oral medicine Flashcards
(15 cards)
salivary gland swelling: main differentials
- whole gland swollen? obstruction (stone/stricture), infection, sialosis
- salivary gland lump (within the gland): lymph node- infection or metastasis, salivary tumour- PSA, warthin’s, carcinoma ex PSA, acinic cell, adenoid cystic carcinoma, mucoepidermoid carcinoma, large salivary stone
- intraoral swelling: salivary gland: sublingual, minor)- obstruction, tumour, mucus extravasation cyst .
bone- torus, infection: chronic or acute abscess, cyst, mucosa: benign- papilloma, malignant- SSC. - lip lumps: mucus retention cyst, mucus extravasation cyst, minor salivary gland tumour
salivary gland LUMP within the gland: differentials
- lymph node: infection. metastatis: intraoral, extraoral, lymphoma
- salivary tumour:
-benign: PSA, warthins tumour
-malignant: carcinoma ex PSA, adenoid cystic carcinoma
-variable: acinic cell carcinoma, mucoepidermoid carcinoma - large salivary stone
sjogren’s
what it is
types
causes
-autoimmune chronic inflammatory disease involving the salivary and lacrimal glands.
destruction of salivary acini as the body produces antibodies that damage the acini. characterised by polyclonal b-cell proliferation as a result of t-cell regulation.
types:
1. primary sjogren’s: dry mouth and dry eyes. oral and eye dryness is more severe in this type.
2. secondary sjogren’s: dry mouth and/or dry eyes WITH a systemic disorder (RA, systemic lupus erythematosus, connective tissue disease, primary biliary cirrhosis)
can experience widespread symptoms: nasal and vaginal dryness, dysphagia and dry skin
sjogren’s:
investigations to give diagnosis and imaging
clinical diagnosis
1. sialometry: whole salivary flow rate test (will be less than or equal to 0.1ml/min
2. schirmer’s test: less than or equal to 5ml/min at least one eye
3. scarring/ulceration of the cornea if not protected by tears
4. blood test for auto-antibodies
5. labial gland biopsy
imaging: sialography
sjogren’s: management
multidisciplinary team management
referral to ophthalmologist
pt education re lymphoma risk
specialist referral if diagnosis unclear
dry mouth management:
-diet, fluoride, OHI
-manage fungal/bacterial infections
-stimulation of saliva agents: sugar free chewing gum, sugar free pastilles, e.g. salivix or saliva stimulating tablets
-artificial saliva
-saliva substitutes: mucin based, gels containing enzymes normally present in saliva, e.g. bioXtra
-Preventive advice relating to high caries. and perio risk in dentate pts, fluoride toothpaste 5000ppm
-sialogogues, e.g. prilocarpine beneficial in radiation-induced xerostomia and sjogren’s
-longer-acting gels, e.g. oral balance gel used in pts with dry mouth symptoms worse at bedtime
sjogren’s: high risk groups of people
middle aged females
HIV
therapeutic immunosuppressants
graft vs host disease
sjogren’s: signs and symptoms
oral symptoms:
-dry mouth every day for the past 3 months
-persistent/recurrent salivary gland swelling
-need to take lots of water to swallow food
eye symptoms:
-dry eyes every day for the past 3 months
-sand/grit sensation in the eyes
-tear/substitute drops more than 3x a day take?
scarring/reduced vision
pt complains of difficulty eating dry foods and the tongue adhering to the palate. symptoms usually worse at night and sleep may be disturbed
difficulty in swallowing, speech, and wearing dentures
the oral mucosa looks glazed, lobulate, beefy-red tongue
oral candidiasis (acute pseudomembraneous) is common and there may be patches of erythema or ulceration
sudden expansion may cause: obstruction, acute infection or transformation to malignant lymphoma (5%)
questions to ask the patient if you suspect sjogren’s
a positive pt response to at least 1 of these 5 questions:
1. daily, persistent and troublesome dry eyes for more than 3 months?
2. recurrent sensation of sand/gravel in eyes?
3. do you use tear substitutes more than 3x a day?
4. have you had a daily feeling of dry mouth for more than 3 months?
5. do you frequently drink liquids to aid swallowing dry food?
exclusion criteria for sjogren’s
past head and neck radiation
AIDS
sarcoidosis
graft vs host disease
hep c
complications of sjogren’s
dental:
-reduced QOL
-caires and perio risk increased
eyes:
-scarring
-reduced vision
lymphoma risk:
-5% of lymphoma development: ensure pt is aware of this so need a follow-up
dry mouth management: our role
-diet, fluoride, OHI
-manage fungal/bacterial infections
-stimulation of saliva agents: sugar free chewing gum, sugar free pastilles, e.g. salivix or saliva stimulating tablets
-artificial saliva
-saliva substitutes: mucin based, gels containing enzymes normally present in saliva, e.g. bioXtra
-Preventive advice relating to high caries. and perio risk in dentate pts, fluoride toothpaste 5000ppm
-sialogogues, e.g. prilocarpine beneficial in radiation-induced xerostomia and sjogren’s
common causes of dry mouth
-drugs: antihistamines, antidepressants, diuretics, PPIs omeprazole
-dehydration
-sjogren’s
-irradiation
-neurological: anxiety
-salivary gland damage
clinical presentation of dry mouth
dry, lobulated tongue
depapillation of tongue
atrophic (thin) red mucosa
glazed glassy appearance of mucosa
high caries especially in cervical areas
angular chelitis
candidiasis: thrush
taste changes
how can salivary glands get damaged?
sjogrens
radiotherapy
sarcoidosis
HIV
hep c
cystic fibrosis
problems dry mouth can cause
high caries/perio risk
problems with denture retention
difficulty speaking/swallowing
debris cleaning
loss of taste or unpleasant due to loss of enzymes
