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Presenter:
2004.09.17
Introduction
Symptoms
& signs
Etiology
Diagnosis
Management
Introduction
Xerostomia (dry mouth):
Defined by Dr. Huchinson,1898.
Is not a disease but a symptom caused by many
factors.
Dr. Ronald
Not all people who complains of xerostomia
actually has salivary gland dysfunction.
Salivary Gland
Parotid gland
Sublingual gland
Submandibular gland
the most responsible when no
stimuli
serous (primarily) + mucous acini
Function of Saliva
Lubrication
Initial digestion of food
Modulate the oral flora
Immune mechanism: IgA, IgG, IgM.
Anti-microbial: lysozyme, peroxidase, lactoferrin,
agglutinins.
Introduction
Symptoms
& signs
Etiology
Diagnosis
Management
Summary
Symptoms:
Oral dryness (most common)
Halitosis
Burning sensation
Signs:
Introduction
Symptoms
& signs
Etiology
Diagnosis
Management
Summary
Etiology
Aging
Foods & drugs
Systemic factors
Radiotherapy
Sjogrens syndrome
Other salivary gland diseases
Etiology
Aging:
Dry mouth: >50y/o:10%, >65y/o:40%.
Mashvash N, 1983
Scott, 1977
Etiology
Etiology
Systemic factors:
Emotions: nervousness , excitation, depression, stress..
Encephalitis, brain tumors, stroke, Parkinsons dis.
diabetes
Anemia, nutrition deficiency.
Etiology
Radiotherapy
Acini atrophy fibrosis or replaced by fatty tissue
Serous acini: more sensitive to R/T
Saliva: thickened, altered electrolytes, pH,
secretion of immunoglobulins
>1000rad (2-3wk): felt oral dryness
>4000rad: irreversible change
Etiology
Sjogrens syndrome:
Systemic autoimmune disorder, exocrine invasion mainly
80-90% in female, middle-aged
1o sicca syndrome
Xerostomia (82%)
Keratoconjunctivitis sicca (KCS)
2o sicca syndrome:
Sicca syndrome + other autoimmune C.T. diseases
(rheumatoid arthritis> SLE> scleroderma, polymyositis)
Possibility of development of MALToma
Etiology
Etiology
Aging
Foods & drugs
reversible change
Systemic factors
Radiotherapy (>4000rad)
irreversible
Sjogrens syndrome
Other salivary gland diseases
change
Introduction
Symptoms
& signs
Etiology
Diagnosis
Management
Diagnosis
History taking
Symptoms & clinical examination
Special investigations
Results:
Resting flow <0.1ml/minxerostomia
Stimulated flow<0.5ml/minirresponsive xerostomia
Salivary Scintiscanning
TC99 sodium pertechnetate
Empty: 10.20.30.40.50.80 min
Uptake of TC99 by salivary
gland: functional acinar tissue
is present
High sensitivity, non-invasive
Sialochemical Analysis
Saliva:
Na+, K+, IgA, amylase, albumin.
Lack of specificity
Laboratory Values
Sjogrens syndrome
Elevated ESR, IgG, RF
Positive auto-antibodies: anti-nuclear, ANA
anti-SS-A, anti-Ro
anti-SS-B, anti-La
Labial Biopsy
Parotid gland:
- Slight acinar destruction
- Dense lymphocytic infiltrate
- Early proliferation of ductal cells
Sialography
Diagnosis
History taking
Symptoms & clinical examination
Special investigations
- Salivary flow rate, SFR
Stimulated flow
- Salivary scintiscanning
- Sialochemical analysis & laboratory values
- Labial biopsy
- Sialography
Introduction
Symptoms
& signs
Etiology
Diagnosis
Management
Management
Dietary:
Environment:
Maintain optimal air humidity in the home
Use Vaseline to protect the lips
Saliva Stimulatants
Chewing gums
Diabetic sweets
Sialagogues:
Pilocarpine
5~10 mg, tid
Bradycardia, sweating, flushing, urgency of urination,
GI upset
Pyridostigmine
Salivary Substitutes
Salivary Substitutes
Carboxy-methyl-cellulose or mucin
Saliva Orthana: contains fluoride.
Mixture of glycerin & citric acid
Natural oral antimicrobial contents: H2O2
Management