Oral Dryness-Dr. Hasan Flashcards
1
Q
What is saliva?
A
- preserve and maintain oral health
- clear
- slightly acidic
- muco-serous exocrine secretion
- Mixture from major and minor salivary glands and gingival crevicular fluid
- 99% water
- not an ultrafiltrate but same amount of DNA as blood
2
Q
What does Whole Saliva contain?
(Fluid normally present in the mouth, not just from any single duct)
A
- Bacteria
- cells
- food debris
- GCF
3
Q
What is the pH of saliva
A
- Normal-6-7
- low=5.3
- High=7.8
4
Q
What do the major salivary glands vs minor salivary glands contribute to saliva?
A
- Major salivary glands:
- most of volume and electrolytes
- cleansing
- buffering
- clearing
- Minor Salivary glands:
- little volume
- most of blood substances
- protection
- lubricate
5
Q
How many major salivary glands do we have?
A
- 3 pairs:
- parotid gland
- Submandibular gland
- sublingual gland
6
Q
How many minor salivary glands do we have?
A
700-800
7
Q
Parotid gland
A
- serous/watery secretion
8
Q
Submandibular gland
A
- mixed serous and mucous secretion
9
Q
sublingual gland
A
- mixture but mainly mucous secretion
10
Q
Where are minor glands found?
A
- under mucosa
- Lower lip
- tongue
- palate
- cheeks
- pharynx
- exceptions:
- anterior hard palate
- gingiva
11
Q
Xerostomia
A
- Subjective feeling of dry mouth
- patient may or may not have dryness
12
Q
Dry Mouth
A
- Patient has less than normal stimulated and/or unstimulated saliva
- patients may not complain of dryness
13
Q
Salivary gland hypo-function
A
- Improper function salivary gland
- patients rate of salivary flow normal or less than normal
14
Q
Saliva values: Resting (ml/min), Resting (%), Stimulated (ml/min), stimulated (%)
- Whole mouth saliva
- Parotid glands
- Submandibular/sublingual glands
- minor glands
A
- Whole-mouth saliva
- resting (ml/min): 0.35
- Resting (%): 100%
- stimulated (ml/min):2.0
- Stimualted (%): 100%
- Parotid glands:
- resting (ml/min): 0.1
- Resting (%): 28
- stimulated (ml/min): 1.05
- Stimualted (%): 53
- Submandibular/sublingual glands
- resting (ml/min): 0.24
- Resting (%): 68
- stimulated (ml/min): 0.92
- Stimualted (%): 46
- Minor glands
- resting (ml/min): <0.05
- Resting (%): 4
- stimulated (ml/min): <0.1
- Stimualted (%): 1
15
Q
oral dryness prevalence
A
- 1-65%
- 50 y.o.= 6%
- 65 y,o.= 15%
- 65+ y.o.= 30%
16
Q
Causes of oral dryness
A
- medicines
- systemic diseases **
- Viral infections
- radiation
- nerve damage
- smoking/chewing tobacco
- drug addiction
- carbonated beverages & coffee
- Dehydration
17
Q
What is normal salivary flow? Unstimulated vs stimulated
A
- Unstimulated
- 1.5ml/15min
- Stimulated:
- 10.5ml/ 15min
18
Q
When will a patient complain of dry mouth?
A
- saliva level below 40-50% of baseline
19
Q
Function of saliva
A
- Mastication
- Swallowing
- Cleansing
- Lubrication
- Digestion
- Maintaining taste perception
- Maintaining and preserving oral helth
- stimulates soft tissue repair
20
Q
what does oral dryness do?
A
- saliva more acidic
- decerease:
- lubrication
- cleansing
- increases:
- plaque/calculus deposits
- fungal infection
- Effects taste perception
- Change in voices
- problems swallowing
21
Q
Signs of dry mouth?
A
- Signs
- Ropy saliva
- lack of pooling
- generalized
- dental caries
- chipped teeth
- dry appearance
- fissured tongue
- recurrent fungal infection
- enlarged parotid gland
- tongue coating
- signs of tissue trauma
- Other
- difficulty chewing and swallowing
- sore throat
- hoarse voice
- difficulty talking
- lipstick transfer
- frictional hyperkeratosis
- Atrophic tongue
- Beefy tongue
- Altered taste
- halitosis
22
Q
Oral dryness: Progression of cavities
A
- Starts as cavities at gingiva
- progresses rapidly
23
Q
What questions to ask patient
A
- does mouth feel dry when eating a meal?
- Do you drink to aid in swallowing dry food?
- Difficulty swallowing any foods?
- Does the amount of saliva in your mouth seem to little, too much, or dont notice?
- Do you get up at night to drink water
- Does your mouth feel dry at night or when you wake up?
- Do you keep a glass of water by your bed?
- Does your mouth frequently feel dry?
- Are you thirsty alot?
24
Q
What patients is rapid deterioration seen in?
A
- Head and neck radiation
- Sjogren’s
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Why is it important to manage oral dryness when planning prosthodontic treatment?
* damage gets worse if untreated
* crucial for long term success
* High risk of:
* unable to wear removable dentures
* repeated failed treatment
* only option for extreme cases=implant
* Untreated for long period-develop oral burning
* more difficult to treat
* impossible to wear dentures
* Weight loss due to difficulty eating
* cost or oral dryness tx is less than repeated txs
26
Problems associated with removable dentures
* Discomfort
* Lack retention
* recurrent fungal infection below denture
* repeated tissue trauma
* can't eat
27
Complete denture
* not good candidates
* retention issue
* saliva creates adhesion, cohesion, and surface tension that leads to retention
* Attemp to save teeth if possible
* will have recurrent tissue trauma
* if only option, encourage patients for implant supported CD
* without might not be successful
* implant help with stability and prevent trauma
* Mini implants might work
28
Partial dentures
* won't do well w/metal frame
* stability is key for succes-helps prevent tissue trauma
* greater compliance
* implant retained partial is best option
* Alternative choice:
* duraflex partial
* patients like it
* good esthetics
* easy to adjust
* Boomer bridge
* not all labs make
* controversy
* not an option for old and certain medical conditions
29
Fixed Prosthodontics concerns
* Crowns & bridges are more expensive option
* Higher failure rate
* main reason of faillure=recurrent decay
* caused by unmanaged oral dryness
* results- fracture at gingiva
30
Implants
* very expensive
* not an option for everyone
* might need bone graft or sinus lift
* time consuming
31
What should you do if patient has dry mouth and still wants a non-implant supported denture?
* manage dry mouth
* start denture process when you see well lubricated tissue
* if patient does not want to manage dryness, document and make denture
* If teeth are present-helps
* prescription grade fluoride toothpaste
* topical dry mouth products
32
Oral dryness management:
steps and tx for partial or complete dentures
* Too dry-oral medicine (OM) should evaluate dryness
* amount and type of saliva different in every patient
* management coordinated b/w OM specialist and patients dentist
* educate on the impact on teeth
* insurance not needed
* Tx for dentures
* Denture adhesive
* nonimplant supported
* duraflex will work
* Soft denture reline when needed
* encourage proper oral hygiene
* recommend taking denture out at night
33
Methods of saliva stimulation
* Mechanical
* act of chewing
* Gustatory
* acid=most powerful
* sweet=least
* Olfactory
* very poor stimulus
* Chemical:
* Sialagogues
34
Oral dryness: OTC measures
* OTC dry mouth products
* washes
* gels
* chewing gum
* Diet counselling
* Cholinergic agents- only after saliva measurement test
* pilocarpine
* cevimeline
35
High vs Moderate vs Healthy pH levels of saliva
* High acidic saliva=5-5.8
* Moderate= 6-6.6
* Healthy: 6.8-7.8
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37
What conditions can salivary gland hypofunction indicate?
* Systemic diseases
* Diabetes
* Thyroid disease
* Rheumatoid Arthritis
* Sjogren's syndrome
* SLE
* primary biliary cirrhosis
* Scleroderma
* Avoid assuming polypharmacy without investigating
38
Salivary Gland stones
* Stones
* form in the ducts in any salivary gland
* 80%-submandibular gland
* 6-15%= parotid gland
* 2%=sublingual and minor salivary glands
* large stones
* block flow of saliva
* cause glands to swell
39
Salivary gland stone: common symptoms
* Sore or painful lump under tongue
* pain or swelling below jaw or ear
* pain that increases when eating
40
Salivary gland stone: Risk factors
* Male
* Old age
* radiation therapy on head or neck
* mouth injuries
* Medication that affect saliva production
* anticholinergics
* Sjogren's syndrome
* Kidney problems
* Not drinking enough water
41
Salivary Gland stone: Home remedy
* Sucking on citrus fruits or hard candies
* sugar free gum
* sour candies-lemon drops
* Drink alot of fluids
* Gentle massage
* Medicine
* OTC-ibuprofen & Acetaminophen
* Sucking on ice cubes
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