Salivary Issues Flashcards

1
Q

What are the functions of saliva?

A

Acid buffering

Mucosal lubrication
- speech and swallowing

Taste facilitation

Antibacterial

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2
Q

Give some common causes of dry mouth

A

Side effect of medication

Salivary gland disease

Radiotherapy / cancer treatment

Medical conditions

Dehydration

Anxiety

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3
Q

Give some common xerostomia causing meds

A

Anti-muscarinic cholinergic drugs
- tricyclic antidepressants e.g. amitriptyline
- antipsychotics

  • Antihistamines
  • diuretics
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4
Q

What chronic medical problems may cause problems like dehydration and thus xerostomia?

A

Diabetes

Renal disease

Stroke - unable to drink

Addisons

Vomiting

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5
Q

What acute medical problems may cause dehydration and xerostomia

A

Acute oral mucosal diseases

Burns

Vesiculobullous disease - fluid lost through skin

Haemorrhage

  • often renders patient unable to drink
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6
Q

What direct salivary gland problems may there be?

A

Aplasia
- ectodermal dysplasia - absence of a salivary gland

Sarcoidosis
- granulomatous infiltrate within gland preventing function

HIV

CF - affects all gland secretions

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7
Q

Patient presents with increased sizing of salivary glands - especially parotid

What should be offered?

A

HIV screening / test

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8
Q

How can amyloidosis and haemachromotosis affect salivary glands?

A

Damage to gland structure

  • amyloidosis = build up of protein in gland
  • haemo = excess storage of iron in the tissue
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9
Q

What are stages 1, 2 and 3 of the challacombe scale

A

1 - mirror sticks to buccal mucosa

2 - mirror sticks to tongue

3 - saliva frothy

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10
Q

Stages 4, 5 and 6 of challacombe scale?

A

4 - no saliva pooling in floor of mouth

5 - tongue shows generalised shortened papillae

6 - altered gingival architecture.g. Smooth

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11
Q

Challacombe scale 7, 8, 9, 10?

A

7 - glassy appearance of oral mucosa, esp palate

8 - fissured tongue

9- cervical caries (more than 2 teeth)

10 - debris on palate or sticking to teeth

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12
Q

What tests can be done when investigation someone with reduced salivary flow?

A

Blood tests
- dehydration, glucose testing
- Anti Ro or Anti La antibodies (found in those with sjogrens)
- complement levels c3 or c4
- Antinuclear antibody (sjogrens / autoimmune)

Salivary flow functional assay test

Labial gland biopsy

Ultrasound imaging

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13
Q

How can anxiety affect saliva?

A

Inhibition of salivation - real oral dryness

Inhibit swallowing - lead to too much saliva complaint

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14
Q

What is a somatoform diseases?

A

Mental health issue that presents with somatic physical symptoms that are not easily explained

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15
Q

Give some frequent somatoform diseases

A

Oral dysaesthesia

TMD pain

Headache

Neck / back pain

IBS

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16
Q

What is normal salivary resting and stimulated flow?

A

Resting flow = .3 - .4ml/min

Stimulated flow = 1-2ml/min

17
Q

What are the hyposalivation rates for resting and stimulated?

A

Resting = <0.1ml/min

Stimulated = <0.5ml/min

18
Q

What causes of dry mouth are often very treatable?

A

Dehydration

Anti-muscarinic side fx drugs

Medicines causing xerostomia

Poor diabetes control

19
Q

When may only symptomatic treatment be available to a pt?

A

Sjogrens

Dry mouth from cancer tx

Dry mouth from salivary gland disease

20
Q

What is my role as a GDP in managing dry mouth?

A

Prevent oral disease!
- caries risk assessment
- education of candida / staph infection, low sugar and good OH

Maximal preventative regime
- diet advice
- fluoride delivery with high fluoride toothpaste / varnish
- treatment plan for a caries free dentition

21
Q

Give some saliva ‘substitutes’

Issues?

A

Sprays
- saliva orthana

Lozenges
- saliva orthana lozenge
- SST

Frequently small sips of water / sugar free chewing gum is very good

More useful for early management / stages where mouth is dry but some saliva remains
- unhelpful in much later treatment

22
Q

Give some possible causes of hypersalivation

A

Perceived (common) - issue with swallowing leading to perceived increase in salivary flow rate
- anxiety
- stroke
- MND

True (rare cause)
- drug interactions
- dementia
- stroke

23
Q

How deal with hypersalivation?

A

Treat cause - anxiety?

Drugs to reduce salivation
- anti muscarinic