Dry mouth and Sjogren's disease Flashcards
What causes dry mouth
Congenital and developmental disease, traumatic and vascular lesions, iatrogenic causes, systemic disease, somatisation, autoimmune conditions
Iatrogenic causes include drugs and radiotherapy.
What are the functions of saliva?
- Acid buffering
- Mucosal lubrication
- Taste facilitation
- Antibacterial/fungal activity
- Digestive function
What are common causes of dry mouth?
- Dehydration
- Drugs
- Age, smoking, alcohol
- Radiotherapy & cancer treatment
- Anxiety & somatisation disorders
- Salivary gland disease
What structural changes occur in salivary glands with age (17-90 years)?
- 37% Submandibular acinar tissue loss
- 32% Parotid acinar tissue loss
- 45% Minor glands acinar tissue loss
What should be assessed during an extraoral examination of salivary glands?
Major salivary glands
Note that a normal parotid gland is completely unpalpable.
What is agenesis in the context of dry mouth?
Complete absence of embryological precursors, resulting in no gland formation.
What is atresia?
Lack of duct formation.
What is aplasia?
Failure in development, resulting in minimal gland tissue.
What is hypoplasia?
Presence of gland tissue but in a deficient state.
What is the significance of cystic fibrosis in relation to dry mouth?
Affects all exocrine glands, leading to altered secretion and duct plugging.
What are complications of traumatic and vascular lesions in salivary ducts?
- Salivary fistula
- Obstructive symptoms
- Hyposalivation
- Gustatory sweating (Frey’s syndrome)
What is Drug-Induced Salivary Hypofunction (DISH)?
Dry mouth caused by various medications.
Name three classes of drugs that can cause dry mouth.
- Antidepressants
- Antihistamines
- Diuretics
What are the acute systemic disease causes of dry mouth?
- Haemorrhage
- Persistent vomiting
True or False: Anxiety can lead to altered perception of salivation.
True
What is Sicca disease?
Partial Sjögren’s findings with dry eyes and mouth but no autoantibodies.
What are the revised European criteria for diagnosing Sjögren’s syndrome?
Four or more of the following: ocular symptoms, oral symptoms, ocular signs, histopathology, salivary gland dysfunction, autoantibodies.
What is the importance of Anti-Ro antibodies in diagnosing Sjögren’s syndrome?
High specificity and sensitivity for Sjögren’s.
What is a Focus Score in relation to gland biopsy?
Histopathologist looks for 50+ lymphocytes per 4mm² of tissue, with a score ≥1 indicating a positive result.
Fill in the blank: The worst offenders for Drug-Induced Salivary Hypofunction are _______.
[Antimuscarinic (anticholinergic)]
What are the chronic causes of dry mouth related to systemic diseases?
- Diabetes Mellitus
- Renal Failure/Cardiac failure
- Hypercalcaemia
- Diabetes Insipidus
- Addison’s disease
What is the typical presentation of oral symptoms in Sjögren’s syndrome?
- Daily feeling of a dry mouth for >3 months
- Recurrent swelling of salivary glands
- Frequently drink liquid to aid swallowing dry foods
What is the estimated morbidity for permanent loss of sensation in Sjogren’s Disease?
Estimated as high as 20%
Commonly quoted as 10%, but can vary from minor loss to neuropathic pain.
What is the histopathological finding in minor salivary glands in Sjogren’s Disease?
Focal lymphocytic sialadenitis, acinar loss, fibrosis
