Dry Mouth Flashcards
Symptoms of dry mouth
Dry mouth, difficulty: eating, swallowing, speaking, wearing dentures. Mucosal surfaces sticking to each other and/or to the teeth, bad taste in the mouth/altered taste, halitosis, sore mouth, deteriorating dentition, salivary gland swelling persistent/ recurrent
History related to dry mouth additional questions
When did it begin?
Any initiating factors?
Is it getting worse, better or staying the same?
Anything that makes it better (ameliorating factors) or worse (Exacerbating factors)?
Any dryness elsewhere?
Any treatment tried - any benefit?
Any other health care professionals seen?
History related to MH
Any relevant systemic conditions?
Any relevant treatment?
Any specialists involved in their care?
History related to DH
Any recent increase in the need for dental treatment?
History related to SH
Occupation
Alcohol intake - fluid intake
History related to FH
Type 2 diabetes
Autoimmune conditions
Dry Mouth Signs
Salivary gland enlargement, mucosa sticks to the dental mirror, consistency of saliva stringy frothy and thick, little or no pooling of saliva in floor of the mouth, lobulated tongue, shiny mucosa, food debris, plaque accumulation, evidence of candidiasis: angular cheilitis, erythematous mucosa, thrush (acute pseudomembranous candidosis), denture stomatitis. Smooth surface caries, traumatic ulceration, poor denture retention, bacterial sialadenitis
Causes of dry mouth
- Developmental: aplasia (complete absence of salivary glands is rare, seen in conjunction with congenital conditions like Treacher Collins syndrome) and atresia (congenital absence or narrowing of duct which causes distension of the gland followed by atrophy)
- Salivary gland diseases: sjogrens syndrome, sarcoidosis, HIV, hep C
- Iatrogenic: drug induced (tricyclic antidepressants, anti-histamines, PPI), radiotherapy, graft vs host disease
- Psychogenic: oral dysaethesia, burning mouth syndrome, depression, stress, anxiety
- Dehydration: febrile illness, diabetes mellitus/insipidus, renal failure, diarrhoea
- Alcohol: dehydration, salivary gland disease
- Local: mouth breathing
- Acute/chronic sialadenitis: mumps
Sjogren’s syndrome
HPC: dryness of other mucosae, eyes in particular
MH + FH: connective tissue/autoimmune disease
Pathology: autoimmune chronic inflammatory condition polyclonal B cell proliferation, acinar atrophy secondary to infiltration by lymphocytes and affects exocrine glands
Classification of Sjogren’s syndrome
Primary SS: dry mouth and dry eyes
Secondary SS: dry mouth, dry eyes and connective tissue disorder e.g. rheumatoid arthritis, lupus erythematosus
Sjogren’s syndrome diagnosis
Oral investigations (salivary gland involvement):
- Sialometry
- Sialography (parotid)
- Scintigraphy
Ocular investigations:
- Schirmer test (lacrimal flow rate)
- Rose Bengal Die
Autoantibodies
Antibodies against extractable nuclear antigen (ENA): SSA (Ro) and/or SSB (La)
Histopathology: labial gland biopsy (gold standard)
Sjogren’s syndrome Prevalence
Affects women 10x more than men
10-15% of pts with rheumatoid arthritis are affected
3rd biggest cause of dry mouth
Sialometry
The pt is asked to dribble any saliva produced into a container. The saliva must be unstimulated. The test is done over a 15 minute period. Normal flow rate 0.3-0.4ml/min. A flow rate of less than 0.1ml/min is abnormal.
Sialography
Is the introduction of a radiopaque contrast medium into the orifice of one of the major salivary glands via a catheter. Radiographs usually lateral obliques are taken before and after the catheter is inserted. These determine the flow of fluid and examine teh drainage of the fluid.
Sialography is good to find any inflammation or obstruction of the gland/ducts.
Scintigraphy
Salivary scintigraphy can be useful in assessing salivary gland function. The isotope 99m-Technetium is intravenously injected and taken up by the salivary glands and then secreted into the saliva. Gamma rays are detected by a camera and can ascertain the rate, uptake and time of excretion in the mouth. This test is especially useful for diagnosis of SS.
