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BDS4- Oral medicine PreReading > salivation > Flashcards

salivation Flashcards

1
Q

How would you investigate salivary disease

A

Blood tests
-FBC
-U&Es,
-Liver function tests
-C-reactive Protein
-Glucose
-Anti Ro Antibody
-Anti La Antibody
-Antinuclear Antibody
-Complement C3 and C4

Functional Assay – Salivary Flow

Tissue Assay – Labial Gland Biopsy

Imaging
-Plain radiographs – reduced dose – stones
-Sialography – contrast to show ducts
-MR Sialography – IV contrast
-Ultrasound

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2
Q

What does saliva do

A

Acid buffering

Mucosal lubrication
-Speech
-Swallowing

Taste facilitation

Antibacterial

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3
Q

What can the causes of dry mouth be

A

Salivary Gland disease

Drugs

Medical Conditions & Dehydration

Radiotherapy & cancer treatments

Anxiety & Somatisation Disorders

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4
Q

With age what happens to the salivary glands

A

Acinar tissue loss

37% Submandibular
32% Parotid
45% Minor glands

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5
Q

What way can medical conditions affects the salivary glands

A

Direct
-Problems with the gland itself

Indirect
-Problems external to the gland

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6
Q

What Indirect problems affect the salivary glands

A

Anti-muscarinic cholinergic drugs

Chronic Medical Problems inducing dehydration

Acute medical Problems

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7
Q

What drugs indirectly affect the salivary glands

A

Tricyclic antidepressant

Antipsychotics

Antihistamine

Atropine

Diuretics

Cytotoxics

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8
Q

What is amitriptyline and how much does it reduce saliva by

A

anti-muscarinic drug and reduces by 26%

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9
Q

What is a Bendrofluazide and what does it reduce flow by

A

Diruetic and reduces by 10%

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10
Q

How much does lithium reduce flow by

A

70%

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11
Q

What chronic Medical Problems inducing dehydration cause reduced flow

A

Diabetes – Mellitus & Insipidus

Renal disease

Stroke

Addison’s Disease

Persisting Vomiting

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12
Q

What acute medical problems cause reduced flow

A

Acute oral mucosal diseases

Burns

Vesiculobullous diseases

Haemorrhage

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13
Q

What direct problems are there that affect salivary glands

A

Aplasia
-Ectodermal dysplasia

Sarcoidosis

HIV disease

Gland infiltration
-Amyloidosis
-Haemochromatosis

Cystic Fibrosis

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14
Q

What is the challacombe scale of mucosal dryness

A

diagnostic medical tool designed to produce a clinical oral dryness score which quantifies the extent of dryness of the mouth, with the aim of making a decision of whether to treat or not

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15
Q

What are the values of the challacombe scale

A

1) Mirror stricks to buccal mucosa

2) Mirror sticks to tongue

3) Saliva frothy

4) No saliva pooling floor of mouth

5) Tongue shows generalised shortened papillae

6) Altered gingival architecture

7) Glossy apperance of oral mucosa

8) Tongue lobulated/fissured

9) Cervical caries

10) Debris on palate or sticking to teeth

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16
Q

What do the challcombe scores indicate

A

1-3= mild dryness may not need treatment, sugar free gum 15mins x2 daily and hydration

4-6= moderate dryness, gum or simple sialogogues may be required. Needs to be investigatd if no clear cause

7-10= Severe dryness, saliva substituues and topical fluoride. Causes needs to be identified and Sjogrens ruled out

17
Q

How does Anxiety and Somatisation Disorders cause dry mouth

A

‘cephalic’ control of salivation
-Inhibition of salivation, anxiety directly causes ‘real’ oral dryness

‘cephalic’ control of perception
-Altered perception of reality, normal information coming from the mouth is ‘misunderstood’ by small changes at synapses as it is processed
-More often seen with anxiety disorders

18
Q

What frequent Somatoform disorders are there

A

Oral Dysaesthesia

TMD pain

Headache

neck/back pain

Dyspepsia

Irritable Bowel Syndrome (IBS)

19
Q

What is the normal salivation flow for resting and stimulated glands

A

Resting= 0.3-0.4 mL/min

Stimulated= 1-2 mL/min

20
Q

What does the flow have to be to be hyposalivation

A

Resting= <0.1 mL/min

Stimulated= <0.5 mL/min

21
Q

What are the treatable causes of dry mouth

A

Dehydration

Medicines with anti-muscarinic side effects

Medicines causing dehydration

Poor Diabetes control – type 1 or type 2

Somatoform Disorders

22
Q

What conditions are there where its only symptomatic treatment of a dry mouth

A

Sjögren’s Syndrome

Dry mouth from cancer treatment

Dry mouth from salivary gland disease

23
Q

In a salivary flow test what must the score be for dry mouth

A

less than 1.5ml unstimulated flow in 15mins

24
Q

What saliva substitues are there

A

Sprays
-Glandosane
-Saliva Orthana

Lozenges
-Saliva Orthana
-SST

Salivary stimulants
-Pilocarpine (Salagen)

Oral Care Systems
-Oral Balance

Frequent sips of water

25
Q

What can cause HYPERsalivation

A

TRUE (rare) – Actual increase in salivary flow
-Drug causes
-Dementia
-CJD
-Stroke

PERCEIVED (Common) – NO increase in saliva flow
Swallowing Failure:
-Anxiety
-Stroke
-Motor Neurone Disease
-Multiple Sclerosis

Postural Drooling:
-Being a baby
-Cerebral Palsy

26
Q

What drugs can cause hypersalivation

A

Parasympathomimetics

Buprenorphine

Anticholinesterases

Haloperidol

Ipecacuanha

Clonazepam

Nicardipine

Clozapine

Remoxipride

Niridazole

Ammonium salts

Bromides

Ethionamide

Iodides

Ketamine

Mercurial salts

27
Q

How would you deal with Hypersalivation

A

Treat the Cause
-Anxiety disorders

Drugs to reduce salivation
-Anti-muscarinic agents
-Botox to prevent gland stimulation

Biofeedback training
-Swallowing control

Surgery to salivary system
-Gland removal
-Duct repositioning

28
Q

What could cause a change in salivary gland size

A

Viral Inflammation
-Mumps
-HIV

Secretion retention
-Mucocele
-Duct obstruction

Gland Hyperplasia
-Sialosis
-Sjögrens Syndrome

29
Q

What are the symptoms of mumps

A

Headache

Joint pain

Nausea

Dry mouth

Mild abdominal pain

Feeling tired

loss of appetite

Pyrexia of 38C, or above

30
Q

What are the common sites for a mucocele

A

Junction Hard/Soft Palate and the Lower lip

31
Q

What is subacute obstruction

A

When there is swellings associated with meal times

Thee swelling increases as salivary flow starts and reduces when salivary flow stops

Usually SUBMANDIBULAR

Will eventually be fixed and painful

32
Q

What is the cause of subacute obstruction

A

duct obstruction
-Usually duct blockage in submandibular
-Usually duct stricture in parotid

Obstruction by:
-Sialolith (stones)
-mucous plugging
-Ductal damage from chronic infection (scarring)

33
Q

What investigations for subacute obstruction is there

A

Low dose plain radiography

lower true occlusal

SIALOGRAPHY – when infection free

Isotope scan if gland function uncertain

Ultrasound assessment of duct system

34
Q

What happens in duct dilation

A

Defect prevents normal emptying

Micro-organisms grow and lead to persisting and recurrent sialadenits

Gland function gradually lost and persisting infection leads to gland removal

35
Q

How do you manage subacute obstruction

A

Surgical sialolith removal if practical

Sialography for ‘no stone’ cases – washing effect

Consider gland removal if fixed swelling

BDS4- Oral medicine PreReading (11 decks)

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