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BDS4 BAMS Oral Medicine > 6. Salivation Disorders > Flashcards

6. Salivation Disorders Flashcards

1
Q

What are the functions of saliva ?

A

Acid buffering.
Mucosal lubrication - speech, swallowing.
Taste facilitation.
Antibacterial.

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2
Q

What can be the cause of xerostomia ?

A

Salivary gland disease.
Drugs.
Medical conditions and dehydration.
Radiotherapy and cancer treatments.
Anxiety and somatisation disorders.

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3
Q

Indirect causes of salivary problems - what drugs cause xerostomia ?

A

Anti-cholinergic drugs i.e. tricyclic antidepressants and antipsychotics.
Anti-muscarinic drugs i.e. amitriptyline.
Antihistamines.
Atropine.
Diuretics i.e. bendrofluazide.
Cytotoxics (chemotherapy).
Lithium.

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4
Q

What percentage reduction of salivary flow do people on amitriptyline experience ?

A

26%

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5
Q

What percentage reduction of salivary flow do people on bendrofluazide experience ?

A

10%

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6
Q

What percentage reduction of salivary flow do people on lithium experience ?

A

70%

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7
Q

Indirect salivary problems - what chronic medical conditions can cause xerostomia ?

A

Diabetes - mellitus and insipidus.
Renal disease - increase in diuresis.
Stroke.
Addisons disease.
Persistant vomiting.

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8
Q

Indirect salivary problems - what acute medical conditions can cause xerostomia ?

A

Acute oral mucosal disease.
Burns.
Vesiculobullous disease.
Haemorrhage.

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9
Q

Direct salivary problems - what are some examples of direct salivary gland problems ?

A

Aplasia - ectodermal dysplasia.
Sarcoidosis.
HIV.
Gland infiltration - amyloidosis and haemochromatosis.
Cystic fibrosis.

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10
Q

What are some symptoms associated with ectodermal dysplasia ?

A

Disorders that affect hair, nails, teeth (hypodontia, cone shaped teeth), salivary and sweat glands.
Hearing and vision.
Cleft lip and palate.

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11
Q

What subtype of ectodermal dysplasia is most likely to cause salivation problems ?

A

Hypohidrotic ectodermal dysplasia type (X-linked).

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12
Q

What is sarcoidosis ?

A

Multisystem disease seen with granulomatous change in lymph nodes in the lung, skin, salivary glands (enlargement of submandibular and parotid glands).

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13
Q

How does HIV affect salivary glands ?

A

Lympho-proliferative disease which causes increased bulk of gland and reduction in function (active acing tissue lost).

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14
Q

What is amyloidosis ?

A

Deposition of protein within gland preventing normal function.

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15
Q

What is haemachromatosis ?

A

Excess storage of iron within the salivary tissues preventing normal function.

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16
Q

Direct salivary problems - what types of cancer treatment cause salivary problems ?

A

Radiation - reduced blood flow.
Graft vs. host disease (bone marrow transplant).
Antineoplastic drugs - accumulate causing death of acing cells.
Radiodine - accumulate causing death of acing cells.

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17
Q

What is the name of the scale used to assess salivary function and degree of oral dryness ?

A

Challacombe Scale of Mucosal Dryness.

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18
Q

What is the treatment for first stage Challacombe Scale of Mucosal Dryness ?

A

Sugar free chewing gum and frequent sips of water.

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19
Q

What is the treatment for second stage Challacombe Scale of Mucosal Dryness ?

A

Advanced treatment and salivary substitutes.
High caries risk - OH, topical fluoride, dietary advice.

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20
Q

What are some special investigations used in assessing salivary disease ?

A

Ultrasound.
Sialography (+/- MR).
Radiographs (stones).
Labial gland biopsy (“tissue assay”).
Salivary flow test (“functional assay”).
Blood tests.

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21
Q

What are you looking for in blood tests for assessment of salivary disease ?

A

Dehydration.
Diabetes.
Autoimmune conditions - Sjorgens.
HIV.

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22
Q

Name some examples of frequent somatoform diseases (complaint fo real symptoms but on examination, disease is not found).

A

Oral dyaesthesia (burning mouth).
TMD pain.
Headache.
Neck and back pain.
Dyspepsia.
IBS.

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23
Q

How much salivary should be produced unstimulated in 15 mins ?

A

1.5ml.

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24
Q

Name treatable causes of xerostomia.

A

Dehydration.
Medicines with anti-muscarinic side effects.
Medicines causing dehydration.
Poor diabetes control.
Somatoform disorder (diagnosis of exclusion).

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25
Q

Name causes of xerostomia with only symptomatic treatment.

A

Sjorgens syndrome.
Due to cancer treatment.
Due to salivary gland disease.

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26
Q

Name some of the treatment options for symptomatic relief of xerostomia in patients with Sjorgens, xerostomia due to cancer treatment or salivary gland disease.

A

Intensive dental prevention.
Salivary substitutes.
Salivary stimulants.

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27
Q

Name two salivary substitute sprays.

A

Glandosane and saliva orthana.

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28
Q

What salivary substitute spray should be recommended ?

A

Saliva orthana.
Glandosane - has high pH.

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29
Q

Names two salivary lozenges.

A

Saliva orthana and SST.

30
Q

Name a salivary stimulant medication.

A

Prilocarpine.

31
Q

Why is pilocarpine not tolerated well ?

A

Causes sweating and tachycardia.

32
Q

What are examples of true causes of hypersalivation ?

A

Drug causes.
Dementia.
CJD.
Stroke.

33
Q

What are examples of perceived causes of hypersalivation ?

A

Swallowing failure - anxiety, stroke, motor neurone disease, multiple sclerosis.
Postural drooling - baby and cerebral palsy.

34
Q

How can excess salivation be managed ?

A

Treat cause - anxiety.
Drugs to reduce salivation - anti-muscarinic agents and bottom to prevent cholinergic gland stimulation.
Biofeedback training - swallowing control.
Surgery to salivary system - gland removal, duct repositioning into pharynx.

35
Q

What are two forms of surgery which might be considered as last resort to manage excess salivation ?

A

Gland removal.
Duct repositioning into pharynx.

36
Q

What are the three main causes of changes in gland size ?

A

Viral inflammation.
Secretion retention.
Gland hyperplasia.

37
Q

What are two examples of viral inflammatory conditions which cause enlargement of salivary glands ?

A

Mumps and HIV.

38
Q

What are two examples of secretion retention conditions causing enlargement of salivary glands ?

A

Mucocele.
Duct obstruction.

39
Q

What are two examples of gland hyperplasia which cause enlargement of salivary glands ?

A

Sjorgens syndrome.
Sialosis - unknown cause for hyperplasia.

40
Q

What vaccine provides protection from mumps ?

A

MMR.

41
Q

What is the incubation period for mumps ?

A

2-3 weeks.

42
Q

What can be the symptoms of mumps ?

A

Headache.
Joint pain.
Nausea.
Dry mouth.
Mild abdominal pain.
Lethargy.
Loss of appetite.
Pyrexia of 38C or above.

43
Q

What is the treatment for mumps ?

A

Symptomatic tx only.
No antiviral tx available.
Analgesics and increased fluid intake.

44
Q

Where are mucoceles normally found in the mouth ?

A

Areas of trauma - soft palate and lip.

45
Q

A patient with a subacute obstruction of their salivary gland will complain of what ?

A

Swelling associated with meal times.
Submandibular (sometimes parotid).
Slow and progressive over weeks.
Eventually becoming fixed and painful.

46
Q

What can be the cause of a subacute salivary gland obstruction ?

A

Sialolith (stones).
Mucous plugging.
Scarring from chronic infection.

47
Q

What investigations should be used to assess subacute salivary gland obstruction ?

A

Low dose plain radiograph.
Sialography if infection free.
Isotope scan if gland function uncertain.
Ultrasound.

48
Q

What type of radiograph should be used to assess subacute parotid gland obstruction ?

A

PA.

49
Q

What type of radiograph should be used to assess subacute submandibular gland obstruction ?

A

Lower true occlusal.

50
Q

Why should sialography not be used to detect subacute salivary gland obstruction where there is infection ?

A

Risk of flushing infection back through duct into gland.

51
Q

Why is it beneficial to use sialography in detection of subacute salivary gland obstruction ?

A

Can show stricture or blockage.
Can also provide treatment by dislodging blockage and cause.

52
Q

What is the problem associated with duct dilation ?

A

Defect prevents normal emptying.
Causes pooling of saliva in duct system.
Micro-organisms grow and lead to persisting and recurrent sialadenits.
Causes gland function to be gradually lost and persisting infection leads to requirement for gland removal.

53
Q

How can strictures in the duct system be treated ?

A

Balloon catheter.

54
Q

What is chronic non-specific sialadenitis ?

A

Ducts and acini replaced by scar tissue.
Can affect minor and major glands.

55
Q

How should a subacute salivary obstruction be managed ?

A

Surgical sialolith removal.
Sialography to wash.
Gland removal if fixed swelling and risk of persisting and recurring infection.

56
Q

Define sialosis.

A

Diagnosis of exclusion - persisting and unexplained major gland enlargement with no obvious glandular cause.

57
Q

What can sialosis be associated with ?

A

Alcohol abuse.
Cirrhosis.
Diabetes mellitus.
Drugs.

58
Q

What are the signs/symptoms of sialosis ?

A

Normal histology.
Gland will be enlarged.
Not painful.
Rarely have dry mouth.
Normal blood tests.

59
Q

Define primary Sjorgens syndrome.

A

Occurs in absence of any other rheumatic disease.

60
Q

Define secondary Sjorgens syndrome.

A

Associated with other CT disease i.e. due to SLE, rheumatoid arthritis, scleroderma.

61
Q

Define Sicca syndrome.

A

Partial Sjorgens findings - dry eyes or mouth (not both) in absence of autoimmune disease.

62
Q

Are men or women more likely to suffer Sjorgens syndrome ?

A

Women (10:1).

63
Q

What other rheumatic condition is most commonly associated with Sjorgens syndrome ?

A

SLE (systemic lupus erythema).

64
Q

What blood marker is a suspicion of Sjorgens syndrome if symptomatic ?

A

Anti Ro

65
Q

What are the symptoms of Sjorgen’s syndrome ?

A

Gradual loss of salivary/lacrimal gland function at 20-30s.
Enlargement of major salivary glands - symmetrical.
Painless.

66
Q

What is Sjorgen’s syndrome ?

A

Gradual loss of salivary/lacrimal gland function - due to inflammatory destruction (autoimmune condition mediated by T lymphocytes).

67
Q

People with Sjorgen’s syndrome are at greater risk of what ?

A

Any lymphoma.
Salivary marginal B-cell lymphoma.
Caries.
Periodontal disease.
Loss of taste.
Difficulty swallowing.
Poor ocular lubrication.
Lack of tear production.

68
Q

What scoring system is used to diagnose Sjorgen’s syndrome ?

A

ACR-EULAR joint criteria.

69
Q

What appearance will Sjorgen’s syndrome have on sialogram ?

A

Snowstorm appearance. Loss of acini causing holes in tissue - holes will fill with dye on sialogram.

70
Q

What appearance with Sjorgens syndrome have histologically in positive labial gland biopsy ?

A

Collection of lymphocytes (>50) around a duct - “lymphocytic focus”.
Most diagnostic feature on ACR-EULAR criteria.

71
Q

What tests should be carried out to diagnose Sjorgen’s syndrome ?

A

Intra-oral examination.
Unstimulated salivary flow (<1.5ml in 15 mins).
Anti-ro antibody blood test.
Baseline MRI of major salivary glands.
Labial gland biopsy.

72
Q

How should Sjorgen’s syndrome be managed ?

A

OH - diet, 5000ppm toothpaste.
Symptomatic tx of oral dryness.
Prilocarpine (licensed drug).
Routine dental appointment check ups.

BDS4 BAMS Oral Medicine (9 decks)

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