Xerostomia and Sjorgens syndrome Flashcards

1
Q

What oral problems can xerostomia cause?

A
Caries
Candidiasis 
Erosion 
Ascending sialadenitis 
Dysgeusia 
Halitosis 
Burning mouth syndrome 
Dysphagia 
Fissured tongue with trophy of filliform papillae 
Difficulty wearing dentures 
Mouth soreness
Oral mucositis 
Dry sore cracked lips and angles of mouth
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2
Q

What are the causes of xerostomia?

A

Local:
- Candida, alcohol, smoking, mouth breathing and sailor has

Salivary gland disease:
- Sjorgens, CF, sarcoidosis, amyloidosis, haemochromatosis

Drug induced:

  • tricyclic antidepressants (amitriptyline), antipsychotics (lithium), antihistamines, diuretics (bendroflumethiazide), atropine, cytotoxic drugs and proton pump inhibitors
  • anticholinergic (anti muscarinic) drugs
  • polypharmacy

Dehydrating conditions
- diabetes, renal, stroke, Addison, persistent vomiting

Radiotherapy and cancer tx

Anxiety and somatostatin disorders
- IBS, PTSD, TMJD

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3
Q

Describe the challacombe scale

A

It is a scale used for measuring severity of xerostomia
Mild <3; moderate 3-6; severe 6-10

  1. Mirror sticks to BM
  2. Mirror sticks to tongue
  3. Saliva frothy
  4. No saliva pooling FOM
  5. Tongue shows generalised shortened papillae
  6. Altered gingival architecture (smooth)
  7. Glossy appearance of oral mucosa especially palate
  8. Tongue lobulated/fissured
  9. Cervical caries
  10. Debris on palate or sticking to teeth
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4
Q

What are the normal flow rates for sialometry?

A

Normal rates
<0.1ml/min Unstimulated flow
<0.4ml/min stimulated flow

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5
Q

How is sialometry carried out?

A

Test of flow of saliva using modified Lashley cup (Carlson-Crittenden cup) attached to parotid gland to sample and calculate flow rates

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6
Q

What is the schirmer test and normal results?,

A

It is an eye test that measures moisture over 5mins.

10mm of moisture on filter paper is normal

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7
Q

What antibodies are tested in xerostomia cases?

A
Anti nuclear antibody 
Anti-SSA (Ro)
Anti-SSV (La)
Rheumatoid factor 
Anti thyroid peroxidase (anti-TPO) 
ESR
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8
Q

What imaging may be used when diagnosing xerostomia:

A

Sialography
Scintigraphy
Ultrasound
Chest X-ray to discount sarcoidosis

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9
Q

What is Sjorgens syndrome?

A

It is a chronic inflammatory condition with autoimmune basis characterised by lymphocytic infiltrate involving exocrine glands.
It causes damage to saliva producing cells and inflammatory changes in moisture producing glands throughout the body leading to reduced secretion from these glands.

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10
Q

What would commonly be seen in salivary gland biopsy of parotid gland?

A

Mononuclear cells infiltrate in labial salivary gland biopsy
90% cases effect parotid gland

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11
Q

What are the 2 types of Sjorgens?

A

Primary:
- no CT disease combination of dry eyes and xerostomia

Secondary
- CT disease such as primary biliary cirrhosis, RA, SLE, scleroderma and primary biliary cirrhosis.

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12
Q

What are the main symptoms of Sjorgens?

A
Dry mouth 
Dry eyes
Arthralgia (joint pain)
Myalgia (muscle pain)
Fatigue
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13
Q

What are the main complications of Sjorgens?

A

Caries
Oral candidiasis
Bacterial sialadenitis
Increased incidence of lymphoma (5-18% risk)

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14
Q

What are the main Sjorgens investigations?

A

Blood tests:
ANA and RF +ve
Anti-Ro and Anti-La +ve
ESR raised

Rose Bengal test

  • measures state and function of lacrimal glands
  • dryness of mouth and eyes >3mnths

Schirmer eye test
- producing <5mm of liquid in 5mins +ve

Slit lamp examination
- reveal dryness of surface of eye

Sialometry

  • saliva flow rate test
  • <1.5ml unstimulated in 15min

Salivary gland biopsy
- clusters of lymphocytes around salivary gland and damage to gland from inflammation

Sialogram
- blockage in parotid duct

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15
Q

What is the management/treatment options for Sjorgens?

A

Main aim:
- relieve symptoms, restore function and prevent further damage

Hydration
- 2-3l per day and reduce caffeine

Medications

  • prilocarpine and cevimeline to stimulate salivary flow
  • NSAIDs for joint pain
  • DMARDs such as methotrexate or hydroxychloroquine
  • steroids

Artificial saliva replacement

  • saliva sprays
  • lozenges

Artificial tear substitute for dry eyes

Saliva stimulants
- sugar free gum and sialogogues

Increase fluid

  • 2800/5000ppm TP
  • 22,600ppm FV 3-4x yearly
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16
Q

What type of lymphoma is patients with Sjorgens at risk of?

A

Low grade MALT lymphoma

- risk up to 10%