Saliva Flashcards

1
Q

4 functions of saliva?

A

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

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2
Q

Name some common drugs that will produce a dry mouth?

A

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

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

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3
Q

Name 6 causes of dry mouth

A

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

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4
Q

Name 5 chronic medical problems that induce dehydration

A

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

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5
Q

Name 4 acute medical problems that cause indirect salivary problems

A

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

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

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

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9
Q

How do anxiety/ somatisation disorders affect control of salivation?

A

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

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10
Q

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

A

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

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11
Q

What are frequent somatoform diseases?

A

Oral dysaesthesia
TMD pain
Headache
Neck/ back pain
Indigestion
IBS

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12
Q

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

A

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

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

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13
Q

What are TREATABLE causes of dry mouth?

A

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

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14
Q

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

A

1.5mls of saliva

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15
Q

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

A

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

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16
Q

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

A

Intensive dental prevention
Salivary substitutes
Salivary stimulants

17
Q

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

A

Glandosane
Xerotin oral spray

18
Q

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

A

Glandosane
Salivix pastilles - acidic pH

19
Q

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

A

Saliva orthana

20
Q

What is mumps?

A

Viral infection of the salivary glands.

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

21
Q

What is sialography and what is it used for?

A

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.

22
Q

What is Sjogren’s syndrome?

A

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

23
Q

What is primary sjogren’s syndrome?

A

Where there is no other connective tissue disease

24
Q

What is secondary sjogren’s syndrome?

A

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

25
Q

What is sicca syndrome?

A

Where there are partial Sjogren’s findings

26
Q

What are the signs and symptoms of Sjogren’s?

A

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

Dry eyes

27
Q

What is the most predictive test for Sjogren’s?

A

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

28
Q

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

A

<1.5ml in 15 minutes

29
Q

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

A

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

30
Q

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

A

ACR-EULAR (2016)
AECG (2002)

31
Q

Oral complications of Sjogren’s syndrome?

A

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

32
Q

Non-oral dryness complications of Sjogren’s syndrome?

A

Salivary enlargement - Sialosis

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

33
Q

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

A

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