problems with salivation

Question 1

What are the components of examinations salivary glands?

Answer 1

E/O - major salivary glands
I/O - minor salivary glands, duct orifices and fluid expression
Palpate parotid and submandibular glands

Question 2

What are the functions of saliva?

Answer 2

Acid buffering
Mucosal lubrication - speech and swallowing
Taste facilitation
Antibacterial - prevents oral infections

Question 3

Give 4 causes of a dry mouth

Answer 3

Salivary gland disease
Drugs (reduce stimulation of glands to produce saliva)
Medical conditions and dehydration
Anxiety and somatisation disorders

Question 4

What salivary changes are seen with age?

Answer 4

Acinar tissue loss (between 17-90):
- 37% submandibular
- 32% parotid
- 45% minor glands
Older people more likely to notice dry mouth due to loss of reserve gland tissue

Question 5

Give 4 examples of drugs that indirectly cause salivary problems

Answer 5

Anti-muscarinic cholinergic drugs:
- tricyclic antidepressants
- antipsychotics
- antihistamine
- cytotoxics

Question 6

Give 4 examples of chronic medical problems which indirectly cause salivary problems

Answer 6

Any from:
- diabetes - mellitus and insipidus
- renal disease - inc in fluid loss
- stroke - unable to drink
- Addison’s disease
- persisting vomiting
They do this by inducing dehydration

Question 7

Give 4 examples of acute medical problems which indirectly cause salivary problems

Answer 7

Acute oral mucosal disease
Burns
Vesiculobullous diseases - fluid loss through skin
Haemorrhage

Question 8

Give 4 examples of direct salivary gland problems

Answer 8

Aplasia eg - ectodermal dysplasia - glands don’t form properly
Sarcoidosis
HIV disease
Gland infiltration eg - amyloidosis, haemochromatosis
Cystic fibrosis - affects all gland secretions throughout body

Question 9

What is sarcoidosis?

Answer 9

A granulomatous condition which causes infiltrate within the gland, preventing it from functioning properly
Skin and salivary changes seen

Question 10

Why may children not complain of a dry mouth?

Answer 10

If born with it, they may think it is normal

Question 11

What is ectodermal dysplasia?

Answer 11

Disorders that affect the hair, teeth, nails, salivary and sweat glands causing abnormal development

Question 12

What is amyloidosis?

Answer 12

Deposition of protein within the gland, preventing it from functioning properly
Can be hereditary

Question 13

What is haemachromatosis?

Answer 13

Excess storage of iron stopping tissue from functioning
Will find a high level of ferritin in the blood
Can be hereditary

Question 14

How can radiation and cancer treatment contribute to dry mouth?

Answer 14

Radiation causes loss of vascular supply
Anti-neoplastic drugs and radioiodine can accumulate and kill off acinar cells

Question 15

What is the Challacombe Scale of Mucosal Dryness?

Answer 15

Scale assessing the degree of mucosal dryness from 1-10

Question 16

Describe stages 1-3 of the Challacombe Scale of Mucosal Dryness

Answer 16

Level of dryness seen with some drugs, often managed with sips of water and sugar-free chewing gum

Question 17

Describe stages 4-6 of the Challacombe Scale of Mucosal Dryness

Answer 17

Moderate dryness, more advanced tx needed such as saliva substitutes
Higher caries rate
OHI, diet advice and topical fluoride needed

Question 18

Describe stages 7-10 of the Challacombe Scale of Mucosal Dryness

Answer 18

No visible saliva
Often seen at end stage of Sjögren’s
Needs to be assessed by a specialist

Question 19

What investigations can be carried out for salivary disease?

Answer 19

Blood tests - FBC, U&Es, Anti Ro and Anti La antibodies
Functional assay - salivary flow
Tissue assay - labial gland biopsy
Imaging - plain radiographs, sialography, MR sialography, ultrasound