salivary gland Hypofunction and Xerostomia Flashcards
what is the definition of salivary gland hypo function?
> Salivary gland hypofunction is a condition where unstimulated and stimulated salivary flow is significantly reduced (Objective)
what is normal salivary flow?
> Unstimulated 0.1-0.2mL per minute
> Stimulated 0.7mL per minute
what is the definition of of xerostomia?
> xerostomia is the subjective perception of a dry mouth
function is commonly found to be normal
what is the age and sex demographic of xerostomia?
> more common in the older population
> more common in women
> prevalence of xerostomia varies between 10-46%
what are the functions of saliva? (6)
- Lubrication
- Protection = Soft Tissue + Hard Tissue
- Digestion
- Anti microbial & immunological
- Wound healing
- Taste
what is the purpose of the lubrication function of saliva?
> speech
mastication
what are the associated problems when the lubricating aspect of the saliva is removed?
> Difficulty speaking
> Difficulty eating
> Soft and hard tissue abrasion
what is the purpose of the protection aspect of saliva?
> Soft tissue
- Mucin rich protective film
- Prevents water loss (glycoproteins)
- Lubrication
> Hard Tissue
- Biologically controlled protective and reparative inorganic environment (statherin, acidic proline rich and pellicle proteins)- Remineralisation
what are the associated problems when the protection aspect of the saliva are removed?
> soft tissue - mucosal atrophy
> hard tissue - demineralisation
what is the purpose of the digestive aspect of saliva ?
> hydrolysis of starch (amylase)
what are the associated problems when the digestive aspect of saliva is removed?
> Increased substrate left in the oral cavity for bacteria to digest
what is the purpose of the antimicrobial system in saliva?
> Antimicrobial systems (Immunoglobulins, glycoproteins, sialoperoxidase, Lactoferrin, lysozyme histatins etc)
> Protect against food and air borne organisms
> Provides defence to both the oral cavity and the airway
what are the associated problems when the antimicrobial system of saliva is removed?
> Colonisation infection, control of pathogens maintaining commensals
> Adhesion versus deletion
what is the purpose of the wound healing aspect of saliva?
> Saliva contains growth factors
> Protective functions of saliva prevent continued damage to the area
what happens when the wound healing aspect of saliva is removed?
> prolonged wound healing
how is saliva involved with you taste?
> Acts as a solvent for taste substances
> Saliva contains Gustin which is thought to be linked with development of taste buds
> Protects taste buds
what happens to your taste when saliva is absent?
> Loss of taste
> associated dietary issues that can lead to caries
what are the aetilogical categories of salivary gland hypo function/ xerostomia
> Developmental
> Acquired
- Inflammatory
- Metabolic
- Iatrogenic
- Miscellaneous
what are the developmental causes of SGH/X?
> Agenesis or hypoplasia
- Associated with lacrimal dysfunction
- Xerostomia rampant caries
> Cystic fibrosis
- Mucous secreting glands only
- Enlarged submandibular glands
what are the inflammatory (acquired) causes of SGH/X?
> Primary Sjogrens syndrome
> Secondary Sjogrens syndrome
what is the metabolic (acquired) cause of SGH/X?
> diabetes
what are the iatrogenic causes of SGH/X?
> drug therapy
> post irradiation damage
what are some miscellaneous causes of of SGH/X?
> Dehydration
> Increasing age
> Mouth breathing
> Anxiety
> Smoking
what does not cause dry mouth?
> salivary gland calculi
what drugs can cause dry mouth?
> Antidepressants
> Antihistamines
> Anticholinergics
> Potent diuretics
> Hypotensive agents
> Muscle relaxants
> Narcotics
> Hypnotics
> Neuroleptics
(major tranquillisers)
> Sympathomimetics
how do you diagnose someone with dry mouth?
> History of presenting complaint
> Clinical examination
> Special Investigation
what are the common HPCs?
Difficulty in =
>Talking
>Eating
>Swallowing
>Appreciating food = Lack of taste / bad taste
> Discomfort
Burning
Halitosis
Altered sensation
Loose dentures
Dry eyes or other mucosal surface – nasal or genital (Sjogren’s syndrome)
what will you see on clinical examination when someone is experiencing dry mouth?
> Lack of saliva
> Frothy saliva
> Mucositis
> Candidal infection
> Caries
> Red, depapillated, lobulated tongue
what is the challacombe scale categories (index of xerostomia) ?
- Mirror sticks to buccal mucosa
- Mirror sticks to tongue
- Saliva frothy
- No saliva pooling in the floor of the mouth
- Tongue shows generalized shortened papillae
- Altered gingival architecture (i.e.: smooth)
- Glassy appearance of oral mucosa especially
palate - Tongue lobulated/fissured
- Cervical cavitations on more than two teeth
- Debris on palate or sticking to teeth
what special investigations can you take for dry mouth?
> Sialometry (stimulated/unstimulated)
> Schirmer Test
> Auto antibody screen: Ro, La
> Sialography
> Ultrasound
> Scinti scanning
> Labial gland biopsy
> HbA1c
what is the treatment of dry mouth?
1. Rectify/improving underlying causes if possible
- Diabetes
- Alter medication
what is the treatment of dry mouth?
2. Avoid contributing factors
- Dry foods
- Alcohol inc alcohol containing mouthwashes
- Smoking
- Diuresis producing drinks e.g. tea/coffee
- Dry hot environments: watch CPAP
what is the treatment of dry mouth?
3. Protect teeth and oral cavity
- Increased caries risk = Fluoride: duraphat etc,
Diet advice, Regular check ups and radiographs- Infections (Sialadenitis, Periodontal and mucosal disease) = Maintain hydration, Oral hygiene advice, Denture hygiene advice
what is the treatment of dry mouth?
4. Replacement
- Saliva Orthana (Non-acidic and contains fluoride)
- Glandosane ok if edentulous
- Biotene (Lubricates and contains fluoride)
what is the treatment of dry mouth?
5. enhance function
- Maintain hydration
- Pilocarpine derivatives = Salagen
