19 - Managing problems with saliva

Question 1

What are the benefits of a labial gland biopsy?

Answer 1

Shows the same changes that would be seen in a major gland biopsy without risk of damage to major nerves

Question 2

What can cause frothy saliva?

Answer 2

Excess proteins

Question 3

How can anxiety and somatoform disorders affect saliva?

Answer 3

• inhibition of saliva (by stress) causes actual oral dryness
• altered perception of normal quantity of saliva causes perceived “oral dryness” often seen in anxiety disorders

Question 4

What are common examples of somatoform disorders?

Answer 4

• oral dysaesthesia
• TMD pain
• headache
• neck/back pain
• dyspepsia (indigestion)
• IBS

Question 5

What is a somatoform disorder?

Answer 5

Patient experiences real symptoms for which no clinical cause can be found

Question 6

What is considered xerostomia on a salivary flow test?

Answer 6

Less than 1.5ml unstimulated flow in 15 mins

Question 7

What is looked for in a labial gland biopsy?

Answer 7

• lymphocytic infiltrate
• focal acinar disease

Question 8

Give examples of saliva substitute sprays.

Answer 8

• glandosane
• saliva orthana

Question 9

Give examples of saliva substitute lozenges.

Answer 9

• saliva orthana
• SST

Question 10

Give examples of saliva stimulants.

Answer 10

Pilocarpine (can cause sweating and tachycardia)

Question 11

What are causes of hypersalivation?

Answer 11

• drugs
• dementia
• CJD
• stroke

Question 12

What are causes of perceived hypersalivation?

Answer 12

• ie no actual increase in saliva, can be due to swallowing failure or postural drooling
• examples of swallowing failure include stroke, anxiety, MND and MS
• examples of postural drooling include cerebral palsy and babies

Question 13

What is the management of hypersalivation?

Answer 13

• treat the cause ie anxiety
• drug therapy (anticholinergics or botox in glands)
• biofeedback training for swallowing
• surgery