Problems with Saliva Flashcards
examination of the salivary glands
E/O
* Major salivary glands – palpation of parotid and submandibular
IO
* quality and quantity of saliva
* Minor salivary glands (size)
* Duct orifices
* Fluid expression – should be clear
what does saliva do
4
Acid buffering
Mucosal lubrication
* Speech
* Swallowing
Taste facilitation
Antibacterial
causes of a dry mouth
5
- Salivary Gland disease
- Drugs
- Medical Conditions & Dehydration
- Radiotherapy & cancer treatments
- Anxiety & Somatisation Disorders (due to chronic anxiety; or free that they have a dry mouth when in reality they do not)
salivary changes with age (17-90yo)
Acinar tissue loss – normal for body tissue, pt may no notice obv oral dryness, may notice other compound affects e.g. drug in 20y slight dryness but same dose and drug to 90y greater effect due to less gland reserve
* 37% Submandibular
* 32% Parotid
* 45% Minor glands
2 modes of effect medical conditions can have on salivary glands
indirect
direct
indirect effect of some medical conditions on salivary glands
external to the gland
direct effect of some medical conditions on salivary glands
problems within the gland itself
examples of drugs which cause indirect salivary problems
6
Anti-muscarinic cholinergic drugs
* Tricyclic antidepressant
* Antipsychotics
* Antihistamine
* Atropine
* Diuretics (overused will cause hypovolemia = dry mouth)
* Cytotoxics
classes of drugs which cause indirect salivary problems
3
Anti-muscarinic cholinergic drugs
diuretics
lithium
drugs and dry mouth
impact
relatively small alone but when combined with age related changes can be significant
antimuscarinic drug which causes dry mouth
amitriptyline 26% reduction
diuretic which causes dry mouth
bendrofluazide 10% reduction
lithium used to tx
bipolar
lithium and dry mouth
70% reduction in saliva
indirect salivary problems due to medical conditions
types
3
medicine induced
chronic medical problems inducing dehydration
acute medical problems
chronic medical problems inducing dehydration
5
Diabetes – Mellitus & Insipidus
* Loss of fluid
Renal disease?
* Inc diuresis, so fluid loss
Stroke
* Unable to drink properly so rehydrate
Addison’s Disease
Persisting Vomiting
acute medical problems causing indirect salivary problems
4
Acute oral mucosal diseases
* Drinking less due to oral discomfort
Burns
* Fluid loss through skin
Vesiculobullous diseases
Haemorrhage
* Lack of circulating volume in vascular system
5 examples of direct salivary gland problems
Aplasia
* Ectodermal dysplasia (born without the submandibular or parotid glands)
* Pt may not notice as ‘normal’ for them
Sarcoidosis
* Granulomatous condition which will cause an infiltrate within the gland and prevent it functioning properly
HIV disease
Gland infiltration
* Amyloidosis
* Haemochromatosis
Cystic Fibrosis – affects all gland sectreiton throughout body
reduction in salivary gland secretion leads to….
inc caries risk
ectodermal dysplasia
is
pt born without: Hair, Nails, Teeth, Salivary & Sweat glands
* May be limited in effect e.g. Salivary aplasia alone
Hearing and vision may be affected
Hypohidrotic – x-linked
* Dental malformations and hypodontia as well as changes in salivation
ectodermal dysplasia
is
pt born without: Hair, Nails, Teeth, Salivary & Sweat glands
* May be limited in effect e.g. Salivary aplasia alone
Hearing and vision may be affected
Hypohidrotic – x-linked
* Dental malformations and hypodontia as well as changes in salivation
sarcoidosis
granulomatous change in hilar lymph nodes in the lung
* skin and salivary changes also
Ultrasound – hypoechoic changes in salivary gland tissue
MRI – enlargement of the parotid and submandibular on scanning
HIV disease and saliva
lymphoproliferative changes in the gland – increase in bulk of the gland but reduction in function as active acinar tissue is gradually lost
* can be presenting feature of HIV
pt present with enlarged salivary glands = HIV test
amyloid and haemochromatosis
salivary change
Damage to gland structure – eventually stop salivary tissue from being able to function#
Amyloidosis – deposition of protein within the gland
Haemochromatosis – excess storage of iron within the tissues
* seen by high level of ferritin in FBC
Hereditary: HFE Gene mutation – 1:10 population carry
radiation therapy
salivary gland changes
Vascular supply salivary gland gradually lost – function lost
Some recovery when radiotherapy stopped but often some permanent deficit
radiation therapy
salivary gland changes
Vascular supply salivary gland gradually lost – function lost
Some recovery when radiotherapy stopped but often some permanent deficit
cancer tx effect on salivary function
3
Radiation effects
* Vascular supply salivary gland gradually lost – function lost
* Some recovery when radiotherapy stopped but often some permanent deficit
Graft versus host effects (after bone marrow transplant)
* Cause immune damage to the salivary gland
Antineoplastic drugs and Radioiodine
* Accumulate in the glands and over time kill off the acinar cells and prevent gland function
measure for mucosal dryness
The Challacombe Scale of Mucosal Dryness
1-10
mirror sticking to mucosa =
severe salivary problem
section 1 of the challacombe scale
1- Stick to buccal mucosa/tongue, some frothy/bubbly saliva collecting in FOM. Often seen with some drugs. Managed by sips of water and sugar free chewing gum
section 2 of the challacombe scale
2- No saliva visible at FOM and general loss of tongue papilla – moderate oral dryness. Pt may need more advance tx and saliva subsititures. HIGHER CARIES RISK – intensive OHI, diet advice, topical fluoride
section 3 of teh challacombe scale
3- No saliva visible, end stage sjogrens syndrome. Needs assessed by a specialist
investigating salivary disease
4
Blood tests
* FBC; U&Es, ; Liver function tests; C-reactive Protein; Glucose; Anti Ro and Anti La Antibody; Antinuclear Antibody; Complement C3 and C4
Functional Assay– Salivary Flow
Tissue Assay – Labial Gland Biopsy
Imaging
* Plain radiographs – reduced dose – stones
* Sialography – contrast to show ducts
* MR Sialography – IV contrast
* Ultrasound
