Pathology Flashcards

1
Q

What is xerostomia?

How much of the population is affected?

A

The complaint of a dry mouth; if salivary flow rate is <0.1ml/min

  • 50% of salivary function must be lost.
  • They are prone to increased dental caries, periodontal disease, intolerance of dentures and oral infections, particularly candidiasis
  • Epidemiology: Less than 2% population
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2
Q

What are the causes of Xerostomia?

A

• Either disease or medication induced.

‣ Antidepressants ➔ MAO inhibitors

‣ Antihistamines ➔ Ethanolamines e.g. Clemastine, Phenothiazines e.g. Proethazine

‣ Antimuscarinic drugs

‣ Anti-epileptic drugs

‣ Antipsychotics ➔ Phenothiazines e.g. romazine

‣ Antihypertensives -> Beta-blockers/Ca+ channel blockers/ACE inhibitors ‣ Painkillers: Morphine (commonly overlooked)

‣ Diuretics ➔ Benzthiazide, hydroflumethiazide, trichlormethiazide ‣ Cocaine, ecstasy, meth

‣ Result of immune-mediated hypofunction

‣ Sjögren’s syndrome

‣ Radiotherapy for head and neck cancer – especially at parotid.

‣ Diabetes insipidus or mellitis

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3
Q

What are the signs and symptoms of xerostomia?

A

A sticky, dry feeling in the mouth and throat

  • Frequent thirst
  • Sores in the mouth; sores or split skin at the corners of the mouth; cracked lips
  • A burning or tingling sensation in the mouth and especially on the tongue
  • A dry, red, raw tongue
  • Problems speaking, tasting, swallowing
  • Bad breath
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4
Q

What are the investigations and diagnoses of xerostomia?

A

• Sialometry test

‣ measure of saliva over period of time by dribbling into container.

‣ Stimulated by citric acid drop on tongue. Uses radio-opaque die (iodine) into duct (Sialography).

‣ Calculus could be blocking duct.

  • Wide variation in the amount of saliva produced by individuals
  • Questions such as:

‣ Had a daily feeling of dry mouth for more than 3 months?

‣ Had recurrently or persistently swollen salivary glands?

‣ Drink liquids to aid in swallowing dry food?

‣ Wake up at night to drink liquids?

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5
Q

What are the treatments for xerostomia?

A

Treating underlying cause

  • Reduce dose of medication or change drug if possible
  • Controlling symptoms
  • Frequent sips of cool drinks, sucking pieces of ice/sugar free sweets • Sugar-free chewing gum (with xylitol/chlorhexidine) – may stimulate salivation in patients with residual salivary function
  • Petroleum jelly – which can be applied to the lips to prevent drying or cracking
  • Artificial saliva
  • Sprays contain calcium phosphates etc. pH 6-7
  • Biotène Oralbalance® gel and Xerotin® oral spray are both artificial saliva preparations which have Advisory Committee on Borderline Substances (ACBS) approval for the treatment of any patient complaining of dry mouth.
  • BioXtra® gel, Glandosane® aerosol spray, Saliva Orthana® spray or lozenges and Saliveze® oral spray are artificial saliva preparations which have ACBS approval only for patients whose dry mouth is secondary to radiotherapy or sicca syndrome.
  • Salivary stimulants
  • Most effective in patients who have some residual salivary gland function.
  • Salivix® pastilles, which act locally as salivary stimulants, are also available and have ACBS approval only for patients whose dry mouth is secondary to radiotherapy or sicca syndrome. – But are acidic!
  • Sinclair tablets – stimulate taste buds and have buffer
  • Pilocarpine hydrochloride – side effects of vomiting – stimulates parasympathetic
  • Sugar-free chewing gum is as effective!
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6
Q

What preventative methods are there for xerostomia in post operative radiotherapy patients?

A
  • Surgical transfer of one submandibular gland to the submental space facilitates shielding of the gland during postoperative radiation therapy
  • Studies confirm that there is no adverse effect on the function of the gland in this position
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7
Q

What is SJOGREN’S SYNDROME?

A

Autoimmune disease where lymphocytes attack exocrine glands – lacrimal and ALL types of salivary glands

• SIALADENITIS = inflammation of the salivary glands

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8
Q

What are the symptoms of sjogren’s syndrome?

A

Xerostomia and keratoconjunctivitis sicca (dry eye syndrome)

• Reduced saliva and tears -> dry mouth/eyes/vaginal dryness.

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9
Q

What are the causes of sjogren’s syndrome?

A
  • Primary ‣ develops on its own
  • Secondary ‣ as a result of other disorders, e.g. RA/lupus
  • Unknown ‣ genetic/hormonal: oestrogen
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10
Q

What are the causes of rheumatoid arthritis?

A

Autoimmune

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11
Q

What are the signs and symptoms of RA?

A

Pain

  • Stiffness
  • Inflammation
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12
Q

What treatments are there for RA?

A

Lifestyle changes

  • Medication - These are often divided into two types of medication: 1. disease-modifying anti-rheumatic drugs (DMARDs) 2. biological treatments
  • Supportive treatments

Surgery

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13
Q

How do DMARDs work?

A

DMARDs work by blocking the effects of the chemicals released when the immune system attacks the joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage. ‣ Examples of DMARDS include: ‣ Methotrexate ‣ Hydrochloroquine ‣ Sulfasalazine ‣ Leflunomide

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