Saliva Flashcards
4 functions of saliva?
Acid buffering
Mucosal lubrication - speech and swallowing
Taste facilitation
Anti-bacterial
Name some common drugs that will produce a dry mouth?
Note - list is extensive and many drugs cause dry mouth.
Tricyclic anti-depressant
Anti-psychotics
Anti-histamine
Diuretics
Methotrexate - cancer drug
Name 6 causes of dry mouth
Salivary gland disease
Drugs/ medication
Medical conditions
Radiotherapy and cancer treatments
Anxiety
Somatisation disorder - enough saliva but perception is wrong
Name 5 chronic medical problems that induce dehydration
Diabetes
Renal disease
Stroke - may be unable to drink properly inducing dehydration
Addison’s disease
Persistent vomiting
Name 4 acute medical problems that cause indirect salivary problems
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
What does a challacombe score of 1-3 indicate and what treatment is needed?
Mild dryness - may not need treatment or management.
Sugar-free chewing gum for 15 mins twice daily and hydration
What does a challacombe score of 4-6 indicate and treatment required?
Moderate dryness.
Sugar-free chewing gum or sialogogue (saliva promoting drug)
What does a challacombe score of 7-10 indicate and treatment required?
Severe dryness
Saliva substitutes and topical fluoride usually needed.
Requires specialist care.
How do anxiety/ somatisation disorders affect control of salivation?
Inhibition of salivation - anxiety directly causes “real” oral dryness.
For example when doing a presentation - dry mouth.
How do anxiety/ somatisation disorders affect control of perception of salivation?
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
What are frequent somatoform diseases?
Oral dysaesthesia
TMD pain
Headache
Neck/ back pain
Indigestion
IBS
What is resting and stimulated flow of saliva in normal vs hyposalivation?
NORMAL
Resting - 0.3-0.4mL/min
Stimulated - 1-2mL/min
HYPOSALIVATION
Resting - <0.1mL/min
Stimulated - <0.5mL/min
What are TREATABLE causes of dry mouth?
Dehydration
Medication with anti-musarinic side effects
Medication causing dehydration
Poor diabetic control
Somatoform disorder
Roughly how much saliva should a patient produce AT REST in 15 minutes?
(salivary flow test)
1.5mls of saliva
What are examples of dry mouth that are un-treatable but only have SYMPTOMATIC treatment?
Sjorgen’s syndrome
Dry mouth from cancer treatment
Dry mouth from salivary gland disease
What are symptomatic treatment options for cases where the causes cannot be treated?
Intensive dental prevention
Salivary substitutes
Salivary stimulants
Name a saliva substitute that may be prescribed for an edentulous patient?
Glandosane
Xerotin oral spray
Name a saliva substitute that would be unsuitable for a dentate patient?
Glandosane
Salivix pastilles - acidic pH
Name a saliva substitute that may be prescribed for a dentate patient?
Saliva orthana
What is mumps?
Viral infection of the salivary glands.
Replicates in upper respiratory tract and is transmitted through direct contact or saliva.
What is sialography and what is it used for?
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.
What is Sjogren’s syndrome?
Sjogren’s is an auto-immune condition that primarily affects production of tears and saliva.
There is no definitive cause but rather associations
What is primary sjogren’s syndrome?
Where there is no other connective tissue disease
What is secondary sjogren’s syndrome?
Where there is other connective tissue present in the body such as:
SLE
Rheumatoid arthritis
Scleroderma
What is sicca syndrome?
Where there are partial Sjogren’s findings
What are the signs and symptoms of Sjogren’s?
Xerostomia
- caries
- altered taste
- recurrent candida infections
- reduced oral lubrication
Dry eyes
What is the most predictive test for Sjogren’s?
Positive labial gland biopsy - collection of >50 lymphocytes around a duct = lymphocytic focus
What value of unstimulated salivary flow would be considered abnormal and indicative of Sjogren’s?
<1.5ml in 15 minutes
What diagnostic indicator tests can be done for sjogren’s?
NOTE - not causative factors just associations
Noticeably dry mouth
Unstimulated whole salivary flow (UWS) test
Test for anti-Ro antibodies
Schirmer test - eye signs
What scoring systems are commonly used for diagnosing sjogren’s syndrome?
ACR-EULAR (2016)
AECG (2002)
Oral complications of Sjogren’s syndrome?
Effects of oral dryness
Caries
Denture retention
Infections - candida
Functional issues - speech, swallowing
Non-oral dryness complications of Sjogren’s syndrome?
Salivary enlargement - Sialosis
Lymphoma risk - salivary lymphoma may present with unilateral gland swelling at any stage
Management of patient with Sjogren’s if presenting with dry mouth and clear salivary deficit?
OH paramount - 5000ppm duraphat, diet, OHI
Symptomatic tx. xerostomia - salivary substitutes/ stimulants
