Problems with Salivation Flashcards
During extra oral exam what glands are you palpating?
- Parotid
- Submandibular
During intra oral exam what are you examining in regard to salivary glands?
- Minor salivary glands
- Duct orifices
- Fluid expression
- Quantity and quality of saliva
What are the key features of what saliva does?
- Acid buffering
- Mucosal lubrication needed for speech and swallowing
- Taste facilitation
- Antibacterial
What are some causes of xerostomia?
- Salivary gland disease
- Drugs
- Medical conditions and dehydration
- Radiotherapy and cancer txt
- Anxiety and somatisation (perception of mouth is wrong but normal amount of saliva) disorders
How do drugs cause xerostomia?
-
What percentage of saliva is excreted from each gland?
- 37% submandibular
- 32% Parotid
- 45% Minor glands (sublingual)
Why are elderly much more aware of changes in saliva and will feel dry mouth more than a younger person?
- As you age acinar tissue loss occurs
- Less gland reserves so will notice changes of drugs much more than younger person who has adequate saliva flow
What are the two types of effect medical conditions can have on salivary glands?
- Indirect effect (external to gland)
- Direct effect (problems with gland itself)
What are some common drugs that can cause indirect salivary problems?
Anti-muscarinic cholinerguc drugs
- Tricyclic antidepressant
- Antipsychotics
- Antihistamine
- Atropine
- Diuretics
- Cytotoxics
What is the percentage reduction of antimuscarinic drug amitripyline on saliva?
- 26% reduction
What is the percentage reduction in saliva of diuretics like bendrofluazide?
- 10% reduction
What is the reduction in saliva percentage of Lithium?
- 70%
- People with bipolar - increased caries correlates with drug use
What are some Chronic medical problems inducing dehydration which can cause indirect salivary problems?
- Diabetes - Melitus and Insipidus
- Renal disease
- Stroke
- Addison’s disease
- Persisting vomiting
What are some acute medical problems which can lead to dehydration and can cause indirect salivary problems?
- Acute oral mucosal disease (painful to drink)
- Burns
- Vesiculobullous disease
- Haemorrhage
What are some disease which cause direct salivary gland problems?
- Ectodermal dysplasia (gland not formed properly or at all)
- Sarcoidosis (cause infiltrate into gland and prevent proper function)
- HIV disease
- Gland infiltration like Amyloidosis or Haemochromatosis
- Cystic fibrosis (affects all gland secretion throughout body)
Is ectodermal dysplasia x or y linked?
- x- linked
- Hypohidrotic
What is Sarcoidosis?
- Multi system disease
- Seen as granulomatous change in the hyler lymoh nodes in lung
- Enlargement of parotid and submandibular glands
How does Amyloid cause damage to gland?
- Through deposition of protein within the gland
which prevent gland from functioning properly
How does Haemachromatosis damage the gland?
- Excess storage of iron in tissues which eventually stops salivary gland from functioning
During a blood test how can Haemochromatosis be identified?
- from high level of ferritin in blood
How does radiotherapy cause saliva reduction?
- Affects vascular supply of gland
- Reduced blood supply to salivary glands
- Some recovery can be seen but most likely permanent deficit
How can Graft versus host disease affect saliva?
- Graft versus host disease following bone marrow transplant cause immune damage to glands and over time cause reduction in salivary gland function
How do antineoplastic drugs and radioiodine affect saliva?
- Accumulate in salivary glands
- Over time kill off the acinar cells and prevent function
What scale do we use to assess dryness?
- Challacombe scale
- Measured from 1-10
What are the 1-3 challacombe scale findings?
1- Mirror sticks to buccal mucosa
2- Mirror sticks to tongue
3 - Saliva frothy and bubbling at mouth
What is the score of 1-3 on challacombe scale indicative of txt wise?
- Mild dryness
- Sugar free chewing gum for 15 mins twice daily and hydration attention
What is the findings of 4-6 on challacombe scale?
4 - No saliva pooling in floor of mouth
5 - Tongue shows generalised shortened papilla
6 - Altered gingival architecture (smooth)
What is the score of 4-6 on challacombe scale indicative of?
- Moderate dryness
- Sugar free chewing gum , simple sialoguges required
- Saliva substitues and topical fluoride as increased caries risk
- OHI and prevention
What does 7-10 on challacombe score mean?
7 - Glossy appearance of oral mucosa esp palate
8 - Tongue lobulated /fissured
9 - Cervical caries (more than 2 teeth)
10 - Debris on palate or sticking to teeth
What is challacombe score 7-10 indicative of txt wise?
- Severe dryness
- Saliva substituese
- Topical fluoride
- Intense OHI
- Usually apparent at end stage of sjogrens syndrome
- Needs assessed by specialist
What are some tests useful for investigating salivary disease?
- FBC
- U&Es
- Liver function tst
- C-reactive protein
- Glucose
- Anti ro antibody
- Anti La antibody
- Antinulcear antibody
- Complement C3 and C4
Functional assay - salivary flow
Tissue assay - Labial gland biopsy
Imaging
- Plain radiographs
- Sialogaphy
- MR sialography
Ultrasound
