DRY MOUTH AND SALIVARY GLAND DISEASES Flashcards
True xerostomia vs false xerostomia and examples of each
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
Normal salivary flow rate vs xerostomia
normal: 0.3-0.4ml/min unstimulated
xerostomia: <0.2ml/min unstimulated
properties of saliva with normal flow and composition
- lubrication 4 speech and swallowing
- defence and antimicrobical
- lavage and buffering
- taste perception
- digestion of by amylase and lipase
Complications of xerostomia
dental problems soft tissue diseases dryness of the GIT speech & swallowing candida overgrowth psychological effect voice hoarsness decreases quality of life nutirional deficiencies
How to diagnose xerostomia
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?
Xerostomia aetiology
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)
Drugs that cause xerostomia
antidepressants antihypertensive E.G. b blockers atenalol anticonvulsants antihistamines some steroid/nsaids steroid inhalers
Types of salivary gland disease
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
Systemic diseases associated to xerostomia
sjogrens syndrome liver disease diabetes thyroid disease HIV related SGD Amyloidosis Sarcoidosis
Salivary gland examination
- 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
Sialadenosis (sialosis)
- non-specific salivary gland enlargement
- typically painless
- usually bilateral parotid gland
- aetiology is unknown and NOT related to infection/neoplasm/inflammation
possible sialadenosis aetiologies
eating disorders medication nutritional deficiencies alcohol abuse diabetes pregnancy
Sialolithiasis / MTS
- obstruction of the salivary gland due to a stone/calculi
- causing pain and swelling
- submandibular gland most common
Sialadenitis + what conditions cause this
-enlargement of one or more salivary gland
-due to infection/inflammation/obstruction
-parotid/submandibular gland
-conditions causing this:
sarcoidosis, Sjogrens, mumps
2 benign epithelial tumours
pleomorphic adenoma (85% of all SG neoplasms) warthin tumor
malignant possibility of submandibular and sublingual glands
submandibular 50%
sublingual v high
refer immediately
Pleomorphic adenoma (location + feature capsule)
- most common benign SG epithelial tumor
- benign slow growing asymptomatic
- parotid gland tail, hard palate, upper lip
- incomplete/difficult capsule -> high recurrence rate
Warthin tumor (location+ capsule)
- benign epithelial tumor
- smooth soft parotid mass
- encapsulates-> low recurrence rate
1 Benign non-epithelial tumors
Haemangioma
Haemangioma ( age group, feature, location)
- 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
Necrotising sialometaplasia (location, feature, differentials)
- hard palate minor SG
- Ulcerative lesion due to ischaemia and necrosis of minor SG
- more common in men
- OSCC & Mucoepidermoid carcinoma
Malignant salivary gland tumor (3)
mucoepidermoid carcinoma (parotid)
adenoid cystic carcinoma (submandibular)
carcinoma ex pleomorphic adenoma (parotid tail)
Sjögren’s Syndrome
-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
2 Types of sjogrens syndrome
- primary sicca: xerostomia xeropthalmia
- secondary: xerostomia xeropthalmia associated with CT disease e.g. RA
What causes sjogrens?
- genetic
- bc female and gender linked possible due to hormones
Sjogrens general clinical presentations
dry eyes, mouth, skin, mucous membranes
raynauds phenomenon
RA
fatigue
Sjogrens h&n presentations
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
Sjogrens systemic involvement/ complications
10% of sjogrens get NHL-> salivary gland swelling
loss of vision
Investigations for sjogrens syndrome
INVESTIGATIONS
- salivary assays (flow rate)
- sialogram (digistal subtraction sialogram)
- FBC- Anti RO Anti LA
- Biopsy of SG
- glucose level eg. urine
- shirmer test
Management/treatment of hyposalivation
-RELIEVE SYMPTOMS
- 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
pilocarpine side effects
GIT
urinary
respiratory
