Managing Problems with Saliva Flashcards
1
Q
When pt complains of salivary gland disease? what Investigations?
A
- blood test
- diabetes
- dehydration
- autoimmune disease, Sjogren
2
Q
Assessing salivary function
A
- by assessing salivary flow
- major SG is harder to assess
- minor SG biopsy will give the same info about immune disease without a higher risk
- minor glands are assess in the lower lip- labial gland biopsy
- may produce a degree of numbness, but most useful way to assess active evidence of inflammatory/ immune salivary gland disease
3
Q
Sialography
A
- contrast into the glands ducts
- show both possibility of strictor and dilation of duct
- normal acinar pattern
- use less nowadays as there is ionising radiation
- Ultrasound has replaced sialography
- some situations, Magnetic resonance based sialography is used as it does not require cannulation
4
Q
MR sialography
A
- magnetic resonance sialography
- does not require cannulation of ducts
5
Q
if reduced salivary flow
A
- normally will have problem in swallowing food, hence affecting eating
6
Q
Frothy saliva?
A
- reduction salivary flow and increase in protein content
- worse at night because pt wakes and find the mouth is dry
- salivary flow shuts down overnight
- frequently seen in clinic, and difficult to diagnose as pt has no dry mouth
7
Q
How can anxiety and somatisation produce dry mouth?
A
- produce dryness due to prevention of salivary gland creation by brain
- ‘cephalic’ control of salivation
- inhibition of salivation
- anxiety directly causes real oral dryness - ‘cephalic’ control of perception
- altered perception of reality-> normla info coming from mouth is misunderstood by small changes at synapses
- more often seen with anxiety disorders
- anxiety can also inhibits swallowing and leads to complaints of too much saliva
- may present as hypersalivation, but its normal salivary flow
- can miss diagnosis
8
Q
Frequent Somatoform Disease
A
- Oral dysaesthesia/ Burning mouth
- TMD pain
- headache
- neck/ back pain
- dyspepsia without evidence of excess acid
- irritable bowel syndrome (IBS)
9
Q
Dry mouth salivary flow rate
A
- test unstimulated salivary flow
- ask pt to spit in a tube for 15 mins
- 1.5ml of saliva is normal salivary flow rate
- if less, then hyposalivation
- actual value is debatable (0.1-0.2 ml/min)
- at rest, pt should produce more than 1.5 ml unstimulated in 15 mins
- simple test chairside
10
Q
Treatable causes of dry mouth
A
- dehydration - change medication with anti-muscarinic side effects
- Diabetes- ensure good diabetes control
- Somatoform disorder- should return pt to feeling a normal comfortable mouth
- more likely to be successful than pt with real salivary gland disease
11
Q
Dry mouth with only symptomatic tx
A
- Sjogren syndrome
- Dry mouth from cancer tx
- Dry mouth from degenerative salivary gland disease
Pt cannot return to normal state hence clinician will need to try and reduce disability associated with reduction in salivary flow
12
Q
Tx options for only symptomatic tx
A
- intensive dental prevention
- salivary substitutes*
- salivary stimulants*
*to improve comfort, but pt finds unhelpful
13
Q
Investigating Dry Mouth
A
- Salivary flow test
- less than 1.5ml unstimulated flow in 15 mins - Blood test
- Dehydration: U&Es, Glucose
- Autoimmune disease: ANA, anti- Ro, anti-La(ENA screen), CRP
- Complement levels - C3 and C4 - Imaging
- salivary ultrasound: look for leopard spots/ sialectasis
- Sialography: useful where obstruction/ ductal disease is suspected
- not used anymore due to ionising radiation - Dry eyes screen
- refer to optician for assessment of tear film (preferred way)
- Schirmer test - tear flow less than 5mm wetting of test paper in 15 mins - Tissue examination
- labial gland biopsy
- at lower lip and look for lymphocytic infiltrate and focal acinar disease
14
Q
Why is sialography not used anymore?
A
- due to ionising radiation
15
Q
Which pt would you see ultrasound changes?
A
- pt with Sjogren’s syndrome
- sialectasis of degenerative salivary disease
