salivary gland Hypofunction and Xerostomia

Question 1

what is the definition of salivary gland hypo function?

Answer 1

> Salivary gland hypofunction is a condition where unstimulated and stimulated salivary flow is significantly reduced (Objective)

Question 2

what is normal salivary flow?

Answer 2

> Unstimulated 0.1-0.2mL per minute

> Stimulated 0.7mL per minute

Question 3

what is the definition of of xerostomia?

Answer 3

> xerostomia is the subjective perception of a dry mouth
function is commonly found to be normal

Question 4

what is the age and sex demographic of xerostomia?

Answer 4

> more common in the older population

> more common in women

> prevalence of xerostomia varies between 10-46%

Question 5

what are the functions of saliva? (6)

Answer 5

1. Lubrication
2. Protection = Soft Tissue + Hard Tissue
3. Digestion
4. Anti microbial & immunological
5. Wound healing
6. Taste

Question 6

what is the purpose of the lubrication function of saliva?

Answer 6

> speech
mastication

Question 7

what are the associated problems when the lubricating aspect of the saliva is removed?

Answer 7

> Difficulty speaking

> Difficulty eating

> Soft and hard tissue abrasion

Question 8

what is the purpose of the protection aspect of saliva?

Answer 8

> Soft tissue
- Mucin rich protective film
- Prevents water loss (glycoproteins)
- Lubrication

> Hard Tissue
- Biologically controlled protective and reparative inorganic environment (statherin, acidic proline rich and pellicle proteins)- Remineralisation

Question 9

what are the associated problems when the protection aspect of the saliva are removed?

Answer 9

> soft tissue - mucosal atrophy

> hard tissue - demineralisation

Question 10

what is the purpose of the digestive aspect of saliva ?

Answer 10

> hydrolysis of starch (amylase)

Question 11

what are the associated problems when the digestive aspect of saliva is removed?

Answer 11

> Increased substrate left in the oral cavity for bacteria to digest

Question 12

what is the purpose of the antimicrobial system in saliva?

Answer 12

> Antimicrobial systems (Immunoglobulins, glycoproteins, sialoperoxidase, Lactoferrin, lysozyme histatins etc)

> Protect against food and air borne organisms

> Provides defence to both the oral cavity and the airway

Question 13

what are the associated problems when the antimicrobial system of saliva is removed?

Answer 13

> Colonisation infection, control of pathogens maintaining commensals

> Adhesion versus deletion

Question 14

what is the purpose of the wound healing aspect of saliva?

Answer 14

> Saliva contains growth factors

> Protective functions of saliva prevent continued damage to the area

Question 15

what happens when the wound healing aspect of saliva is removed?

Answer 15

> prolonged wound healing

Question 16

how is saliva involved with you taste?

Answer 16

> Acts as a solvent for taste substances

> Saliva contains Gustin which is thought to be linked with development of taste buds

> Protects taste buds

Question 17

what happens to your taste when saliva is absent?

Answer 17

> Loss of taste

> associated dietary issues that can lead to caries

Question 18

what are the aetilogical categories of salivary gland hypo function/ xerostomia

Answer 18

> Developmental

> Acquired
- Inflammatory
- Metabolic
- Iatrogenic
- Miscellaneous

Question 19

what are the developmental causes of SGH/X?

Answer 19

> Agenesis or hypoplasia
- Associated with lacrimal dysfunction
- Xerostomia rampant caries

> Cystic fibrosis
- Mucous secreting glands only
- Enlarged submandibular glands

Question 20

what are the inflammatory (acquired) causes of SGH/X?

Answer 20

> Primary Sjogrens syndrome

> Secondary Sjogrens syndrome

Question 21

what is the metabolic (acquired) cause of SGH/X?

Answer 21

> diabetes

Question 22

what are the iatrogenic causes of SGH/X?

Answer 22

> drug therapy

> post irradiation damage

Question 23

what are some miscellaneous causes of of SGH/X?

Answer 23

> Dehydration

> Increasing age

> Mouth breathing

> Anxiety

> Smoking

Question 24

what does not cause dry mouth?

Answer 24

> salivary gland calculi

Question 25

what drugs can cause dry mouth?

Answer 25

> Antidepressants

> Antihistamines

> Anticholinergics

> Potent diuretics

> Hypotensive agents

> Muscle relaxants

> Narcotics

> Hypnotics

> Neuroleptics
(major tranquillisers)

> Sympathomimetics

Question 26

how do you diagnose someone with dry mouth?

Answer 26

> History of presenting complaint

> Clinical examination

> Special Investigation

Question 27

what are the common HPCs?

Answer 27

Difficulty in =
>Talking
>Eating
>Swallowing
>Appreciating food = Lack of taste / bad taste

> Discomfort
Burning
Halitosis
Altered sensation
Loose dentures
Dry eyes or other mucosal surface – nasal or genital (Sjogren’s syndrome)

Question 28

what will you see on clinical examination when someone is experiencing dry mouth?

Answer 28

> Lack of saliva

> Frothy saliva

> Mucositis

> Candidal infection

> Caries

> Red, depapillated, lobulated tongue

Question 29

what is the challacombe scale categories (index of xerostomia) ?

Answer 29

1. Mirror sticks to buccal mucosa
2. Mirror sticks to tongue
3. Saliva frothy
4. No saliva pooling in the floor of the mouth
5. Tongue shows generalized shortened papillae
6. Altered gingival architecture (i.e.: smooth)
7. Glassy appearance of oral mucosa especially
   palate
8. Tongue lobulated/fissured
9. Cervical cavitations on more than two teeth
10. Debris on palate or sticking to teeth

Question 30

what special investigations can you take for dry mouth?

Answer 30

> Sialometry (stimulated/unstimulated)

> Schirmer Test

> Auto antibody screen: Ro, La

> Sialography

> Ultrasound

> Scinti scanning

> Labial gland biopsy

> HbA1c

Question 31

what is the treatment of dry mouth?
1. Rectify/improving underlying causes if possible

Answer 31

• Diabetes
  
  • Alter medication

Question 32

what is the treatment of dry mouth?
2. Avoid contributing factors

Answer 32

• Dry foods
  
  • Alcohol inc alcohol containing mouthwashes
  • Smoking
  • Diuresis producing drinks e.g. tea/coffee
  • Dry hot environments: watch CPAP

Question 33

what is the treatment of dry mouth?
3. Protect teeth and oral cavity

Answer 33

• Increased caries risk = Fluoride: duraphat etc,
  Diet advice, Regular check ups and radiographs
  
  • Infections (Sialadenitis, Periodontal and mucosal disease) = Maintain hydration, Oral hygiene advice, Denture hygiene advice

Question 34

what is the treatment of dry mouth?
4. Replacement

Answer 34

• Saliva Orthana (Non-acidic and contains fluoride)
  
  • Glandosane ok if edentulous
  • Biotene (Lubricates and contains fluoride)

Question 35

what is the treatment of dry mouth?
5. enhance function

Answer 35

• Maintain hydration
  
  • Pilocarpine derivatives = Salagen