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Dental Management of Salivary Gland Disorders

Terms in this set (33)

What are some possible etiologic factors for salivary gland disorders?
• Infectious
• Inflammatory
• Iatrogenic
• Autoimmune
• Developmental
• Trauma
• Neoplastic
• Side effects of drugs/other treatments
What are methods you can use to assess salivary gland disorders?
- medical history (xerostomia)
- physical examination (enlargement)
- saliva collection
- imaging
- biopsy
- serological studies
What are some possible findings upon physical examiniation?
- salivary gland enlargement
- suppuration
- hyposalivation
What is xerostomia?
the subjective sensation of oral dryness
Who does xerostomia affect?
- 17-29% of patients
- women > men
T/F: xerostomia is always accompanied by an objective decrease in salivary flow rate
false!
What is sialometry?
Technique used to measure salivary flow rate. Helps to determine salivary gland function.
How does sialometry work?
Spitting method

Patient seated vertically & accumulates saliva in the mouth for 5-15 min without swallowing. Patient is asked to spit in a pre-weighed tube every 60 seconds

- can either be stimulated or non-stimulated
What are some common causes of acute xerostomia?
short term medications
infections (mumps)
psychogenic (anxiety)
Which is more common, xerostomia due to acute or chronic conditions?
chronic
What are some examples of chronic causes of xerostomia?
- medications
- chronic diseases
- therapeutic consequences
- absence or malformed glands
What are the signs of xerostomia/ hyposalivation?
•Lip dryness/ crusting
•Fissures at lip commissures
•Fragile/atrophic mucosa
•Difficulty in speech, chewing, swallowing
•Little or no pooled saliva in mouth
•Dry/sticky mucosa
•Multiple cervical caries
•Signs of erythematous Candidiasis
What are the symptoms of xerostomia/ hyposalivation?
- increased thirst
- sensitivity to spicy foods, strong flavors
- oral burning sensation
- altered taste perception
- difficulty wearing mucosal bearing prostheses
What imaging is used to help diagnose salivary gland diseases?
- X ray
- Sialography
- US
- scintigraphy
- CT scan
- MRI
- PET scan
Who performs the biopsy for minor salivary gland pathology? Major salivary gland pathology?
<minor>
- mucocele: DDS
- Sjogren: DDS

<Major>
- Deep tissue, difficult to reach- MD, ENT
What is the Challacombe scale of clinical oral dryness?
A scoring system to determine your patients level of xerostomia
What are all of the types of candidiasis?
- Erythematous
- pseudomembranous
- Hyperplastic
- Median rhomboid glossitis
- angular cheilitis
- denture stomatitis
What are the complications of hyposalivation?
- candidiasis
- sialadenitis
- infections (mumps, HIV, staph, strep)
- non infectious (sjogren, sarcoidosis, radiation)
- sialolithiasis
- burning mouth (NOT burning mouth syndrome)
- caries
How can you treat the complications of hyposalivation?
- hydration
- antibiotics
- drainage
- steroids if chronic
What are the signs & symptoms of Sjogren system?
<glandular>
- dry eyes
- dry mouth

<extraglandular>
- neuropathy
- arthritis

<complications>
- CVD
- Non-hodgkin's Lymphoma --MALT most common
What biomarkers precede the classic biomarkers for Sjogren syndrome?
- salivary protein 1
- Parotid secretory protein
- Carbonic anhydrase 6
What are the classic biomarkers for Sjogren?
SS-A (Ro)
SS-B (La)

ANA
RF
how to diagnose Sjogren's?
Focal scoring >1 4mm² foci
How many acini do you need to obtain for a minor salivary gland biopsy?
5-7 acini
How can you test the patients dry eyes in sjogren?
- ocular staining fluorescein & lissamine : to highlight corneal staining & conjunctival damage as consequence of xerophthalmia

- Schimer's test: uses a strip of paper to quantify the tears
What medications can you use to treat sjogren's syndrome?
• Cholinergic agonist - exocrine glands stimulants- Pilocarpine and Cevimeline.
• Corticosteroids - immunosupressor - Prednisone
• Antimalarial - immunomodulatory - Hydroxychloroquine.
• Biologics - immunomodulatory - Rituximab.
• NSAIDs- analgesics - Celecoxib (COX-2 selective)
• Anticonvulsants - pain modulator - Gabapentin.
How can you manage dry mouth?
- Increase water intake
- diet/ habits: avoid drying and irritating agents - smoking, alcohol, spicy foods.
- sugar free candy: xylitol
- OTC saliva substitutes:
- Sialogogues
What is the MOA of sialogogues?
stimulates parasympathetic division of the ANS. Bind to muscarinic receptors stimulating exocrine gland activity, and increasing smooth muscle tone in the GI and urinary tract.
What drugs are FDA approved for the management of hyposalivation associated with H&N radiation and Sjogren's syndrome?
Pilocrapine - non-selective muscarinic agonist 5 - 10 mg TID -QID

Cevimeline - Selective for M1/M3 muscarinic receptors 30 mg TID
What are the common adverse effects of Pilocarpine & Civemiline?
Common adverse effects include sweating, headache, GI discomfort, nausea, increased lacrimation, urinary frequency, and palpitations
Which patients should you use caution with when prescribing sialogogues?
- COPD
- asthma
- significant CVD
- hepatic impairment
- nephrolithiasis or cholelithiasis
- pt. taking B-blockers
Which patients are c/i for the use of sialogogues?
in patients with known hypersensitivity to the drug, uncontrolled asthma, and when miosis is undesirable (e.g., in acute iritis and in narrow-angle-closure glaucoma).
Preventive therapies for patients with hyposalivation:
<Caries prevention>
• Frequent recall (3 months)
• Excellent oral hygiene
• Chlorhexidine gluconate rinse
• Fluoride varnish (OTC)
• Toothpaste with higher concentration of fluoride (prescription)
• Preferred restorative materials: amalgam, resin modified glass ionomer
<Candidiasis prevention>
• Frequent recall (3 months)
• Remove prostheses at night
• Soak prostheses
• Topical antifungals
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