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BDS4 Oral Medicine > Salivary Gland Problems & Management > Flashcards

Salivary Gland Problems & Management Flashcards

1
Q

What are the functions of saliva

A
  • buffering
  • mucosal lubrication
  • taste facilitation
  • antimicrobial
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2
Q

How does saliva buffer

A

through the following
* bicarbonate - effective at high flow rates
* phosphates - important at rest
* proteins - limited effect, main action at pH<5

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3
Q

What is mucosal lubrication important for and what proteins are involved

A
  • speech and swallowing
  • mucoproteins
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4
Q

What are mucoproteins

A
  • bind to tooth and epithelial surface
  • forming primary pellicle
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5
Q

What proteins are involved in antimicrobial function

A

cystatin
histatin
lactoferrin
lactoperoxidase
the last 2 give antibacterial function
secretory IgA is present

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6
Q

What are the flow rates in xerostomia

A

less than 50% of normal
unstimulated: <0.1ml/min
stimulated: <0.5ml/min

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7
Q

What are the causes of xerostomia

A
  • drugs
  • medical conditions
  • salivary gland disease
  • dehydration
  • radiotherapy and cancer tx
  • anxiety and somatisation disorders
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8
Q

What drugs can cause xerostomia

A
  • antimuscarinic drugs
  • anticholinergic
  • diuretics
  • cytotoxic
  • lithium
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9
Q

What are antimuscarinic drugs a subtype of

A

anticholinergic drugs

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10
Q

What do anticholinergic drugs to

A

block cholinergic/acetylcholine receptors
divided into antimuscarinic and antinicotinics

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11
Q

What do antimuscarinic drugs do

A
  • inhibit functions of parasympathetic system
  • block muscarinic receptors from the action of acetylcholine
  • acetylcholine acts on salivary glands to produce saliva via calcium activated chloride channels
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12
Q

What are common drugs that are antimuscarinic

A
  • amitryptiline (tricyclic)
  • oxybutynin
  • antipsychotics
  • drugs used to tx parkisons
  • atropine
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13
Q

What is an example of anticholinergic drugs

A

antihistamines

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14
Q

What are diuretics used for and how do they cause dry mouth

A
  • used to tx heart failure and high BP
  • 3 types - loop, thiazide, potassium sparing
  • increases water output - dehydrating effect
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15
Q

What are cytotoxic drugs used for and how do they cause dry mouth

A
  • chemotherapy
  • damages the gland
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16
Q

What is lithium used for

A

bipolar

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17
Q

What chronic medical conditions have an indirect effect on the gland

A
  • diabetes (uncontrolled) - increased urine output
  • stroke - dehydration
  • addison’s
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18
Q

What acute medical conditions have a indirect effect on the gland

A
  • acute oral mucosal disease - dehydration
  • vesiculobullous disease - fluid loss
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19
Q

What medical conditions have a direct effect on the gland

A
  • ectodermal dysplasia
  • sarcoidosis
  • HIV
  • amyloidosis
  • haemachromatosis
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20
Q

What is ectodermal dysplasia and whats its effect on the glands

A
  • glands dont form properly
  • hearing and vision may also be effected
  • may be limited in effect: salivary aplasia
  • teeth may also be effected
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21
Q

What is sarcoidosis and whats its effect on the gland

A
  • inflammatory disease
  • overreaction from immune system
  • granulomatous disesase
  • may see hyperechoic changes and enlargement
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22
Q

How does HIV effect the glands

A
  • lymphoproliferative changes in the gland
  • bulk of gland increases but function decreases
  • acinar tissue gradually lost
  • if unexplained increase in size of glands - HIV test
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23
Q

What is the effect of amyloidosis on the glands

A
  • abnormal protein called amyloid fibrils build up in the tissue
  • build up in tissues including salivary glands
24
Q

What is haemachromatosis and what is its effect on the gland

A
  • increased accumulation of iron in the body
  • excess iron can end up stored in glands preventing function
  • excess ferritin will show in blood
25
Q

How does radiotherapy impact the salivary glands

A
  • reduced vascular supply
  • function of gland reduced
  • doesnt usually return to normal post tx
26
Q

How does graft vs host disease impact the glands

A
  • immune damage to the glands
27
Q

How do antineoplastics and radioiodine impact the glands

A
  • will damage acinar cells and prevent gland function
28
Q

What are the different salivary gland diseases that can impact gland function

A
  • developmental anomalies
  • sialadenitis (bacterial, viral, radiation)
  • sialoliths
  • sjogrens
  • sialodenosis
  • salivary gland tumours (adenoma/carcinoma)
29
Q

What are somatoform disorders

A
  • psychiatric disorders causing unexplained symptoms
30
Q

How does anxiety result in ‘dry mouth’

A
  • anxiety can cause inhibition of salivation so chronic anxiety can cause chronic reduction in saliva
  • anxiety can also alter perception - flow may be normal but percieved differently
  • however anxiety can also inhibit swallowing resulting in the opposite of dry mouth
31
Q

What are examples of other somatoform disorders

A
  • oral dysaesthesia
  • tmd pain
  • dyspepsia
  • IBS
32
Q

How is xerostomia classified

A

challcombe scale

33
Q

How is the challocombe scale used

A

additive score
each symptom is one point

34
Q

What are the different symptoms assessed in the challacombe scale

A

Dental mirror sticks to buccal mucosa
Mirror sticks to tongue
Saliva frothy
No saliva pooling in floor of mouth
Tongue shows generalised shortened papillae (mild depapillation)
Altered gingival architecture (i.e. smooth)
Glassy appearance of oral mucosa, especially palate
Tongue lobulated/fissured
Cervical caries (more than two teeth)
Debris on palate or sticking to teeth

35
Q

What is the management for a score of 1-3

challacombe scale

A
  • no tx or management needed
  • sugar free gum for 15 mins twice daily
  • hydration
  • routine checkups
36
Q

What is the management for scores 4-6

A
  • sugar free gum or simple sialogogues may be required
  • investigations for dryness if reason not clear
  • saliva subtitutes
  • topical fluoride
  • monitor regularly
  • look out for decay and symptom change
37
Q

What is the management for scores 7-10

A
  • saliva substitutes
  • topical fluoride
  • acertain cause of hyposalivation
  • exclude sjogrens
  • monitor for change in symptoms
  • referral to specialist if worsening
38
Q

What are the investigations that can be done for xerostomia

A
  • bloods
  • functional assay (flow rates)
  • tissue assay
  • imaging
39
Q

What bloods can be taken for xerostomia

A
  • fbc
  • u/e
  • lft
  • crp
  • glucose
  • antibodies
  • complement c3 and c4
40
Q

What antibodies would we test for in xerostomia

A

anti ro and anti la
antinuclear antibody
sjogren test

41
Q

Where is the biopsy taken for in tissue assays

A

labial gland biopsy
for minor salivary glands
taking biopsy from major ones too invasive and risky

42
Q

What images can be taken for xerostomia

A
  • plain radiographs
  • sialography
  • MRI sialography
  • ultrasound
43
Q

What causes of dry mouth can be treated

A
  • dehydration
  • medication
  • poor diabetic control
  • somatoform disorder
44
Q

What causes of dry mouth require symptomatic tx, cause cannot be treated

A
  • sjogrens
  • cancer tx
  • salivary gland disease
45
Q

What can symptomatic tx of xerostomia be divided into

A
  • intense prevention
  • salivary subtitutes
46
Q

What does intense prevention consist of

A
  • caries RA
  • candida/staphylococci awareness - good OH and low sugar diet
  • fluoride
47
Q

What are the different salivary subtitues

A
  • sprays
  • lozenges
  • salivary stimulants
  • oral care system
  • sugar free gum
  • water frequently
48
Q

What are the different saliva sprays

A

glandosane
saliva orthana

49
Q

Why is use of glandosane discouraged

A

acidic

50
Q

What are the different saliva lozenges

A

saliva orthana
SST

51
Q

What is an example of a salivary stimulant

A

pilocarpine

52
Q

What are true causes of hypersalivation

A
  • drugs
  • dementia
  • CJD
  • stroke
53
Q

What are percieved causes of hypersalivation (flow is normal)

A
  • swallowing failure
  • postural drooling
54
Q

What conditions may result in swallowing failure

A
  • anxiety
  • stroke
  • mnd
  • ms
55
Q

What conditions may result in postural drooling

A

cerebral palsy
struggle to keep head up

56
Q

What is the management options for hypersalivation

A
  • treat cause
  • reduce salivation through drugs e.g antimuscarinics or botox
  • biofeedback training to improve swallowing, good for stroke px
  • surgery to remove or move gland

BDS4 Oral Medicine (17 decks)

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