingiva, forming tartar. The microorganisms that form the biofilm are almost entirely bacteria (mainly streptococcus and anaerobes). Certain bacteria in the mouth in the absence of oxygen produce lactic acid, which dissolves the calcium and phosphorus in the enamel. This process - demineralisation, leads to tooth destruction.

ScurvyScurvy

ScurvyScurvy - dietary - dietary deficiency in deficiency in vitamin Cvitamin C, , leading to leading to abnormal abnormal collagencollagen..

(hemorrhages, loose of teeth, gums swell and bleed easily)

Dental cariesDental caries, also described as "tooth decay" or "dental

cavities", is an infectious disease which damages the structures of teeth.

Tooth decay is caused by certain types of acid-producing bacteria which cause the most damage in the presence of fermentable carbohydrates such as sucrose, fructose, and glucose. The resulting acidic levels in the mouth affect teeth because a tooth's special mineral content causes it to be sensitive to low pH

Teeth demineralisationTeeth demineralisation::

Са10 (РО4)6(ОН)2 + 2Н+  → Са9Н2 (РО4)6(ОН)2 + Са10 (РО4)6(ОН)2 + 2Н+  → Са9Н2 (РО4)6(ОН)2 + Са2+Са2+

Conversion of GAP into ftorapatiteConversion of GAP into ftorapatite::  Са10 (РО4)6(ОН)2  + 2Са10 (РО4)6(ОН)2  + 2FF-  →  Са10 (РО4)6-  →  Са10 (РО4)6FF2 + 2(ОН)-2 + 2(ОН)-

Excess of Excess of FF-- couses demineralisationcouses demineralisationСа10 (РО4)6(ОН)2  + 20Са10 (РО4)6(ОН)2  + 20F-F- → 10 → 10CCааFF2 + 6РО4 3- + 2 + 6РО4 3- +

2(ОН)-2(ОН)-

ph ph 6,4 6,4 -- 7,8 7,8 assists in assists in mineralizationmineralization

Са2+/ Р Са2+/ Р for mineralization in salivafor mineralization in saliva is is 1,671,67

MgMg2+, 2+, MnMn2+, 2+, ZnZn2+, 2+, CuCu2+, Si2+2+, Si2+ increase mineralization increase mineralization

phph<<6,26,2 leads to the leads to the dedemineralization mineralization

ORAL ENVIRONMENTORAL ENVIRONMENTCARIESCARIES

A progressively destructive, infectious disease resulting in:A progressively destructive, infectious disease resulting in: Demineralization of enamel / cementumDemineralization of enamel / cementum Bacterial penetration to pulpBacterial penetration to pulp Formation of macroscopic activityFormation of macroscopic activity

Caries promotionCaries promotion Caries reductionCaries reductiondietary carbohydratedietary carbohydrate increased salivary flowincreased salivary flowreduced salivary flowreduced salivary flow reduced plaquereduced plaquecariogenic bacteriacariogenic bacteria fluoridefluoride

Sound enamelplaque acid prod

mineral loss

salivaacid neutralization

mineral gain(fluoride)

Lesions

Cavity

ORAL ENVIRONMENTORAL ENVIRONMENTSALIVASALIVA

A complex fluid secreted by salivary glands containing A complex fluid secreted by salivary glands containing water, mucin, proteins, salts and enzymes.water, mucin, proteins, salts and enzymes.

Functions:Functions:– aids in digestionaids in digestion– lubricates both hard and soft tissueslubricates both hard and soft tissues– buffers cariogenic acidsbuffers cariogenic acids– forms the pellicleforms the pellicle– provides minerals for repairing enamel / cementum provides minerals for repairing enamel / cementum

(remineralization)(remineralization)– delivers antimicrobial agents (immunoglobulins, enzymes, delivers antimicrobial agents (immunoglobulins, enzymes,

etc.)etc.)

Saliva neutralises the acids which cause the pH of the tooth surface to rise above the critical pH. This causes 'remineralisation', the return of the dissolved minerals to the enamel.

In the presence of plaque, saliva is unable to penetrate through the plaque to neutralize the acid produced by the bacteria.

Salivary glandsSalivary glands

SALIVA•Mixture of mucus and serous fluids

•Helps to form a food bolus

•Contains salivary amylase to begin starch digestion

•Dissolves chemicals so they can be tasted

Saliva is secreted to the mouth by Saliva is secreted to the mouth by three major paired salivary glands three major paired salivary glands (submamandibular, parotid, and (submamandibular, parotid, and sublingual glands) and by numerous sublingual glands) and by numerous minor mucous glands, at a rate of minor mucous glands, at a rate of approximately 0.025 ml.min-1. approximately 0.025 ml.min-1.

65 % from the submandibular, 65 % from the submandibular, 23 % from the parotid,23 % from the parotid, 8 % from the minor mucous, 8 % from the minor mucous, 4 % from the sublingual.4 % from the sublingual.

Secretions of Salivary Secretions of Salivary GlandsGlands

Parotid glands – clear– water, serous fluid– rich in amylase

Sublingual glands– primarily mucus– most viscous

Submandibular glands– primarily serous

fluid– some mucus

The most important The most important small salivary glandsmall salivary glandss are: are: lingual glands lingual glands minor sulblingual glands close to the larger major minor sulblingual glands close to the larger major

sublingual glandssublingual glands labial glands on the inner surface of the lips labial glands on the inner surface of the lips palatine glands palatine glands tonsillar glands tonsillar glands buccal glands buccal glands

The labial, sublingual, mlnor lingual and buccal The labial, sublingual, mlnor lingual and buccal

glands are composed predominantly of mucous glands are composed predominantly of mucous cells, but some serous cells may be present. cells, but some serous cells may be present.

The palatine and lateral lingual glands are entirely The palatine and lateral lingual glands are entirely mucous secreting mucous secreting

DigestionDigestion The digestive functions of The digestive functions of

saliva include moistening food, saliva include moistening food, and helping to create a food and helping to create a food bolusbolus, so it can be swallowed , so it can be swallowed easily. easily.

Saliva contains the Saliva contains the enzymeenzyme AmylaseAmylase that breaks some that breaks some starchesstarches down into down into maltosemaltose and and dextrindextrin. .

Salivary glands also secrete Salivary glands also secrete enzyme to start fat digestion. enzyme to start fat digestion. This is useful for infants to This is useful for infants to digest the fat in milk.digest the fat in milk.

Pellicle depositsPellicle deposits

In addition to this, saliva is In addition to this, saliva is responsible for depositing responsible for depositing salivary pelliclesalivary pellicle that covers the that covers the entirety of the tooth surfaces. entirety of the tooth surfaces.

This pellicle This pellicle

play a role in play a role in plaqueplaque formation, it may formation, it may also act as a protective barrier also act as a protective barrier between acids and the tooth surfacebetween acids and the tooth surface

DisinfectantsDisinfectants Saliva contained in the mouth Saliva contained in the mouth

has natural has natural disinfectantsdisinfectants.. Human saliva contains such Human saliva contains such

antibacterialantibacterial agents as secretory agents as secretory IgAIgA,,

lactoferrinlactoferrin, and , and lactoperoxidaselactoperoxidase..

StimulationStimulation

The production of saliva is stimulated The production of saliva is stimulated both by the both by the sympathetic nervous systemsympathetic nervous system and the and the parasympatheticparasympathetic..

The saliva stimulated by sympathetic The saliva stimulated by sympathetic innervation is thicker, and saliva innervation is thicker, and saliva stimulated parasympathetically is stimulated parasympathetically is more watery.more watery.

Daily salivary outputDaily salivary output

There has been some disagreement There has been some disagreement regarding the daily salivary output in regarding the daily salivary output in a healthy individual. Today, it is a healthy individual. Today, it is believed that the average person believed that the average person produces approximately 700mL of produces approximately 700mL of saliva per day, which is much less saliva per day, which is much less than was once thought.than was once thought.

Saliva is characteristically a Saliva is characteristically a colorless dilute fluid, with a density colorless dilute fluid, with a density ranging from 18 to 35. Its pH is ranging from 18 to 35. Its pH is usually around 6.64, and varies usually around 6.64, and varies depending on the concentration of depending on the concentration of CO2 in the blood. CO2 in the blood.

The total concentration of inorganic The total concentration of inorganic and organic constituents is and organic constituents is generally low when compared to generally low when compared to serum. serum.

– There are four major components of saliva: There are four major components of saliva: mucusmucus that serves as a lubricant, that serves as a lubricant, amylaseamylase, an enzyme that initiates the , an enzyme that initiates the

digestion of starch, digestion of starch, lingual lipaselingual lipase, an enzyme that begins the , an enzyme that begins the

digestion of fat, and digestion of fat, and a slightly a slightly alkaline electrolyte solutionalkaline electrolyte solution that that

moistens food. moistens food.

– Human saliva is always hypotonic to plasma. Na+ and Human saliva is always hypotonic to plasma. Na+ and Cl- concentrations are less than that of plasma; but K+ Cl- concentrations are less than that of plasma; but K+ and HCO3- concentrations are higher in saliva than in and HCO3- concentrations are higher in saliva than in plasma. Amylase and mucus also increase in plasma. Amylase and mucus also increase in concentration after stimulation. concentration after stimulation.

Saliva CompositionSaliva Composition Produced in Produced in salivary glandssalivary glands, saliva is 98% , saliva is 98% waterwater, ,

but it contains many important substances, but it contains many important substances, including including electrolyteselectrolytes, , mucusmucus, , antibacterialantibacterial compounds and various compounds and various enzymesenzymes. .

WaterWater Electrolytes: Electrolytes:

– 2-21 mmol/L 2-21 mmol/L sodiumsodium (lower than (lower than blood plasmablood plasma) ) – 10-36 mmol/L 10-36 mmol/L potassiumpotassium (higher than plasma) (higher than plasma) – 1.2-2.8 mmol/L 1.2-2.8 mmol/L calciumcalcium – 0.08-0.5 mmol/L 0.08-0.5 mmol/L magnesiummagnesium – 5-40 mmol/L 5-40 mmol/L chloridechloride (lower than plasma) (lower than plasma) – 25 mmol/L 25 mmol/L bicarbonatebicarbonate (higher than plasma) (higher than plasma)

- 1.4-39 mmol/L - 1.4-39 mmol/L phosphatephosphate

MucusMucus. Mucus in saliva . Mucus in saliva mainly consists of mainly consists of mucopolysaccharidesmucopolysaccharides and and glycoproteinsglycoproteins; ;

Antibacterial compoundsAntibacterial compounds ((thiocyanatethiocyanate, , hydrogen peroxidehydrogen peroxide, and , and secretory secretory immunoglobulin Aimmunoglobulin A) )

In its secretory form, IgA is In its secretory form, IgA is the main immunoglobulin the main immunoglobulin found in mucous secretions, found in mucous secretions, including tears, salivaincluding tears, saliva

ENZYMESENZYMES There are three major There are three major

enzymes found in saliva. enzymes found in saliva. – α-α-amylaseamylase. Amylase starts . Amylase starts

the digestion of starch and the digestion of starch and lipase fat before the food is lipase fat before the food is even swallowed. It has a pH even swallowed. It has a pH optima of 7.4. optima of 7.4.

– lysozyme. Lysozyme acts to lysozyme. Lysozyme acts to lyse bacteria. lyse bacteria.

– lingual lipase. Lingual lipase lingual lipase. Lingual lipase has a pH optimum ~4.0 so it has a pH optimum ~4.0 so it is not activated till entering is not activated till entering an acidic environment. an acidic environment.

EnzymesEnzymes

– Minor enzymesMinor enzymes include salivary acid include salivary acid phosphatases A+B,phosphatases A+B,

– N-acetylmuramyl-L-alanine amidase, NAD(P)H N-acetylmuramyl-L-alanine amidase, NAD(P)H dehydrogenase-quinone, dehydrogenase-quinone,

– salivary lactoperoxidase, salivary lactoperoxidase, – superoxide dismutasesuperoxide dismutase, , – glutathione transferase, glutathione transferase, – aldehyde dehydrogenase, aldehyde dehydrogenase, – glucose-6-phosphate isomerase,glucose-6-phosphate isomerase,– tissue kallikrein. tissue kallikrein.

Cells: Possibly as much as 8 million human and Cells: Possibly as much as 8 million human and 500 million bacterial cells per mL. The presence 500 million bacterial cells per mL. The presence of bacterial products (small organic acids, of bacterial products (small organic acids, amines, and mercaptans) causes saliva to amines, and mercaptans) causes saliva to sometimes exhibit foul odor. sometimes exhibit foul odor.

Biochemical composition of human saliva in Biochemical composition of human saliva in relation to other mucosal fluidsrelation to other mucosal fluids

Histatins are polypeptides which possess Histatins are polypeptides which possess exceptional anti-fungal and anti-bacterial exceptional anti-fungal and anti-bacterial activities, but are nevertheless present only in activities, but are nevertheless present only in saliva. saliva.

Proline-rich proteins (PRPs) are members of a Proline-rich proteins (PRPs) are members of a closely related family, of which the acidic PRPs are closely related family, of which the acidic PRPs are found solely in saliva. found solely in saliva.

Mucins are a group of glycoproteins that Mucins are a group of glycoproteins that contribute to the visco-elastic character of the contribute to the visco-elastic character of the mucosal secretions. mucosal secretions. MMucins have distinct tissue ucins have distinct tissue distributions and amino acid sequences. Other distributions and amino acid sequences. Other salivary proteins are present in one or more salivary proteins are present in one or more mucosal secretions.mucosal secretions.

Lysozyme is an example of a componentLysozyme is an example of a componentbelonging to an ancient self-defense system,belonging to an ancient self-defense system, whereas secretory immunoglobulin A (sIgA)whereas secretory immunoglobulin A (sIgA) is the secreted part of a adaptive immune system.is the secreted part of a adaptive immune system.

Cystatins are closely related proteins which belong to a Cystatins are closely related proteins which belong to a multigene family. multigene family.

Alpha-Amylase playAlpha-Amylase playss a specific role in digestion, but is a specific role in digestion, but is nevertheless present in several body fluids.nevertheless present in several body fluids.

Kallikrein and albumin are components of blood plasma. Kallikrein and albumin are components of blood plasma. But whereas albumin diffuses into the different mucosal But whereas albumin diffuses into the different mucosal secretions, kallikrein is secreted specifically by the mucosal secretions, kallikrein is secreted specifically by the mucosal glands.glands.

the pH changes the pH changes from being from being slightly acidic (at slightly acidic (at rest) to basic (pH rest) to basic (pH 8) at ultimate 8) at ultimate stimulation. This stimulation. This increase in increase in alkalinity is due alkalinity is due to the increase of to the increase of HCO3- in the HCO3- in the salivasaliva

Salivary DysfunctionSalivary Dysfunction MMajor types of disorders affect the salivary glands: one ajor types of disorders affect the salivary glands: one

that results in salivary gland malfunction, whereby not that results in salivary gland malfunction, whereby not enough saliva is produced, and one that results in enough saliva is produced, and one that results in salivary gland swelling. salivary gland swelling.

When the flow of saliva is insufficient or almost When the flow of saliva is insufficient or almost nonexistentnonexistent..This condition This condition - - dry mouth dry mouth (xerostomia)(xerostomia).. Hypothyroid states, diabetes mellitus, and HIV and Hypothyroid states, diabetes mellitus, and HIV and hepatitis C infection have all been associated with hepatitis C infection have all been associated with xerostomia.xerostomia.

TThe loss of saliva can have multiple deleterious he loss of saliva can have multiple deleterious consequences, including a constant sense of dryness consequences, including a constant sense of dryness (xerostomia), increased tooth decay, fungal infections (xerostomia), increased tooth decay, fungal infections and oral burning (Candidiasis), decreased or altered and oral burning (Candidiasis), decreased or altered taste, difficulty speaking and swallowing, and recurrent taste, difficulty speaking and swallowing, and recurrent salivary gland infections. salivary gland infections.

Too much or too little saliva can affect oral Too much or too little saliva can affect oral health and quality of life.health and quality of life.

HypoHyposalivasalivationtion leads to dental decay, oral leads to dental decay, oral yeast infections, taste problems, bad yeast infections, taste problems, bad breath, difficulty speaking and swallowing, breath, difficulty speaking and swallowing, and recurrent salivary glands infections. and recurrent salivary glands infections. The loss of saliva is not associated The loss of saliva is not associated with the development of periodontal with the development of periodontal diseasedisease

HyperHypersalivasalivationtion can cause social problems can cause social problems and may be a sign of an underlying and may be a sign of an underlying medical problemmedical problem (stomatitis, pulpitis, (stomatitis, pulpitis, parodontitis etc)parodontitis etc).  .  

ORAL ENVIRONMENTORAL ENVIRONMENTPLAQUEPLAQUE

Soft sticky, invisible film constantly forming in your mouth. Covers Soft sticky, invisible film constantly forming in your mouth. Covers teeth and gums.teeth and gums.

Oral mucosa cellsOral mucosa cells SalivaSaliva BacteriaBacteria

Can be removed by brushing and flossing.Can be removed by brushing and flossing.

Gram + cocci Gram + rodsGram + cocci Gram + rods Gram – anaerobesGram – anaerobes(healthy mouth)(healthy mouth) (gingivitis) (gingivitis)

Formation / progression influenced by:Formation / progression influenced by: DietDiet Host immune systemHost immune system Oral environmentOral environment

Taste DisordersTaste Disorders

Loss of taste Loss of taste Persistent unusual or unexpected tastes Persistent unusual or unexpected tastes Perversions of taste (for example, when Perversions of taste (for example, when

something sweet tastes salty) something sweet tastes salty)

Evaluation includes medical history review, Evaluation includes medical history review, head, neck and oral examination, diagnostic head, neck and oral examination, diagnostic imaging, salivary function assessment, and imaging, salivary function assessment, and testing of ability to taste and smell.testing of ability to taste and smell.

Salivary Gland Swelling: Salivary Gland Swelling: Salivary gland Salivary gland swelling can occur when one of the ducts swelling can occur when one of the ducts that carry saliva from the salivary gland to that carry saliva from the salivary gland to the mouth is blocked. Pain may occur, the mouth is blocked. Pain may occur, especially during eating.especially during eating.

The most common cause of blockage is a The most common cause of blockage is a stone. Salivary gland stones are most stone. Salivary gland stones are most common in adults; 25% of those with common in adults; 25% of those with stones have more than one. A stone can stones have more than one. A stone can form from salts contained in the saliva. form from salts contained in the saliva. Blockage makes saliva back up inside the Blockage makes saliva back up inside the duct, causing the salivary gland to swell. A duct, causing the salivary gland to swell. A blocked duct and gland filled with stagnant blocked duct and gland filled with stagnant saliva may become infected with bacteria. saliva may become infected with bacteria.

CandidiasisCandidiasis

MumpsMumps Mumps is an infection caused by a virus Mumps is an infection caused by a virus

and can cause:and can cause: Fever Fever Headache Headache Swelling and tenderness of glands in one Swelling and tenderness of glands in one

or both sides of the neck (called parotitis) or both sides of the neck (called parotitis) Running nose and eyes, sore throat and Running nose and eyes, sore throat and

ears particularly in young children. ears particularly in young children.

Occasionally serious complications of mumps Occasionally serious complications of mumps infection can occur. These less common, infection can occur. These less common, but more serious symptoms include:but more serious symptoms include:

A meningitisA meningitis Ear infections which can lead to hearing Ear infections which can lead to hearing

impairment. impairment. Swelling and tenderness of the testicles Swelling and tenderness of the testicles

in adult men (orchitis), and inflammation in adult men (orchitis), and inflammation of the ovaries (oophoritis) in women, of the ovaries (oophoritis) in women, though it is very rare for these to cause though it is very rare for these to cause serious complications such as infertility.serious complications such as infertility.

Pancreatitis inflammation of the Pancreatitis inflammation of the pancreas. pancreas.

  

Mumps, certain bacterial infections, Mumps, certain bacterial infections, and other diseases (such as AIDS, and other diseases (such as AIDS, Sjögren's syndrome, diabetes Sjögren's syndrome, diabetes mellitus, and sarcoidosis) may be mellitus, and sarcoidosis) may be accompanied by swelling of the major accompanied by swelling of the major salivary glands. Swelling also can salivary glands. Swelling also can result from cancerous or result from cancerous or noncancerous tumors in the salivary noncancerous tumors in the salivary glands. glands.

An injury to the lower lipAn injury to the lower lip may harm may harm any of the minor salivary glands any of the minor salivary glands found there and block the flow of found there and block the flow of saliva. saliva.