DRY MOUTH AND SALIVARY GLAND DISEASES

Question 1

True xerostomia vs false xerostomia and examples of each

Answer 1

true xerostomia- dry mouth due to reduction/absence of saliva flow
e.g. Sjogrens, dehydration, drugs, irridation, developmental
false xerostomia- sensation of dry mouth despite normal salivary flow
e.g. mouth breathing, psychological, mucosal disease

Question 2

Normal salivary flow rate vs xerostomia

Answer 2

normal: 0.3-0.4ml/min unstimulated
xerostomia: <0.2ml/min unstimulated

Question 3

properties of saliva with normal flow and composition

Answer 3

• lubrication 4 speech and swallowing
• defence and antimicrobical
• lavage and buffering
• taste perception
• digestion of by amylase and lipase

Question 4

Complications of xerostomia

Answer 4

dental problems
soft tissue diseases
dryness of the GIT
speech & swallowing 
candida overgrowth
psychological effect
voice hoarsness
decreases quality of life
nutirional deficiencies

Question 5

How to diagnose xerostomia

Answer 5

history+clinical examination
4 questions:
1) have you had daily dry mouth for >3 months?
2) do you drink liquid to aid swallowing?
3) wakeup at night to drink liquids?
4) do you have recurrent/persistent swollen salivary glands?

Question 6

Xerostomia aetiology

Answer 6

Drug-induced (including irridation) 2+ xerogenic agents
Systemic diseases (sjogrens, diabetes, HIV associated SGD)
Dehydration/ reduced fluids
salivary gland disease
habits (mouth breathing-false)
age
psychological
change in oral perception due to nerve damage (Alzheimers/ stroke)

Question 7

Drugs that cause xerostomia

Answer 7

antidepressants
antihypertensive E.G. b blockers atenalol
anticonvulsants 
antihistamines
some steroid/nsaids
steroid inhalers

Question 8

Types of salivary gland disease

Answer 8

Infectious

• bacterial sialadenitis
• viral mumps/HIV associated SGD

Obstruction

• MTS/sialolithiasis
• mucocele
• ranula

Damage
-secondary to cancer tx

Tumours
-benign/malignant
-MUCOEPIDERMOID CARCINOMA/PLEOMORPHIC
ADENOMA

Degenerative disease

• autoimmune disease
• Sjogrens syndrome

Question 9

Systemic diseases associated to xerostomia

Answer 9

sjogrens syndrome
liver disease
diabetes
thyroid disease
HIV related SGD
Amyloidosis
Sarcoidosis

Question 10

Salivary gland examination

Answer 10

• palapte + note tenderness
• gland enlargement/swelling
• mass: size fixed mobility structure associated
• erythema overlying skin
• lymph nodes
• note changes in muscle tone e.g. facial palsy
• check facial nerve weakenss

Question 11

Sialadenosis (sialosis)

Answer 11

• non-specific salivary gland enlargement
• typically painless
• usually bilateral parotid gland
• aetiology is unknown and NOT related to infection/neoplasm/inflammation

Question 12

possible sialadenosis aetiologies

Answer 12

eating disorders
medication
nutritional deficiencies
alcohol abuse
diabetes
pregnancy

Question 13

Sialolithiasis / MTS

Answer 13

• obstruction of the salivary gland due to a stone/calculi
• causing pain and swelling
• submandibular gland most common

Question 14

Sialadenitis + what conditions cause this

Answer 14

-enlargement of one or more salivary gland
-due to infection/inflammation/obstruction
-parotid/submandibular gland
-conditions causing this:
sarcoidosis, Sjogrens, mumps

Question 15

2 benign epithelial tumours

Answer 15

pleomorphic adenoma (85% of all SG neoplasms)
warthin tumor

Question 16

malignant possibility of submandibular and sublingual glands

Answer 16

submandibular 50%
sublingual v high
refer immediately

Question 17

Pleomorphic adenoma (location + feature capsule)

Answer 17

• most common benign SG epithelial tumor
• benign slow growing asymptomatic
• parotid gland tail, hard palate, upper lip
• incomplete/difficult capsule -> high recurrence rate

Question 18

Warthin tumor (location+ capsule)

Answer 18

• benign epithelial tumor
• smooth soft parotid mass
• encapsulates-> low recurrence rate

Question 19

1 Benign non-epithelial tumors

Answer 19

Haemangioma

Question 20

Haemangioma ( age group, feature, location)

Answer 20

• common in children as strawberry marks
• vascular tumor with solid cells and anastomosing capillaries
• 1-6 months rapid growth and reduces until age of 12
• parotid gland common
• asymptomatic unilateral compressable mass

Question 21

Necrotising sialometaplasia (location, feature, differentials)

Answer 21

• hard palate minor SG
• Ulcerative lesion due to ischaemia and necrosis of minor SG
• more common in men
• OSCC & Mucoepidermoid carcinoma

Question 22

Malignant salivary gland tumor (3)

Answer 22

mucoepidermoid carcinoma (parotid)
adenoid cystic carcinoma (submandibular)
carcinoma ex pleomorphic adenoma (parotid tail)

Question 23

Sjögren’s Syndrome

Answer 23

-most common disease causing xerostomia
-Autoimmune disease
-female
-exocrine gland inflammation and lymphocytic infiltration of the SG and lacrimal glands
=xerostomia and xeropthlamia

-10% of sjogrens syndrome pt develop NHL

Question 24

2 Types of sjogrens syndrome

Answer 24

• primary sicca: xerostomia xeropthalmia

- secondary: xerostomia xeropthalmia associated with CT disease e.g. RA

Question 25

What causes sjogrens?

Answer 25

• genetic

- bc female and gender linked possible due to hormones

Question 26

Sjogrens general clinical presentations

Answer 26

dry eyes, mouth, skin, mucous membranes
raynauds phenomenon
RA
fatigue

Question 27

Sjogrens h&n presentations

Answer 27

dry mouth eyes
burning mouth symptoms
oral soreness
dry atrophic mucosa
glassy mucosa
no saliva pooling
sialadenitis (also linked to bacteria+mumps+HIV)
oral candidosis
increased DMF
halitosis
cervical and incisal caries pattern

Question 28

Sjogrens systemic involvement/ complications

Answer 28

10% of sjogrens get NHL-> salivary gland swelling

loss of vision

Question 29

Investigations for sjogrens syndrome

Answer 29

INVESTIGATIONS

• salivary assays (flow rate)
• sialogram (digistal subtraction sialogram)
• FBC- Anti RO Anti LA
• Biopsy of SG
• glucose level eg. urine
• shirmer test

Question 30

Management/treatment of hyposalivation

-RELIEVE SYMPTOMS

Answer 30

• regular dental visits OHI treat caries
• sip water
• diet advice: reduce sugar/caffeine/carb drinks/alcohol/smoking
• avoid drugs causing xerostomia
• treat associated disorders eg. candidosis
• pilocarpine
• saliva substitutes eg. carboxy methyl cellulose

Question 31

pilocarpine side effects

Answer 31

GIT
urinary
respiratory