Salivary Gland Problems & Management Flashcards
(56 cards)
1
Q
What are the functions of saliva
A
- buffering
- mucosal lubrication
- taste facilitation
- antimicrobial
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
3
Q
What is mucosal lubrication important for and what proteins are involved
A
- speech and swallowing
- mucoproteins
4
Q
What are mucoproteins
A
- bind to tooth and epithelial surface
- forming primary pellicle
5
Q
What proteins are involved in antimicrobial function
A
cystatin
histatin
lactoferrin
lactoperoxidase
the last 2 give antibacterial function
secretory IgA is present
6
Q
What are the flow rates in xerostomia
A
less than 50% of normal
unstimulated: <0.1ml/min
stimulated: <0.5ml/min
7
Q
What are the causes of xerostomia
A
- drugs
- medical conditions
- salivary gland disease
- dehydration
- radiotherapy and cancer tx
- anxiety and somatisation disorders
8
Q
What drugs can cause xerostomia
A
- antimuscarinic drugs
- anticholinergic
- diuretics
- cytotoxic
- lithium
9
Q
What are antimuscarinic drugs a subtype of
A
anticholinergic drugs
10
Q
What do anticholinergic drugs to
A
block cholinergic/acetylcholine receptors
divided into antimuscarinic and antinicotinics
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
12
Q
What are common drugs that are antimuscarinic
A
- amitryptiline (tricyclic)
- oxybutynin
- antipsychotics
- drugs used to tx parkisons
- atropine
13
Q
What is an example of anticholinergic drugs
A
antihistamines
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
15
Q
What are cytotoxic drugs used for and how do they cause dry mouth
A
- chemotherapy
- damages the gland
16
Q
What is lithium used for
A
bipolar
17
Q
What chronic medical conditions have an indirect effect on the gland
A
- diabetes (uncontrolled) - increased urine output
- stroke - dehydration
- addison’s
18
Q
What acute medical conditions have a indirect effect on the gland
A
- acute oral mucosal disease - dehydration
- vesiculobullous disease - fluid loss
19
Q
What medical conditions have a direct effect on the gland
A
- ectodermal dysplasia
- sarcoidosis
- HIV
- amyloidosis
- haemachromatosis
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
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
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
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
How does radiotherapy impact the salivary glands
* reduced vascular supply
* function of gland reduced
* doesnt usually return to normal post tx
26
How does graft vs host disease impact the glands
* immune damage to the glands
27
How do antineoplastics and radioiodine impact the glands
* will damage acinar cells and prevent gland function
28
What are the different salivary gland diseases that can impact gland function
* developmental anomalies
* sialadenitis (bacterial, viral, radiation)
* sialoliths
* sjogrens
* sialodenosis
* salivary gland tumours (adenoma/carcinoma)
29
What are somatoform disorders
* psychiatric disorders causing unexplained symptoms
30
How does anxiety result in 'dry mouth'
* 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
What are examples of other somatoform disorders
* oral dysaesthesia
* tmd pain
* dyspepsia
* IBS
32
How is xerostomia classified
challcombe scale
33
How is the challocombe scale used
additive score
each symptom is one point
34
What are the different symptoms assessed in the challacombe scale
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
What is the management for a score of 1-3
| challacombe scale
* no tx or management needed
* sugar free gum for 15 mins twice daily
* hydration
* routine checkups
36
What is the management for scores 4-6
* 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
What is the management for scores 7-10
* saliva substitutes
* topical fluoride
* acertain cause of hyposalivation
* exclude sjogrens
* monitor for change in symptoms
* referral to specialist if worsening
38
What are the investigations that can be done for xerostomia
* bloods
* functional assay (flow rates)
* tissue assay
* imaging
39
What bloods can be taken for xerostomia
* fbc
* u/e
* lft
* crp
* glucose
* antibodies
* complement c3 and c4
40
What antibodies would we test for in xerostomia
anti ro and anti la
antinuclear antibody
sjogren test
41
Where is the biopsy taken for in tissue assays
labial gland biopsy
for minor salivary glands
taking biopsy from major ones too invasive and risky
42
What images can be taken for xerostomia
* plain radiographs
* sialography
* MRI sialography
* ultrasound
43
What causes of dry mouth can be treated
* dehydration
* medication
* poor diabetic control
* somatoform disorder
44
What causes of dry mouth require symptomatic tx, cause cannot be treated
* sjogrens
* cancer tx
* salivary gland disease
45
What can symptomatic tx of xerostomia be divided into
* intense prevention
* salivary subtitutes
46
What does intense prevention consist of
* caries RA
* candida/staphylococci awareness - good OH and low sugar diet
* fluoride
47
What are the different salivary subtitues
* sprays
* lozenges
* salivary stimulants
* oral care system
* sugar free gum
* water frequently
48
What are the different saliva sprays
glandosane
saliva orthana
49
Why is use of glandosane discouraged
acidic
50
What are the different saliva lozenges
saliva orthana
SST
51
What is an example of a salivary stimulant
pilocarpine
52
What are true causes of hypersalivation
* drugs
* dementia
* CJD
* stroke
53
What are percieved causes of hypersalivation (flow is normal)
* swallowing failure
* postural drooling
54
What conditions may result in swallowing failure
* anxiety
* stroke
* mnd
* ms
55
What conditions may result in postural drooling
cerebral palsy
struggle to keep head up
56
What is the management options for hypersalivation
* 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
