Mixed Connective Tissue Disorders Flashcards
Difference between xerostomia and hyposalivation?
Xerostomia is symptom of oral dryness
Hyposalivation - decrease saliva flow rate
What are 3 major salivary glands?
Partoid - largest gland
Sublingual
Submandibular
What are acini?
Saliva producing cells
Difference between serous and mucous saliva?
Serous - watery
Mucous - viscous
What saliva does parotid produce?
Serous
Main component of saliva?
Mainy water
Organic and inorganic solids
Example of organic solids in saliva?
Proteins Amylase Lipids Amino acids Glucose
Example of inorganic solids in saliva?
Sodium
Calcium
Chloride
Fluoride
How is saliva formed?
Secretion under autonomic nervous control
Hormones modify saliva composition
Increased flow as result parasympathetic activity
What are 2 components of saliva?
Fluid component - ions product by parasympathetic stimulation
Protein competent - arise secretory vesicle in acini - sympathetic stimulation
If have parasympathetic stimulation what type of saliva?
Lots of saliva w/ low protein conc
If have sympathetic stimulation what type of saliva?
Low flow with high protein conc
Average salivary flow rate?
500ml in 24 hours
Expect to be reduced at night
What gland produces most of saliva in unstimulated conditions?
Submandibular
Which glands produces most saliva when eating?
Parotid
What measure unstimulated saliva flow?
Spit graduated container for 15 mins
What amount of unstimulated saliva flow would suggest reduced function?
Less 1.5ml in 15 min
How take stimulated salivary flow?
Place citric acid dorsal tongue
Place carlsson-crittenden cup over parotid orifice
What flow would suggest reduced functional salivary flow rate?
less 5ml in 5 minutes
What are functions of saliva?
Lubrication Physical cleanswer Caries control - buffer Antimicrobial Taste Digestion - amylaste Pellcile formation
Effects of xerostomia?
Difficulty oral function Increased caries Gingivits Dysphagia Taste distrurbance Increased susceptibility oral candidosis burning tonuge dry sore mucosa salivary gland enlargement
What are factors associated with hyposalivation/ xerostomia?
Anxiety/ depression Drugs Radiotherapy Dehydration Diabetes
What can congenital xerostomia be related to?
ectodermal dysplasia
What drugs can be linked to xerostomia?
Antidepressants - tricyclics/ SRRIS Antihistamines Diuretics Antichloinergics Antipsychoitcs Sedatives
What are confounding factors for drug related xerostomia?
Age
Smoking
Psychological factors
Issue with radiotherapy?
Therapeutic dose = permanet reduction salivary gland function
Damage depends on amount salivary glands exposed
How does radiotherapy damage glands?
Acute inflammatory reaction
Fibrosis within glands
Reduced blood flow
Loss acini cells
Oral problems w/ radiotherapy?
Reduced saliva
Increase risk caries/ candidosis/ dysphagia
What are 3 causes of xerostomia?
Autoimmune
Infection
Rare causes
Examples of autoimmune cause xerostomia?
Sjogrens
Sarcoidosis
Examples of infections cause xerostomia?
HIV related
EBV
Rare causes of xerostomia?
Amlyodosis
Salivary gland agenesis
Qs to ask pt with xerostomia?
Does mouth usually feel dry Dry when eating Diff swallowing Diff wearing dnetures Soreness mouth
Important factors to note when taking hx of xerosotmia?
PMH
Anxiety/ depression
Drug hx
Smoking hx
Extra-oral features of xerostomia?
Connective tissue diseases
Salivary gland swelling
Intra-oral findings of xerostomia?
Sticky musoca Food retention Caries Candidosis Depapillation of tongue Lack saliva
3 ways to investigate xerostomia?
Clinical
Radiological
Lab-based
Clinical tests of xerosotmia?
Sialometry
Schirmers test
Radiological tests of xerostomia?
Ultrasound
Sialography
Lab based tests of xerostomia?
Immunological tests - ENA/ANA/RF
Haematological tests - FBC/ ESR/ CRP
Antibody tests
What would expect to see sialogram in those w/ xerostomia?
Punctate sialectasis = snow storm effect
How should biopsy be done in those w/ xerostomia?
Examination at least 5 lobules of minor glands
Features in histo-pathology of those w/ xerostomia?
Similar sjogrens
Acinar loss, focal lymphocytic infiltrate, fibrosis
Tx of xerostomia?
Tx of underlying causes
Prevention - oral health management
Salivary prodcuts/ substitutes
Management of xerostomia
- improve symptoms: salivary substitues
- prevention oral disease -F supplements, mouth rinse, OHE
- Manage candidosis
- investigate causes
What is involved in dental caries prevention?
Education - diet/ hygiene/F-
What diet advice should be given?
Avoid soft sticky foods
Eliminate spicy foods - irritant
Limit caffeine = dehydration
Why do those with xerostomia struggle with dentures?
Common mucosal irritation and ulcers dry tissues (esp tongue) dislodge dentures
Management of dry mouth?
Saliva subsitutes Gustatory/mechanical stimulants Oral moisturisers F- Lip creams
Practical advice to give those w/ xerostomia?
Frequent sips of water can wash away saliva
Examples of stimulants which can help with xerostomia?
Acidic stimulation - issue enamel demin
Sugarless chewing gum
Lozenges
Issue w/ salivary substitutes?
Relief often insignificant and short lives
Unpalatable
Impractical
Expernsive
What consider when giving salivary subsitutes?
Its pH and if pt is dentate or edentulous
If pt dentate needs pH >6
What saliva substitute can’t be used on dentate pt
Glandosane
Issue saliva orthana?
Has animal products
When can cholinergic be used
Is have residual salivary capacity - use cholinergic agents
Example of cholinergic agent?
Pilocarpine
What does pilocarpine do?
Targets all exocrine glands
Increases salivary output
Adverse effect pilocarpine?
Flushing, sweating, urinary frequency
Contraindication pilocarpine?
Asthamtics - uncontrolled (increased secretion in lungs)
Narrow angle glaucoma
Examples of systemic therapy for sjogrens?
Cholingergics
Infliximab
Hydroxychloroquine
What is infliximab?
TNF blocker that can increase salivary flow rate
What is infliximab increase risk of?
Lymphoma
Adv of hydroxychlorquine?
Increased flow rate and oral discomfort
Few adverse effects
What systemic treatment can increase risk of infection and pain?
Corticosteroid irrigation of parotid
How prevent oral candidosis?
Denture hygiene
CHX mouthwash 3x weekly
factors increase susceptibility oral candidosis?
dentures, immunosuppression, diabetes, broad spec ab
Tx of oral candidosis?
Topical antigunfals - nystatis/ miconazole gel
First line tx of ascending parotitis?
Amoxilcillin