Mixed Connective Tissue Disorders Flashcards by Francesca Savio

Difference between xerostomia and hyposalivation?

Xerostomia is symptom of oral dryness

Hyposalivation - decrease saliva flow rate

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What are 3 major salivary glands?

Partoid - largest gland
Sublingual
Submandibular

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What are acini?

Saliva producing cells

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Difference between serous and mucous saliva?

Serous - watery

Mucous - viscous

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What saliva does parotid produce?

Serous

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Main component of saliva?

Mainy water

Organic and inorganic solids

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Example of organic solids in saliva?

Proteins
Amylase
Lipids
Amino acids
Glucose

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Example of inorganic solids in saliva?

Sodium
Calcium
Chloride
Fluoride

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How is saliva formed?

Secretion under autonomic nervous control
Hormones modify saliva composition
Increased flow as result parasympathetic activity

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What are 2 components of saliva?

Fluid component - ions product by parasympathetic stimulation
Protein competent - arise secretory vesicle in acini - sympathetic stimulation

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If have parasympathetic stimulation what type of saliva?

Lots of saliva w/ low protein conc

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If have sympathetic stimulation what type of saliva?

Low flow with high protein conc

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Average salivary flow rate?

500ml in 24 hours

Expect to be reduced at night

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What gland produces most of saliva in unstimulated conditions?

Submandibular

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Which glands produces most saliva when eating?

Parotid

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What measure unstimulated saliva flow?

Spit graduated container for 15 mins

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What amount of unstimulated saliva flow would suggest reduced function?

Less 1.5ml in 15 min

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How take stimulated salivary flow?

Place citric acid dorsal tongue

Place carlsson-crittenden cup over parotid orifice

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What flow would suggest reduced functional salivary flow rate?

less 5ml in 5 minutes

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What are functions of saliva?

Lubrication
Physical cleanswer
Caries control - buffer
Antimicrobial 
Taste
Digestion - amylaste
Pellcile formation

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Effects of xerostomia?

Difficulty oral function
Increased caries
Gingivits
Dysphagia
Taste distrurbance
Increased susceptibility oral candidosis
burning tonuge
dry sore mucosa 
salivary gland enlargement

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What are factors associated with hyposalivation/ xerostomia?

Anxiety/ depression
Drugs
Radiotherapy 
Dehydration
Diabetes

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What can congenital xerostomia be related to?

ectodermal dysplasia

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What drugs can be linked to xerostomia?

Antidepressants - tricyclics/ SRRIS
Antihistamines
Diuretics
Antichloinergics
Antipsychoitcs
Sedatives

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What are confounding factors for drug related xerostomia?

Age Smoking Psychological factors

Issue with radiotherapy?

Therapeutic dose = permanet reduction salivary gland function Damage depends on amount salivary glands exposed

How does radiotherapy damage glands?

Acute inflammatory reaction Fibrosis within glands Reduced blood flow Loss acini cells

Oral problems w/ radiotherapy?

Reduced saliva | Increase risk caries/ candidosis/ dysphagia

What are 3 causes of xerostomia?

Autoimmune Infection Rare causes

Examples of autoimmune cause xerostomia?

Sjogrens | Sarcoidosis

Examples of infections cause xerostomia?

HIV related | EBV

Rare causes of xerostomia?

Amlyodosis | Salivary gland agenesis

Qs to ask pt with xerostomia?

``` Does mouth usually feel dry Dry when eating Diff swallowing Diff wearing dnetures Soreness mouth ```

Important factors to note when taking hx of xerosotmia?

PMH Anxiety/ depression Drug hx Smoking hx

Extra-oral features of xerostomia?

Connective tissue diseases | Salivary gland swelling

Intra-oral findings of xerostomia?

``` Sticky musoca Food retention Caries Candidosis Depapillation of tongue Lack saliva ```

3 ways to investigate xerostomia?

Clinical Radiological Lab-based

Clinical tests of xerosotmia?

Sialometry | Schirmers test

Radiological tests of xerostomia?

Ultrasound | Sialography

Lab based tests of xerostomia?

Immunological tests - ENA/ANA/RF Haematological tests - FBC/ ESR/ CRP Antibody tests

What would expect to see sialogram in those w/ xerostomia?

Punctate sialectasis = snow storm effect

How should biopsy be done in those w/ xerostomia?

Examination at least 5 lobules of minor glands

Features in histo-pathology of those w/ xerostomia?

Similar sjogrens | Acinar loss, focal lymphocytic infiltrate, fibrosis

Tx of xerostomia?

Tx of underlying causes Prevention - oral health management Salivary prodcuts/ substitutes

Management of xerostomia

1. improve symptoms: salivary substitues 2. prevention oral disease -F supplements, mouth rinse, OHE 3. Manage candidosis 4. investigate causes

What is involved in dental caries prevention?

Education - diet/ hygiene/F-

What diet advice should be given?

Avoid soft sticky foods Eliminate spicy foods - irritant Limit caffeine = dehydration

Why do those with xerostomia struggle with dentures?

``` Common mucosal irritation and ulcers dry tissues (esp tongue) dislodge dentures ```

Management of dry mouth?

``` Saliva subsitutes Gustatory/mechanical stimulants Oral moisturisers F- Lip creams ```

Practical advice to give those w/ xerostomia?

Frequent sips of water can wash away saliva

Examples of stimulants which can help with xerostomia?

Acidic stimulation - issue enamel demin Sugarless chewing gum Lozenges

Issue w/ salivary substitutes?

Relief often insignificant and short lives Unpalatable Impractical Expernsive

What consider when giving salivary subsitutes?

Its pH and if pt is dentate or edentulous | If pt dentate needs pH >6

What saliva substitute can't be used on dentate pt

Glandosane

Issue saliva orthana?

Has animal products

When can cholinergic be used

Is have residual salivary capacity - use cholinergic agents

Example of cholinergic agent?

Pilocarpine

What does pilocarpine do?

Targets all exocrine glands | Increases salivary output

Adverse effect pilocarpine?

Flushing, sweating, urinary frequency

Contraindication pilocarpine?

Asthamtics - uncontrolled (increased secretion in lungs) | Narrow angle glaucoma

Examples of systemic therapy for sjogrens?

Cholingergics Infliximab Hydroxychloroquine

What is infliximab?

TNF blocker that can increase salivary flow rate

What is infliximab increase risk of?

Lymphoma

Adv of hydroxychlorquine?

Increased flow rate and oral discomfort | Few adverse effects

What systemic treatment can increase risk of infection and pain?

Corticosteroid irrigation of parotid

How prevent oral candidosis?

Denture hygiene | CHX mouthwash 3x weekly

factors increase susceptibility oral candidosis?

dentures, immunosuppression, diabetes, broad spec ab

Tx of oral candidosis?

Topical antigunfals - nystatis/ miconazole gel

First line tx of ascending parotitis?

Amoxilcillin

Mixed Connective Tissue Disorders Flashcards

(69 cards)