Xerostomia

• xerostomia?


  abnormal reduction of saliva caused by local factors, adverse se of medications or adverse se of certain diseases
• local factors?

  • tobacco
  • alcohol
  • mouth breathing
• examples of drugs that cause xerostomia?

  Tricyclic antidepressants, antipsychotics, benzodiazepines, Beta-blockers, antihistamines, anticholinergics, diuretics, vasodilators and decongestants
• example of alpha-sympathomimetic?

  methyldopa
• example of analgesic?

  • codein
  • dihydrocodein
  • hydrocodon
  • morphin
  • pethiclin
  • fentanly
  • tramadol
• chemotherapy?

  • dysgeusia. dysphagia, dysphonia
  • related to total number of drugs used for tx
  • Paclitaxel, Carboplatin, 5-fluoruracil infusion & Rx
• radiotherrapy?

  • salivary tissue sensitivity to radiation damage
  • parotid gland most damaged
  • degree of xerostomia depends on degree of exposure of the salivary tissue
• psychogenic?

  • depression
  • anxiety
  • stress
  • fear
• Sjogrens Syndrome?

  Chronic multisystemic immune-mediated disorder characterized by inflammation and destruction of exocrine glands leading to clinical symptoms of dryness, particularly of the eyes and the mouth. Primary or secondary.
• primary sjogrens:

  • common autoimmune disease
  • 0.1-0.6% women, 9:1
  • features include: fatigue, oral + ocular symptoms, rashes, peripheral neuropathies, non-erosive arthiritis
• secondary sjogren's:

  • ocular, oral, connective tissue disorders eg rheumatoid arthiritis, systemic lupus erythematous
• investigations for sjogrens?


  • immunology: IgG, IgM, IgA, Anti-Ro, Anti-La, Complement C3-C4
  • Salivary gland biopsy
  • sialometry
  • sialography
  • ultrasound scan
• how do we classify SS?


  american-european consensus diagnostic criteria
• Sialometry?


  salivary flow rate estimation, non-specific, dribble into a container to measure over 15mins
• normal salivary flow rate?


  >1.5ml/15 mins
• Sialography?


  • radiographic investigation of salivary glands
  • radiopaque dye in salivary duct to show if obstructer or dilation
  • risk of discomfort and infection
• pt with SS

  
• labial gland biopsy

  
• prognosis?


  • risk of developing b cell non hodgkins lymphoma
  • predictors: persistant gland swelling, hypocomplementaemia, cutaneous vasculiris
• tx?


  • Currently not effective therapy that can alter the progress of the disease
  • symptomatic therapies for ocular/oral symptoms
  • hydroxychloroquine for fatigue
  • prednisolone, azathioprine, ciclosporine, MMF
• other diseases that cause xerostomia?


  • diabetes
  • HIV
  • sarcoidosis
  • chronic graft vs host disease
  • salivary gland agenesia
• clinical symptoms?


  • need to sip water, suck sweets, chew gum
  • lips and tongue stick to teeth and palate
  • difficulty in speech and swallowing
  • food debris in mouth
  • loss of taste/ altered taste
  • poor denture retention
• clinical signs?


  • sticky mucosa
  • fissured tongue and lips
  • no pooling in FOM
  • no expression from salivary ducts
  • food debris around mucosa
  • atrophic thinned mucosa
  • increased caries, plaque and perio
  • candida infection
• caries?


  • cervical caries
  • rampant in children
  • duraphat tp/mw 2800ppm or 5000ppm
  • fluoride 0.05% daily 0.2% weekly