Journal of
Dental Research
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Modified Carlson-Crittenden Device for the Collection of Parotid Fluid
Ira L. Shannon, John R. Prigmore and Howard H. Chauncey
J DENT RES 1962 41: 778
DOI: 10.1177/00220345620410040801
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Modified Carlson-Crittenden Device for the
Collection of Parotid Fluid
IRA L. SHANNON, JOHN R. PRIGMORE, and HOWARD H. CHAUNCEY
Department of Dental Sciences, USAF School of Aerospace Medicine, Brooks AFB, Texas,
Medical Laboratory Branch, USAF Medical Service School, Gunter AFB, Alabama, and
Tufts College of Dental Medicine, Boston, Massachusetts
Prior to 1910, parotid fluid from normal (non-fistulated) subjects was collected by
cannulation. It was pointed out as early as 1860 that this was an unsatisfactory procedure for quantitative endeavor because of leakage outside the cannula and because of
the frequency with which the cannula slipped from the expanding duct.'
A significant innovation in methods for collecting human parotid fluid was introduced by Carlson and Crittenden2 in 1910. Their principle was "to surround the opening of Stensen's duct with a metal cup which communicates with the exterior by means
of a metal tube; surrounding this inner cup and fixed to it is an outer larger one communicating with the exterior by means of another metal tube." Vacuum produced in the
outer cup held the device in place. Parotid fluid was free to flow into the central chamber and through the outlet tube under virtually physiologic conditions. Although this
device was very susceptible to dislodgement during mastication, it represented the first
expression of a new collection principle by obviating the disadvantages of cannulation
and of collection devices that exerted negative pressure directly upon the duct orifice.
Lashley,3 in 1916, fabricated a heavily silver-plated metal disk 18 mm. in diameter
in which two concentric chambers were cut. The two chambers opened through the back
of the disk into two separate, 2-mm., soft-drawn silver tubes. The instrument was
placed against the inner surface of the cheek so that the central chamber covered the
orifice of Stensen's duct and the air was evacuated from the outer chamber by a suction
pump. This dual-chambered device provided, for the first time, adequate retention
characteristics.
Richter and Wada4 modified Lashley's sialometer by placing an additional tube in
the central chamber. This tube was used to allow warm water to fill the system for flowrate studies. The disk and tubes were silver-plated brass and copper, respectively.
Poth5 collected parotid fluid by placing tared nasal tampons about 4 cm. long over
the duct openings and leaving them in place until their thickness was doubled. In 1-5
minutes, between 1 and 2 gm. of fluid could be obtained.
Krasnogorski6 designed a silver, dual-chambered vacuum cap differing from the
Lashley cap primarily in that the outer annular suction chamber had a silver cover containing 20-25 round perforations. This arrangement was said to produce an even distribution of the suction. Finesinger and Finesinger7 employed this silver-tubed Krasnogorski capsule but simplified the suction system.
Jenness and Hackman8 reproduced Richter and Wada's metal device in light, hard
rubber and provided negative pressure by a heavy-walled, rubber syringe bulb connected by a rubber tube to the suction ring of the sialometer.
778
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Vol. 41, No. 4
MODIFIED CARLSON-CRITTENDEN DEVICE FOR PAROTID FLUID 779
Gore9 constructed an appliance for collecting from both parotid ducts simultaneously. Two rubber cups were fitted over the ducts and held in place by adjustable pressure
on rubber-tipped wires extending outside the mouth and grasping the cheeks. A partial
vacuum was produced by a suction bulb, thus causing the parotid fluid to flow toward
the collecting vessel.
Bercher and Sohier'" devised a funnel-shaped, single-chambered glass collecting cap
from which the parotid fluid could flow into a sealed test tube under negative pressure.
Direct vacuum was produced in the test tube by suction bulb, and this direct suction
was also active on the duct orifice, as well as the surrounding mucosa within the confines of the funnel. A fundamentally similar device was described by Sohier and Nabonne."
In 1953 Curby'2 developed a transparent plastic parotid cap machined from methyl
methacrylate polymer. He inserted flexible polyethylene tubing into entrance holestwo of which were drilled into the collecting chamber and one into the suction ring. This
cap-to-tubing connection left much to be desired, and the choice of material introduced
sterilization problems.
Kerr'3 replaced the central chamber of a Lashley-type collection cup with a fine
polyethylene cannula and found its use superior to routine cannulation. How it compared with non-cannulating suction caps was not made clear.
Schneyer'4 modified the Pickerill'5 segregator for the collection of submaxillary and
sublingual saliva and was one of theh authors who credited Carlson and Crittenden2 for
their primary contribution in parotid fluid sampling.'6
Tsaturov"7 developed a double-cup device in which digital pressure on a rubber
membrane produced stabilizing suction. In other respects, this capsule very closely
resembled the Krasnogorski apparatus.
Miller'8 recently published a description of a Lucite cap that appeared virtually as a
two-tubed Curby device.
Hayakawa'9 devised a suction cup based on the Carlson-Crittenden principle but
fabricated in light metal and especially designed for the "physical peculiarities of the
Japanese people." Suhara and Asakawa20 designed an improved version of this cap
fabricated from hard glass.
Thus several names have become associated with parotid sampling devices. Virtually all collection devices now in use are based on the original Carlson-Crittenden principle-no cannula, no direct vacuum on the duct orifice, and cap stability from a
peripheral suction ring. All caps based on this fundamental concept should, we think,
be classed as Carlson-Crittenden caps.
This paper presents directions for the fabrication, cleaning, and sterilization of a
performance-tested device for collecting parotid fluid, another modification of the
fundamental contribution of Carlson and Crittenden.
MATERIALS AND METHODS
The capping device may be tooled from any one of several clear, rigid plastics or
from metal blanks. The advantages of metal will be discussed later. The dual-chambered cap is 0.625 inch in diameter (Fig. 1) and 0.187 inch thick (Fig. 2). The central,
fluid-collecting chamber is 0.251 inch in diameter and 0.093 inch deep, while the
peripheral vacuum ring measures 0.062 inch in both width and depth (Fig. 3). The
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FIG. 1.-Horizontal section, showing diameter measurements and needle-to-chamber relationships
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FIG. 2.-Side view, showing width, vertical needle relationships, and hypothetic circle radius
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FIG. 3.-Side view cross-section, showing chamber depths and vertical needle-to-chamber relationships.
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Vol. 41, No. 4
MODIFIED CARLSON-CRITTENDEN DEVICE FOR PAROTID FLUID 781
side walls of this ring are tooled at an angle of 60° to the surface of the device contacting the mucosa. The flat surface of each of the two annular metal rings contacting the
mucosa is 0.062 inch in width. A section cut from a 15-gauge, stainless-steel needle is
placed in a channel drilled from the other surface of the cap into the collection chamber, and another needle section opens into the suction ring. The former provides a
means of exit for the free-flowing parotid fluid, while the latter, when connected by
tubing to a suction bulb, affords the negative pressure necessary to maintain the device
in sampling position.
The oval-shaped rubber suction bulb is approximately 2.50 inches in length and has
a capacity of 0.5 ounce (Fig. 4). The 0.156-inch bore in the reinforced neck provides a
satisfactory seal around the hub of the 15-gauge needle by which the bulb is connected
to the tubing.
The tubing is flexible, clear plastic tubing* with an inside diameter of 0.062 inch and
an outside diameter of 0.130 inch. This provides a snug fit around the 15-gauge needle
sections. Different formulations of this tubing are available to provide varying degrees
of resistance to dry or steam heat and to chemical sterilization.
After use, the cap and tubing are flushed several times with warm soapy water and
thoroughly rinsed with tap water under pressure. Portions of distilled water are repeatedly aspirated through the system, and this procedure is then repeated with ionexchange water. Alcohol is aspirated, and drying is carried out under negative pressure.
The devices are then autoclaved (15 pounds, 15 minutes) in gauze-lined sterilizing
trays and are thus stored until needed. The suction bulbs are treated separately and are
rejoined to the collection apparatus immediately prior to use.
DISCUSSION
The greatest problem in collecting parotid fluid is to prevent cap dislodgment. Suction must be such as to provide adequate cap retention without inducing significant
mucosal erythema, even when in position for several hours. Of equal importance is the
contour of the back side of the cap (that is, the convex surface extending into the oral
cavity). Our experience with the Curby device made it quite clear that no edges or
sharp prominences could be left exposed. When the periphery of this device was
rounded with dental stones until the surface described the arc of a portion of a circle,
mechanical dislodgment was reduced greatly. This alteration is not necessary if collections are to be made without exogenous stimulation, but if masticatory movements are
to be carried out, all sharp edges must be removed. Another factor in suction maintenance is the seal of the needle section into the collecting cap. Plastic caps are prone
to give trouble in this regard, but the problem can be reduced by sealing the needle into
position by flowing a wet mixture of plastic polymer and monomer into the intervening
space. There is no such problem with metal devices, since the needle sections are
soldered permanently into position. Machining an undercut into the outer suction ring
has provided very adequate cap retention and has made possible prolonged collections
without the fear of extravasation of blood into the collection device.
Several metals may be used in cap fabrication, but for routine collections when relatively innocuous stimulants are being used, nickel-plated brass caps are quite satisfac*
Tygon formulation S22-1, U.S. Stoneware Co., Akron, Ohio.
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782 SHANNON, PRIGMORE, AND CHA UNCEY
J. D. Res.
July-August 1962
tory. Chromium plating-much more difficult in this particular instance-provides a
surface that adds resistance. For situations in which even chromium will not suffice, we
substitute caps tooled from stainless steel. Metal caps are very desirable because of
their relative indestructibility, their splendid resistance to sterilization methods, and
the fact that their dimensions may be reduced to a minimum. The surfaces remain
smooth indefinitely, and the permanence of the solder joints is a great advantage over
plastic devices. The cracking and checking that appear with prolonged use in some of
the solid plastics are also obviated.
/7
FIG. 4.-The suction system
SUMMARY
Directions were given for the fabrication, cleaning, and sterilizing of a modified
Carlson-Crittenden device for collecting parotid fluid. The device has been use-tested
by the authors in the collection of more than 40,000 specimens. It has served particularly well in prolonged collections made with exogenous stimulants. The size of the
device is such that it is easily adapted for use in making collections from dogs and
other large experimental animals.
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REFERENCES
ORDENSTEIN, L. Ueber den Parotidenspeichel des Menschen, Beitr. Anat. Physiol., 2:103, 1860.
CARLSON, A. J., and CRITTENDEN, A. L. The Relation of Ptyalin Concentration to the Diet and
to the Rate of Secretion of the Saliva, Am. J. Physiol., 26:169, 1910.
LASHLEY, K. S. Reflex Secretion of the Human Parotid Gland, J. Exptl. Psychol., 1:461, 1916.
RICHTER, C. P., and WADA, T. Method of Measuring Salivary Secretions in Human Beings,
J. Lab. Clin. Med., 9:271, 1924.
POTH, E. J. A Simplified Technique for Quantitative Collection of Salivary Secretions in Man,
Proc. Soc. Exptl. Biol. Med., 30:977, 1933.
KRASNOGORSKI, N. I. Bedingte und unbedingte Reflexe im Kindesalter und ihre Bedeutung fur
die Klinik, Ergeb. inn. Med. u. Kinderheilk., 39:613, 1931.
FINESINGER, J. E., and FINESINGER, G. L. Modification of Krasnogorski Method for Stimulating
and Measuring Secretion from Parotid Glands in Human Beings, J. Lab. Clin. Med., 23:267,
1937.
JENNESS, A., and HACKMAN, R. C. Salivary Secretion during Hypnosis, J. Exptl. Psychol.,
22:58,1938.
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Vol. 41, No. 4
MODIFIED CARLSON-CRITTENDEN DEVICE FOR PAROTID FLUID 783
9. GORE, J. T. Saliva and Enamel Decalcification. II. Saliva Separator, J. D. Res., 17:69, 1938.
10. BERCHER, J., and SOHIER, R. Un Appareil simple pour l'aspiration de la salive parotidienne,
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11. SOHIER, R., and NABONNE, A. Procede simple et rapide de prelevement de la salive parotidienne,
applications pratiques, Compt. Rend. Soc. Biol., 131:881, 1939.
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13. KERR, A. C. Continuous Recording of the Rate of Flow of Parotid Secretion in Man, J. D. Res.,
34:784, 1955 (abstr.).
14. SCHNEYER, L. H. Method for the Collection of Separate Submaxillary and Sublingual Salivas
in Man, J. D. Res., 34:257, 1955.
15. PICKERILL, H. P. The Prevention of Dental Caries and Oral Sepsis. 2d ed. New York: Paul B.
Hoeber, Inc., 1919.
16. SCHNEYER, L. H., DuBosE, W. J., LEVIN, L. K., and OHME, H. E. Time Course of Parotid Secretion in Man, J. D. Res., 38:172, 1959.
17. TSATUROV, V. L. New Modifications for the Saliva Collecting Capsule, Bull. Exptl. Biol. Med.,
USSR, 43:124, 1957.
18. MILLER, J. L. Method of Pure Parotid Saliva Collection without Cannulization, J. D. Res.,
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19. SUHARA, R., TAKASHITA, H., KASAI, S., and MAJIMA, T. Comparative Study on Quantities of Submaxillar, Sublingual, and Parotid Salivas in Man, J. Nihon U.S.D., 1:211, 1959.
20. SUHARA, R., and ASAKAWA, H. On the Composition of Human Parotid Resting Saliva and
Reflex Saliva, J. Nihon U.S.D., 1:153, 1959.
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