Dry Mouth and Salivary Gland Disease

Question 1

What are important functions of the saliva?

Answer 1

• 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

Question 2

Benign nonepithelial tumours are of what origin?

Answer 2

Benign nonepithelial tumours are of mesenchymal origin

Question 3

What are potenial aeteologies of xerostomia?

Answer 3

1. Dehydration/Reduced fluid intake
2. Habits (such as mouth breathing)
3. Medication
4. Salivary gland disease
5. Systemic disease
6. Change in oral perception due to nerve damage (surgery or trauma) or conditions such as Alzheimer’s or stroke.
7. Psychological
8. Age
9. Idiopathic

Question 4

Comment on the prevalence of
Adenoid Cystic Carcinoma

Answer 4

2nd most common malignant tumour (6% of all SG neoplasms) & most common malignancy in submandibular gland

Question 5

Why do we ask “Have you had a daily feeling of dry mouth for more than 3 months?” to xerostomia patients?

Answer 5

Transient dry mouth is common, causes include anxiety & sports which lead to dehydration.

This Question distinguishes from Chronic dry mouth

Question 6

What are some intra oral clinical features of sjogrens syndrome?

Answer 6

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

Question 7

Describe the clinical appearance of a haemangioma

What areas are most affected

Answer 7

Dark red, lobulated, asymptomatic, unilateral & compressible mass

Usually involve parotid & (less so) submandibular gland

Question 8

What do the grades (Low/Intermediate/High) mean in regards to Mucoepidermoid Carcinoma grading?

Answer 8

The ratio of epidermoid cells rises in higher grades

Question 9

Describe the change in growth you may expect to see in a hameangioma

Answer 9

Grows rapidly between the age of 1-6 months and then reduces until age 12

Question 10

What is a Carcinoma Ex-Pleomorphic Adenoma?

Answer 10

Benign Pleomorphic Adenoma which is untreated/not fully excised

Question 11

Why is complete excision of a pleomorhphic adenoma difficult?

Answer 11

Their incomplete capsule makes complete excision difficult and recurrence rate high

Question 12

What is Sialadenosis?

Answer 12

Non-specific salivary gland enlargement often affecting the parotid gland bilaterally & not painful

not related to infection, inflammation or neoplasm

Question 13

What is the most common salivary gland tumour?

Answer 13

Pleomorphic Adenoma

Benign epethelial

Question 14

What is a mucocele?

What is a ranula?

What is the tx of a ranula?

Answer 14

Mucocele - trauma to duct leading to collection of saliva and duct in submucosal tissue

Ranula - sublingual mucocele

Marsupialization

Question 15

Define hyposalivation

Answer 15

Objective reduction in salivary secretion due to reduced salivary gland function

Question 16

What are the different types of benign nonepithelial tumours?

Answer 16

Neural sheath tumours
Angioma
Hemangioma
Lymphangioma (cystic hygroma)
Lipoma

No alien has loose lips

Question 17

Describe the clinical appearance of a warthin tumour

Answer 17

Smooth, soft, parotid mass, multicystic and well encapsulated

Question 18

What are some possible complications of xerostomia?

Answer 18

• Caries
• Oral soft tissue disease
• Dryness of rest of GIT
• Difficulty speaking and swallowing
• Voice hoarseness
• Psychological
• Nutrition

Question 19

How does an adenoid cystic carcinoma present?

Answer 19

Presents as slow-growing, painless mass

Locally invasive – Metastasis to regional LNs is uncommon

Question 20

What are some extra oral clinical features of sjogrens syndrome?

Answer 20

Dry eyes
Dryness of mucosal membranes (e.g. throat or genitals) & skin
Rheumatoid Arthritis
Fatigue
Raynaud’s phenomenon (fingers turn blue)

Question 21

What are common areas affected by pleomorphic adenoma?

Describe the growth

Answer 21

1. Tail of parotid gland (most)
2. Hard palate minor SG
3. Upper lip minor SG

Often slow growing & asymptomatic

Question 22

What is sjogrens syndrome?

Answer 22

Multi-system Autoimmune Exocrinopathy disorder characterised by:

• Inflammation of exocrine glands (mainly salivary & lacrimal)
• Lymphocyte infiltration

Question 23

What is Necrotizing Sialometaplasia?

How does it present?

Who is it most common in?

Answer 23

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)

Question 24

What is Sialolithiasis?

What is the most commonly affected gland?

Answer 24

Presence of stones or calculi in the Salivary glands causing pain and swelling.

The most commonly affected gland is the submandibular

Question 25

What is Sialadenitis?

Answer 25

Enlargement of one or more salivary glands due to infection, inflammation or obstruction

Question 26

What are the different types of Benign Epithelial Tumours

Answer 26

Monomorphic adenoma
Warthin tumor
Intraductal papilloma (IDP)
Pleomorphic adenoma
Oncocytoma
Sebaceous neoplasms

My willy is purple on Sunday

Question 27

What areas are most affected by sialadenitis?

What are some possible causes of this?

Answer 27

Parotid & Submandibular glands most commonly affected

Possible causes include mumps, Sjögren’s & Sarcoidosis (enlargement of LNs)

Question 28

What special investigations would you conduct for sjogrens syndrome?

Answer 28

Saliva analysis
FBC (+ive inflammatory markers)
Serology (+ive SS antibodies)
Radiograph (of salivary glands)
Biopsy

Question 29

What is the most common salivary gland tumour?

Answer 29

Pleomorphic Adenoma

Benign epethelial

Question 30

What is the most common salivary gland tumour in children?

Answer 30

Haemangioma

Question 31

Comment on the prevalence of Mucoepidermoid Carcinoma

Answer 31

Most common malignant neoplasm of parotid gland (8% of all parotid tumours) & 2nd most common of submandibular gland

Question 32

What is the peak onset for a mucoepidermoid carcinoma?

Answer 32

10 - 20 years (children and young adults)

Question 33

How do Benign Lymphoepithelial Lesions present?

Who is it most common in?

Answer 33

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)

Question 34

What are some relavant questions when taking a history of presenting complaint for xerostomia?

Answer 34

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?

Question 35

What are the different types of malignant epethelial tumours?

Answer 35

Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Carcinoma Ex-Pleomorphic Adenoma

Question 36

Comment on the difference between low grade and high grade Mucoepidermoid Carcinoma

Answer 36

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)

Question 37

For a xerostomia diagnosis what should be conducted during an extra oral examination?

Answer 37

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

Question 38

What is the managment for hyposalivation

Answer 38

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

Question 39

What is pilocarpine?

What are some of its side effects?

Answer 39

Drug used in severe dry mouth but has many side effects affecting GIT, cardiovascular, respiratory & urinary systems

Question 40

Why do we ask “How much water do you drink a day?” to xerostomia patients?

Answer 40

Distinguish from dehydration from reduced fluid intake, most common cause of dry mouth.

Recommended = 8 glasses/day

Question 41

Define xerostomia

Answer 41

Dry mouth resulting from reduced or absent salivary flow (hyposalivation)