dry mouth and sjogrens Flashcards
what does saliva do
- acid buffering
- mucosal lubrication
- speech
- swallowing
- taste facilitation
- antibacterial/fungal
- digestive
causes of dry mouth
- dehydration
- drugs - shut down stimulation of salivation
- age, smoking, alcohol
- radiotherapy and cancer treatment
- anxiety and somatisation disorders
- salivary gland disease
why is dry mouth more likely in elderly
- acinar tissue loss as we age
- metabolic and functional change
what would be expected if seeing a yellow bead at opening of duct
- stone or pus
effect of dry mouth on oral cavity
- function
-discomfort - increased cares risk
-increased risk of fungal infections
-poorer retention of denture
some developmental abnormalities in salivary gland
- agenesis - complete absence of embryological precursors
- atresia - ducts not formed
- aplasia - failure in development
- ectodermal dysplasia
- hypoplasia - present but deficient
some types of ectopic gland tissue
- stafnes bone cavity
- accessory parotid - at risk of same disease as other glands
- lymph node inclusion - need to exclude metastatic salivary neoplasia
cystic fibrosis
ausotomal recessive inheritance
abnormal CFTR gene
affects mucous clearance
all exocrine glands effected - altered secretion, duct plugging, calculi, atrophy
trauma effect on salivary gland
- trauma can lead to permanent damage to the salivary glands
- poor healing potential is a hallmark of duct structures - difficult to manipulate/repair
complications and sequale to gland trauma
- salivary fistula
- obstructive symptoms
- hyposalivation
- gustatory sweating
- poor healing
- permanent damage
what is DISH
drug induced salivary hypo function
what drugs included in DISH
-amitriptyline
-lithium
-antidepressants
-anticonvulsants
-diuretics
radiotherapy effects on salivary gland
- gland tissue sensitive to radiation
– radiation effects - apoptosis then inflammation and fibrosis - graft versus host effects - important part of the treatment responce in patients recieving bone marrow transplant but can affect saliva glands as well as the mucosa
- antineoplastic drugs - glands are sensitive and can accumulate these
- radioiodine - accumulates in salivary tissue and thyroid
systemic diseases which lead to dehydration
- diabetes mellitus
-renal/cardiac failure
-addisons - haemorrhage
-vomiting
anxiety and somatisation effect on saliva
‘cephalic’ control of salivation
- inhibition of salivation
‘cephalic’ control of perception
- altered perception of reality i.e. burning mouth syndreom/oral dysaesthesia
somatisation symptoms
- oral dysaesthesia
- TMD pain
- headache
- neck/back pain
- dyspepsia
- IBS
- fibromyalgia
- chronic pelvic pain
- dysfunctional uterine leeding
- myallgic encephalomyelitis
- PTSD
what is sicca disease
autoimmune
-partial sjogrens
- negative serology
- dry eyes and mouth but dont know why
what is sjogrens
autoimmune
-dry eyes and mouth
- primary : no connective tissue disease
-secondary- connective tissue disease
aetiopathogenesis of sjogrens
- HLA association : DR3 and DR52
- role of viruses e.g. EBV
what issued for diagnosing sjogrens
EULAR
eyes symptoms needed for sjogrens diagnosis
at least 1
- persistent troublesome dry eyes for >3 months
- recurrent sensation of sand/gravel in eyes
- tear substitutes used >3 times day
what oral symptoms are needed for sjogrens diagnosis
- daily feeling of dry mouth >3 months
- recurrent swelling of salivary glands as an adult
- frequently drink liquid to aid swallowing dry foods
what is needed for confirming sjogrens diagnosis (tests)
- Anti-Ro antibodies (score 3) - Blood test
- Focus score of > or =1 (score 3) - Gland Biopsy
- Abnormal ocular staining score > or =5 (score 1) Slit lamp examination
- Schirmer’s test without anaesthetic result of < or = 5mm/5 min (score 1) Filter paper
- Unstimulated salivary flow <0.1ml/min (score 1) Spit in cup
need score of 4
anti-Ro test in sjogrens
- Anti-Ro (anti-SSA)is an example of an antibody in the blood against an Extractable Nuclear Antigen (ENA)
- High specificity and sensitivity for Sjogren’s
- Usually we do an Anti-Nuclear Antibody (ANA) test first-if it’s positive we dig deeper to see just which antibodies to ENA are present
gland biopsy in sjogrens diagnosis
-positive labial gland biopsy = gold standard
Focus= 50+ lymphocytes per 4mm2 of tissue. Focus score > or =1 translates to a Score of 4 EULAR/ACR 2026 criteria
- do non invasive methods first
