Disorders Of Salivation

Question 1

Why can anxiety lead to a dry mouth

Answer 1

Cephalic control of saliva
- inhibition of salivation, chronic reduction in flow and oral dryness

Question 2

What is a normal rate of stimulated saliva flow

Answer 2

1-2mL/min

Question 3

What is a normal resting flow of salvia

Answer 3

0.3-0.4ml/min

Question 4

What test can we use for salivary flow and what result would indicate a dry mouth

Answer 4

Unstimulated salivary flow test

Result of less than 1.5ml would indicate a dry mouth

Question 5

What is the schrimer test

Answer 5

This is a tear flow test, in a salivary issue there would be less than 5mm in 15 mins

Question 6

Why is glandosane discouraged as a salvia substitute in dentate patients

Answer 6

Has it has an acidic PH so can lead to decay

Question 7

Name three conditions that may be assciated with a dry mouth and why

Answer 7

Ectodermal dysplasia - glands dont form properly, may not complain of a dry mouth as is all they have known

Sarcoidosis - granulomatosis, condition causes infiltrate into the gland preventing functioning properly

HIV
Cystic fibrosis ; affects all gland secretions throughout the body

Question 8

What are common sites for mucocles

Answer 8

Junction of the hard and soft palate
Lower li[

Question 9

What is a mucocele

Answer 9

Obstruction of a minor gland can result in a mucocel

Question 10

Patient comes to you complaining of a swelling when eating but it goes away once they have ate - what might this be nd why

Answer 10

Subacute obstruction of the salivary glands usually submandibular

Swelling is associated with meal times as this is when salivary flow starts and reduces when salivary flow stops

Usually caused by a duct obstruction in submandibular or a stricture in the parotid

Question 11

Why do we take occlusl films with low exposure when looking for salivary stones

Answer 11

This is because they have a low calcium content so may missed if normal radiation permitted

Question 12

Silalosis is major gland enlargement - it has no identified cause, name 4 potienal causes

Answer 12

Alcohol abuse
Cirrhosis
Diabetes mellitus
Drugs

Question 13

Why is SJogrens often diagnosed late

Answer 13

Because inflammatory process takes place in the glands and so is hidden there and there is no pain usually - this happens over years as the tissue is gradually lost and patient will complain of a dry mouth

Question 14

What are the things we test in the ACR-EULAR 2016 for diagnosis of sjogrens

Answer 14

Histopathology findings - lymphocytic foci
Auto-antibody findings - anti-ro
Dry eyes and mouth - objective salivary flow and schirmer test
Ultrasound - snowstorm appareance §

Question 15

What would the results be in an abnormal schirmer test

Answer 15

<5MM in 5 mins

Question 16

What would the results be in an abnormal unstimulated whole salivary flow test

Answer 16

<1.5ml in 15 mins

Question 17

What two types of antibodies tend to be found in sjogrens

Answer 17

AntiRO and antiLA

Question 18

How do we deal with a sjogrens patient who is presenting with a dry mouth and salivary deficit

Answer 18

Gland function is already very low
Oral health !! - enhanced prevention
Symptomatic treatment of oral dryness
Salivary stimulants - pilocarpine

Question 19

What can be a problem with pilocarpine

Answer 19

Often produces unwanted side affects such as sweating and palpation as it affects all the glands in the body

Question 20

What is a severe complication of sjogrens that patients must be made aware of

Answer 20

It is rare but they can develop salivary lymphoma