Problems with Salivation Flashcards

1
Q

Examination of SG

A
  • palpation of Parotid and submandibular gland
  • quality and quantity of saliva in mouth

E/O
- major salivary gland (size changes)

I/O
- minor SG
- duct orifices
- fluid expression of clear saliva from ducts

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2
Q

Functions of saliva

A
  • acid buffering
  • mucosal lubrication
    1. speech
    2. swallowing
  • taste facilitation
  • antibacterial

All will be compromised if salivary problems arise.

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3
Q

Cause of dry mouth

A

Pt complain of having a dry mouth
- SG disease
- drugs, ie: anti-muscarinic
- medical conditions affecting the glands itself
- dehydration
- radiotherapy & cancer tx

** anxiety and somatisation disorders- may cause dry mouth when nervous

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4
Q

Salivary gland changes

A
  • with age 17-90

Acinar tissue loss
- 37% submandibular
- 32% parotid
- 45% minor glands

Dryness due to tricyclic medication older pt will feel more dryness than younger pt

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5
Q

Medical conditions

A
  1. Indirect effect
    - external to gland
  2. Direct effect
    - problems with gland itself
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6
Q

What drugs cause Indirect salivary problems?

A

Anti- muscarinic cholinergic drugs
- Tricyclic antidepressant
- antipsychotics
- antihistamines
- atropine
- diuretics - if overused, cause hypovolaemia and cause pt to develop dry mouth
- cytotoxics- chemotherapy

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7
Q

Drugs and dry mouth

A
  1. Anti- muscarinic
    - Amitriptyline 26% reduction
  2. Diuretics
    - Bendrofluazide 10% reduction
  3. Lithium
    - 70% have a significant reduction
    - increased caries correlates with drug use
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8
Q

Chronic Medical problems

A
  1. Diabetes - Mellitus and Insipidus
    - loss of fluid
  2. Renal disease
  3. Stroke- may not be able to drink properly
  4. Addison’s disease
  5. Persisting vomitting
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9
Q

Acute medical problems

A
  • acute oral mucosal disease
  • burns
  • vesiculobullous disease
  • haemorrhage
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10
Q

Direct SG Problems

A
  1. Aplasia
    - ectodermal dysplasia; glands do not form properly
  2. Sarcoidosis- infiltrate in the gland and prevent it from functioning properly
  3. HIV disease
  4. Gland infiltration
    - Amyloidosis
    - Haemochromatosis
  5. Cystic fibrosis- affects all gland secretion in the body
  • can increase caries risk
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11
Q

Ectodermal Dysplasia

A
  • when fully expressed, cna affect hair, nails, teeth, salivary and sweat glands
  • hearing and vision may be affected too
  • salivary aplasia alone

Hypohidrotic ectodermal dysplasia (X- linked): commonest unusual form

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12
Q

Sarcoidosis

A
  • multi-system disease
  • granulomatous change in hilar lymph nodes in lungs
  • skin and salivary changes
  • ultrasound shows MRI: show changes within gland where are hypoechoic change on ultrasound and often enlargement of parotid and submandibular glands
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13
Q

HIV

A
  • lymphoproliferative changes in gland
  • increase in bulk of gland
  • reduction in function as active acinar tissue is lost
  • can be seen before any changes are noted
  • may still be a presenting feature to dental team (when increase size of SG, offer HIV test)***
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14
Q

Amyloid & Haemachromatosis

A
  • damage to gland structure
  • amyloidosis through deposition of protein within the gland, which rpvents gland from functioning properly
  • haemachromatosis by excess storage of iron within tissues, hence stop salivary tissue from being able to function
  • hereditary
  • associated with other diseases
  • look through a gene mutation test
  • if FBC carried out, will notice high levels of ferritin in blood
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15
Q

Radiotherapy and cancer treatment

A
  • Direct radiation effect-> affect vascular supply to the salivary gland, causing blood supply to gradually lost, Salivary function lost
  • may be some recovery, but may permanent deficit
  • GvHD- inadequent salivary gland tissue
  • anti-neoplastic drug
  • accumulate in salivary glands and overtime gradually kill acinar cells, prevent gland function
  • same for radioiodine
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16
Q

How to assess degree of mucosal dryness?

A
  • Challacombe scale of mucosal dryness
  • Measure of 1-10
17
Q

Challacombe scale 1-3

A
  • mild dryness
  • mirror sticks to buccal mucosa and tongue
  • saliva frothy
  • may not need tx or management
  • sugar free chewing gum for 15 mins, twice daily
  • routine checkup and monitoring required
18
Q

Challacombe scale 4-6

A
  • moderate dryness
  • no saliva visible in FoM
  • tongue shows generalised shortened papillae (mild depapillation)
  • altered gingival architecture (smooth appearance)
  • sugar free chewing gum/ simple sialogogues may be required
  • saliva substitutes and topical fluoride may be helpful
  • monitor at regular intervals, especially for early decay and symptom change
  • pt may have higher caries rate
19
Q

Challacombe scale 7-10

A
  • severe dryness
  • glassy appearance of oral mucosa, especially palate
  • tongue lobulated/ fissured
  • cervical caries (more than 2 teeth)
  • debris on palate/ sticking to teeth
  • no saliva visible
  • end stage of Sjogren syndrome and needs to be seen by a specialist
20
Q

How to investigate salivary disease?

A

Blood test
- FBC
- U&Es
- Liver function test
- C-reactive protein
- glucose
- Anti Ro antibody
- 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