Managing problems with saliva Flashcards
How can anxiety cause dry mouth?
- Cephalic inhibition of saliva due to anxiety directly causes real oral dryness
- Reduced salivary flow
- Feel like when you are to give a speech etc
What has replaced sialography for investigating salivary disease due to sialography containing radiation?
- Ultrasound
How can somatisation disorders cause dry mouth?
- There is a cephalic control of perception
- Altered perception of reality
- Normal info coming from mouth is misunderstood by small changes at synapses as it is processed
- Normal salivary flow
- Can be seen with anxiety disorders too
Other than dry mouth what else can anxiety cause?
- Inhibit swallowing
- Lead to complaint of too much saliva
What are some frequent Somatoform disease ?
- Oral dysesthesia
- TMD pain
- Chronic headache
- Neck/back pain
- Dyspepsia
- IBS
What is the normal rate of resting and stimulated flow of saliva?
- Resting flow = 0.3-0.4mL/min
- Stimulated flow 1-2mL/min
What is Hyposalivation resting and stimulated flow of saliva?
- Resting flow = <0.1mL/min
- Stimulated flow = <0.5mL/min
On clinic how can you test salivary flow?
- Test unstimulated salivary flow
- Spit into test tube for 15 mins
- Expect 0.3-0.4mL/min
What are some treatable causes of dry mouth?
- Dehydration
- Medicines with anti-muscarinic side effects
- Medicines causing dehydration
- Poor diabetes control - type 1 or 2
- Somatoform disorder
- Management of these should return pt oral comfort
What are some causes of dry mouth with only symptomatic txt?
- Sjogren’s syndrome
- Dry mouth from cancer txt
- Dry mouth from salivary gland disease
What are the txt options for cases of dry mouth with only symptomatic txt
- Intensive dental prevention to prevent other oral disease that can cause symptoms
- Frequent sips of cool drinks
- Suagr free chewing gum
- Artificial salvia gel
- Saliva orthana
- Bioxtra
- Glandosane
What blood test should be carried out when investigating dry mouth?
To test dehydration - U&Es , Glucose
To test autoimmune disease ANA, Anti-Ro, Anti-La (ENA screen), CRP
To test complement levels - c3 and C4
What imaging test can be carried out when investigating dry mouth?
Salivary ultrasound - looking for leopard spots or sialectasis
Sialography - useful were obsrtuction/ductal disease is suspected
What dry eyes screen can be done to investigate dry mouth?
- Schirmer test
- Tear flow less than 5mm wetting of test paper in 15mins
- Refer to optician for assessment of tear film
What tissue examination can be done when investigating dry mouth?
- Labial gland biopsy of lower lip
- Looking for lymphocytic infiltrate and local acinar disease
- Last resort to confirm presence of gland disease
