Dry Mouth and Sjorgren's disease

Question 1

saliva function

Answer 1

acid buffering
mucosa lubrication
- speech
- swallowing
taste facilitation
antibacterial/antifungal
digestive

Question 2

causes of dry mouth

Answer 2

dehydration
drugs
age
smoking
alcohol
radiotherapy and cancer treatment
anxiety
salivary gland disease

Question 3

describe how age affects salivary production

Answer 3

acinar tissue loss (structural)
metabolic and functional change
older glands more affected by other factors which reduce salivary production

Question 4

drugs which reduce salivary gland function

Answer 4

amphetamines
- ADHD
anticonvulsants
antidepressants
antihistamines
antineoplastic drugs
antiparkinsonian
antipsychotics
antiretrovirals
diuretics
antihypertensives
muscle relaxants
opined analgesics
benzodiazepines

Question 5

drugs which cause significant reduction in salivary production

Answer 5

amitriptyline
- 26% reduction
diuretics
- 10% reduction
lithium
- 70% have a significant reduction

Question 6

chronic systemic diseases which can lead to dehydration

Answer 6

• diabetes mellitus
• renal failure /cardiac failure
• hypercalcaemia
• diabetes insipidus
• Addison’s disease

Question 7

acute problems that can lead to dehydration

Answer 7

haemorrhage
persistent vomiting

Question 8

Primary sjorgrens

Answer 8

no connective tissue disease

Question 9

secondary Sjogren’s disease

Answer 9

connective tissue disease
- SLE
- rheumatoid arthritis
- systemic sclerosis

Question 10

Sjogren’s - features

Answer 10

4 or more (out of 6) criteria

• ocullar symptoms
• oral symptoms
• ocular signs
• histopathology
• salivary gland dysfunction
• autoantibodies

Question 11

Sjorgrens disease eye symptoms

Answer 11

persistent troublesome dry eyes >3 months
recurrent sensation of sand/gravel in eyes
tear substitutes used >3 times a day

Question 12

Sjogren’s - diagnosis

Answer 12

Blood test for anti ro antibodies (score 3)
gland biopsy
- focus score of > or =1 (score 3)
slit lamp examination
- abnormal ocular staining score > or = 5 (score 1)
Schirmer’s test without anaesthetic
- result of < or = 5mm/min (score 1)
spit in cup (siolometry)
- unstimulated salivary flow <0.1ml/min (score 1)

Question 13

what score is required for a condition to be classified as Sjogren’s disease?

Answer 13

4 or more

Question 14

Sjogrens oral symptoms

Answer 14

daily feeling of a dry mouth for > 3 months
recurrent swelling of salivary glands as an adult
difficulty eating dry foods e.g. cream crackers

Question 15

Sjogren’s disease head and neck complications

Answer 15

oral infection
caries risk
functional loss
- speech
- swallowing
dentire retention
salivary lymphoma

Question 16

What is Sjorgren’s disease and what can it affect?

Answer 16

multisystem autoimmune disease
can affect
CNS
- fatigue, peripheral and CN neuropathies
skin
- xeroderma, rashes
vascular
- Raynaud’s syndrome
eyes
- corneal ulcers, keratoconjunctivitis sicca
respiratory
- chronic cough/hoarseness
GI
- dysphagia
- pancreatic insufficiency
haematological
- anaemia
muscolosketal
GU
- vaginal dryness and dyspareunia

Question 17

How to assess dry mouth

Answer 17

gland palpation
duct expression
challacombe scale

Question 18

dry mouth management

Answer 18

treat underlying cause
- correct hydration
- avoid caffeine, smoking, alcohol
- modify drug regime
- treat diabetes
- treat somatoform disorder
preventative care
symptomatic relief
artificial saliva products

Question 19

dry mouth preventative care

Answer 19

caries
- diet
- fluoride
- treatment planning
candida
SLS free toothpaste for sore tongue

Question 20

dry mouth symptomatic relief

Answer 20

sprays
- glandosane (pH 5.75)
- saliva Orthana
- Xerotin
lozenges
salivary stimulants
oral care gels
- bioextra gel

Question 21

simple lifestyle measures to manage Sjogrens

Answer 21

moist, oily foods
humidify home environment
omega 3 supplements
regular exercise
glasses/goggles to reduce tear evaporation