Chapter 87 - Part D: Saliva Is Not Benign: Fistulas, Dehiscence, and the Oral Failure Cascade

In this BoardsCast episode, we continue Tobias Chapter 87 – Soft Tissues of the Oral Cavity by focusing on the single greatest enemy of oral wound healing: saliva.

Saliva isn’t harmless — it is enzymatic, contaminated, and constantly bathing wounds in a chemical soup that dissolves clots, weakens sutures, and sabotages primary closure. Combined with tongue motion, mastication forces, and the oral microbiome, it creates a predictable failure cascade leading to dehiscence, oronasal fistulas, and chronic breakdown.

You’ll learn:

• Why saliva chemically interferes with wound healing
• How the oral cavity’s microbiology accelerates contamination
• The mechanical forces that tear apart even “perfect” closures
• Why oronasal fistulas recur — and how to stop the cycle
• High-yield principles of tension-free closure in the mouth
• What clinical signs predict imminent dehiscence
• Board-relevant differences between palatal, buccal, gingival & mucosal wounds

If you’ve ever wondered why oral wounds fail more often — and more dramatically — than cutaneous wounds, this episode explains the entire cascade.

🎁 Simini Bonus

Claim your free sample of Simini Protect Lavage (just cover shipping):
https://www.simini.com/getstarted1620808454519

Listen On: Spotify | Apple Podcasts | Amazon Music

Chapters

• 0:00 Introduction: The "Dissolved" Wound Nightmare
• 1:00 The Oral Failure Cascade: Defining the mechanical collapse
• 2:30 Saliva Dynamics: Fibrin breakdown and enzymatic interference
• 4:15 The Micro-Gap: How saliva finds the "weakness built into the repair"
• 6:00 Fistula Mechanics: The permanent epithelial bridge
• 8:15 Differentiating Failure: Leaking and soggy vs. Hot and filled with pus
• 10:30 The "Cheese Wire" Effect: When tissue swelling meets tight sutures
• 12:00 Summary: Saliva as the ultimate stress test