VOLUME 41 • NUMBER 4 • APRIL 2010 321 QUINTESSENCE INTERNATIONAL Physiologic amounts of salivary secretion are essential for oral health. 1 Saliva influences various events in the oral cavity such as caries protective, digestive, and immunologic processes. The ability to promote remineral- ization and to reduce demineralization makes saliva a major player in caries protec- tion. 2 Furthermore, this fluid is implicated in a wide variety of digestive events including lubrication of mucosa, bolus formation, and enzymatic digestion of food. 3 Saliva’s protec- tive role to the human organism is exhibited by delivering antimicrobial peptides and pro- teins to the oral epithelium. 4 Saliva is predominately secreted from three major paired salivary glands: parotid, sublingual, and submandibular (in all, about 90% of the total saliva production). 3 In addi- tion, hundreds of minor salivary glands (eg, buccal, labial, palatal), which are spread over all parts of the oral mucosa, contribute to secretion of saliva. Regulation of salivary secretion is reflex controlled by both the sym- pathetic and parasympathetic divisions of the autonomic nervous system. 5 The impuls- es, induced by action of gustation, mastica- tion, or smell are forwarded from afferent receptors to the salivary nuclei (salivation center) in the medulla oblongata. 3 The Etiologic factors of hyposalivation and consequences for oral health Peter Tschoppe, Dr Med Dent 1 /Michael Wolgin, Dr Med Dent 2 / Nicole Pischon, Dr Med Dent Habil 2 / Andrej M. Kielbassa, Dr Med Dent Habil 3 Hyposalivation is represented by a reduced salivary flow rate and can be caused by etiolog- ic factors such as systemic diseases and intake of various medications or by radiotherapy following head and neck cancer. The aim of this review was to compile data about the qualitative and quantitative changes of salivary components during hyposalivation, and to summarize their consequences for oral health. A Medline/PubMed/Scopus search was con- ducted to identify and summarize articles published in English and German that reported on etiology of hyposalivation and changes in the salivary composition due to hyposalivation of different origins. The search revealed 94 articles, 71 of which were original articles. Apart from the reduction of the salivary flow rate, the quality of saliva is strongly altered because of systemic diseases, medications, and radiotherapy, including increased viscosity and pH shift to more acidic values and changes in salivary protein compositions. Furthermore, hypo- salivation may be accompanied by pronounced shifts in specific microbial components, in particular toward a highly acidogenic microflora. Moreover, therapy of hyposalivation is often restricted to palliative treatment (ie, saliva substitutes or gels). To prevent tooth tissue de- mineralization, clinicians should consider saliva substitutes that are supersaturated with calcium and phosphates and contain fluoride. (Quintessence Int 2010;41:321–333) Key words: caries, drugs, hyposalivation, microflora, periodontitis, radiotherapy, saliva substitutes, Sjögren syndrome, xerostomia 1 Assistant Professor, Department of Operative Dentistry and Periodontology, CharitéCentrum 3, University School for Dental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. 2 Lecturer, Department of Operative Dentistry and Periodon- tology, CharitéCentrum 3, University School for Dental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. 3 Professor and Head, Department of Operative Dentistry and Periodontology, CharitéCentrum 3, University School for Dental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. Correspondence: Dr Michael Wolgin, Abteilung für Zahnerhaltungskunde und Parodontologie, CharitéCentrum 3 für Zahn-, Mund- und Kieferheilkunde, Charité- Universitätsmedizin Berlin, Assmannshauser Strasse 4-6, 14197 Berlin, Deutschland. Fax: 49 30 450 562 932. Email: michael. wolgin@charite.de © 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.