In previous articles, Dr. Roseann Mulligan explored Xerostomia, Salivary Gland Hypofunction, the role of saliva in older adults, and the causes of dry mouth including xerogenic medications and systemic diseases. In this article, we’ll cover a few practical methods to test the salivary glands and salivary flow to help patients manage dry mouth.
Salivary Gland Exam
Before testing for salivary flow, it’s recommended that dentists examine the patient’s individual glands as follows.
1. Parotid Gland Exam
Inspect and palpate the parotid gland.
2. Submandibular Gland Exam
Palpate the submandibular salivary gland using a bimanual technique (e.g. one finger inside the mouth beneath the tongue on the side and the other hand just inside the inferior border of the mandible).
3. Salivary Duct and Flow Exam
Identify the anatomic landmarks intraorally for Stensen’s duct (usually at the maxillary second molar tooth on the inner surface of the buccal mucosa at the parotid papilla) and Wharton’s duct (anterior floor of mouth bilaterally at sublingual caruncles).
Perform a flow assessment at Stensen’s ducts by first positioning your light correctly, pulling the buccal mucosa out to expose the duct, and then drying all fluid from the buccal mucosa area.
Next, compress the parotid gland externally with the other hand moving from posterior to anterior across the gland. This should produce an expression of fluid from the duct.
Next, perform a flow assessment at Wharton’s ducts: position your light, push the tongue posterior with a mirror or tongue blade, and dry all fluid from the floor of the mouth with gauze.
Then, compress the submandibular gland with the other hand from beneath the mandible to produce fluid from the duct.
Salivary Flow Exam
In addition to examining individual glands, there are many other ways to measure salivary flow including whole mouth measurement, drooling during rest, or chewing a neutral substance. Below are two practical collection methods for clinicians:
Unstimulated Saliva Collection
- Subjects are instructed to adopt a sitting position with head hanging forwards slightly.
- They will be given a large glass funnel that sits inside an empty glass beaker or test tube.
- Before starting the test, the subject swallows the saliva he/she has in the mouth.
- During the next five minutes of the test, the subject remains relaxed and with eyes closed and drools into the funnel for 5 minutes.
- The volume of saliva generated is then weighed and measured in ml.
Stimulated saliva collection
- Stimulated saliva collection with paraffin wax involves the subject drooling into a funnel while chewing the wax for 3 minutes.
- Stimulated saliva collection with sugar-free lemon drop candy involves the subject drooling into a funnel while chewing the candy for 3 minutes.
An unstimulated salivary flow rate of 0.1 to 0.2 ml/min and a paraffin wax stimulated flow rate of 0.7 ml/min or less is considered to be abnormally low flow rates indicative of salivary gland hypofunction. Dentists may also measure the salivary flow rate using a sialometer.
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