Problems with Salivation Flashcards

1
Q

During extra oral exam what glands are you palpating?

A
  • Parotid
  • Submandibular
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2
Q

During intra oral exam what are you examining in regard to salivary glands?

A
  • Minor salivary glands
  • Duct orifices
  • Fluid expression
  • Quantity and quality of saliva
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3
Q

What are the key features of what saliva does?

A
  • Acid buffering
  • Mucosal lubrication needed for speech and swallowing
  • Taste facilitation
  • Antibacterial
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4
Q

What are some causes of xerostomia?

A
  • 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
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5
Q

How do drugs cause xerostomia?

A

-

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6
Q

What percentage of saliva is excreted from each gland?

A
  • 37% submandibular
  • 32% Parotid
  • 45% Minor glands (sublingual)
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7
Q

Why are elderly much more aware of changes in saliva and will feel dry mouth more than a younger person?

A
  • 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
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8
Q

What are the two types of effect medical conditions can have on salivary glands?

A
  • Indirect effect (external to gland)
  • Direct effect (problems with gland itself)
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9
Q

What are some common drugs that can cause indirect salivary problems?

A

Anti-muscarinic cholinerguc drugs
- Tricyclic antidepressant
- Antipsychotics

  • Antihistamine
  • Atropine
  • Diuretics
  • Cytotoxics
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10
Q

What is the percentage reduction of antimuscarinic drug amitripyline on saliva?

A
  • 26% reduction
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11
Q

What is the percentage reduction in saliva of diuretics like bendrofluazide?

A
  • 10% reduction
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12
Q

What is the reduction in saliva percentage of Lithium?

A
  • 70%
  • People with bipolar - increased caries correlates with drug use
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13
Q

What are some Chronic medical problems inducing dehydration which can cause indirect salivary problems?

A
  • Diabetes - Melitus and Insipidus
  • Renal disease
  • Stroke
  • Addison’s disease
  • Persisting vomiting
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14
Q

What are some acute medical problems which can lead to dehydration and can cause indirect salivary problems?

A
  • Acute oral mucosal disease (painful to drink)
  • Burns
  • Vesiculobullous disease
  • Haemorrhage
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15
Q

What are some disease which cause direct salivary gland problems?

A
  • 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)
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16
Q

Is ectodermal dysplasia x or y linked?

A
  • x- linked
  • Hypohidrotic
17
Q

What is Sarcoidosis?

A
  • Multi system disease
  • Seen as granulomatous change in the hyler lymoh nodes in lung
  • Enlargement of parotid and submandibular glands
18
Q

How does Amyloid cause damage to gland?

A
  • Through deposition of protein within the gland
    which prevent gland from functioning properly
19
Q

How does Haemachromatosis damage the gland?

A
  • Excess storage of iron in tissues which eventually stops salivary gland from functioning
20
Q

During a blood test how can Haemochromatosis be identified?

A
  • from high level of ferritin in blood
21
Q

How does radiotherapy cause saliva reduction?

A
  • Affects vascular supply of gland
  • Reduced blood supply to salivary glands
  • Some recovery can be seen but most likely permanent deficit
22
Q

How can Graft versus host disease affect saliva?

A
  • Graft versus host disease following bone marrow transplant cause immune damage to glands and over time cause reduction in salivary gland function
23
Q

How do antineoplastic drugs and radioiodine affect saliva?

A
  • Accumulate in salivary glands
  • Over time kill off the acinar cells and prevent function
24
Q

What scale do we use to assess dryness?

A
  • Challacombe scale
  • Measured from 1-10
25
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
26
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
27
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)
28
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
29
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
30
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
31
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
32