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Week 2-D2 > Oral Dryness-Dr. Hasan > Flashcards

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
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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
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3
Q

What is the pH of saliva

A
  • Normal-6-7
    • low=5.3
    • High=7.8
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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
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5
Q

How many major salivary glands do we have?

A
  • 3 pairs:
    • parotid gland
    • Submandibular gland
    • sublingual gland
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6
Q

How many minor salivary glands do we have?

A

700-800

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7
Q

Parotid gland

A
  • serous/watery secretion
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8
Q

Submandibular gland

A
  • mixed serous and mucous secretion
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9
Q

sublingual gland

A
  • mixture but mainly mucous secretion
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10
Q

Where are minor glands found?

A
  • under mucosa
    • Lower lip
    • tongue
    • palate
    • cheeks
    • pharynx
  • exceptions:
    • anterior hard palate
    • gingiva
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11
Q

Xerostomia

A
  • Subjective feeling of dry mouth
  • patient may or may not have dryness
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12
Q

Dry Mouth

A
  • Patient has less than normal stimulated and/or unstimulated saliva
  • patients may not complain of dryness
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13
Q

Salivary gland hypo-function

A
  • Improper function salivary gland
  • patients rate of salivary flow normal or less than normal
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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
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15
Q

oral dryness prevalence

A
  • 1-65%
    • 50 y.o.= 6%
    • 65 y,o.= 15%
    • 65+ y.o.= 30%
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16
Q

Causes of oral dryness

A
  • medicines
  • systemic diseases **
  • Viral infections
  • radiation
  • nerve damage
  • smoking/chewing tobacco
  • drug addiction
  • carbonated beverages & coffee
  • Dehydration
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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
25
Q

Why is it important to manage oral dryness when planning prosthodontic treatment?

A
  • 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
Q

Problems associated with removable dentures

A
  • Discomfort
  • Lack retention
  • recurrent fungal infection below denture
  • repeated tissue trauma
  • can’t eat
27
Q

Complete denture

A
  • 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
Q

Partial dentures

A
  • 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
Q

Fixed Prosthodontics concerns

A
  • 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
Q

Implants

A
  • very expensive
  • not an option for everyone
  • might need bone graft or sinus lift
  • time consuming
31
Q

What should you do if patient has dry mouth and still wants a non-implant supported denture?

A
  • 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
Q

Oral dryness management:

steps and tx for partial or complete dentures

A
  • 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
Q

Methods of saliva stimulation

A
  • Mechanical
    • act of chewing
  • Gustatory
    • acid=most powerful
    • sweet=least
  • Olfactory
    • very poor stimulus
  • Chemical:
    • Sialagogues
34
Q

Oral dryness: OTC measures

A
  • OTC dry mouth products
    • washes
    • gels
    • chewing gum
  • Diet counselling
  • Cholinergic agents- only after saliva measurement test
    • pilocarpine
    • cevimeline
35
Q

High vs Moderate vs Healthy pH levels of saliva

A
  • High acidic saliva=5-5.8
  • Moderate= 6-6.6
  • Healthy: 6.8-7.8
36
Q
A
37
Q

What conditions can salivary gland hypofunction indicate?

A
  • Systemic diseases
    • Diabetes
    • Thyroid disease
    • Rheumatoid Arthritis
    • Sjogren’s syndrome
    • SLE
    • primary biliary cirrhosis
    • Scleroderma
  • Avoid assuming polypharmacy without investigating
38
Q

Salivary Gland stones

A
  • 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
Q

Salivary gland stone: common symptoms

A
  • Sore or painful lump under tongue
  • pain or swelling below jaw or ear
  • pain that increases when eating
40
Q

Salivary gland stone: Risk factors

A
  • 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
Q

Salivary Gland stone: Home remedy

A
  • 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
42
Q
A

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