xerostomia.ppt

8/10/2019 XEROSTOMIA.ppt

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XEROSTOMIA

Presenter:黃

2004.09.17



Introduction

Symptoms & signs

Etiology

DiagnosisManagement



Introduction

Xerostomia (dry mouth):

Defined by Dr. Huchinson,1898.

Is not a disease but a symptom caused by manyfactors. Dr. Ronald

Not all people who complains of xerostomia

actually has salivary gland dysfunction.



Salivary Gland

Parotid gland

– major source when eating

– serous acini only

Submandibular gland – the most responsible when no

stimuli

– serous (primarily) + mucous acini

Sublingual gland

– only 2-3% of saliva

– mucous (primarily) + serou

Minor salivary gland – mucous (primarily)



Function of Saliva

Lubrication Initial digestion of food

Modulate the oral flora – Immune mechanism: IgA, IgG, IgM.

– Anti-microbial: lysozyme, peroxidase, lactoferrin,agglutinins.

Buffering action: tooth remineralization

Retention of removable denture



Introduction

Symptoms & signs

Etiology

Diagnosis

Management

Summary



Symptoms & Signs Symptoms:

– Oral dryness (most common)

– Halitosis

– Burning sensation

– Loss of sense of taste or bizarre taste – Difficulty in swallowing

– Tongue tends to stick to the palate

– Decreased retention of denture



Symptoms & Signs Signs:

– Saliva pool disappear

– Mucosa: dry or glossy

– Duct orifices: viscous and opaque saliva

– Tongue:

glossitis fissured red with papilla atrophy

– Angular cheilitis

– Rampant caries: cervical or cusp tip

– Periodontitis

– Candidiasis



IntroductionSymptoms & signs

Etiology

DiagnosisManagement

Summary



Etiology

Aging

Foods & drugs

Systemic factors

Radiotherapy Sjogren’s syndrome

Other salivary gland diseases



Etiology Aging:

– Dry mouth: >50y/o:10%, >65y/o:40%. Mashvash N, 1983

– 46% of 341 subjects (98M, 243F) had noticed subjectivexerostomia, more frequent in women.

T.O. Narhi, 1994

– Acinar tissue was replaced by fat and connective tissue.

Waterhouse, 1973 Scott, 1977

– When become elder, mucin secretion increase.



Etiology

Foods: alcohol, coffee, coco cola, smoke

Drugs:

– Anti-depressants

– Anti-histamine

Cimitidine – Anti-cholinergic

– Anti-HTN (sympathomimetic drugs)

– Anti-inflammatory



Etiology

Systemic factors: – Emotions: nervousness , excitation, depression, stress..

– Encephalitis, brain tumors, stroke, Parkinson’s dis.

– Dehydration: diarrhea, vomiting, polyuria of

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

Sjogren’s 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

Other salivary gland diseases:

– Obstruction or infection of gland

– Sarcoidosis, amyloidosis

– Benign or malignant tumor – Excision of gland or congenital missing



Etiology

Aging

Foods & drugs

Systemic factors

Radiotherapy (>4000rad) Sjogren’s syndrome

Other salivary gland diseases

irreversible change

reversible change



IntroductionSymptoms & signs

Etiology

DiagnosisManagement



Diagnosis

History taking Symptoms & clinical examination

Special investigations – Salivary flow rate, SFR

– Salivary scintiscanning – Sialochemical analysis & laboratory values

– Labial biopsy

– Sialography



Salivary Flow Rate (Sialometry)

Stenson’s duct Methods:

– Resting flow, 10min

– Stimulated flow, 10min: citric acid

Results: – Resting flow <0.1ml/minxerostomia

– Stimulated flow<0.5ml/minirresponsive xerostomia

Basic, sensitive, time-consuming



Salivary Scintiscanning

TC99 sodium pertechnetate

Empty: 10.20.30.40.50.80 min

Uptake of TC99 by salivarygland: functional acinar tissueis present

High sensitivity, non-invasive

http://images.google.com.tw/imgres?imgurl=http://www.ualberta.ca/~csps/JPPS5(1)/Y.Krishnaiah/Figure3.gif&imgrefurl=http://www.ualberta.ca/~csps/JPPS5(1)/Y.Krishnaiah/scintigraphy.htm&h=216&w=241&sz=3&tbnid=lP7nV12R92sJ:&tbnh=94&tbnw=104&start=2&prev=/images%3Fq%3Dscintigraph%26hl%3Dzh-TW%26lr%3D%26ie%3DUTF-8%26sa%3DG



Sialochemical Analysis Saliva:

– Na+, K +, IgA, amylase, albumin…. – Lack of specificity

Sjogren’s syndrome: have diagnostic value

Laboratory Values

Sjogren’s syndrome – Elevated ESR, IgG, RF

– Positive auto-antibodies: anti-nuclear, ANA

anti-SS-A, anti-Ro

anti-SS-B, anti-La



Labial Biopsy

Chisolm & Mason, 1968:

– Minor salivary gland & major gland: high relation

– Focus: ≥50 lymphocytes & plasma cells

– ≥ 1 focus / 4 mm2: SS is diagnosed.



Parotid gland:

- Slight acinar destruction

- Dense lymphocytic infiltrate

- Early proliferation of ductal cells



Sialography

Instillation of radiopaque fluid into glands

– Identification of non-calcified sialoliths & tumors

– Unsuitable for diagnosis of xerostomia



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 & environmental considerations Preventive Dental Care Measures

Saliva stimulatants

Saliva substitutes



Dietary & Environmental Considerations

Dietary:

– Avoid drugs that may produce xerostomia – Avoid dry & bulky foods

– High fluid intake & rinsing with water

– Avoid alcohol, smoking and sugar

– Take protein and vitamin supplements

Environment:

– Maintain optimal air humidity in the home

– Use Vaseline to protect the lips



Preventive Dental Care Measures

Smooth sharp cusps, occlusal grooves or fissures, irregular fillings. Check and adjust the denture.

OHI.

Topical fluoride with carrier use.

Fluoride rinses & chlorhexidine rinses. Antifungal medications:

– Denture: Miconazole gel,amphotericin or nystatin ointment

– Topical: Nystatin, amphotercin suspension or fluconazole..



Saliva StimulatantsChewing 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

Dietary & environmental considerations Preventive Dental Care Measures

Saliva stimulatants

Saliva substitutes



Thank you foryour attention !!

xerostomia.ppt

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