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4th year > OM- saliva > Flashcards

OM- saliva Flashcards

1
Q

What are the functions of saliva?

A

Acid buffer
Mucosal lubrication (for swallowing and speech)
Taste facilitation
Antimicrobial.

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2
Q

Give some causes of dry mouth:

A
  • Salivary gland disease
  • Drugs (Tricyclic antidepressants/ Diuretics/ Antihistamines/ Antipychotics)
  • Medical conditions (conditions that can cause dehydration e.g. diabetes, renal disease) / Conditions directly affecting the salivary glands e.g. Cystic fibrosis/Ectodermal dysplasia. )
  • Radiotherapy & cancer treatment
  • Anxiety
  • Somatisation disorders (perception of mouth wetness is wrong)
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3
Q

What scale is used to assess the degree of mouth wetness?

A

Challocombe scale.

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4
Q

Patient attends complaining of a dry mouth but they don’t actually have a dry mouth :
The dry mouth gets worse at night
There are no problems when eating.

What could be causing this ?

A
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5
Q

List some treatable causes of dry mouth?

A

Anxiety
Medicines causing Dehydration
Medicines with anti- muscarinic side effects
Poor diabetes control (type 1 or type 2 )
Somatoform disorder (diagnosis of exclusion)

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6
Q

List some conditions that can only be treated with symptomatic treatment?

A

Dry mouth from cancer treatment
Sjögrens
Dry mouth from salivary gland disease.

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7
Q

How can we investigate dry mouth ?

A
  • salivary flow test- Spit in a cup for 15 minutes <1.5ml unstimulated flow.
  • Blood tests (dehydration U&E/ glucose) Autoimmune disease. Complement levels
  • Imaging- Look at the salivary gland structure
  • Dry eyes screening
  • Labial gland biopsy
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8
Q

What is the dental management of dry mouth.

A

Prevention (Diet/ Fluoride/ Treatment planning for a caries risk mouth)

Salivary subsitutes
spray (saliva orthana/ glandosane)
losenges (saliva orthana /SST)
Salivary stimulants (Prilocarpine- a salagen)
Frequent sips of water)

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9
Q

Compare true and percieved hypersalivation

A

True hypersalivation is when there is an increased saliva flow .

Percieved hypersalivation is when there is no increase in salivary flow but the patient has difficulty swallowing causing a build up of saliva in the mouth. e.g. MND/ cerebral palsy.

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10
Q

How do we deal with excess saliva ?

A

Due to anxiety- treat the anxiety.
True salivation- Use drugs to reduce saliva production. (anti-muscarinic or botox)
Biofeedback training (to improve swallowing control)
Surgery to reposition the salivary gland.

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11
Q

What is mumps?
What are the symptoms?
How do we treat it?

A
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12
Q

Discuss HIV salivary disease ?

A

This is inflammation of the salivary glands found in sufferers of HIV (same appearance as mumps but no symptoms)
This swelling will not reduce with time.

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13
Q

What is a mucoele?
What are the symptoms

A

A mucoele is a recurrent swelling in the mucosa filled with saliva which is caused by obstruction of the salivary gland.
It can be a swelling within the duct (mucous retention cyst) or swelling in the soft tissue (mucous extravasion cyst)
Symptoms:
Recurrent swelling (bursts in days)
Salty taste.
Common sites (junction of hard/soft palate/ lower lip)
Often assoicated with trauma.

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14
Q

Discuss major gland obstruction and the symptoms of this.

A

An obstruction to the salivary gland caused by stones or mucous plugging.

Symptoms:
Swelling associated with meals.
Increases as salivary flow starts and reduces when the salivary flow stops.
Normally happens in the submandibular gland as the ductal pathway is longer .

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15
Q

What causes a subacute obstruction?

A

Sialoth (salivary stone) or mucous plugging.

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16
Q

How do we treat a subacute obstruction and what would happen if we don’t treat it?

A

Removal of the sialoth if we can. Sialography for no stone cases to wash the gland.

The duct dilatation prevents normal emptying- allowing micro-organisms to grow leading to persisting recurrent sialadentitis. Gland function is lost and the persisting infection leads to gland removal.

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17
Q

What is sialosis?

A

A persistant and inexplained Inflammation of one or more of the salivary glands.

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18
Q

What is sjögren’s

A

This is an autoimmune disease affaecting the salivary glands.

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19
Q

What is the main difference between sialosis and sjögren’s

A

In patients with sialosis they will not have a dry mouth. Sjögrens patients will also suffer from a dry mouth.

20
Q

What are the causes of sjögren’s

A

Genetic predisposition (Anti-ro and anti-la antibodies)

21
Q

How can sjögren’s be classified?

A

sicca syndrome- This is partial sjögrens. The patient either has dry mouth or dry eyes.
Primary sjögrens- No other connective tissue disease effects are found
secondary sjögrens- Effects are part of a connective tissue disease.

22
Q

Discuss the histology of sjögrens

A

There is more than one foci of lymphocytes
A focus is >50 lymphocytes located around the duct.

23
Q

What are the consequences of Sjögrens

A

Gradual loss of salivary/lacrimal gland tissue due to the inflammatory destruction.
Oral and ocular effects of loss of saliva nad tears (causing caries risk/increased oral infection risk/reduced lubrication for eating/ speech problems/ denture retention)
Enlargement of the major salivary glands (usually symmetrical)
Increased risk of lymphoma. (5% of any lymphoma. Mostly salivary marginal B cell lymphoma

24
Q

What are the symptoms of Sjögrens

A

Daily Dry mouth >3 months
Swollen salivary glands
Frequently drinking liquid to aid swallowing of dry foods.

Persistent Dry eyes >3 months
Feeling like sand in their eyes.
Tear substitutes used >3 times a day.

25
Q

Compare AECG and EULAR for diagnosis of sjögrens.

A

AECG- you need to have 4 of the characteristics:
Histopathology.
Autoantibodies
Imaging findings.
Dry mouth & eyes
Radio nucleotide assessment .

EULAR has a weighting system.
Weight 3
Histopathological and autoantibodies

Weight 1
Dry eyes/ mouth
Ultrasounds.

26
Q

Discuss the testing plan for sjögrens

A
  1. Clinical examination is there a dry mouth after C/O dry mouth
  2. Salivary flow test. Autoantibody test. Salivary ultrasound scan. Baseline MRI of major salivary glands.
  3. Labial gland biopsy. (due to risks of skin numbness after the procedure)
27
Q

How do we manage Sjögrens?

A

Dry mouth management
(Saliva orthana)

28
Q

Discuss the management of an early diagnosis of sjögrens

A

If patient presents early sjögrens the salivary destruction is ongoing. We can stop this from progressing to the dry mouth by using immunomodulating treatment (Hydroxychloroquine/ Methotrexate) .
Adv- Stops the progression of the salivary gland destruction
Disadvantages-
Risks of immunosupression.
Cannot gaurentee that the Sjögrens will progress far enough for the patient to experience the dry mouth. some people will never progress far enough to have the dry mouth.

29
Q

What is characteristic of salivary neoplasms?

A

Slow growing
Painless
Well defined

30
Q

What effect can salivary neoplasms have ?

A
  • Localised swelling in the salivary gland.
    Neurological change e.g. Facial palsy? dysthesia due to pressure on the facial nerves.
31
Q

How common are salivary gland tumours & discuss the incidence of malignancy?

A

10 in 100,000
The smaller the gland the greater the likelyhood of malignancy.
Partoid- 80% of tumours- 15% malignant.
Minor- 10% of tumours- 45% malignant.

32
Q

How can we classify salivary tumours ?

A

Epithelial (Adenoma- benign.
Carcinoma- malignant)
Non-epithelial
Sacroma or lymphoma.

33
Q

Give the clinical features of a major gland neoplasm?

A
  • Lump in the affected gland
  • Assymetry
  • Obstruction
  • Pain
  • Facial palsy.
34
Q

Give the clinical features of a minor gland neoplasm ?

A

Can be located:
* Tongue
* Upper lip/cheek
* Junction between soft and hard palate.

If it ulcerates late (Malignancy)

35
Q

What diagnostic techniques can we use for salivary neoplasms?

A
  • Fine needle aspirate - enough to differentiate between benign and malignant but not enough for a diagnosis.
  • Core biopsy (more tissue taken in the sample)
  • Incisional biopsy
36
Q

List some of the problems we face with diagnosis of salivary biopsies?

A
  • So many types of tumour
  • Variation within the tumour because the tissue originates from the different stem cell lines (so pathology will be complex
  • Features are similar for different types
  • Not all tumours fit the classification (We name this adenocarcinoma not otherwise specified)
  • Immunohistochemistry may be needed to differentiate between many of these tumours.
37
Q

The patient attending has been diagnosed with a pleomorphic adenoma.
List some characteristics of a pleomorphic adenoma and the treatment.

A

75% of all salivary tumours.
Mostly found in parotid gland
Incomplete capsule
Slow growth.

Treatment- wide local exicision because there is an increased risk of recurrence (sometimes as multifocal) due to the incomplete capsule) - Review patient every 5 years.

38
Q

Discuss the epithelium of a pleomorphic adenoma?

A
  • Duct like structures
  • Myoepithelial cells (Look like muscle cells and can contract- moving saliva through the duct)
  • Myxoid (Loose ground tissue)
  • Chondroid areas (look a bit like cartilage tissue)
39
Q

The patient attending has been diagnosed with a Warthin’s tumour.
List some characteristics of a Warthin’s tumour and the treatment.

A

15% of all tumours
most commonly parotid
Occasionally multiple/ bilateral (10%)

Treatment- excision (fully encapsulated so no problem with recurrence)

40
Q

Discuss the histology of a warthin’s tumour?

A

Histologically:
Cystic
Distinctive epithelium
Lymphoid tissue.

41
Q

Discuss the incidence of salivary gland carcinomas?

A

<1% of all malignancy.
15% of all salivary tumours
Higher proportion are found in the minor salivary glands.

42
Q

The patient attending has been diagnosed with a Adenoid cystic carcinoma. Discuss the incidence, spread and treatment. ?

A

5%
More commonly in minor salivary glands.
Varied pattern (Cribiform- swiss cheese/ tbular (solid)
Local spread- via blood and bone.
Late spread- metastasis by blood to the lungs

Treatment- it is difficult to treat because it grows along the nerve fibres (Recurrence- so long term prognosis is poor)

43
Q

The patient attending has been diagnosed with a mucoepidermoid carcinoma
List some characteristics of a pleomorphic adenoma

A

3-5%
Can be squamous (epidermoid) or glandular (Mucous)
Unpredictable
Source is the mucous tissue that may be present within the jaw bone.

44
Q

What is an acinic cell carcinoma?

A

Rare carcinoma mostly found in the partoid gland.

45
Q

What is a polymorphous adenocarcinoma?

A

Minor gland in the palate
Locally infiltrative- through the nerves.

4th year (51 decks)

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