Saliva Disorders Flashcards
(131 cards)
What special tests can be done to investigate salivary disease?
Bloods
Functional assays
Tissue assays
Imaging (inc. sialograhy/ultrasound)
How can anxiety cause a disorder in saliva production?
Cephalic control of salivation leading to too little saliva.
Cephalic control of perception leading to too little saliva.
Inhibition in swallowing leading to too much saliva.
What is a somatoform disease?
A disease process with symptoms that cannot be properly explained or identified.
List six common somatoform diseases.
Oral Dysaesthesia
TMD pain
Headache
neck/back pain
Dyspepsia
Irritable Bowel Syndrome (IBS)
What is the normal rate of resting salivary flow?
0.3-0.4mL/min
What is the normal rate of stimulated salivary flow?
1-2mL/min
What rates of salivary flow would be considered hyposalivation, both resting and stimulated?
<0.1mL/min resting
<0.5mL/min stimulated
Which causes of dry mouth can be treated to resolve the symptoms?
Dehydration
Medicines with anti-muscarinic side effects
Medicines causing dehydration
Poor Diabetes control – type 1 or type 2
Somatoform Disorder – diagnosis of exclusion
Which diseases can the dry mouth be treated, but not fully resolved?
Sjögren’s Syndrome
Dry mouth from cancer treatment
Dry mouth from salivary gland disease
What is the treatment for dry mouth where the underlying cause cannot be resolved?
Intensive prevention
Salivary substitutes
Salivary stimulants
What blood tests should be done when investigating dry mouth?
Dehydration – U&Es, Glucose
Autoimmune disease – ANA, Anti-Ro, Anti-La (ENA Screen), CRP
Complement levels – c3 and c4
What special tests might an optitian be able to provide with regards to investigating dry mouth?
Assessment of tear film (preferred)
Schirmer test – tear flow less than 5mm wetting of test paper in 15 mins
How should a dentist manage???????????????
Prevent oral disease
Caries risk assessment
Candida/staphylococci
Angular chelitis
Sore tongue
Maximal preventative strategy
Diet!
Fluoride
Treatment Planning for a caries risk mouth
List four true causes of hypersalivation.
Drug causes
Dementia
CJD
Stroke
List six perceived causes of hypersalivation (causes where there is no increase in flow rate).
Swallowing Failure
Anxiety
Stroke
Motor Neurone Disease
Multiple Sclerosis
Postural Drooling
Being a baby
Cerebral Palsy
What treatment options are there for hypersalivation?
Treat the Cause
Anxiety disorders
Drugs to reduce salivation
Anti-muscarinic agents
Botox to prevent gland stimulation
Biofeedback training
Swallowing control
Surgery to salivary system
Gland removal
Duct repositioning
What clinical signs can be used to assess salivary issues?
E/o examination of major salivary glands
I/o examination of minor salivary glands, ducts, fluid levels
What is the function of saliva?
Acid buffering
Mucosal lubrication (for speech and swallowing)
Taste facilitation
Antibacterial role
What are the main broad causes of xerostomia?
Salivary gland disease
Drugs
Medical conditions + dehydration
Radiotherapy and cancer treatments
Anxiety & somatization disorders
Why does the incidence of xerostomia increase as a patient gets older?
Acinar tissue loss of the major salivary glands, can be between 30-45% of tissue loss leading to reduced function.
What is an indirect problem with a salivary gland?
A problem which does not affect the gland itself, but is results in impacted salivary gland problem.
Give six examples of medications that can cause indirect salivary problems.
Tricyclic anti-depressants
Anti-psychotics
Anti-histamines
Atropine
Diuretics
Cytotoxics
Give six examples of medical conditions that can cause indirect salivary problems.
Diabetes (type 1 and type 2)
Renal disease
Stroke
Addison’s disease
Vomiting conditions
Acute oral mucosal diseases/injuries
List five direct salivary gland problems that can lead to xerostomia?
Aplasia (ectodermal dysplasia)
Sarcoidosis
HIV disease
Gland infiltration
Cystic fibrosis