SlideShare a Scribd company logo
1 of 55
Sialadenitis/Parotitis/Sjogren’s   Vincent Steniger, D.M.D  4-17-08
Outline ,[object Object],[object Object],[object Object],[object Object]
Chief Complaint ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History of Present Illness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Past Medical Hx  (SHH) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EOE/ IOE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sialadentitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sialadentitis: Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parotitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parotitis: Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Overall Treatment for Parotitis  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mumps
Mumps: (Viral Parotitis) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mumps: Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Features- continued ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mumps: Histopathology ,[object Object],[object Object]
Mumps: Treatment ,[object Object],[object Object],[object Object],[object Object]
Sjogren’s Syndrome
Sjogren’s Syndrome ,[object Object],[object Object]
Sjogren’s Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sjogren’s Syndrome:  Who is effected? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sjogren's Syndrome: Age of Onset   ,[object Object],0 5 10 15 20 25 30 35 40 45 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 AGE % OF PATIENTS At diagnosis Onset
Sjogren’s Syndrome: Clinically ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Crocodile Skin” Tongue, Carious Teeth
Tests and Studies: Scintigraphy ,[object Object],0.00 0.42 1.60 Salivary flow rate  (ml/5-min/gland) Severe Mild None Degree of xerostomia Marked involvement Moderate involvement Normal Scintigraphy diagnosis
Scintigraphy: Continued ,[object Object]
Tests and Studies: Schirmer’s Test  ,[object Object],[object Object],[object Object],[object Object]
Tests and Studies: Serology 30 Cryoglobulins (type II) 60 Ro/SSA 80  Rheumatoid factors (Igs) 95 a-fodrin 30 La/SSB % positive Autoantibodies
Tests and Studies: Salivary Gland Biopsy ,[object Object]
Tests and Studies: Salivary Flow Rate ,[object Object],[object Object]
Sjogren’s Syndrome: Exclusion Criteria   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sjogren’s Syndrome: Differential Diagnosis   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sjogren's Syndrome  Algorithm for the diagnosis If positive Sjogren's Syndrome   Dry mouth Dry eyes Salivary gland enlargement Raynaud’s phenomenon  Purpura Renal tubular acidosis or or Eye & salivary gland tests Serology If any positive
Sjogren’s Syndrome: Pathophysiology   ,[object Object],[object Object]
Pathophysiology: Continued ,[object Object],[object Object],[object Object],[object Object],[object Object]
Parotitis/Sjogren’s: Histology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal
Pathological
Sjogren’s Syndrome: Systemic Manifestations Skopouli et al., Semin Arthritis Rheum. 2000, 29:296 30 Raynaud’s phenomenon 60 Arthralgia/arthritis 10 (25) Lung involvement (increased liver enzymes) 15 (1) Purpura/Vasculitis 1 Muscle involvement 5 Liver involvement 8 (25) Kidney involvement (Interstitial Nephritis/Glomerulonephritis) Frequency (%) Systemic manifestations
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Why Do the Study?
Purpose of the Study ,[object Object]
Materials and Methods: Subjects   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Materials and Methods: Methods: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A Review… ,[object Object],[object Object],[object Object],[object Object]
Results: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object],[object Object]
Case Study ,[object Object],[object Object],[object Object],[object Object]
Case Subject ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Salivary Function and Biopsy
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Patient: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
To Do For The Patient: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sjogren’s Syndrome: Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment: Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

More Related Content

What's hot (20)

Maxillary sinusitis
Maxillary sinusitisMaxillary sinusitis
Maxillary sinusitis
 
Salivary glands disorders ii
Salivary glands disorders iiSalivary glands disorders ii
Salivary glands disorders ii
 
Acute and chronic sinusitis
Acute and chronic sinusitisAcute and chronic sinusitis
Acute and chronic sinusitis
 
Cleft lip
Cleft lipCleft lip
Cleft lip
 
Leukoplakia
LeukoplakiaLeukoplakia
Leukoplakia
 
Lichen planus
Lichen planusLichen planus
Lichen planus
 
Aphthous ulcers
Aphthous ulcersAphthous ulcers
Aphthous ulcers
 
CASE PRESENTATION ON CHRONIC SUPPURATIVE OTITIS MEDIA
CASE PRESENTATION  ON CHRONIC SUPPURATIVE OTITIS MEDIACASE PRESENTATION  ON CHRONIC SUPPURATIVE OTITIS MEDIA
CASE PRESENTATION ON CHRONIC SUPPURATIVE OTITIS MEDIA
 
02.dental caries
02.dental caries02.dental caries
02.dental caries
 
Phemphigus
PhemphigusPhemphigus
Phemphigus
 
Midline swellings of the neck
Midline swellings of the neckMidline swellings of the neck
Midline swellings of the neck
 
History taking and examination of swelling
History taking and examination of swellingHistory taking and examination of swelling
History taking and examination of swelling
 
Ulcer case presentation
Ulcer case presentationUlcer case presentation
Ulcer case presentation
 
Acute gingival infections
Acute gingival infections Acute gingival infections
Acute gingival infections
 
Tuberculous cervical lymphadinitis
Tuberculous cervical lymphadinitisTuberculous cervical lymphadinitis
Tuberculous cervical lymphadinitis
 
Sjögren's syndrome
Sjögren's  syndromeSjögren's  syndrome
Sjögren's syndrome
 
Ankyloglossia a congenital oral anomaly
Ankyloglossia a congenital oral anomaly Ankyloglossia a congenital oral anomaly
Ankyloglossia a congenital oral anomaly
 
Oral candidiasis
Oral candidiasis Oral candidiasis
Oral candidiasis
 
Aphthous Ulcer
Aphthous UlcerAphthous Ulcer
Aphthous Ulcer
 
Osteomyelitis
OsteomyelitisOsteomyelitis
Osteomyelitis
 

Viewers also liked

Salivary gland infections
Salivary gland infectionsSalivary gland infections
Salivary gland infectionsSaeed Bajafar
 
A case of submandibular swelling
A case of submandibular swellingA case of submandibular swelling
A case of submandibular swellingArun Nair
 
Oral Pathology - Diseases of salivary glands
Oral Pathology - Diseases of salivary glandsOral Pathology - Diseases of salivary glands
Oral Pathology - Diseases of salivary glandsHamzeh AlBattikhi
 
salivary gland diseases
salivary gland diseasessalivary gland diseases
salivary gland diseasesshabeel pn
 
Reducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine
Reducing the Incidence of 131I Induced Sialadenitis - The Role of PilocarpineReducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine
Reducing the Incidence of 131I Induced Sialadenitis - The Role of PilocarpineXiu Srithammasit
 
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..Nelson Hendler
 
Dry eye: A Multifactorial Disease
Dry eye: A Multifactorial DiseaseDry eye: A Multifactorial Disease
Dry eye: A Multifactorial DiseaseDr Samarth Mishra
 
Diseases of salivary glands
Diseases of salivary glandsDiseases of salivary glands
Diseases of salivary glandsYaqoob Marri
 
lesiones no neoplasicas de glandulas salivales
lesiones no neoplasicas de glandulas salivaleslesiones no neoplasicas de glandulas salivales
lesiones no neoplasicas de glandulas salivalesVictor Garcia
 
indices measuring dental fluorosis
indices measuring dental fluorosisindices measuring dental fluorosis
indices measuring dental fluorosisNitya Sharma
 

Viewers also liked (20)

Salivary gland infections
Salivary gland infectionsSalivary gland infections
Salivary gland infections
 
A case of submandibular swelling
A case of submandibular swellingA case of submandibular swelling
A case of submandibular swelling
 
Oral Pathology - Diseases of salivary glands
Oral Pathology - Diseases of salivary glandsOral Pathology - Diseases of salivary glands
Oral Pathology - Diseases of salivary glands
 
Sjogren's syndrome
Sjogren's syndromeSjogren's syndrome
Sjogren's syndrome
 
salivary gland diseases
salivary gland diseasessalivary gland diseases
salivary gland diseases
 
Reducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine
Reducing the Incidence of 131I Induced Sialadenitis - The Role of PilocarpineReducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine
Reducing the Incidence of 131I Induced Sialadenitis - The Role of Pilocarpine
 
Psoriasis
PsoriasisPsoriasis
Psoriasis
 
Penyakit Tidak Berjangkit
Penyakit Tidak BerjangkitPenyakit Tidak Berjangkit
Penyakit Tidak Berjangkit
 
Mumps 1234
Mumps 1234Mumps 1234
Mumps 1234
 
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..
Facial pain due to TMJ, trigminal neuralgia, Sjogren syndrome, Eagles etc..
 
Saliva
SalivaSaliva
Saliva
 
S. sjogrens
S. sjogrensS. sjogrens
S. sjogrens
 
Salivary gland Viral infections
Salivary gland Viral infections Salivary gland Viral infections
Salivary gland Viral infections
 
Gaky
GakyGaky
Gaky
 
Dry eye: A Multifactorial Disease
Dry eye: A Multifactorial DiseaseDry eye: A Multifactorial Disease
Dry eye: A Multifactorial Disease
 
Mumps presentation s agun
Mumps presentation   s agunMumps presentation   s agun
Mumps presentation s agun
 
Mumps
MumpsMumps
Mumps
 
Diseases of salivary glands
Diseases of salivary glandsDiseases of salivary glands
Diseases of salivary glands
 
lesiones no neoplasicas de glandulas salivales
lesiones no neoplasicas de glandulas salivaleslesiones no neoplasicas de glandulas salivales
lesiones no neoplasicas de glandulas salivales
 
indices measuring dental fluorosis
indices measuring dental fluorosisindices measuring dental fluorosis
indices measuring dental fluorosis
 

Similar to Sjogren-Parotitis (20)

Sjogren
SjogrenSjogren
Sjogren
 
A Case of Sjogren's Syndrome
A Case of Sjogren's SyndromeA Case of Sjogren's Syndrome
A Case of Sjogren's Syndrome
 
Sjogren syndrome, halitosis & treatment of osf
Sjogren syndrome, halitosis & treatment of osfSjogren syndrome, halitosis & treatment of osf
Sjogren syndrome, halitosis & treatment of osf
 
Case of sjogren’s syndrome
Case of sjogren’s syndromeCase of sjogren’s syndrome
Case of sjogren’s syndrome
 
SJOGREN'S SYNDROME
SJOGREN'S SYNDROMESJOGREN'S SYNDROME
SJOGREN'S SYNDROME
 
Sjogrens's Syndrome
Sjogrens's SyndromeSjogrens's Syndrome
Sjogrens's Syndrome
 
Sjogren's syndromee
Sjogren's syndromeeSjogren's syndromee
Sjogren's syndromee
 
Dns
DnsDns
Dns
 
Psgn nephrotic syndrome
Psgn nephrotic syndromePsgn nephrotic syndrome
Psgn nephrotic syndrome
 
Sle by dr qudsia
Sle by dr qudsiaSle by dr qudsia
Sle by dr qudsia
 
@ Non neoplasitc salivary gland diseases
@ Non neoplasitc salivary gland diseases@ Non neoplasitc salivary gland diseases
@ Non neoplasitc salivary gland diseases
 
Str Pyo+ Sequelae
Str Pyo+ SequelaeStr Pyo+ Sequelae
Str Pyo+ Sequelae
 
Infective Endocarditis Pediatrics
Infective Endocarditis PediatricsInfective Endocarditis Pediatrics
Infective Endocarditis Pediatrics
 
Management salivary gland disease .pptx
Management salivary gland disease  .pptxManagement salivary gland disease  .pptx
Management salivary gland disease .pptx
 
cerebral toxoplasmosis
cerebral toxoplasmosiscerebral toxoplasmosis
cerebral toxoplasmosis
 
Sjogrens
Sjogrens Sjogrens
Sjogrens
 
Fever of unkown origin
Fever of unkown originFever of unkown origin
Fever of unkown origin
 
Typoidfever
TypoidfeverTypoidfever
Typoidfever
 
Sjogren syndrome by aseem
Sjogren syndrome by aseemSjogren syndrome by aseem
Sjogren syndrome by aseem
 
Dengue Fever Clinical
Dengue Fever ClinicalDengue Fever Clinical
Dengue Fever Clinical
 

More from Flavio Guzmán (20)

Ops
OpsOps
Ops
 
Pk2
Pk2Pk2
Pk2
 
Pk2
Pk2Pk2
Pk2
 
Kinetika En 2002
Kinetika En 2002Kinetika En 2002
Kinetika En 2002
 
Pk1 Ppt
Pk1 PptPk1 Ppt
Pk1 Ppt
 
Kinetika En 2002
Kinetika En 2002Kinetika En 2002
Kinetika En 2002
 
Ceorins
CeorinsCeorins
Ceorins
 
AUPDATE
AUPDATEAUPDATE
AUPDATE
 
05052008OvarianTelehealth
05052008OvarianTelehealth05052008OvarianTelehealth
05052008OvarianTelehealth
 
mati
matimati
mati
 
DrTerespolsky
DrTerespolskyDrTerespolsky
DrTerespolsky
 
15
1515
15
 
gopalan031607
gopalan031607gopalan031607
gopalan031607
 
IncidentalomaTalk
IncidentalomaTalkIncidentalomaTalk
IncidentalomaTalk
 
Nikiforov
NikiforovNikiforov
Nikiforov
 
Thpt
ThptThpt
Thpt
 
Thyroid Disease
Thyroid DiseaseThyroid Disease
Thyroid Disease
 
THYCER
THYCERTHYCER
THYCER
 
DrRobertFoxUtahSSF
DrRobertFoxUtahSSFDrRobertFoxUtahSSF
DrRobertFoxUtahSSF
 
Sjögren's_syndrome~_Role_for_Cevimeline
Sjögren's_syndrome~_Role_for_CevimelineSjögren's_syndrome~_Role_for_Cevimeline
Sjögren's_syndrome~_Role_for_Cevimeline
 

Recently uploaded

Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...
Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...
Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...GENUINE ESCORT AGENCY
 
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kakinada Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426jennyeacort
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...chandars293
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Ishani Gupta
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...Arohi Goyal
 
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur  Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Guntur  Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...khalifaescort01
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Anamika Rawat
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeCall Girls Delhi
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...parulsinha
 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappInaaya Sharma
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...chetankumar9855
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...parulsinha
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...narwatsonia7
 

Recently uploaded (20)

Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...
Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...
Call Girls Vasai Virar Just Call 9630942363 Top Class Call Girl Service Avail...
 
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
 
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kakinada Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kakinada Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
Call Girls in Delhi Triveni Complex Escort Service(🔝))/WhatsApp 97111⇛47426
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
 
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur  Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Guntur  Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Guntur Just Call 8250077686 Top Class Call Girl Service Available
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
 
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
Call Girl In Pune 👉 Just CALL ME: 9352988975 💋 Call Out Call Both With High p...
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
 

Sjogren-Parotitis

  • 1. Sialadenitis/Parotitis/Sjogren’s Vincent Steniger, D.M.D 4-17-08
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Mumps
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. “ Crocodile Skin” Tongue, Carious Teeth
  • 25.
  • 26.
  • 27.
  • 28. Tests and Studies: Serology 30 Cryoglobulins (type II) 60 Ro/SSA 80 Rheumatoid factors (Igs) 95 a-fodrin 30 La/SSB % positive Autoantibodies
  • 29.
  • 30.
  • 31.
  • 32.
  • 33. Sjogren's Syndrome Algorithm for the diagnosis If positive Sjogren's Syndrome Dry mouth Dry eyes Salivary gland enlargement Raynaud’s phenomenon Purpura Renal tubular acidosis or or Eye & salivary gland tests Serology If any positive
  • 34.
  • 35.
  • 36.
  • 39. Sjogren’s Syndrome: Systemic Manifestations Skopouli et al., Semin Arthritis Rheum. 2000, 29:296 30 Raynaud’s phenomenon 60 Arthralgia/arthritis 10 (25) Lung involvement (increased liver enzymes) 15 (1) Purpura/Vasculitis 1 Muscle involvement 5 Liver involvement 8 (25) Kidney involvement (Interstitial Nephritis/Glomerulonephritis) Frequency (%) Systemic manifestations
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.