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Oral Medicine > Dry mouth & salivary gland disease > Flashcards

Dry mouth & salivary gland disease Flashcards

1
Q

Definition of xerostomia?

A

Dry mouth resulting from reduced or absent salivary flow

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2
Q

Definition of hyposalivation?

A

Objective reduction in salivary secretion due to reduced salivary gland function

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3
Q

What is the function of saliva?

A

Lubrication - aids speech & swallowing

Antimicrobial & defensive properties

Taste perception

Amylase & lipase

Lavage (washing) & buffering properties

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4
Q

Aetiology of xerostomia?

A
  1. Dehydration/reduced fluid intake
  2. Habits (e.g. mouth breathing)
  3. Medication
  4. Salivary gland disease
  5. Systemic disease
  6. Nerve damage
  7. Psychological
  8. Age
  9. Idiopathic
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5
Q

Examples of salivary gland diseases?

A

Infections (viral/bacterial) [e.g. mumps]

Obstructions [e.g. meal time syndrome, mucocele/ranula]

Tumours [benign/malignant on major/minor salivary glands]

Degenerative disease [e.g. Sjogren’s]

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6
Q

HPC Qs if a pt c/o dry mouth?

A

Have you had a daily feeling of dry mouth for more than 3 months? (Transient dry mouth is common, causes include anxiety & sports => dehydration. - distinguishes from chronic dry mouth)

How much water do you drink a day? (Distinguish from dehydration)

Do you drink liquids to aid in swallowing dry foods?

Do you wake up at night to drink liquids?

Have you had recurrent/persistent
swollen salivary glands?

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7
Q

Which medications are xerogenic?

A

Cardiovascular agents, incl. antihypertensive drugs

Antidepressants

Tranquilizers & hypnotics

Anti-psychotic agents

Amphetamine derivatives

Anticonvulsants

Anti-Parkinsonian drugs

Some gastro-intestinal & genitourinary systems agents

Respiratory system & anti-allergic agents, incl. antihistamines

Some steroidal & NSAIDs

Anti-neoplastic agents

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8
Q

Examples of systemic diseases which can cause xerostomia?

A

Sjögren’s syndrom, poorly controlled Diabetes, liver diseases, amyloidosis, sarcoidosis, thyroid disease & HIV-related salivary gland disease

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9
Q

What to note in e/o exam when a pt c/o dry mouth?

A

TMJ symmetry

Palpation of salivary gland - note any pain/tenderness, size of swelling, mobility, whether fixed or not, appearance of surrounding skin & cervical lymphadenopathy

Nerve weakness in CNVII (e.g. malignant tumours invading more => facial palsy)

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10
Q

What would make you worried that there is a malignancy?

A

New onset of pain

Rapid growths

Facial nerve weakness

Paraesthesia

Hoarseness of voice

Skin & cervical LN involvement (lymphadenopathy)

Fixed lesions

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11
Q

What are the 2 common benign epithelial salivary gland tumours?

A

Pleomorphic adenoma

Warthin tumour

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12
Q

What type of tumour is a haemangioma?

A

Benign non-epithelial

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13
Q

What are some malignant epithelial salivary gland tumours?

A

Mucoepidermoid carcinoma

Adenoid cystic carcinoma

Carcinoma ex-pleomorphic adenoma

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14
Q

What is Sjögren’s syndrome characterised by?

A

Inflammation of exocrine glands (mainly salivary & lacrimal)

Lymphocyte infiltration

=> Xerostomia & xerophthalmia

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15
Q

E/O features of Sjogren’s syndrome?

A

Keratoconjunctivitis sicca (‘Dry eyes’) & lacrimal gland secretion inability

Dryness of mucosal membranes (e.g. throat or genitals) & skin

Rheumatoid arthritis or other CT diseases

Fatigue/fibromyalgia

Raynaud’s phenomenon

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16
Q

I/O features of Sjögren’s syndrome?

A

Cracked lips

Oral burning sensation or soreness

Dry & atrophic mucosa

No/lack of saliva pooling

Sticky or glassy mucosa (mirror easily adheres to)

Painful salivary gland infection (sialadenitis) +/- SG swelling, pain & fever

Oral candidiasis

=> increased DMF, halitosis, distinctive cervical & incisal caries pattern, difficulties speaking, eating, swallowing, denture wear; diminished taste sensation & interrupted sleep

17
Q

How to diagnose SS?

A

Saliva analysis

FBC

Serology

Radiography

Biopsy

18
Q

How to manage hyposalivation?

A

Regular dental visits, OHI, Fluoride m/w, diet advice (reduce sugar frequency, avoid caffeine, carbonated drinks, alcohol, tobacco & strong foods which may irritate mouth) & tx/prevention of candidiasis

Sip water frequently (especially when eating & speaking)

Use SF gum/sweets to stimulate salivary flow

Artificial saliva substitutes

Use humidifier (especially at night)

19
Q

Pharmacological therapy for hyposalivation?

A

Pilocarpine used severe dry mouth

20
Q

Non-pharmacological therapy for dry mouth?

A

Acupuncture or electrotherapy

21
Q

Complications of Sjögren’s syndrome?

A

Lymphoma

Neonatal heart block

Untreated dry eyes/infection => Corneal ulcers => eye damage & loss of vision

Oral Medicine (9 decks)

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