SEMINAR ON XEROSTOMIA

Submitted to: Dr. Shivani Prepared By: Vijayta Kaushal BDS IV yr Roll no. 7096

XEROSTOMIA: It is not a disease but can be a symptom of

certain diseases. There is decreased flow of saliva. ETIOLOGY: Its classified broadly as temporary or permanent.

TEMPORARY CAUSES: 1. Psychological Anxiety and depression may be responsible for reduced salivary outflow. 2. Duct Canalculi Blockage of a major salivary gland may lead to decreased flow of saliva and hence dryness on the affected side along with pain and swelling in the gland. Untreated, duct canalculi may lead to fibrosis of gland and permanent xerostomia. 3. Sialoadenitis Inflammation of the salivary gland may cause reduced secretion of saliva. Acute infections such as mumps and post-operative periostitis

4. Drug Therapy:

Anti-cholinergic and sympathomimetic agents may cause xerostomia. Tricyclic anti-depressants, bronchiodilators and antihistamines are responsible for xerostomia. Diuresis produced by drugs and alcohol can also result in xerostomia

PERMANENT CAUSES 1. Salivary Gland Aplasia: Congenital absence of one or more major salivary glands may be responsible for xerostomia. 2. Sjogren's Syndrome:

It consists of a triad of keratoconjuctivitis sicca, xerostomia and rheumatoid arthiritis.

It is prevalent in women above 40 years of age. Along with the classical symptoms of dry eyes and rheumatoid arthritis, xerostomia is also a major symptom.

3. Other systemic disorders. Xerostomia is associated with:

Diabetes Mellitus Parkinson's disease Cystic Fibrosis Sarcoidosis Vitamin Deficiency such as Vitamin A, riboflavin and nicotinic acid deficiencies. Radiotherapy used to cure cancer of head and neck region my cause xerostomia.

4. Radiation Induced

There is reduction in the vascularity of the gland and partially due to the effect of the x-rays on the highly specialized and sensitive epithelial cells. There is degeneration of the acini and replacement by fibrous or fatty tissue. The extent of damage is proportional to the radiation dose.

CLINICAL FEATURES

There is alteration in the mucosa of the oral cavity, causing burning sensation, ulceration, dryness. The mucosa will appear dry and atrophic, sometimes inflamed but mostly pale and transclucent. There is difficulty in retention of the dentures and abnormalities of taste and smell. Rampant caries are often present in patients of xerostomia. This id due to the absence of saliva, which has important anti-microbial and buffering actions. There is soreness of the tongue, atrophy of the papilla along with inflammation, fissuring, cracking of the tongue.

TREATMENT
1. Treatment involves treatment of the underlying cause of xerostomia. 2. The patient is asked to sip water and other sugar-free juices at regular intervals.

3. Sugar-free gums should be chewed in order to stimulate the formation of saliva.

4. Chewing lemon pieces is recommended.

5. Patients with xerostomia should avoid alcohol, smoking and caffeine.

6.Fluoridated Mouthwashes should be used.

20-30 ml of mouthwash is used twice day, after brushing. A mouth wash is always used in diluted form and not directly, a 1:1 ratio of the mouth wash to water is employed. It is typically swished or gargled in the mouth for about half a minute.

Biotene is a commonly used medication available in mouthwash and toothpaste form. It contains sodium monoflourophosphate, gucose oxidase, lactoferrin and lysozyme. It is useful as it reduces the plaque formation.It can be used as required, but particularily after brushing and before bed.

7. Salivary substitutes: These contain salt ions, a flavoring agent, paraben, cellulose derivative or animal mucins. -They are dispensed in spray bottle or rinse and swish bottle. There is no specific dose and it used as needed. - Xero-lube, Moi-stir, Salivar are commonly used salivary substitutes. 8. Medical Treatment Pilocarpine is used to treat xerostomia. In radiation induced xerostomia, 5 mg thrice daily are used while in Sjogren's syndrome it is used four times daily

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