XEROSTOMIA

1
XEROSTOMIA
Presenter ??? 2004.09.17
2

• Introduction
• Symptoms signs
• Etiology
• Diagnosis
• Management

3
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.

4
Salivary Gland

• Sublingual gland
• only 2-3 of saliva
• mucous (primarily) serous
• Minor salivary gland
• mucous (primarily)

• Parotid gland
• major source when eating
• serous acini only
• Submandibular gland
• the most responsible when no stimuli
• serous (primarily) mucous acini

5
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

6

• Introduction
• Symptoms signs
• Etiology
• Diagnosis
• Management
• Summary

7
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

8
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

9

• Introduction
• Symptoms signs
• Etiology
• Diagnosis
• Management
• Summary

10
Etiology

• Aging
• Foods drugs
• Systemic factors
• Radiotherapy
• Sjogrens syndrome
• Other salivary gland diseases

11
Etiology

• Aging
• Dry mouth gt50y/o10, gt65y/o40.
• 
  Mashvash N,
  1983
• 46 of 341 subjects (98M, 243F) had noticed
  subjective xerostomia, 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.
• 
  

12
Etiology

• Foods alcohol, coffee, coco cola, smoke
• Drugs
• Anti-depressants
• Anti-histamine
• Cimitidine
• Anti-cholinergic
• Anti-HTN (sympathomimetic drugs)
• Anti-inflammatory

13
Etiology

• Systemic factors
• Emotions nervousness , excitation, depression,
  stress..
• Encephalitis, brain tumors, stroke, Parkinsons
  dis.
• Dehydration diarrhea, vomiting, polyuria of
  diabetes
• Anemia, nutrition deficiency.

14
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?
• gt1000rad (2-3wk) felt oral dryness
• gt4000rad irreversible change

15
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 arthritisgt SLEgt scleroderma,
  polymyositis)
• Possibility of development of MALToma

16
Etiology

• Other salivary gland diseases
• Obstruction or infection of gland
• Sarcoidosis, amyloidosis
• Benign or malignant tumor
• Excision of gland or congenital missing

17
Etiology

• Aging
• Foods drugs
• Systemic factors
• Radiotherapy (gt4000rad)
• Sjogrens syndrome
• Other salivary gland diseases

?reversible change
?irreversible change
18

• Introduction
• Symptoms signs
• Etiology
• Diagnosis
• Management

19
Diagnosis

• History taking
• Symptoms clinical examination
• Special investigations
• Salivary flow rate, SFR
• Salivary scintiscanning
• Sialochemical analysis laboratory values
• Labial biopsy
• Sialography

20
Salivary Flow Rate (Sialometry)

• Stensons duct
• Methods
• Resting flow, 10min
• Stimulated flow, 10min citric acid
• Results
• Resting flow lt0.1ml/min?xerostomia
• Stimulated flowlt0.5ml/min?irresponsive xerostomia
• Basic, sensitive, time-consuming

21
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

22

• Sialochemical Analysis
• Saliva
• Na, K, IgA, amylase, albumin.
• Lack of specificity
• Sjogrens syndrome have diagnostic value
• Laboratory Values
• Sjogrens syndrome
• Elevated ESR, IgG, RF
• Positive auto-antibodies anti-nuclear, ANA
• 
  anti-SS-A, anti-Ro
• 
  anti-SS-B, anti-La

23
Labial Biopsy

• Chisolm Mason, 1968
• Minor salivary gland major gland high relation
  
• Focus 50 lymphocytes plasma cells
• 1 focus / 4 mm2 SS is diagnosed.

24
Parotid gland - Slight acinar destruction -
Dense lymphocytic infiltrate - Early
proliferation of ductal cells
25
Sialography

• Instillation of radiopaque fluid into glands
• Identification of non-calcified sialoliths
  tumors
• Unsuitable for diagnosis of xerostomia

26
Diagnosis

• History taking
• Symptoms clinical examination
• Special investigations
• ?- Salivary flow rate, SFR
• Stimulated flow
• ?- Salivary scintiscanning
• - Sialochemical analysis laboratory values
• ?- Labial biopsy
• - Sialography

27

• Introduction
• Symptoms signs
• Etiology
• Diagnosis
• Management

28
Management

• Dietary environmental considerations
• Preventive Dental Care Measures
• Saliva stimulatants
• Saliva substitutes

29
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

30
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..

31
Saliva Stimulatants

• Chewing gums
• Diabetic sweets
• Sialagogues
• Pilocarpine
• 510 mg, tid
• Bradycardia, sweating, flushing, urgency of
  urination, GI upset
• Pyridostigmine

32
Salivary Substitutes

• Salivary Substitutes
• Carboxy-methyl-cellulose or mucin
• Saliva Orthana contains fluoride.
• Mixture of glycerin citric acid
• Natural oral antimicrobial contents H2O2

33
Management

• Dietary environmental considerations
• Preventive Dental Care Measures
• Saliva stimulatants
• Saliva substitutes

34
Thank you for your attention !!