Oral Med Revision - Dry Mouth Flashcards
causes of dry mouth
dehydration
drugs
age, smoking, alcohol
radiotherapy / cancer tx
anxiety & somatisation disorders
salivary gland disease i.e. sjogren’s
complications of dry mouth
discomfort / pain
increased caries risk
candida infection
swallowing problems
drugs that can cause dry mouth
antimuscarinic (amitriptyline) 26% reduction
diuretics (bendroflumethiazide) 10% reduction
lithium 70% have a significant reduction, increased caries correlates with drug use
radiotherapy & cancer tx
radiation effects (apoptosis, inflammation then fibrosis)
GVHD effects
antineoplastic drugs
radioiodine
systemic disease causing dehydration
chronic - DM, renal or cardiac failure, hypercalcaemia, addison’s (hypovolaemia)
acute - haemorrhage, persistent vomiting
assessing the dry mouth
gland palpation
duct expression
challacombe scale
discriminating DISH from sjogren’s i.e. can you eat without having a drink
mx of dry mouth (4)
- investigate
- treat underlying cause
- preventative care
- symptomatic relief
investigations dry mouth
bloods HbA1c / U&E / ANA
sialometry
US scan of salivary glands
tx of underlying cause
correct hydration
avoid caffeine / smoking / alcohol
modify drug regime
control diabetes
treat somatoform disorder
preventative care
caries - diet, fluoride, txp
candida
angular cheilitis tx
sore tongue - remember SLS free toothpaste
symptomatic relief
sprays - glandosane, saliva orthana, saliveze, xerotin
lozenge / pastilles - saliva orthana, salivix (acidic pH), saliva stimulating tablets
salivary stimulants - prilocarpine
oral care systems / gels - biotene oral balance, bioextra gel, xerostom
simple lifestyle measures
moist oily foods / sauces
humidify home environment
regular exercise
omega 3 supplements
glasses / goggles to reduce tear evaporation
warm eye compresses 10min daily
why do salivary glands develop lumps or swell
- obstruction - something stopping saliva leaving gland - salivary duct calculi, duct stricture
- sialadenitis - inflammation of salivary glands - sjogren’s, infection, IgG4 syndrome
- sialosis - bilateral painless swelling - unknown cause
- neoplasm - malignant & non malignant tumours - pleomorphic adenoma, warthin’s tumour, mucoepidermoid carcinoma
- trauma & fluid - oedema & blood - trauma, allergy
- solid deposits - protein build up - amyloidosis
- intra gland node swelling - lymph nodes within glands swelling - lymphoma, acute infection
obstructive sialadenitis hx
aka mealtime syndrome
pain hx if necessary
ask if associated with eating / food
coming & going or persistent
swallowing problems
bad taste or pus
generally unwell - to exclude acute infection
obstructive sialadenitis assessment & investigations
clinical assessment:
- EO exam
- bimanual palpation of FoM
- express saliva from ducts; can you? is there pus? is there obstruction I can see?
investigations:
- lower occlusal xray +/- OPT to identify calcification
- US scan; 2ndary care
- sialography; 2ndary care
- MRI / CT; 2ndary care
acute viral sialadenitis clinical features
painful parotid swelling
usually bilateral
sometimes can be a single gland
no hyposalivation
10% have submandibular gland involvement
very rare to involve only submandibular gland
malaise, fever, feeling generally unwell which likely precedes the parotid swelling
trismus
swelling will last approx 7 days
acute viral sialadenitis dx & mx
dx
- clinical grounds
- serum antibodies
- viral swab of saliva
mx
no specific antivirals
supportive therapy i.e. hydration, analgesia, pyrexia mx, isolation for 6-10 days advisable, contact public health
acute bacterial sialadenitis signd/symptoms
most common in parotid glands
typically unilateral
painful swelling
overlying erythema
pus from duct rarely may have EO pointing
trismus
pyrexia
cervical lymphadenopathy
often 2ndary to salivary gland obstruction
acute bacterial sialadenitis dx & mx
dx
- clinical grounds
- exclude odontogenic infection; may consider OPT
- pus swab for culture & sensitivities often caused by strep viridans and staph aureus
- exclude pyrexia / sepsis
- exclude airway obstruction
- may need inpatient support / management
mx
- antibiotics through GP/OMFS
- 1st choice is flucloxacillin or erythromycin in penicillin allergic pts
- airway mx if needed
- mx of causative factors when acute sialadenitis resolved
mucocele hx & mx
hx
- swelling
- rupture
- partial resolution
- recurrence
- hx of trauma / lip biting
mx
- no tx but unlikely to resolve; can be good option when waiting for children to be able to tolerate intervention
- excision by OS; cysts enucleated ideally but high recurrence rate and poss damage to neighbouring structures
- clinical photos
