Saliva 2

Question 1

Saliva Buffering Capacity

____ helps to stabilize the pH and resist fluctuation.

The buffering capacity is a _______

High buffering capacity resists pH changes and keeps the mouth stable.

Buffering capacity indicates how well the saliva can moderate __________

Answer 1

Bicarbonate helps to stabilize the pH and resist fluctuation.

The buffering capacity is a measurement of the bicarbonate concentration.

High buffering capacity resists pH changes and keeps the mouth stable.

Buffering capacity indicates how well the saliva can moderate plaque pH changes.

Question 2

Saliva parameters

Normal saliva flow

• Resting pH
• Stimulated flow rate
• Stimulated pH
• buffering capacity

Abnormal saliva flow

• Resting pH
• Stimulated flow rate
• Stimulated
• buffering capacity

Answer 2

Normal saliva flow

Resting pH >6.8, Stimulated flow rate >.7 mL/min,

Stimulated pH >7, buffering capacity >10

Abnormal saliva flow

Resting pH<6.8, stimulated flow rate <.7 mL/min,

Stimulated pH<7, buffering capacity <10

Question 3

Calculus and caries? Rarely….

A ____ environment results in __________ and ________
Mouths with high levels of calculus tend to have _____ salivary pH
Patients with ___ failure tend to develop more calculus due to the high content of ____ in their saliva
l

Answer 3

A basic environment results in precipitation of ions and calcification of plaque
lMouths with high levels of calculus tend to have high salivary pH
Patients with renal failure tend to develop more calculus due to the high content of urea in their saliva
l

Question 4

3.2.1 Digestive Enzymes & Amylase

The enzymes found in saliva are essential in beginning the process of digestion of dietary ___ and ____.

These enzymes also play a role in_________, _____.

Furthermore, saliva serves a lubricative function, wetting food and permitting the initiation of swallowing, and protecting the mucosal surfaces of the oral cavity from desiccation.

Answer 4

The enzymes found in saliva are essential in beginning the process of digestion of dietary starches and fats. These enzymes also play a role in breaking down food particles entrapped within dental crevices, protecting teeth from bacterial decay. Furthermore, saliva serves a lubricative function, wetting food and permitting the initiation of swallowing, and protecting the mucosal surfaces of the oral cavity from desiccation.

Question 5

Amylase

Amylase, an enzyme of___structure, plays an active role in the digestive system. Foods such as rice, wheat, corn, potatoes, beans, nuts etc. initiate digestion in the oral cavity.

In animals, it is a major digestive enzyme, and its optimum pH is____ In human physiology, both the salivary and pancreatic amylases are ___-amylases. It will break ____ ____ ____molecules into ____ starches (amylodextrin, erythrodextrin and achrodextrin), producing successively ____ starches and ultimately ____.

Most Importantly
•Hydrolyzes_____ bonds of starches such as___ and ____
•___ is the major end-product (___ is glucose)

Answer 5

Amylase, an enzyme of protein structure, plays an active role in the digestive system. Foods such as rice, wheat, corn, potatoes, beans, nuts etc. initiate digestion in the oral cavity.

In animals, it is a major digestive enzyme, and its optimum pH is 6.7-7.0. In human physiology, both the salivary and pancreatic amylases are α-amylases. It will break large, insoluble starch molecules into soluble starches (amylodextrin, erythrodextrin and achrodextrin), producing successively smaller starches and ultimately maltose.

Most Importantly
•Hydrolyzes a(1-4) bonds of starches such as amylose and amylopectin
•Maltose is the major end-product (20% is glucose)

Question 6

3.2.1 Digestive Enzymes - lipase

Salivary glands also secrete salivary ____ (a more potent form of lipase) to begin ___ digestion.

Salivary lipase plays a large role in fat digestion in ______ as their ____lipase still needs some time to develop.

It also has a protective function, helping to _____________

Answer 6

Salivary glands also secrete salivary lipase (a more potent form of lipase) to begin fat digestion. Salivary lipase plays a large role in fat digestion in newborn infants as their pancreatic lipase still needs some time to develop.

It also has a protective function, helping to prevent bacterial build-up on the teeth and washing away adhered food particles.

Question 7

Lingual Lipase

Secreted by ________ of tongue

Involved in first phase of fat digestion.

Hydrolyzes ____________

Important in digestion of ____ in new-borns.

Unlike other mammalian lipases, it is highly ____ and readily_________

Answer 7

Secreted by von Ebner’s glands of tongue Involved in first phase of fat digestion.

Hydrolyzes medium- to long-chain triglycerides.

Important in digestion of milk fat in new-borns.

Unlike other mammalian lipases, it is highly hydrophobic and readily enters fat globules

Question 8

Calcium & Phosphorus

Some loss of ____ inevitably occurs at ____, as the cariogenic bacteria in the biofilm on the surface of the tooth _______________________.

This creates a ____ pH that is capable of driving ________

Between meals, the saliva __________________________ when the Calcium ions can __________

If there is not enough time for sufficient remin, then there is an overall ____________ from the tooth, the __________ may develop, bacteria __________ and the cavitation process commences.

Answer 8

Some loss of Calcium inevitably occurs at mealtimes, as the cariogenic bacteria in the biofilm on the surface of the tooth metabolizes the sugars in the diet via glycolysis.

This creates a low pH or acidic environment that is capable of driving demineralization. Between meals, the saliva brings the pH back to safe levels (above pH 5.5) when the Calcium ions can return to the tooth (remin). If there is not enough time for sufficient remin, then there is an overall loss of Calcium from the tooth, the subsurface lesion may develop, bacteria enter the tooth material and the cavitation process commences.

Question 9

Dietary Prevention

To prevent the occurrence of caries in your patients, it is important to include information about foods that lead to _______ in oral health counseling, and note that saliva needs time between food intakes to restore any loss of calcium by sugar-containing foods and beverages. Foods _________ and that _______ are very beneficial at the end of any meal. Examples would be yogurt, cheese, or milk (super-saturated with calcium) or a sugar-free chewing gum.

Answer 9

To prevent the occurrence of caries in your patients, it is important to include information about foods that lead to demineralization in oral health counseling, and note that saliva needs time between food intakes to restore any loss of calcium by sugar-containing foods and beverages. Foods rich in calcium and that stimulate saliva flow are very beneficial at the end of any meal. Examples would be yogurt, cheese, or milk (super-saturated with calcium) or a sugar-free chewing gum.

Question 10

Statherin
Statherin - a PRP that _________ and allows for__________

A _____ binding protein from ___ and _____ saliva.

______inhibits ____________ __________.

__________ inhibits ________ __________ ( _____ _____)

Known to promote the_______ of Actinomyces viscosus and Streptococcus gordonii to ______.

Statherin is responsible for saliva’s unique ability to stabilize calcium and phosphate. Although the saliva is ________with respect to _____ and _____, this protein prevents the ____________________.

Answer 10

Statherin - a PRP that stabilizes inorganic ions and allows for super-saturation

A calcium binding protein from parotid and submandibular saliva.

Entire molecule inhibits primary precipitation.

Amino-terminal hexapeptide inhibits secondary precipitation (crystal growth).

Known to promote the adhesion of Actinomyces viscosus and Streptococcus gordonii to tooth surfaces

Although the saliva is supersaturated with respect to calcium and phosphate, this protein prevents the precipitation from saliva to dental enamel.

Question 11

~ PAROTID GLAND ~

The gland is _________

The ___ _____ _____communicates with the oral cavity. The opening is called _______ duct and is located ___________.

The parotid is the _____ of the salivary glands.

Answer 11

The gland is entirely serous.

The main secretory duct communicates with the oral cavity. The opening is called Stenson’s duct and is located opposite the second molar.

The parotid is the largest of the salivary glands.

Question 12

~ PAROTID ANATOMY ~

Resembles an ______

Approximately ___ cms in length _____ cms in width and weighs _____ grams.

Located ____ and ____ to the external acoustic meatus, _____ to the zygomatic arch, _____ to the ramus of the mandible and the masseter muscle and _____ to the styloid process.

Answer 12

Resembles an inverted pyramid.

Approximately 6 cms in length 3 - 4 cms in width and weighs 15 - 30 grams.

Located anterior and inferior to the external acoustic meatus, inferior to the zygomatic arch, posterior to the ramus of the mandible and the masseter muscle and lateral to the styloid process.

Question 13

~ PAROTID BLOOD SUPPLY ~

The arterial blood supply to the parotid is provided by ______________________________.

These arteries are: _____, ____, ______, ______ and_____

Blood return is provided by the __________.

Answer 13

The arterial blood supply to the parotid is provided by glandular branches from several arteries.

These arteries are: external carotid, posterior auricular, superficial temporal, transverse facial and maxillary arteries.

Blood return is provided by the retromandibular vein.

Question 14

~ PAROTID LYMPHATICS ~

The lymphatic vessels of the gland drain into the ______________ embedded deep within the gland and to the_______________

Answer 14

The lymphatic vessels of the gland drain into the deep parotid nodes embedded deep within the gland and to the superficial and deep cervical nodes.

Question 15

Parotid gland Micro-Anatomy

____ has ____ cells.

_____ cells _____________and _________

Acinar epithelium secretes ___ and ____ filtrate

Answer 15

Acinus has acinar cells.

Myoepithelial cells constrict intercalated duct and squirt saliva into striated duct.

Acinar epithelium secretes proteins and isotonic filtrate

Question 16

~ SUBMANDIBULAR GLAND ~

The submandibular is a mixed salivary gland; however, it is predominately ____.

The __________ are of the same type as the parotid.

Ducts are _______ and generally ______ than those of the parotid gland.

The mucous alveoli are capped with ___ _____.

Answer 16

The submandibular is a mixed salivary gland; however, it is predominately serous. (It is also mucosal. )

The intralobular ducts are of the same type as the parotid.

Ducts are more numerous and generally longer than those of the parotid gland.

The mucous alveoli are capped with serous demilunes.

Question 17

-SUBMANDIBULAR GLAND

The gland is roughly ____shaped ____ cms long and weighs ___ gms.

It is located in the _____________________ on the ____ surface of the body of the _____ below the _____.

The ____ or recess also includes the ____ and _____ muscles medially and superiorly.

Answer 17

The gland is roughly egg-shaped 4 – 5 cms long and weighs 7 – 19 gms.

It is located in the submandibular fossa on the medial surface of the body of the mandible below the mylohyoid line.

The bed or recess also includes the mylohyoid and hypoglossus muscles medially and superiorly.

Question 18

~ BLOOD SUPPLY ~

The_____ and____ arteries supply the gland.

The veins of the gland are ____ to the___ and ____ veins.

Answer 18

The facial and lingual arteries supply the gland.

The veins of the gland are tributary to the submental and facial veins.

Question 19

~ LYMPHATICS ~

The lymphatic drainage is to the nearby ____ nodes.

Answer 19

The lymphatic drainage is to the nearby submandibular nodes.

Question 20

~ SUBLINGUAL GLAND ~

It is a mixed gland, but its secretions are predominately ______

The _____ of the three glands.

Similar to the submandibular gland, the sublingual gland empties into the oral cavity at the side of the ____ of the tongue, near the opening of ________ duct.

Answer 20

It is a mixed gland, but its secretions are predominately mucous.

The smallest of the three glands.

Similar to the submandibular gland, the sublingual gland empties into the oral cavity at the side of the frenum of the tongue, near the opening of Wharton’s duct.

Question 21

Sublingual Gland

It is an elongated ______________ shaped gland about ____ cms in length and weighs ____

The gland is located between the________ and the body of the mandible where it occupies the _______ _______of the mandible superior to the _____ line.

The main body of the gland produces numerous ducts called the ______ ducts.

The ducts join together to form the duct of _____, which then joins the ________ duct near the ________.

Answer 21

It is an elongated “almond-shaped” gland about 3 – 4 cms in length and weighs 2 – 3 grams.

The gland is located between the genioglossus muscle and the body of the mandible where it occupies the sublingual fossa of the mandible superior to the mylohyoid line.

The main body of the gland produces numerous ducts called the “Ravinus” ducts.

The ducts join together to form the duct of Bartholin, which then joins the submandibular duct near the sublingual papilla.

Question 22

Sublingual Gland

The arteries to the gland are branches of the ____ and _____ arteries.

These arteries empty into tributaries of the ___ _____ _____ _____and _____ vein.

The lymphatic drainage is to the____________.

Answer 22

The arteries to the gland are branches of the submental and sublingual arteries.

These arteries empty into tributaries of the vena comitans nervi hypoglossi and facial vein.

The lymphatic drainage is to the superior deep cervical nodes.

Question 23

~ Minor Salivary Glands ~

• Minor salivary glands are on the ___ ____ ___ & _____ mucosa.
• They are____ and produce ____ secretions with ____ buffering capacity.
• The von Ebner’s glands of the tongue, however, are ____!
• They are located at the _______________.

Answer 23

• Minor salivary glands are on the tongue, palate, buccal and labial mucosa.
• They are monoductal and produce mucous secretions with little buffering capacity.
• The von Ebner’s glands of the tongue, however, are serous!
• They are located at the base of the circumvallate papilla of the tongue.

Question 24

Von Ebner’s Glands

Answer 24

These glands are serous.

Question 25

MASTICATION

The ___ nerve (the ____ cranial nerve, also called the ______, or simply ___ or ___). It is a nerve responsible for _________ and certain________ such as ____ ____ _____.

Answer 25

The trigeminal nerve (the fifth cranial nerve, also called the fifth nerve, or simply CNV or CN5). It is a nerve responsible for sensation in the face and certain motor functions such as biting, chewing, and swallowing.

Question 26

Parasympathetic control:

_______ _____ ( ) innervates _____ and _____ glands

________ (___) innervates____ gland with some fibers from the _______ ______( ).

Parasympathetic stimulation ______salivary secretion:

basal rate = _____ ml/min, stimulate rate = ____ ml/min

Total volume about 1.5 L/day produced

Flow is modulated by _____ and____________ drugs.

Answer 26

Facial nerve (VII) innervates sublingual and submandibular glands

Glossopharyngeal (IX) innervates parotid gland with some fibers from the Trigeminal Nerve (V).

Parasympathetic stimulation increases salivary secretion:

basal rate = 0.5 ml/min, stimulate rate = 1.5+ ml/min

Total volume about 1.5 L/day produced

Flow is modulated by cholinergic and anti-cholinergic drugs.

Question 27

Sympathetic control

_____ _____in secretion.

Blood flow initially _____(___-_____) then _____ due to _____ ______ and ____ of ______.

Stimulates_____________________.

It also ________ protein content in the saliva.

Answer 27

Weaker increase in secretion. Blood flow initially decreased (alpha-adrenergic) then increases due to increased metabolism and release of metabolites. Stimulates myoepithelial cell contraction. It also increases protein content in the saliva.

Question 28

~ Parasympathetic Innervation ~

CLINICAL NOTE

The ____ nerve courses through the body of the ___ gland making surgery difficult to perform.

Great care must be given during the course of surgical dissection as paresthesia may result if the nervous tissue is damaged.

Answer 28

CLINICAL NOTE

The facial nerve courses through the body of the parotid gland making surgery difficult to perform.

Great care must be given during the course of surgical dissection as paresthesia may result if the nervous tissue is damaged.

Question 29

Salivary Gland Secretion

Stimulation comes to _____ cells, comes down to ____ and ___ is removed

When saliva is in aciner cells : it is ____ (same as Na)

After Na removed (in mouth) ,secretions are ___

Acinus secretes an ____ of plasma driven by _____ ______

____ _____ actively ____ NaCl

____ of K+ and HCO3- by ducts ___ than salt absorption

______________ leads to greater salt absorption than water and a ______ saliva

Answer 29

Stimulation comes to aciner cells, comes down to striated ducts and Na is removed

When saliva is in aciner cells : it is isotonic (same as Na)

After Na removed (in mouth) ,secretions are hypotonic

Acinus secretes an ultrafiltrate of plasma driven by chloride secretion

Ductal epithelium actively absorbs NaCl

Excretion of K+ and HCO3- by ducts less than salt absorption

Low water permeability leads to greater salt absorption than water and a hypotonic saliva

Question 30

Salivary Secretion
•At low flow rates the saliva is ____ and rich in ____
•At high flow rates, its ion composition approaches ____ that of ____ (300 mosmole/L)
•Reduced time for ___ _____in ducts at high flow rates.

Answer 30

• At low flow rates the saliva is hypotonic and rich in K+.
• At high flow rates, its ion composition approaches 70% that of plasma (300 mosmole/L)
• Reduced time for water reabsorption in ducts at high flow rates.

Question 31

Cellular Ion Transport

Acinar secretion driven by ______, ____ and ______.

Leaky _____ _____ allow ___ and ____ to follow ____ to produce an _____ secretion

___ and __ follow _____ gradient.

Isotonic volume flow carries ____ secreted by ____ cells into the ducts

there is ____ stimulations which opens up a ____

When you have ____ charge in lumen, it wants to balance out

Use ___ (blood to lumen)

Then you have NaCl

It has an ___

As Osmotic gradient increases, ____ will follow it

Answer 31

Acinar secretion driven by Na+/K+ ATPase, Na+ gradient and Na+ / Cl- cotransporter.

Leaky intercellular junctions allow Na+ and water to follow Cl- to produce an isotonic secretion K+ and HCO3- follow electro-chemical gradient.

Isotonic volume flow carries amylase secreted by acinar cells into the ducts

is cholinergic stimulations which opens up a Cl channel

When you have (-) charge in lumen, it wants to balance out

Use Na (blood to lumen)

Then you have NaCl

It has an osmotic grad

As Osmotic gradient increases, water will follow it

Question 32

Cellular Ion Transport

Duct absorption is also driven by _______ with ___ following ______

Tight intercellular junctions do not allow ___ to follow ____ ______ to produce a_____ secretion.

___ & ____enter the lumen in exchange for ___ and___

Answer 32

Duct absorption is also driven by Na+/K+ ATPase with Cl- following electrochemical gradient.

Tight intercellular junctions do not allow water to follow Na+ and Cl- to produce a hypotonic secretion.

K+ and HCO3- enter the lumen in exchange for Na+ and Cl-

Question 33

Protein Syn

Answer 33

Adrenergic Receptor–>Adenylate Cyclase cycle (with ATP and cAMP)–>nucleus–> ER–> golgi –>vesicle

Question 34

Viscous saliva

Causes: ____ ____ _____ ____ ____

On the very worst side, it could be something much greater like ____ or ________

Answer 34

Causes: Allergies, medications, dehydration as well as head/nasal cold or chest cold or pneumonia.

On the very worst side, it could be something much greater like Bronchiectasis or cystic fibrosis.

Question 35

Components secreted by Acinar cells PL MALL

Components secreted by ducts

Answer 35

PRP
Mucin glycoproteins
Alpha Amylase
Lipase
Lactoperoxidase
Lactoferrin
FLOW RATE INDEPENDENT

Ribonuclease
Kalikrein
Lysozyme
IgA receptor
IgA secretory piece
Growth Factors
FLOW RATE DEPENDENT

Question 36

~ Sjögren’s Syndrome ~

Sjögren’s syndrome (SS) is defined as an _____ disease of the ____ glands, involving in particular the____ and ____ glands.

It may occur ______, or in ____________________(__________).

The spectrum of presentation of the disorder is very broad, ranging from the local consequences of ______________ to major, life-threatening systemic complications such as _____ ____ ________.

First described by ____ Sjögren in ____

Female : male is approximately _____

Patients present with:

_____
____
______

Often associated with connective tissue disorders

Answer 36

Sjögren’s syndrome (SS) is defined as an autoimmune disease of the exocrine glands, involving in particular the salivary and lacrimal glands.

It may occur alone (primary SS), or in association with a variety of connective tissue diseases and autoimmune disorders (secondary SS).

The spectrum of presentation of the disorder is very broad, ranging from the local consequences of exocrine gland dysfunction to major, life-threatening systemic complications such as vasculitis, and renal or lung involvement.

First described by Henrich Sjögren in 1933

Female : male is approximately 10:1

Patients present with:

§Dry eyes - keratoconjunctivitis sicca
§Dry mouth - xerostomia
§Bilateral parotid enlargement

Often associated with connective tissue

disorders

Question 37

Sjögren’s Syndrome – DIAGNOSTIC TESTS

____ Test is used to determine ____

__-___ ____ Test is used to Assess for _____

Eye examination using a ___ lamp. This instrument shines a fine beam of light into the eye, and magnifying lenses allow the optician to explore the spot where the beam falls. This examination focuses on __________________________ including the eyelid, sclera, conjunctiva, iris, crystalline lens, and cornea.

Answer 37

Schirmers’ Test is used to determine Tear production.

Rose-Bengal Staining Test is used to Assess for inflamation

Eye examination using a slit lamp. This instrument shines a fine beam of light into the eye, and magnifying lenses allow the optician to explore the spot where the beam falls. This examination focuses on checking the health of the frontal structures of the eye including the eyelid, sclera, conjunctiva, iris, crystalline lens, and cornea.

Question 38

Sjögren’s Syndrome

Primary Sjögren’s Syndrome -

Secondary Sjögren’s Syndrome -________________________________________

____% patients with rheumatoid arthritis and ___% patients with SLE develop Sjögren’s Syndrome

Associated with increased risk of ______________

_____ shows a characteristic sialectasis and parenchymal destruction

Diagnosis can be confirmed by ____ _____biopsy

Treatment is ____

No treatment will reverse the ____ and _____.

Answer 38

Primary Sjögren’s Syndrome - No connective tissue disorder

Secondary Sjögren’s Syndrome - associated with connective tissue disorders (Lupus, Rheumatoid Arthritis: secondary to these disorders)

15% patients with rheumatoid arthritis and 30% patients with SLE develop Sjögren’s Syndrome

Associated with increased risk of B-cell lymphoma

Sialogram shows a characteristic sialectasis and parenchymal destruction

Diagnosis can be confirmed by labial gland biopsy

Treatment is symptomatic

No treatment will reverse the keratoconjunctivitis and xerostomia

Question 39

Sjögren’s Syndrome – SYSTEMIC Associations

Pulmonary Problems

bronchitis

tracheobronchitis

lymphocytic interstitial pneumonitis

pleurisy

Kidney Problems

interstitial nephritis

glomerulonephritis (rarely)

renal tubular acidosis

hypokalemia

Hashimoto’s thyroiditis

Nervous System Problems

peripheral neuropathy

cranial neuropathy

Liver Problems

hepatitis

cirrhosis

Thyroid Problems

Grave’s disease

Hashimoto’s thyroiditis

Vascular Problems:

Raynaud’s phenomenon

Answer 39

Pulmonary Problems

bronchitis

tracheobronchitis

lymphocytic interstitial pneumonitis

pleurisy

Kidney Problems

interstitial nephritis

glomerulonephritis (rarely)

renal tubular acidosis

hypokalemia

Hashimoto’s thyroiditis

Nervous System Problems

peripheral neuropathy

cranial neuropathy

Liver Problems

hepatitis

cirrhosis

Thyroid Problems

Grave’s disease

Hashimoto’s thyroiditis

Vascular Problems:

Raynaud’s phenomenon

Question 40

Classification Criteria for Sjögren’s Syndrome

The European American Revised Criteria

I

II

III

IV

V

VI

classifying patients with primary SS: ___________

Answer 40

The European American Revised Criteria

I Ocular symptoms: a positive response to at least 1 of the 3 selected questions.

II Oral symptoms: a positive response to at least 1 of the 3 selected questions.

III Ocular signs, i.e., objective evidence of ocular involvement defined as a positive result in at least 1 of the following 2 tests:

1. Schirmer’s I test 2. Rose Bengal or other dye score

IV Histopathology: a focus score of 1 or more in minor salivary gland biopsy.

V Salivary gland involvement: objective evidence of salivary gland involvement defined by a positive result in at least 1 of the following 3 diagnostic tests:

1. Salivary scintigraphy 2. Parotid sialography 3.Unstimulated salivary flow

VI Autoantibodies: presence in the serum of at least 1 of the following autoantibodies:

1. Antibodies to Ro/ La

Positivity of 4 out of the 6 items in classifying patients with primary SS

Sensitivity: 89.5% Specificity 95.2%

Question 41

Blood tests Sjögren’s Syndrome

______________
___ are a group of ____ that react against normal components of a _____. About ___% of Sjögren’s patients have a positive test result.

_________

This antibody test is indicative of a most often performed for the diagnosis of ______. but is positive in many rheumatic diseases. In Sjögren’s patients, _____% have a positive RF.

______________
These are the ________________. _____ percent of Sjögren’s patients are positive for SS-A and_____% are positive for SS-B (these may also found in lupus patients).

______
This test measures _____. An ______ ESR indicates the presence of an inflammatory disorder, including Sjögren’s.

IGs (Immunoglobulins)
These are normal ______ ______that participate in____ ____ and are usually ____ in Sjögren’s patients.

Answer 41

ANA (Anti-Nuclear Antibody)
ANAs are a group of antibodies that react against normal components of a cell nucleus. About 70% of Sjögren’s patients have a positive ANA test result.

RF (Rheumatoid Factor)
This antibody test is indicative of a most often performed for the diagnosis of rheumatoid arthritis (RA) but is positive in many rheumatic diseases. In Sjögren’s patients, 60-70% have a positive RF.

SS-A (or Ro) and SS-B (or La)
These are the marker antibodies for Sjögren’s. Seventy percent of Sjögren’s patients are positive for SS-A and 40% are positive for SS-B (these may also found in lupus patients).

ESR (Erythrocyte Sedimentation Rate)
This test measures inflammation. An elevated ESR indicates the presence of an inflammatory disorder, including Sjögren’s.

IGs (Immunoglobulins)
These are normal blood proteins that participate in immune reactions and are usually elevated in Sjögren’s patients.

Question 42

American-European Classification Criteria are:

the only ____

the most ____ and

the most ______

tool presently available for the classification of patients with

Answer 42

the only validated,

the most reliable, and

the most widely accepted

tool presently available for the classification of patients with primary and secondary Sjögren’s syndrome.

Question 43

The ophthalmologic (eye) tests

Schirmer Test

Rose Bengal and Lissamine Green

Answer 43

Schirmer Test
Measures tear production.

Rose Bengal and Lissamine Green
Eye drops containing dyes that an eye care specialist uses to examine the surface of the eye for dry spots.

Question 44

The dental tests

Salivary ____
Measures the

Salivary ____
A ___ ____ test that measures _______

Salivary ____________
Confirms ____ _____(lymphocytic) ____ of the ____ salivary glands

____ Saliva

Answer 44

Salivary Flow
Measures the amount of saliva produced over a certain period of time.

Salivary scintigraphy
A nuclear medicine test that measures salivary gland function.

Salivary gland biopsy (usually in the lower lip)
Confirms inflammatory cell (lymphocytic) infiltration of the minor salivary glands

Foamy Saliva

Question 45

Oral Complications

___ ____

___:

___:

____:

Answer 45

Gland Swelling

Tongue: Red, lobulation

Palate: Fungal Infection

Lips: Cheilitis

Question 46

~ Oral Sequelae ~

Answer 46

Burning Tongue

Question 47

Oral Complications
Rampant Dental Caries

Answer 47

Xerostomia is a condition caused by diminished flow of saliva.

It is one of the most common, yet least appreciated, oral complaints.
For some patients, xerostomia is simply a nuisance. For others it seriously interferes with activities of daily living, or leads to medical or dental consequences.

The complications of untreated xerostomia may include: accelerated cavities,
oral candidiasis, malnutrition, weight loss, sleep disruption, depression and fibromyalgia.²