Saliva

Question 1

4 functions of saliva?

Answer 1

Acid buffering
Mucosal lubrication - speech and swallowing
Taste facilitation
Anti-bacterial

Question 2

Name some common drugs that will produce a dry mouth?

Answer 2

Note - list is extensive and many drugs cause dry mouth.

Tricyclic anti-depressant
Anti-psychotics
Anti-histamine
Diuretics
Methotrexate - cancer drug

Question 3

Name 6 causes of dry mouth

Answer 3

Salivary gland disease
Drugs/ medication
Medical conditions
Radiotherapy and cancer treatments
Anxiety
Somatisation disorder - enough saliva but perception is wrong

Question 4

Name 5 chronic medical problems that induce dehydration

Answer 4

Diabetes
Renal disease
Stroke - may be unable to drink properly inducing dehydration
Addison’s disease
Persistent vomiting

Question 5

Name 4 acute medical problems that cause indirect salivary problems

Answer 5

Acute oral mucosal diseases - inability to drink due to discomfort
Burns - loss of fluid from wounds
Veisculobullous diseases - “
Haemorrhage - lack of circulating volume in vascular system

Question 6

What does a challacombe score of 1-3 indicate and what treatment is needed?

Answer 6

Mild dryness - may not need treatment or management.
Sugar-free chewing gum for 15 mins twice daily and hydration

Question 7

What does a challacombe score of 4-6 indicate and treatment required?

Answer 7

Moderate dryness.
Sugar-free chewing gum or sialogogue (saliva promoting drug)

Question 8

What does a challacombe score of 7-10 indicate and treatment required?

Answer 8

Severe dryness
Saliva substitutes and topical fluoride usually needed.
Requires specialist care.

Question 9

How do anxiety/ somatisation disorders affect control of salivation?

Answer 9

Inhibition of salivation - anxiety directly causes “real” oral dryness.
For example when doing a presentation - dry mouth.

Question 10

How do anxiety/ somatisation disorders affect control of perception of salivation?

Answer 10

Altered perception of reality - normal information coming in from the mouth is “misunderstood” by small changes at synapses as it is processed
More often associated with anxiety

Question 11

What are frequent somatoform diseases?

Answer 11

Oral dysaesthesia
TMD pain
Headache
Neck/ back pain
Indigestion
IBS

Question 12

What is resting and stimulated flow of saliva in normal vs hyposalivation?

Answer 12

NORMAL
Resting - 0.3-0.4mL/min
Stimulated - 1-2mL/min

HYPOSALIVATION
Resting - <0.1mL/min
Stimulated - <0.5mL/min

Question 13

What are TREATABLE causes of dry mouth?

Answer 13

Dehydration
Medication with anti-musarinic side effects
Medication causing dehydration
Poor diabetic control
Somatoform disorder

Question 14

Roughly how much saliva should a patient produce AT REST in 15 minutes?
(salivary flow test)

Answer 14

1.5mls of saliva

Question 15

What are examples of dry mouth that are un-treatable but only have SYMPTOMATIC treatment?

Answer 15

Sjorgen’s syndrome
Dry mouth from cancer treatment
Dry mouth from salivary gland disease

Question 16

What are symptomatic treatment options for cases where the causes cannot be treated?

Answer 16

Intensive dental prevention
Salivary substitutes
Salivary stimulants

Question 17

Name a saliva substitute that may be prescribed for an edentulous patient?

Answer 17

Glandosane
Xerotin oral spray

Question 18

Name a saliva substitute that would be unsuitable for a dentate patient?

Answer 18

Glandosane
Salivix pastilles - acidic pH

Question 19

Name a saliva substitute that may be prescribed for a dentate patient?

Answer 19

Saliva orthana

Question 20

What is mumps?

Answer 20

Viral infection of the salivary glands.

Replicates in upper respiratory tract and is transmitted through direct contact or saliva.

Question 21

What is sialography and what is it used for?

Answer 21

Radiographic examination of salivary glands.
Can loosen a mucous plug.
Do not use when infection present because don’t want to wash back into the gland.

Question 22

What is Sjogren’s syndrome?

Answer 22

Sjogren’s is an auto-immune condition that primarily affects production of tears and saliva.
There is no definitive cause but rather associations

Question 23

What is primary sjogren’s syndrome?

Answer 23

Where there is no other connective tissue disease

Question 24

What is secondary sjogren’s syndrome?

Answer 24

Where there is other connective tissue present in the body such as:
SLE
Rheumatoid arthritis
Scleroderma

Question 25

What is sicca syndrome?

Answer 25

Where there are partial Sjogren’s findings

Question 26

What are the signs and symptoms of Sjogren’s?

Answer 26

Xerostomia
- caries
- altered taste
- recurrent candida infections
- reduced oral lubrication

Dry eyes

Question 27

What is the most predictive test for Sjogren’s?

Answer 27

Positive labial gland biopsy - collection of >50 lymphocytes around a duct = lymphocytic focus

Question 28

What value of unstimulated salivary flow would be considered abnormal and indicative of Sjogren’s?

Answer 28

<1.5ml in 15 minutes

Question 29

What diagnostic indicator tests can be done for sjogren’s?
NOTE - not causative factors just associations

Answer 29

Noticeably dry mouth
Unstimulated whole salivary flow (UWS) test
Test for anti-Ro antibodies
Schirmer test - eye signs

Question 30

What scoring systems are commonly used for diagnosing sjogren’s syndrome?

Answer 30

ACR-EULAR (2016)
AECG (2002)

Question 31

Oral complications of Sjogren’s syndrome?

Answer 31

Effects of oral dryness
Caries
Denture retention
Infections - candida
Functional issues - speech, swallowing

Question 32

Non-oral dryness complications of Sjogren’s syndrome?

Answer 32

Salivary enlargement - Sialosis

Lymphoma risk - salivary lymphoma may present with unilateral gland swelling at any stage

Question 33

Management of patient with Sjogren’s if presenting with dry mouth and clear salivary deficit?

Answer 33

OH paramount - 5000ppm duraphat, diet, OHI
Symptomatic tx. xerostomia - salivary substitutes/ stimulants