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BDS4 Oral Medicine > Management of problems with Saliva > Flashcards

Management of problems with Saliva Flashcards

1
Q

What salivary related conditions do blood tests help us diagnose?

A

Diabetes

Dehydration

Autoimmune diseases- sjogrens

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2
Q

What is the issue with major gland investigation?

A

Damage to facial nerve

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3
Q

Why is labial gland biopsy done instead of major glands?

A
  • Histopathology of inflammatory changes in major glands is reflected in minor
  • Minor gland biopsy (labial gland in lip)- gives same info about immune/inflammatory diseases in major glands without risk
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4
Q

What are the risks of labial gland biopsy?

A

Risk of labial gland biopsy- area of numbness (informed consent- only if other evidence of salivary gland disease)

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5
Q

What is sialography useful for investigating?

A

Strictures and dilatation of ducts

  • MR requires no cannulation
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6
Q

Why has ultrasound replaced sialography?

A

No ionising radiation in ultrasound

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7
Q

What causes saliva to be frothy?

A

Protein content

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8
Q

What is a somatisation disorder?

A

significant symptoms that are real to patient but no evidence with disease in tissues of the patient

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9
Q

How can anxiety and somatisation disorders affect salivation/swallowing?

A

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

‘cephalic’ control of perception (anxiety disorders)
-> Altered perception of reality – ability to detect moistness is altered by small changes at synapses as it is processed (saliva levels are normal)

Anxiety can also inhibit swallowing and can lead to patient feeling they have excess salivation

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10
Q

What are other examples of somatoform disorders?

A

Oral Dysaesthesia

TMD pain

Headache

neck/back pain

Dyspepsia- with no evidence of excess of acid

Irritable Bowel Syndrome

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11
Q

What is the resting and stimulated salivary flow rate in normal patients?

A

Resting- 0.3-0.4 ml/min

Stimulated- 1-2 ml/min

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12
Q

What is the resting and stimulated salivary flow rate in patients with hyposlaivation?

A

Resting- <0.1 ml/min

Stimulated- <0.5 ml/min

-> Patients only really notice when salivation has decreased by 50%

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13
Q

What are the treatable causes of dry mouth?

A

Dehydration

Use of medicines with anti-muscarinic side effects Or that cause dehydration

Poor diabetes control- T1/T2

Somatoform disorders

-> Management of these should return normal function and patient comfort

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14
Q

What are the conditions causing dry mouth for which only symptomatic treatment is available?

A

Sjogren’s

Dry mouth from cancer tx

Dry mouth from salivary gland disease

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15
Q

What are the treatment options for dry mouth caused by sjogrens, cancer tx, gland disease?

A

Intensive dental prevention

Salivary stimulants

Salivary replacements

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16
Q

What flow test is done for dry mouth?

A

Patient spits into tube for 15 mins
-> if less than 1.5ml unstimulated flow in this time it suggests dry mouth

17
Q

What blood tests are done to investigate cause of dry mouth?

A

Dehydration – U&Es, Glucose (diabetes)

Autoimmune disease – ANA, Anti-Ro, Anti-La (ENA Screen), CRP

Complement levels – c3 and c4

18
Q

What imaging can be done when investigating cause of dry mouth?

A

Salivary ultrasound – looking for leopard spots (sjogrens) OR sialectasis

Sialography – useful where obstruction/ductal disease is suspected

19
Q

Why is a dry eyes screen done at same time when investigating cause of salivary disease?

A

Salivary gland disease is often associated with lacrimal disease

20
Q

What tests are done as part of dry eye screen?

A

Refer to optician for assessment of tear film (preferred)

Schirmer test – tear flow less than 5mm wetting of test paper in 15 mins

21
Q

What are the signs of disease in a labial gland biopsy?

A

Lymphocytic infiltrate and focal acinar disease

22
Q

What should dentists do to manage dry mouth?

A

Prevent oral disease:
-> Caries risk assessment
-> Candida/staphylococci awareness and reduction – low sugar diet and OHI (angular chelitis)

Maximal preventative strategy
-> Diet advice
-> Fluoride
-> Treatment Planning for high caries risk

23
Q

Which saliva substitutes are available?

A

Sprays
-> Glandosane- acidic so discouraged
-> Saliva Orthana

Lozenges
-> Saliva Orthana
-> SST

Salivary stimulants
-> Pilocarpine (Salagen)

Oral Care Systems
-> Oral Balance- gels (to stop mucosa sticking), toothpastes

Frequent sips of water

Sugar free gum

24
Q

What is the side effect of Pilocarpine?

A

Increased residual gland function- excess sweating

Tachycardia

25
Q

What are the issues with saliva substitutes?

A

Lack of persisting relief- may work briefly

Patients find difficulty in using often enough to get proper relief

26
Q

What are the true causes of hypersalivation? (actual increase in flow)

A

Drug causes

Dementia

CJD

Stroke

27
Q

What drugs are associated with hypersalivation?

A

Parasympathomimetic
Buprenorphine
Anticholinesterases
Haloperidol
Ipecacuanha
Clonazepam
Nicardipine
Clozapine

28
Q

What are the causes of swallowing failure which can lead to perceived hypersalivation?

A

Anxiety

Stroke

Motor Neurone Disease

Multiple Sclerosis

29
Q

What causes drooling in MND/MS?

A

Frequency and efficacy of swallowing is reduced resulting in saliva build up and drooling

30
Q

What patients suffer postural drooling?

A

Babies

Cerebral palsy

-> no issue swallowing or with excess saliva but with keeping head up right

31
Q

What drugs can be used to reduce salivation?

A

Anti-muscarinics

Botox- prevents activation of glands by cholinergic stimulation

32
Q

What can help stroke victims with swallowing control?

A

Biofeedback training

33
Q

What surgeries can be used to prevent excess salivation ?

A

Duct repositioning (CP/MND if head positioning causing issue)- moved into pharynx from front of mouth
-> saliva empties directly into pharynx for easier swallowing

Gland removal- last resort

BDS4 Oral Medicine (28 decks)

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