Salivary Issues Flashcards
What are the functions of saliva?
Acid buffering
Mucosal lubrication
- speech and swallowing
Taste facilitation
Antibacterial
Give some common causes of dry mouth
Side effect of medication
Salivary gland disease
Radiotherapy / cancer treatment
Medical conditions
Dehydration
Anxiety
Give some common xerostomia causing meds
Anti-muscarinic cholinergic drugs
- tricyclic antidepressants e.g. amitriptyline
- antipsychotics
- Antihistamines
- diuretics
What chronic medical problems may cause problems like dehydration and thus xerostomia?
Diabetes
Renal disease
Stroke - unable to drink
Addisons
Vomiting
What acute medical problems may cause dehydration and xerostomia
Acute oral mucosal diseases
Burns
Vesiculobullous disease - fluid lost through skin
Haemorrhage
- often renders patient unable to drink
What direct salivary gland problems may there be?
Aplasia
- ectodermal dysplasia - absence of a salivary gland
Sarcoidosis
- granulomatous infiltrate within gland preventing function
HIV
CF - affects all gland secretions
Patient presents with increased sizing of salivary glands - especially parotid
What should be offered?
HIV screening / test
How can amyloidosis and haemachromotosis affect salivary glands?
Damage to gland structure
- amyloidosis = build up of protein in gland
- haemo = excess storage of iron in the tissue
What are stages 1, 2 and 3 of the challacombe scale
1 - mirror sticks to buccal mucosa
2 - mirror sticks to tongue
3 - saliva frothy
Stages 4, 5 and 6 of challacombe scale?
4 - no saliva pooling in floor of mouth
5 - tongue shows generalised shortened papillae
6 - altered gingival architecture.g. Smooth
Challacombe scale 7, 8, 9, 10?
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
What tests can be done when investigation someone with reduced salivary flow?
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
How can anxiety affect saliva?
Inhibition of salivation - real oral dryness
Inhibit swallowing - lead to too much saliva complaint
What is a somatoform diseases?
Mental health issue that presents with somatic physical symptoms that are not easily explained
Give some frequent somatoform diseases
Oral dysaesthesia
TMD pain
Headache
Neck / back pain
IBS