sjogren's syndrome Flashcards
sjogren’s syndrome
a chronic, autoimmune, inflammatory disorder of exocrine glands, characterized by diminished lacrimal and salivary gland secretion in association with autoantibody production or a CT disorder
epidemiology of sjogren’s syndrome
- one of the most common autoimmune rheumatic disease–9:1 ratio of women:men
- 1-4 million individuals affected in USA
- typical diagnosed patient in perimenopausal or postmenopausal female
- documented pediatric cases exist
ACR criteria
- positive sjogren’s specific antibody (Ro or La)
- positive lip biopsy
- positive eye test
signs + symptoms of sjogren’s
- asymptomatic or complain of dry mouth
- hoarse voice
- may experience trouble eating/chewing/speaking/ swallowing or taste sensation
- frequent need to sip water while eating dry food
- awakening at night with oral dryness
- difficulty in wearing oral prostheses
- sore and painful mouth
- pain in the ear due to blocked parotid glands
Sjogren’s syndrome associated with
GERD
as dry as a desert.. severe mucosal problems have a moderate to severe impact on a patient’s quality of life
-tongue fissuring occurs but creates spaces for microorganisms to reside
complications from radiation
taste loss mucositis hyposalivation radiation caries susceptibility to osteoradionecrosis
door to all systemic infections
mucositis
mucositis
painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually an adverse effect of chemotherapy and radiotherapy
chemotherapy mechanism
initiation upregulation signaling and amplification ulceratoin healing
reactive oxygen species
ROS created after radiation and chemo
outcome of chemotherapy
intact epithelium
tissue “appears” normal
residual angiogenesis
tissue you start with is NOT the tissue you end with
ibrutinib
med for leukemia
-complication; virus was activated and led to ulceration of the tongue
treatment duration
injury starts on day 1 of cancer therapy
acute oral toxicity
pain, mucositis, salivary and taste loss, infection
long term oral toxicity
pain, infection, tissue necrosis, caries, periodontal disease, candida, trismus, swallowing and speech problems
before treatment
- consult the oncologist
- determine hematologic status within 24 hrs of tx (plateley count, clotting factors, absolute neutrophil count
use prophylactic antibiotic treatment if
-patient has catheter or ports, low absolute neturophil count
platelet count
can treat patients with count as low as 50-80,000
WBC count
can treat as low as 1000 with antibiotic coverage
indications for extractions
- dental nonrestorable carious lesions
- active periapical disease (not if chronic or well localized) symptomatic teeth
- moderate to advanced periodontal disease
- lack of opposing teeth
- compromised hygiene
- partial impaction/incomplete eruption
- bifurcation involvement
after radiation tx, avoid
invasive surgical procedures like extractions and periodontal surgery
if an invasive procedure is required, use
hyperbaric oxygen therapy before and after surgery is advised
complications of systemic therapies in oral cavity
xerostomia
mucositis
oral bleeding
increased dryness and erythema
most prevalent side effect reported by patients receiving radiation therapy for head and neck cancer
xerostomia
mucositis
- extremely painful often requiring morphine
- a painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy tx of cancer
oral bleeding
decreased platelets and clotting factors are frequently associated with the effects of chemotherapy and bone marrow transplantation
a significant cause of death in immunosuprssed patients is oral infection
mucositis ?
consequences of salivary hypofunction
increased infection
loss of remineralizatoin
decreased lubrication
increased infection from salivary hypofunction
salivary gland infections, swellings, sialotliths, candidasis, periodontal disease
loss of remineralization from salivary hypofunction
dental caries erosion
decreased lubrication from hypofunction
trouble speaking and swallowing
taste buds
need saliva to solubilize chemicals in food
lubrication
mastication, swallowing, and speech
what glands are the first to be affected by radiation
serous glands like parotid glands
mucous is thick and viscous saliva
patients with sjorgren’s feel that they have lots of saliva in their mouth
candidiasis
35% in autoimmune vs. 4% peer controls
candida can penetrate deep into the tissue and bother nerve endings causing
burning sensation and irritated mucosa
niastatin
medicine for candidasis, full of sugar so may cause caries
angular cheilitis
chapped lips at the angle of the mouth
sialoliths can lead to
retrograde infection
protective factors in the mouth that remineralize
saliva, fluoride, chlorhexidine and other antimicorbials, calcium phosphate
pathological factors that demineralize
saliva hypofunction, acid producing bacteria, frequent consumption of fermentable carbs and acidic drinks, GERD
loss of saliva can lead to
demineralization
post radiation therapy contains what 2 bacteria in the mouth
s. mutans + lactobacillus
acid erosion is common from diet and
GERD
red palate is seen in
GERD
acid erosion caused by
sipping fruid drinks and eating acidic fruit with a dry mouth
osteoradionecrosis is caused by
radiation tx
trismus
- secondary to surgery
- fibrosis due to radiation therapy effect on masticatory muscles
- occurs 6 mos post RT
treatment for mucositis
stretching exercises, mechanical devices like therabite, saliva flow stimulants
stimulate flow of saliva
xylitol gum
salagen
evoxac (take w/ food)
pilocarpine effect on unstimulated parotid flow
given 1 hr prior to radiation may spare some salivary gland tissue
percent of oncology patients that stop fluoride tray tx
70%, time consuming and reminds them of their cancer
high fluoride toothpastes
1.1% , enamel pro, controlRx, Oral B neutraCare, PreviDent
duraphat
high potency sodium fluoride varnish
artificial saliva
- duration of effect is short
- do not provide same protective roles as saliva
- removed during swallowing
examples of artificial saliva
caphosol and neutrasal
- 1 box has 30 doses
- 1 dose is 2 ampules mixed together
caphasol reduces the amount of ….intake
morphine
other tx for mucositis
magic mouthwash
gelclair-oral gel for pain relief and oral lesions, no eating or drinking after one hour after use
frequent use of what can paralyze vocal cords and interfere with swallowing
magic mouthwash, or gelclair-lidocaine
biotene
- does not have abrasives and irritans so is good to use toothpaste during tx
- xylitol gum helpful in stimulating saliva without increasing caries
MI paste
paste with lots of calcium and phosphate
lubricants
vitamin E, borage seed oil, oil pooling
what should you do first in a patient who is a young female, history of smoking, B cell lymphoma on left tonsil, scheduled for therapeutic radiation and hemopoetic stem cell transplant
fluroride varnish before any tx
- no big sips of water
- dental visit every 3 mos
