Tutorial 4 Flashcards
how can a dry mouth impact the oral cavity
affects acid buffering
decreased mucosal lubrication
speech + swallowing
decreased taste
reduced antibacterial/antifungal
reduced digestive
discomfort
increased caries/perio/infection risk
decreased denture retention
questions to ask pt re- dry mouth
is it persistent
is it better on eating
anything helps
association with meal times
any systemic - changes to urination
swallowing problems
EO and IO assessment for dry mouth
EO - major salivary, hardening, asymmetry, swelling, lumps, mass
IO - minor, duct orifices, fluid expression, saliva production, change of duct location, level of dryness [mirror]
1.5ml per min is normal
pt presents with dry mouth. he takes mirtazapine and amitriptyline
what is your differential diagnosis
DRUG INDUCED SALIVARY HYPOFUNCTION [DISH]
differentials - anxiety, meds, CF, DM, radiotherapy, sjogrens, age
how would you treat DISH dry mouth in primary care
treat underlying cause - drug regime
preventative
symptomatic - saliva replacements, stimulants, oral gels, lozenges
lifestyle chantes
frequent sips of waret
sugar free gum
liaise with GP re meds
what additional investigations could be considered in pt with DISH in secondary care + why
sialometry
ANA
ultrasound
sailography
what investigations would you consider sjogrens
screening questions - eye symptoms
Anti-RO antibodies via blood test
unstimulated salivary flow via spit in cup
ANA
labial gland biopsy
what are adv and disadv of labial gland biopsy for sjogrens
adv - determines if likely to develop lymphoma
disadv - risks of swelling, scarring, numbness, infection, damage, mucocele
what is sjogrens syndrome
chronic autoimmune disease where body attacks moisture producing glands
dry mouth, eyes, fatigue, joint pain, swollen glands
immune mediated
associated wit exocrine glands
can affect GI, neurological
long term sequelae of sjogrens
caries, perio
functional loss [speech, swallow]
salivary lymphoma
keratoconjunctivitis
eye scarring
fatigue
skin changes
gi disease
lymphoma
what other parts of body can be affected by sjogrens
eyes, skin, joints, salivary glands, mouth, vag
what other conditions are more likely to occur in pt with sjogrens
CNS - fatigue, TN, neuropathy
skin - rashes
vascular - raynauds
eyes - keratoconjunctivitis
respiratory - cough, hoarse
GI - dysphagia, pancreatic insufficiency
haematological - anaemia
MS - maylgia
GU - vaginal dryness
what classification is used to diagnosis sjogrens
which score should be reached
BSR 2024
> 4
sjogrens management in primary care vs secondary care
primary -
preventative, symptom relief [lozenges, spray], artificial saliva, lifestyle
secondary -
pilocarpine, hydroxychloroquine
pt presents with swelling submandibularly. it is painless and intermittent. it gets swollen around mealtimes
what is your diagnosis
what further questions
obstructive sialadentitis
mealtime, coming going
swallowing problems
unwell
joint pain, fatigue
cancer history
what might you see on clinical examination of obstructive sialadenitis
EO - bimanual FOM swollen, firm
IO - express saliva from duct, obstruction, reduced saliva, gland stone
pain due to stretching of fascia around gland
why are submandibular glands more affected by obstructive sialadenitis than parotid glands
due to length of ducts
saliva flow against gravity
higher mucous content
how would you further investigate obstructive sialadenitis in primary vs secondary
primary -
lower occlusal xray +/- OPT
secondary -
ultrasound, sialography, MRI/CT
conservative measures for obstructive sialadentitis
massage duct/gland
heat appliacation
suck on citrus fruit/sweets
hydration
excellent OH
analgesia
what surgical/radiological management may be considered for obstructive sialadentitis
lithotripsy
sialoendoscopy
balloon dilation
basket removal
incisional removal
therapeutic sialography
how would obstructive sialadenitis be managed differently if acute infection
pus FOM, pain, swelling, redness, heat, loss of function
URGETN max fax for abz
amoxicillin + metronidazole
drainage or removal of gland
6 y/o presents with lump on lower labial mucosa, 5 weeks persistence
what further questions
diagnosis
has it changed, has it ruptured, is it recurring, trauma, lip-biting
mucocele
tx options for mucocele
no tx - photos, unlikely to resolve but non invasive
excision by OS - removes it but high recurrence, can cause damage, invasive
6 y/o presents with mucocele to upper lip
what now
high risk of malignancy
suspect neoplasm
REFER
list common causes of salivary gland swellings
- obstructive sialadenitis
- sialadenitis [acue viral/bacterial]
- necrotising sialometaplasia
- neoplasm
- obstructive
- autoimmune
- Whartons
70 y/o pt presents with swelling affect RHS of face
painless, no neurological deficit
what gland is affected
what is provisional diagnosis
parotid
pleomorphic adenoma
suspected pleomorphic adenoma investigations secondary care
ultrasound
ultrasound guided fine needle aspiration - determined malignancy
histological specimen
MRI
sialography
