pemphigus and salivation

Question 1

what is the most common form of pemphigus

Answer 1

pemphigus vulgaris

Question 2

what do antibodies attack in pemphigus

Answer 2

desmosomes
they join epithelial cells together therefore adhesion is lost and intra epithelial bullae form

Question 3

describe a pemphigus blister

Answer 3

intra epithelial bullae
few cells above and round lesion therefore epithelial layer will thin and eventually disappear
rare to see intact bullae
will present as mucosal erosion and surface loss

Question 4

what cells are characteristic of pemphigus

Answer 4

tzank cells

Question 5

what will direct immunofluorescence show if pemphigus is present

Answer 5

antibody binding all around cells
characteristic ‘basket weave’

Question 6

name 3 functions of saliva

Answer 6

acid buffering
mucosal lubrication - aids speech and swallowing
taste facilitation

Question 7

name 3 potential causes of a dry mouth

Answer 7

salivary gland disease
drugs
medical conditions
radiotherapy and cancer treatment
anxiety

Question 8

amyloidosis

Answer 8

deposition of protein amyloid
can be deposited in salivary glands preventing proper function and leading to dry mouth

Question 9

haemachromatosis

Answer 9

excess storage of iron within tissues eventually preventing function
can occur in salivary glands
FBC will show very high ferritin levels

Question 10

describe 1-3 on the challacombe scale

Answer 10

mild dryness, sugar free gum and attention to hydration needed
1. mirror sticks to buccal mucosa
2. mirror sticks to tongue
3. saliva frothy

Question 11

describe 4-6 on the challacombe scale

Answer 11

moderate dryness, sugar free gum recommended. substitutes and topical fluoride may be helpful
4. no saliva pooling in floor of mouth
5. mild depapillation on tongue
6. altered gingival architecture e.g smooth

Question 12

describe 7-10 on the challacombe scale

Answer 12

indicates severe dryness, saliva substitues and topical fluoride needed
7. glassy appearance of mucosa
8. tongue lobulated/ fissured
9. cervical caries on more than 2 teeth
10. debris on palate

Question 13

describe the unstimulated whole salivary flow test

Answer 13

patient given tube to spit into and volume of saliva produced is measured over 15 mins
If more than 1.5ml produced in 15 mins they dont have an objective dry mouth

Question 14

name 2 situations where a patient may think they have hypersalivation

Answer 14

cerebral palsy - postural drooling - difficulty keeping head in upright position makes swallowing a challenge
stroke - swallowing failure

Question 15

what surgery may be done to combat postural drooling

Answer 15

duct repositioning e.g into pharynx

Question 16

name 3 symptoms of mumps

Answer 16

headache, joint pain , dry mouth , nausea , appetite loss, tiredness, pyrexia of 38 and above

Question 17

sialolith

Answer 17

salivary stones
calcified mass
most common in submandibular duct or gland

Question 18

sialadenitis

Answer 18

salivary gland infection

Question 19

sialosis

Answer 19

persisitng unexplained enlargement of one or more major salivary glands
most often bilateral