Salivary Glands & Salivation Flashcards
function of saliva (4)
acid buffering
mucosal lubrication (speech & swallowing)
taste facilitation
antibacterial
causes of dry mouth
- salivary gland disease - consequence of degenerative disease of gland
- drugs - have anticholinergic muscarinic action which reduces stimulation to glands (v common)
- medical conditions & dehydration (lack of production of saliva)
- radiotherapy & cancer tx - harmful to gland itself or to bloody supply preventing production of saliva
- anxiety & somatisation (enough saliva but mouth still feels dry) disorders
salivary changes with age
acinar tissue loss leading to reduction of
37% submandibular
32% parotid
45% minor glands
indirect v direct
indirect effect = external to the gland
direct effect = problems with gland itself
impact of drugs as indirect salivary problems
anti muscarinic cholinergic drugs i.e. tricyclic antidepressants, antipsychotics (amytriptyline 26% reduction)
(lithium 70% reduction & increased caries risk correlates also)
antihistamine
atropine
diuretics - bendrofluazide (10% reduction)
cytotoxics
indirect salivary problems
chronic medical problems inc dehydration:
diabetes
renal disease
stroke
addison’s
persistant vomiting
acute medical problems:
acute oral mucosal disease
burns
vesiculobullous disease
haemorrhage
direct salivary gland problems
aplasia - ectodermal dysplasia
sarcoidosis
HIV
gland infiltration - amyloidosis, haemochromatosis
cystic fibrosis
* dry mouth very uncommon in children so would suggest issue with their salivary glands
ectodermal dysplasia
2 or more ectodermally derived structures from abnormally i.e. hair, nails, teeth, salivary & sweat glands
may be limited in effect i.e. salivary aplasia alone
hypohidrotic - x linked
sarcoidosis
inflammatory disease in which the immune system overreacts, causing groups of cells to form clusters of inflamed tissue called “granulomas” in one or more organs of the body
Parotid sarcoidosis is presented as a persistent asymptomatic or painful, diffuse, non-nodular parotid swelling. Sarcoidosis of the parotid gland is more often bilateral, with onset slightly more common in women in their third or fourth decades
HIV impact
increases bulk of salivary gland but reduction in function as acinar tissue is lost
pt with increased size of salivary gland with no other attributable cause should be offered HIV test
amyloid & haemochromatosis
cause is damage to gland structure
amyloid - deposition of protein within the gland prevents proper function
haem - excess storage of iron in the tissues which will stop salivary tissue from functioning
how does radiotherapy / cancer tx impact salivary glands
radiation effects
graft v host disease (GVHD)
antineoplastic drugs
radioiodine
management of challacombe scale of dryness score 1-3
mild dryness
may not need tx
sugar free chewing gum for 15mins x2 daily
attention to hydration i.e. small sips
many drugs will cause mild dryness
routine check up monitoring required
management of challacombe scale of dryness 4-6
moderate dryness
sugar free chewing gum / simple sialagogues may be required
needs to be investigated further if reasons for dryness are not clear
saliva substitutes & topical fluoride may be helpful
monitor at regular intervals especially for early decay & symptom change
management of challacombe scale for dryness 7-10
severe dryness
saliva substitutes & topical fluoride usually needed
cause of hyposalivation needs to be ascertained & sjogren’s excluded
refer for investigation & diagnosis
pt need to be monitored for changing symptoms & signs with possible further specialist input if worsening
