Dry Mouth and Salivary Gland Disease Flashcards
What are important functions of the saliva?
- Lubrication necessary for speech and swallowing
- Defensive and antimicrobial properties
- Taste perception
- Salivary amylase and lipase which start the digestion of starch and fat
- Lavage (flushing) and buffering properties
Benign nonepithelial tumours are of what origin?
Benign nonepithelial tumours are of mesenchymal origin
What are potenial aeteologies of xerostomia?
- Dehydration/Reduced fluid intake
- Habits (such as mouth breathing)
- Medication
- Salivary gland disease
- Systemic disease
- Change in oral perception due to nerve damage (surgery or trauma) or conditions such as Alzheimer’s or stroke.
- Psychological
- Age
- Idiopathic
Comment on the prevalence of
Adenoid Cystic Carcinoma
2nd most common malignant tumour (6% of all SG neoplasms) & most common malignancy in submandibular gland
Why do we ask “Have you had a daily feeling of dry mouth for more than 3 months?” to xerostomia patients?
Transient dry mouth is common, causes include anxiety & sports which lead to dehydration.
This Question distinguishes from Chronic dry mouth
What are some intra oral clinical features of sjogrens syndrome?
Cracked lips
Oral burning sensation or soreness
Dry & atrophic mucosa
No/Lack of saliva pooling
Sticky or glassy mucosa
Oral candidiasis
Increased caries
Halitosis
Dysphagia
Describe the clinical appearance of a haemangioma
What areas are most affected
Dark red, lobulated, asymptomatic, unilateral & compressible mass
Usually involve parotid & (less so) submandibular gland
What do the grades (Low/Intermediate/High) mean in regards to Mucoepidermoid Carcinoma grading?
The ratio of epidermoid cells rises in higher grades
Describe the change in growth you may expect to see in a hameangioma
Grows rapidly between the age of 1-6 months and then reduces until age 12
What is a Carcinoma Ex-Pleomorphic Adenoma?
Benign Pleomorphic Adenoma which is untreated/not fully excised
Why is complete excision of a pleomorhphic adenoma difficult?
Their incomplete capsule makes complete excision difficult and recurrence rate high
What is Sialadenosis?
Non-specific salivary gland enlargement often affecting the parotid gland bilaterally & not painful
not related to infection, inflammation or neoplasm
What is the most common salivary gland tumour?
Pleomorphic Adenoma
Benign epethelial
What is a mucocele?
What is a ranula?
What is the tx of a ranula?
Mucocele - trauma to duct leading to collection of saliva and duct in submucosal tissue
Ranula - sublingual mucocele
Marsupialization
Define hyposalivation
Objective reduction in salivary secretion due to reduced salivary gland function
What are the different types of benign nonepithelial tumours?
Neural sheath tumours
Angioma
Hemangioma
Lymphangioma (cystic hygroma)
Lipoma
No alien has loose lips
Describe the clinical appearance of a warthin tumour
Smooth, soft, parotid mass, multicystic and well encapsulated
What are some possible complications of xerostomia?
- Caries
- Oral soft tissue disease
- Dryness of rest of GIT
- Difficulty speaking and swallowing
- Voice hoarseness
- Psychological
- Nutrition
How does an adenoid cystic carcinoma present?
Presents as slow-growing, painless mass
Locally invasive – Metastasis to regional LNs is uncommon
What are some extra oral clinical features of sjogrens syndrome?
Dry eyes
Dryness of mucosal membranes (e.g. throat or genitals) & skin
Rheumatoid Arthritis
Fatigue
Raynaud’s phenomenon (fingers turn blue)
What are common areas affected by pleomorphic adenoma?
Describe the growth
- Tail of parotid gland (most)
- Hard palate minor SG
- Upper lip minor SG
Often slow growing & asymptomatic
What is sjogrens syndrome?
Multi-system Autoimmune Exocrinopathy disorder characterised by:
- Inflammation of exocrine glands (mainly salivary & lacrimal)
- Lymphocyte infiltration
What is Necrotizing Sialometaplasia?
How does it present?
Who is it most common in?
Benign, self-healing lesion of minor SGs (no tx needed)
Presents as a single, unilateral, painless/slightly painful lesion on hard palate (“looks black & necrotic”)
2-3x more common in males (usually aged over 40 years)
What is Sialolithiasis?
What is the most commonly affected gland?
Presence of stones or calculi in the Salivary glands causing pain and swelling.
The most commonly affected gland is the submandibular
What is Sialadenitis?
Enlargement of one or more salivary glands due to infection, inflammation or obstruction
What are the different types of Benign Epithelial Tumours
Monomorphic adenoma
Warthin tumor
Intraductal papilloma (IDP)
Pleomorphic adenoma
Oncocytoma
Sebaceous neoplasms
My willy is purple on Sunday
What areas are most affected by sialadenitis?
What are some possible causes of this?
Parotid & Submandibular glands most commonly affected
Possible causes include mumps, Sjögren’s & Sarcoidosis (enlargement of LNs)
What special investigations would you conduct for sjogrens syndrome?
Saliva analysis
FBC (+ive inflammatory markers)
Serology (+ive SS antibodies)
Radiograph (of salivary glands)
Biopsy
What is the most common salivary gland tumour?
Pleomorphic Adenoma
Benign epethelial
What is the most common salivary gland tumour in children?
Haemangioma
Comment on the prevalence of Mucoepidermoid Carcinoma
Most common malignant neoplasm of parotid gland (8% of all parotid tumours) & 2nd most common of submandibular gland
What is the peak onset for a mucoepidermoid carcinoma?
10 - 20 years (children and young adults)
How do Benign Lymphoepithelial Lesions present?
Who is it most common in?
Slowly progressing potentially painful
Presents discreet mass or diffuse enlargement of all or part of parotid gland
More common in females (peak incidence in 4th & 5th decades of life)
What are some relavant questions when taking a history of presenting complaint for xerostomia?
Have you had a daily feeling of dry mouth for more than 3 months?
How much water do you drink a day?
Do you drink liquids to aid in swallowing dry foods?
Do you wake up at night to drink liquids?
Have you had recurrent/persistent swollen salivary glands?
What are the different types of malignant epethelial tumours?
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Carcinoma Ex-Pleomorphic Adenoma
Comment on the difference between low grade and high grade Mucoepidermoid Carcinoma
Low grade lesions = Non-aggressive with good prognosis with treatment
High grade lesions = Aggressive, high metastatic rates to regional LNs & may resemble Squamous Cell Carcinoma (SCC)
For a xerostomia diagnosis what should be conducted during an extra oral examination?
TMJ Symmetry
Palpitation of salivary glands noting any pain/tenderness
Assess lymph nodes
Assess facial nerve (CN VII) to rule out malignant tumour invading nerve
What is the managment for hyposalivation
Regular dental visits (OHI & diet)
Sip water frequently (esp eating & speaking)
Use sugar free gum/sweets for increased salivary flow
No known cure, therefore tx aim = symptomatic relief & OH promotion
What is pilocarpine?
What are some of its side effects?
Drug used in severe dry mouth but has many side effects affecting GIT, cardiovascular, respiratory & urinary systems
Why do we ask “How much water do you drink a day?” to xerostomia patients?
Distinguish from dehydration from reduced fluid intake, most common cause of dry mouth.
Recommended = 8 glasses/day
Define xerostomia
Dry mouth resulting from reduced or absent salivary flow (hyposalivation)
