Managing problems with saliva Flashcards

1
Q

How can anxiety cause dry mouth?

A
  • 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
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2
Q

What has replaced sialography for investigating salivary disease due to sialography containing radiation?

A
  • Ultrasound
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3
Q

How can somatisation disorders cause dry mouth?

A
  • 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
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4
Q

Other than dry mouth what else can anxiety cause?

A
  • Inhibit swallowing
  • Lead to complaint of too much saliva
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5
Q

What are some frequent Somatoform disease ?

A
  • Oral dysesthesia
  • TMD pain
  • Chronic headache
  • Neck/back pain
  • Dyspepsia
  • IBS
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6
Q

What is the normal rate of resting and stimulated flow of saliva?

A
  • Resting flow = 0.3-0.4mL/min
  • Stimulated flow 1-2mL/min
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7
Q

What is Hyposalivation resting and stimulated flow of saliva?

A
  • Resting flow = <0.1mL/min
  • Stimulated flow = <0.5mL/min
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8
Q

On clinic how can you test salivary flow?

A
  • Test unstimulated salivary flow
  • Spit into test tube for 15 mins
  • Expect 0.3-0.4mL/min
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9
Q

What are some treatable causes of dry mouth?

A
  • 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
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10
Q

What are some causes of dry mouth with only symptomatic txt?

A
  • Sjogren’s syndrome
  • Dry mouth from cancer txt
  • Dry mouth from salivary gland disease
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11
Q

What are the txt options for cases of dry mouth with only symptomatic txt

A
  • 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
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12
Q

What blood test should be carried out when investigating dry mouth?

A

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

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13
Q

What imaging test can be carried out when investigating dry mouth?

A

Salivary ultrasound - looking for leopard spots or sialectasis

Sialography - useful were obsrtuction/ductal disease is suspected

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14
Q

What dry eyes screen can be done to investigate dry mouth?

A
  • Schirmer test
  • Tear flow less than 5mm wetting of test paper in 15mins
  • Refer to optician for assessment of tear film
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15
Q

What tissue examination can be done when investigating dry mouth?

A
  • Labial gland biopsy of lower lip
  • Looking for lymphocytic infiltrate and local acinar disease
  • Last resort to confirm presence of gland disease
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16
Q

What is the maximal preventative strategy?

A
  • Encourgaed for low sugar diet and intense OHI as increased risk of candida/staphylococci infections (angular chelitis/sore tongue)
  • Topical sodium fluoride 22,600ppm F-
  • Prescribed 2800ppmF- (0.619%) sodium fluoride toothpaste
  • Prescribe 5000ppm 1.1% sodium fluoride toothpaste
  • Sodium fluoride mouthwash 0.05%
  • Caries free mouth txt plan
17
Q

Why is Saliva orthana preferred over glandosane?

A
  • Glandosane has high pH so may be unsuitable for dentulous pts (only suitable for radiotherapy or sicca syndrome)
  • Orthana has mucin based structure
18
Q

What are some TRUE causes of hypersalivation?

A
  • Rare but do cause an actual increase in salivary flow from lack of normal regulation
  • Drug causes
  • Dementia
  • CJD
  • Stroke
19
Q

What are some common PERCEIVED causes of hypersalivation?

A

Can be either Swallowing failure of Postural drooling

Swallowing failure where saliva pools in mouth
- Anxiety
- Stroke
- Motor neurone disease
- Multiple sclerosis

Postural drooling where pt has difficulty in getting head into position to swallow
- Being a baby
- Cerebral palsy

20
Q

What are some txt for excess saliva?

A
  • If due to anxiety txt anxiety disorder
  • Drugs to reduce salivation like anti-muscarinic agents or botox to prevent gland stimulation
  • Biofeedback training for swallowing control
  • Surgery to salivary system i.e. gland removal or duct repositioning into pharynx where swallowing saliva much more manageable