CT Disorders and Xerostomia Flashcards

Question

What drugs can cause lupus like lesions?

Answer 1

Carbamazepine Hydralazine Penicillamine

Answer 2

Autoimmune disorder Affects mainly females 20-50yrs Dense collagen is deposited in tissues of the body Clinical features include raynaud's phenomenon

Answer 3

limited cutaneous form of systemic sclerosis (lcSSc) ``` Presentation: C - Calcinosis (calcium nodules can become ulcerated) R - Raynaud's phenom E - Oesophageal dysfunction S - Scelorodactyly T - Telangiectasia ```

Answer 4

Limited to skin on face, hands and feet | 10 yr survival 75%

Answer 5

More extensive skin involvement May progress to visceral organs 10 yr survival 55% Death most often from pulmonary, heart and kidney involvement

Answer 6

Limited cutaneous systemic sclerosis Diffuse cutaneous systemic sclerosis Crest syndrome

Answer 7

``` Facial skin rigidity Sharp nose Thinning of lips Loss of facial wrinkles Microstomia - Poor access for OH - Increase incidence of dental caries - Increase incidence of periodontal disease (abnormal immunoregulation and obliterative microvasculopathy) ``` Hypomobile tongue (less mobile) Dysphagia and xerostomia PDL widening on XR Pseudoankylosis of TMJ Tight cheeks = affects speech, eating, cleaning, deteriorating QoL

Answer 8

Difficult diagnosis Clinical Skin biopsy Scl-70 autoantibodies

Answer 9

Difficult tx Aims to reduce symptoms, slow progression of disease, prevent complications, minimise disability Nifedipine D-penicilllamine Corticosteroids DMARDs

Answer 10

Exercise programme - Mouth stretching and oral augmentation Sectional dentures Implants

Answer 11

Autoimmune exocrinopathy Primary and secondary (with another systemic autoimmune condition such as RA/SLE) Focal lymphocytic infiltration of salivary and lacrimal glands Incidence 0.5-2% Females only 15% RA pts have secondary SS 30% SLE pts have secondary SS

Answer 12

Genetic predisposition - HLA-B8, HLA-DR3 | Viral agents - herpes viruses (EBV, BMV, HHV6), retroviruses

Answer 13

Lymphatic infiltration of exocrine glands Hypertrophy of ductal epithelium: formation of epimyoepithelal islands Acinar atrophy and fibrosis Probable hyperactivity of B cells

Answer 14

``` Difficulty swallowing/chewing dry food Sensitivity to spicy food Altered salty bitter metallic taste Burning mucosa Lack of diminished taste Salivary gland swelling/pain Cough Voice disturbance Nocturnal discomfort ```

Answer 15

Initially often little change Oral mucosa - dry, atrophic, wrinkled, ulcerated, increased debris Tongue - dry, red, lobulated, loss of papilla Teeth - increased caries Salivary glands - firm on palpation (if swollen)

Answer 16

European diagnostic criteria: - I Ocular symptoms - II Oral symptoms - III Ocular signs - IV Histopathology (Biopsy from salivary gland - lower lip minor salivary glands) - V Salivary gland involvement - VI Autoantibodies Primary SS: - Presence of any 4 of the above items as long as either item IV or VI positive - Presence of any 3 of III, IV, V, VI Secondary SS - Well defined CT disease and presence of item I or II plus any 2 from III, IV and V

Answer 17

``` Worse in pts with: Vasculitis peripheral neuropathy anemia lymphopenia chronic glandular swelling ```

Answer 18

Palliative; - Increase lubrication - Maintain oral/dental health - Review candida status Therapeutic - Pilocarpine - Immunomodulating agents

Answer 19

Symptom of oral dryness May exist with or without hyposalivation Hyposalivation = actual decrease in saliva flow rate

Answer 20

3 Major - Parotid - Submandibular - Sublingual >600 minor salivary glands Within lips/cheeks and palate

Answer 21

Acini = saliva producing cells Serous - watery secretion Mucous - viscous saliva Parotid glands mainly serous cells Other glands mainly mucous

Answer 22

99.4% water Organic solids: - Protein - Gamma globulin - Amylase - Lactoferrin - Glucose - Lipids Inorganic - Sodium - K - Ca - F - Cl

Answer 23

Salivary gland secretion mainly under autonomic nervous control Various hormones may modify salivary composition Salivary flow mainly a result of parasympathetic activity Vasodilation in BVs within glands 2 components of saliva: - Fluid component includes ions produced by parasympathetic stimulation - Protein component arising from secretory vesicles in acini - released in response to sympathetic stimulation Effects of parasympathetic stimulation stronger and longer lasting Parasymp stimulation - copious saliva of low protein concentration Symp stimulation - little saliva but with high protein concentration

Answer 24

``` 500mls saliva in 24hrs Resting flow rate 0.3ml/min Flow rate during sleep 0.1/minute During eating/chewing 4-5ml/minute Unstimulated conditions - 60% saliva from submandibular glands, 20% from parotids and 2-5% from sublingual glands During eating parotid contributes to 50% saliva Smell/taste affect salivary flow Anxiety can decrease salivary flow ```

Answer 25

Lubricant effect Physical cleaner Caries control - buffers acid Saliva saturation with ca and phosphate = prevents demineralisation Pellicle formation - salivary proteins form barrier Antimicrobial Taste Digestion of carbohydrates begins (amylase)

Answer 26

``` Difficulties in oral function and wear of dentures Freq of caries (particularly cervical caries) Acute gingivitis Dysarthria Dysphagia Taste disturbances Susceptibility to oral candida Burning tongue/depapillation of tongue Dry, cracked lips Salivary gland enlargement ```

Answer 27

Physiological: - Dehydration - Mouth breathing - Anxiety Congenital - Salivary gland hypoplasia Iatrogenic - Drugs - antidepressants (tricyclics and SSRIs), antihistamines, diuretics, sedatives etc - Radiation Disease - Sjogren's syndrome - HIV - Sarcoidosis - HCV Congential - Ectodermal dysplasia (hypodontia and missing salivary glands)

Answer 28

Therapeutic doses of radiation for head and neck cancer - permanent reduction in salivary gland function Damage dependent on no and volume of salivary glands exposed 26Gy = threshold below which recovery of 25% stimulated saliva flow rate can occur Saliva can become sticky

Answer 29

``` Does your mouth usually feel dry? Does your mouth feel dry when eating? Difficulty swallowing food? Require liquids to swallow foods? Water to bed at night? Soreness of mouth? Difficulty wearing dentures? Dryness of eye/skin/genital area? ``` ``` PMH Anxiety/depression Drug history SH - smoking/alcohol FH - autoimmune diseases ```

Answer 30

``` General appearance Extraoral - CT disease features, salivary gland swellings Intraoral: - Lack of pooling of saliva in floor of mouth - Dental mirror sticks to mucosa - Food retention - Gingival health - Caries - Candidosis - Depapillation/lobulation of tongue ```

Answer 31

Sialometry Schirmer's test Rose bengal staining Radiological - Ultrasound - Sialography - Salivary scintigraphy - PET scan - MRI - CT Lab based - Immunology - ENA/ANA/Rh factor - Haematology - FBC/CRP/ESR, HbA1c (glucose diabetes) Liver func, thyroid function, immunoglobulins Labial gland biopsy - Examine at least 5 lobules of minor glands Histopathological features supportive of sjogrens: - Acinar loss - Duct dilation - Focal aggregate of at least 50 lymphocytes

Answer 32

``` Directed at underlying cause Prevention key Assess pts before radio and chemo tx Manage xerostomia early Prevent dental complications Multidisciplinary approach often required ``` Improve symptoms - Salivary substitutes - Stimulate saliva - sialogogues - OH Manage candidosis - Antifungals - Denture hygiene Prevent/treat caries, gingivitis: - F- - Antibac MW - OH advice - Scale and polish - Diet advice Investigations - Antibiotics? - USS?

Answer 33

``` Pt education Diet and nutrition counselling Hygiene control Fluoride Microbial control Rehydration therapy Dental tx considerations ```

Answer 34

Avoid soft sticky and liquid diets which promote plaque formation Eliminate salty spicy foods - irritant Non cariogenic foods - suggest sugar substitutes Limit caffeine - dehydration

Answer 35

``` Soft electric toothbrush ID brush, floss Disclosing tablets Children's toothpaste - mint irritant Oranurse toothpaste - bland ```

Answer 36

``` High levels of lactobacilli reported Chlorhexidine rinse Chlorhexidine varnish F rinse has some antimicrobial activity Alcohol containing mouthwashes avoided ```

Answer 37

3-4 monthly visits Consider F applications Remember fragility of oral tissues Consider FS Glass ionomer for provisional restorations Dentine of exposed roots - dentine bonding resin adhesive systems Amalgam more successful than bonded materials Tongue can adhere to and dislodge denture Mucosal irritation and ulceration common Implants - increased comfort and function of prostheses

Answer 38

``` Oral moisturisers Gustatory and mechanical stimulation of salivation Milder toothpastes and alcohol free MW Saliva substitutes Lip creams and ointments Systemic therapy ``` Frequent sips of water Saline solutions Water plus sodium bicarbonate Overuse of water removes mucous saliva from oral tissues = increases dry mouth sensation

Answer 39

Acidic stimulation - uncomfortable and increase enamel demineralisation Sugarless chewing gum Lozenges Acupuncture - Stimulated salivary function affected Electrostimulation

Answer 40

``` Carboxymethyl cellulose, mucin, oils, glycerin Majority of pts prefer water Relief insignificant and short lived Impractical to handle Expensive Mucin may have better pt acceptance ``` ``` ph>6 dentate pts = use saliva orthana ph<6 edentulous subjects = glandosane Glycerin Olive oil Anhydrous crystalline maltose ```

Answer 41

Used when residual secretory capacity in salivary glands exists may use cholinergic agents: Pilocarpine - Approved for tx of radiation induced sjogrens Interferon alpha - Improvement of salivary gland histopathology Infliximab - Increases salivary flow rate - Improved symptoms of oral dryness - Increased risk lymphoma Hydroxychloroquine - Improved oral discomfort - Flow rate increased in 82% pts - Improved oral discomfort - 40% decrease in number of oral infections - Few adverse effects Corticosteroid irrigation of parotid gland - Increased flow rate - Symptom relief - Risk of infec and pain

Answer 42

Flushing, sweating, urinary infrequency

Answer 43

Uncontrolled asthmatics Narrow angle glaucoma Acute iritis

Answer 44

Denture hygiene Do not wear at night Chlorhexidine MW 3x weekly Acrylic dentures soaked in milton solution diluted to 50% with water Metal dentures soaked in 0.2% chlorhexidine

CT Disorders and Xerostomia Flashcards

(68 cards)