Xerostomia and Sjorgens syndrome Flashcards
What oral problems can xerostomia cause?
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
What are the causes of xerostomia?
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
Describe the challacombe scale
It is a scale used for measuring severity of xerostomia
Mild <3; moderate 3-6; severe 6-10
- Mirror sticks to BM
- Mirror sticks to tongue
- Saliva frothy
- No saliva pooling FOM
- Tongue shows generalised shortened papillae
- Altered gingival architecture (smooth)
- Glossy appearance of oral mucosa especially palate
- Tongue lobulated/fissured
- Cervical caries
- Debris on palate or sticking to teeth
What are the normal flow rates for sialometry?
Normal rates
<0.1ml/min Unstimulated flow
<0.4ml/min stimulated flow
How is sialometry carried out?
Test of flow of saliva using modified Lashley cup (Carlson-Crittenden cup) attached to parotid gland to sample and calculate flow rates
What is the schirmer test and normal results?,
It is an eye test that measures moisture over 5mins.
10mm of moisture on filter paper is normal
What antibodies are tested in xerostomia cases?
Anti nuclear antibody Anti-SSA (Ro) Anti-SSV (La) Rheumatoid factor Anti thyroid peroxidase (anti-TPO) ESR
What imaging may be used when diagnosing xerostomia:
Sialography
Scintigraphy
Ultrasound
Chest X-ray to discount sarcoidosis
What is Sjorgens syndrome?
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.
What would commonly be seen in salivary gland biopsy of parotid gland?
Mononuclear cells infiltrate in labial salivary gland biopsy
90% cases effect parotid gland
What are the 2 types of Sjorgens?
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.
What are the main symptoms of Sjorgens?
Dry mouth Dry eyes Arthralgia (joint pain) Myalgia (muscle pain) Fatigue
What are the main complications of Sjorgens?
Caries
Oral candidiasis
Bacterial sialadenitis
Increased incidence of lymphoma (5-18% risk)
What are the main Sjorgens investigations?
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
What is the management/treatment options for Sjorgens?
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