Disorders Of Salivation Flashcards
What are the main causes of dry mouth?
Salivary gland disease
Drugs
Medical conditions (eg diabetes/ stroke)
Dehydration
Radiotherapy and cancer treatment
Anxiety
Age
What is the cause of dry mouth with age?
Acinar tissue loss - makes changes in the stimulation more obvious
How is dry mouth tested?
Challacomb scale
According to challocomb scale, what is mild dryness and its treatment
Scores 1-3
1= mirror sticks to mucosa
2= mirror sticks to tongue
3= frothy saliva
Sugar free chewing gum, hydration
According to the challocomb scale, what is moderate dryness and its treatment?
Scores 4-6
4= no pooling of saliva
5= tongue de papillation
5= smooth gingiva
Saliva substitutes
Fluoride
OHI
According to the challocomb scale, what is moderate dryness and its treatment?
Scores 7-10
7= glossy mucosa
8= fissured tongue
9= cervical caries (>2 teeth)
10= debris sticking to palate
Specialist referral
What is Sjögren’s syndrome?
Autoimmune disorder in which exocrine glands are destroyed, causing salivary hypo function.
Primary sjogrens - salivary and lacrimal glands are most affected, and non-specific signs of autoimmune disease such as raynauds is common.
Secondary sjogrens - accompanying connective tissue disorder eg RA
Mouth is less dry than primary
Why might a dry mouth pt complain of soreness?
Superimposed candida infection
Smear sample/ antifungal therapy to exclude this
What is raynauds?
Poor circulation in her fingers
Blanch rapidly in the cold and painful on rewarming
How might a Sjögren’s syndrome pt present?
Long standing xerostomia
Fissured tongue
Glazed/ translucent or thin atrophic gingiva
Carious lesions at cervical margins
Oral debris adhering between teeth (lack of clearance)
What are the tests used for xerostomia? And their results which would indicate xerostomia?
Measuring unstimulated whole saliva - < 2ml in 10mins indicates xerostomia
FBC - mild anaemia is common in autoimmune conditions
Salivary gland ultrasonography/ sialography - snowflake effect
Minor salivary gland biopsy (labial gland biopsy) - histology appearance
Why is a labial gland biopsy indicated (instead of major gland)?
Major gland biopsy risks damage to CNV II
Histological changes in major glands are reflected in minor glands also
What is a risk of labial gland biopsy?
Lip numbness
How is ocular involvement measured?
Schirmer test
Measures lacrimal secretion
Length wetted is recorded after 5 mins (<5mm wetting in 5 mins)
How many glands is required for a reliable labial gland biopsy?
6-8 glands
