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5th Oral Disease - Other > Mixed Connective Tissue Disorders > Flashcards

Mixed Connective Tissue Disorders Flashcards

1
Q

Difference between xerostomia and hyposalivation?

A

Xerostomia is symptom of oral dryness

Hyposalivation - decrease saliva flow rate

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2
Q

What are 3 major salivary glands?

A

Partoid - largest gland
Sublingual
Submandibular

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3
Q

What are acini?

A

Saliva producing cells

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4
Q

Difference between serous and mucous saliva?

A

Serous - watery

Mucous - viscous

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5
Q

What saliva does parotid produce?

A

Serous

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6
Q

Main component of saliva?

A

Mainy water

Organic and inorganic solids

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7
Q

Example of organic solids in saliva?

A 
Proteins
Amylase
Lipids
Amino acids
Glucose
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8
Q

Example of inorganic solids in saliva?

A

Sodium
Calcium
Chloride
Fluoride

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9
Q

How is saliva formed?

A

Secretion under autonomic nervous control
Hormones modify saliva composition
Increased flow as result parasympathetic activity

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10
Q

What are 2 components of saliva?

A

Fluid component - ions product by parasympathetic stimulation
Protein competent - arise secretory vesicle in acini - sympathetic stimulation

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11
Q

If have parasympathetic stimulation what type of saliva?

A

Lots of saliva w/ low protein conc

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12
Q

If have sympathetic stimulation what type of saliva?

A

Low flow with high protein conc

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13
Q

Average salivary flow rate?

A

500ml in 24 hours

Expect to be reduced at night

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14
Q

What gland produces most of saliva in unstimulated conditions?

A

Submandibular

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15
Q

Which glands produces most saliva when eating?

A

Parotid

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16
Q

What measure unstimulated saliva flow?

A

Spit graduated container for 15 mins

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17
Q

What amount of unstimulated saliva flow would suggest reduced function?

A

Less 1.5ml in 15 min

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18
Q

How take stimulated salivary flow?

A

Place citric acid dorsal tongue

Place carlsson-crittenden cup over parotid orifice

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19
Q

What flow would suggest reduced functional salivary flow rate?

A

less 5ml in 5 minutes

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20
Q

What are functions of saliva?

A 
Lubrication
Physical cleanswer
Caries control - buffer
Antimicrobial 
Taste
Digestion - amylaste
Pellcile formation
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21
Q

Effects of xerostomia?

A 
Difficulty oral function
Increased caries
Gingivits
Dysphagia
Taste distrurbance
Increased susceptibility oral candidosis
burning tonuge
dry sore mucosa 
salivary gland enlargement
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22
Q

What are factors associated with hyposalivation/ xerostomia?

A 
Anxiety/ depression
Drugs
Radiotherapy 
Dehydration
Diabetes
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23
Q

What can congenital xerostomia be related to?

A

ectodermal dysplasia

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24
Q

What drugs can be linked to xerostomia?

A 
Antidepressants - tricyclics/ SRRIS
Antihistamines
Diuretics
Antichloinergics
Antipsychoitcs
Sedatives
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25
Q

What are confounding factors for drug related xerostomia?

A

Age
Smoking
Psychological factors

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26
Q

Issue with radiotherapy?

A

Therapeutic dose = permanet reduction salivary gland function
Damage depends on amount salivary glands exposed

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27
Q

How does radiotherapy damage glands?

A

Acute inflammatory reaction
Fibrosis within glands
Reduced blood flow
Loss acini cells

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28
Q

Oral problems w/ radiotherapy?

A

Reduced saliva

Increase risk caries/ candidosis/ dysphagia

29
Q

What are 3 causes of xerostomia?

A

Autoimmune
Infection
Rare causes

30
Q

Examples of autoimmune cause xerostomia?

A

Sjogrens

Sarcoidosis

31
Q

Examples of infections cause xerostomia?

A

HIV related

EBV

32
Q

Rare causes of xerostomia?

A

Amlyodosis

Salivary gland agenesis

33
Q

Qs to ask pt with xerostomia?

A 
Does mouth usually feel dry 
Dry when eating
Diff swallowing
Diff wearing dnetures
Soreness mouth
34
Q

Important factors to note when taking hx of xerosotmia?

A

PMH
Anxiety/ depression
Drug hx
Smoking hx

35
Q

Extra-oral features of xerostomia?

A

Connective tissue diseases

Salivary gland swelling

36
Q

Intra-oral findings of xerostomia?

A 
Sticky musoca
Food retention
Caries
Candidosis 
Depapillation of tongue 
Lack saliva
37
Q

3 ways to investigate xerostomia?

A

Clinical
Radiological
Lab-based

38
Q

Clinical tests of xerosotmia?

A

Sialometry

Schirmers test

39
Q

Radiological tests of xerostomia?

A

Ultrasound

Sialography

40
Q

Lab based tests of xerostomia?

A

Immunological tests - ENA/ANA/RF

Haematological tests - FBC/ ESR/ CRP

Antibody tests

41
Q

What would expect to see sialogram in those w/ xerostomia?

A

Punctate sialectasis = snow storm effect

42
Q

How should biopsy be done in those w/ xerostomia?

A

Examination at least 5 lobules of minor glands

43
Q

Features in histo-pathology of those w/ xerostomia?

A

Similar sjogrens

Acinar loss, focal lymphocytic infiltrate, fibrosis

44
Q

Tx of xerostomia?

A

Tx of underlying causes
Prevention - oral health management
Salivary prodcuts/ substitutes

45
Q

Management of xerostomia

A
  1. improve symptoms: salivary substitues
  2. prevention oral disease -F supplements, mouth rinse, OHE
  3. Manage candidosis
  4. investigate causes
46
Q

What is involved in dental caries prevention?

A

Education - diet/ hygiene/F-

47
Q

What diet advice should be given?

A

Avoid soft sticky foods
Eliminate spicy foods - irritant
Limit caffeine = dehydration

48
Q

Why do those with xerostomia struggle with dentures?

A 
Common mucosal irritation and ulcers
dry tissues (esp tongue) dislodge dentures
49
Q

Management of dry mouth?

A 
Saliva subsitutes
Gustatory/mechanical stimulants 
Oral moisturisers
F-
Lip creams
50
Q

Practical advice to give those w/ xerostomia?

A

Frequent sips of water can wash away saliva

51
Q

Examples of stimulants which can help with xerostomia?

A

Acidic stimulation - issue enamel demin
Sugarless chewing gum
Lozenges

52
Q

Issue w/ salivary substitutes?

A

Relief often insignificant and short lives
Unpalatable
Impractical
Expernsive

53
Q

What consider when giving salivary subsitutes?

A

Its pH and if pt is dentate or edentulous

If pt dentate needs pH >6

54
Q

What saliva substitute can’t be used on dentate pt

A

Glandosane

55
Q

Issue saliva orthana?

A

Has animal products

56
Q

When can cholinergic be used

A

Is have residual salivary capacity - use cholinergic agents

57
Q

Example of cholinergic agent?

A

Pilocarpine

58
Q

What does pilocarpine do?

A

Targets all exocrine glands

Increases salivary output

59
Q

Adverse effect pilocarpine?

A

Flushing, sweating, urinary frequency

60
Q

Contraindication pilocarpine?

A

Asthamtics - uncontrolled (increased secretion in lungs)

Narrow angle glaucoma

61
Q

Examples of systemic therapy for sjogrens?

A

Cholingergics
Infliximab
Hydroxychloroquine

62
Q

What is infliximab?

A

TNF blocker that can increase salivary flow rate

63
Q

What is infliximab increase risk of?

A

Lymphoma

64
Q

Adv of hydroxychlorquine?

A

Increased flow rate and oral discomfort

Few adverse effects

65
Q

What systemic treatment can increase risk of infection and pain?

A

Corticosteroid irrigation of parotid

66
Q

How prevent oral candidosis?

A

Denture hygiene

CHX mouthwash 3x weekly

67
Q

factors increase susceptibility oral candidosis?

A

dentures, immunosuppression, diabetes, broad spec ab

68
Q

Tx of oral candidosis?

A

Topical antigunfals - nystatis/ miconazole gel

69
Q

First line tx of ascending parotitis?

A

Amoxilcillin

5th Oral Disease - Other (13 decks)

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