Salivary Issues

Question 1

What are the functions of saliva?

Answer 1

Acid buffering

Mucosal lubrication
- speech and swallowing

Taste facilitation

Antibacterial

Question 2

Give some common causes of dry mouth

Answer 2

Side effect of medication

Salivary gland disease

Radiotherapy / cancer treatment

Medical conditions

Dehydration

Anxiety

Question 3

Give some common xerostomia causing meds

Answer 3

Anti-muscarinic cholinergic drugs
- tricyclic antidepressants e.g. amitriptyline
- antipsychotics

• Antihistamines
• diuretics

Question 4

What chronic medical problems may cause problems like dehydration and thus xerostomia?

Answer 4

Diabetes

Renal disease

Stroke - unable to drink

Addisons

Vomiting

Question 5

What acute medical problems may cause dehydration and xerostomia

Answer 5

Acute oral mucosal diseases

Burns

Vesiculobullous disease - fluid lost through skin

Haemorrhage

• often renders patient unable to drink

Question 6

What direct salivary gland problems may there be?

Answer 6

Aplasia
- ectodermal dysplasia - absence of a salivary gland

Sarcoidosis
- granulomatous infiltrate within gland preventing function

HIV

CF - affects all gland secretions

Question 7

Patient presents with increased sizing of salivary glands - especially parotid

What should be offered?

Answer 7

HIV screening / test

Question 8

How can amyloidosis and haemachromotosis affect salivary glands?

Answer 8

Damage to gland structure

• amyloidosis = build up of protein in gland
• haemo = excess storage of iron in the tissue

Question 9

What are stages 1, 2 and 3 of the challacombe scale

Answer 9

1 - mirror sticks to buccal mucosa

2 - mirror sticks to tongue

3 - saliva frothy

Question 10

Stages 4, 5 and 6 of challacombe scale?

Answer 10

4 - no saliva pooling in floor of mouth

5 - tongue shows generalised shortened papillae

6 - altered gingival architecture.g. Smooth

Question 11

Challacombe scale 7, 8, 9, 10?

Answer 11

7 - glassy appearance of oral mucosa, esp palate

8 - fissured tongue

9- cervical caries (more than 2 teeth)

10 - debris on palate or sticking to teeth

Question 12

What tests can be done when investigation someone with reduced salivary flow?

Answer 12

Blood tests
- dehydration, glucose testing
- Anti Ro or Anti La antibodies (found in those with sjogrens)
- complement levels c3 or c4
- Antinuclear antibody (sjogrens / autoimmune)

Salivary flow functional assay test

Labial gland biopsy

Ultrasound imaging

Question 13

How can anxiety affect saliva?

Answer 13

Inhibition of salivation - real oral dryness

Inhibit swallowing - lead to too much saliva complaint

Question 14

What is a somatoform diseases?

Answer 14

Mental health issue that presents with somatic physical symptoms that are not easily explained

Question 15

Give some frequent somatoform diseases

Answer 15

Oral dysaesthesia

TMD pain

Headache

Neck / back pain

IBS

Question 16

What is normal salivary resting and stimulated flow?

Answer 16

Resting flow = .3 - .4ml/min

Stimulated flow = 1-2ml/min

Question 17

What are the hyposalivation rates for resting and stimulated?

Answer 17

Resting = <0.1ml/min

Stimulated = <0.5ml/min

Question 18

What causes of dry mouth are often very treatable?

Answer 18

Dehydration

Anti-muscarinic side fx drugs

Medicines causing xerostomia

Poor diabetes control

Question 19

When may only symptomatic treatment be available to a pt?

Answer 19

Sjogrens

Dry mouth from cancer tx

Dry mouth from salivary gland disease

Question 20

What is my role as a GDP in managing dry mouth?

Answer 20

Prevent oral disease!
- caries risk assessment
- education of candida / staph infection, low sugar and good OH

Maximal preventative regime
- diet advice
- fluoride delivery with high fluoride toothpaste / varnish
- treatment plan for a caries free dentition

Question 21

Give some saliva ‘substitutes’

Issues?

Answer 21

Sprays
- saliva orthana

Lozenges
- saliva orthana lozenge
- SST

Frequently small sips of water / sugar free chewing gum is very good

More useful for early management / stages where mouth is dry but some saliva remains
- unhelpful in much later treatment

Question 22

Give some possible causes of hypersalivation

Answer 22

Perceived (common) - issue with swallowing leading to perceived increase in salivary flow rate
- anxiety
- stroke
- MND

True (rare cause)
- drug interactions
- dementia
- stroke

Question 23

How deal with hypersalivation?

Answer 23

Treat cause - anxiety?

Drugs to reduce salivation
- anti muscarinic