Salivary gland infectionsInflammation of salivary gland – sialadenitis.Can be viral (majority), bacterial and fungal (minority).Parotid glands are more commonly infected thansubmandibular glands while accessory salivary glands arevery rare infected.Majority of sialadenitis seen in adults.Initiation and progression of salivary gland infectionsdepend upon the virulence of the causative organism andthe host resistance.
Dr. Adel Jumaan BinsaadXerostomia (Dry Mouth):Is not a disease but it is symptom of diseases.It can effects the nutritional status, speech, taste,tolerance to dental prosthesis and increases susceptibilityto dental caries.Causes include:Medications - antihypertensives, antidepressants,analgesics, diuretics and antihistamines.Cancer Therapy - Chemotherapeutic drugs change theflow and composition of the saliva.Radiation treatment that is focused on or near thesalivary gland can temporarily or permanently damage thesalivary glands.Sjogrens syndrome - An autoimmune disease, causesxerostomia and dry eyes (xerophthalmia).
Dr. Adel Jumaan BinsaadSurgery or wounds can damage the nerves that supplysensation. Salivary glands may be left intact, but cannotfunction normally without the nerves signal.Other conditions -such as endocrine disorders, stress,depression, and nutritional deficiencies.Dry leathery tongue
Clinical features• Increase thirst• Difficulty in speech, swallowing & eating dry food• Burning sensation• Fissuring of tongue.• Treatment:Identify the cause. In many situations, it is difficult to eliminate the causes.• Palliative treatment: Salagen, special food preparation (moist foods). Artificial saliva. Avoidance of alcohol-based mouth rinses. Use of water and glycerin mixed in a small aerosol spraybottle. It will be necessary to control the results ofxerostomia especially the increase in dental caries.• Control dental caries: This will outlined in the cariologycourse.
Dr. Adel Jumaan BinsaadSjögrens SyndromeAutoimmune disease in which the immune system attacksthe glands and leading to dryness of the eye and themouth.Predominantly affects salivary, lacrimal & other glands.It was first described by HENNIK SJOGREN in 1933.It’s most common in white women who are in their 40sand 50s.It may also occur along with other diseases, such asrheumatoid arthritis, lupus, or scleroderma.The most common symptoms of Sjögrens syndrome aredry eyes and mouth that last for at least 3 months. Patient may have itching in eyes.
Dr. Adel Jumaan BinsaadTreated will focus on symptoms:Artificial teardrops.Mouth lubricants.Saliva substitutes.Steroid medicines to relieve muscle and joint pain.Antirheumatic drugs, such as methotrexate.Sialorrhea (Increase in saliva flow)Psychosis, mental retardation, certain nuerologicvaldiseases, rabies, mercery poisoning.
Viral infectionsMumps (endemic parotitis)the most common viral cause of sialadenitis.Aetiology and pathogenesisRNA paramyxovirus which infect circulating lymphocytes.In salivary duct epithelial cells virus replicate leading toperiductal oedema and infiltrate.The virus shed in saliva and spread into bloodstream,causing viraemia.EpidemiologySeen in winter and spring.Occur at all ages but most common in childhood.Transmitted via direct contact with saliva and by dropletspread.
Incubation and infectivity14-18 days.Saliva during prodromal period is infectious and up to 2weeks after the onset of clinical symptoms.Clinical featuresPyrexia, sore throat and earache.Pain on chewing.Reddening of the opening of parotid duct.Increased in glandular size.Low salivary flow rate leading to non-specificstomatitis?? and halitosis. Either one or both parotid glands involved, with a delayof up to 5 days.
ComplicationsMeningoencephalitisOrchitisNeuritis, myocarditis, thyroiditis and nephritis.DiagnosisOn clinical groundSerology.Electronic microscopy (examination of saliva collected bycannulation).Salivary gland disease in HIV infection:May occur and the main presentations of the disease ofthe major salivary glands are: xerostomia and /orenlargement of the salivary glands.
Other viral infectionsCytomegalovirus – causes cytomegalic inclusion disease??,in newborns, children and adults and has multiple systemicmanifestations.Parainfluenza types 2 and 3, echo and coxsackie viruses– non-specific suppurative sialadenitis ??.Bacterial infections of salivary glands:Acute suppurative parotitis (bacterial sialadenitis):•Seen mostly in adults with salivary gland abnormalities andother predisposing factors.•A retrograde infection via salivary duct may occur if theflow of saliva is reduced or stopped.
Predisposing factors:Drugs that reduce salivary flow such as diuretics.Salivary gland abnormalities such as calculus, mucus plugor benign strictures.Dehydration.Sjogrens syndrome.Clinical features1.Unilateral or bilateral swelling of parotid glands. Swellingmay extend, involving pre- and postauricular areas.2.Purulent salivary secretions at the duct orifice.3.Fever, chills and leukocytosis.4.Recurrent bouts of acute infection followed by remissionmay lead to fibrosis.
TreatmentParenteral antibiotic therapy with amoxicillin orerythromycin, guided by culture of pus and sensivity tests.Oral hygiene.Pus aspirated through catheter attached to a syringe orcollected aseptically on a cotton-wool swab by milking theduct.Encourage the salivation by increased fluid intake and bysialagogues e.g. lemon juice.In sever cases: surgical drainage of pus.If acute bacterial parotitis is untreated:1.Extension of inflammation and oedema into the neckleading to respiratory obstruction2.Cellulitis of the face and neck3.Osteomyelitis of adjacent facial bones4.Septicaemia and death
Mycotic InfectionsActinomycosisCaused by Actinomyces israelii.Types:1. Primary endogenous, ascending infection via salivaryducts. Infection penetrates from mouth into gland andaffects it entirely.2. Secondary when transferred to gland from tissuesurrounding, non tender, non fluctuant indurated lesionwith formation of multiple fistulae with discharge ofsulphur granules.
Dr. Adel Jumaan BinsaadSIALOGRAPHY: radiographic examination of the salivaryglands & their ducts following the injection of a radiographiccontrast media.Indications:Done when acute condition has resolved.To identify abnormalities such as calculi, mucus plugs,benign strictures, sialectasia (dilation), Fistulae, neoplasms& other pathology which lead to recurrence of infection.Contraindications:– Severe inflammation of ducts– History of contrast sensitivitySubsequent treatment include duct dilation, removal ofduct obstructions or surgical revision of duct.Fistulae: abnormal passage that connects an abscess, cavity,or hollow organ to the body surface or to another holloworgan.
Dr. Adel Jumaan BinsaadPlain radiograph shows radio opaque stone
Dr. Adel Jumaan BinsaadSalivary stones80 % occur in the submandibular gland10 % occur in the parotid gland7 % occur in the sublingual gland
Submandibular sialadenitisLess common and most bacterial infections are associatedwith obstructive duct disease.Neonatal suppurative parotitis and recurrentparotitis of childhoodRare diseases, of unknown aetiology, and occur in thefirst decade of life.In recurrent parotitis, child complain of repeated acuteepisodes of painful parotid gland enlargement.Rare bacterial infections of salivary glandsEndogenous, ascending infection via salivary ducts e.g.Actinomyces israelii.Reactivation of old lesion e.g. Mycobacteriumtuberculosis.Infection via adjacent , contiguous locus e.g. Treponemapallidum.
CommonisolatesLess isolates RareisolatesAlpha-haemolyticstreptococciHaemophilusspp.NeisseriagonorrhoeaeStaphylococcusaureusBacteroidesspp.MycobacteriumtuberculosisAnaerobicstreptococciActinomycesspp.Eikenella spp. TreponemapallidumBacteria commonly isolated from bacterialparotitis
Infective endocarditisIs the most important disease of relevance to dentistry.It is the most common fatal complication of dentalprocedures.Can be caused by bacteria, fungi, rickettsiae andchlamydiae.Inflammation of the endocardium of the heart valves, andsometimes the endocardium around congenital defects.More than 80% of infective endocarditis is caused bystreptococci and staphylococci and 35% of cases caused byStreptococcus viridians.Signs and symptomsfever, loss of weight, anaemia, haematuria, petechiae,splinter haemorrhages, and splenomegaly.
Clinical forms of diseaseClinical forms of diseaseacuteacute subacutesubacuteRapidly progressiveRapidly progressive More insidious, chronic, andMore insidious, chronic, andprogress slowlyprogress slowlyCaused by StaphylococcusCaused by Staphylococcusaureus,aureus,Streptococcus pyogenes andStreptococcus pyogenes andStreptococcus pneumoniaeStreptococcus pneumoniaeCaused byCaused byStreptococcus viridiansStreptococcus viridiansStaphylococcus epidermidisStaphylococcus epidermidisand Streptococcus faecalisand Streptococcus faecalis
PathogenesisInfective endocarditis occurs in patients withpathological condition of endocardium. In patients withnormal heart valves rarely.The risk of development of infective endocarditis in arisk patient following dental procedures has been estimatedvary between 10% and 90%.Bacteraemia can occur after dental procedures such asextraction, surgical or non-surgical endodontitics,gingivectomy, root-planing, scaling and flossing,intraligamentary injections and reimplantation of avulsedteeth.Supragingival and subgingival plaque is the main sourcemicroorganisms in dental septicaemias.These procedures requiring antimicrobial prophylaxis inpersons at risk.
Persons at risk who need antibiotic prophylaxisAny type of heart lesion is susceptible to infection, butantibiotic prophylaxis is imperative for patients with:Congenital cardiac defectsRheumatic heart diseaseProsthetic cardiac valvesPrevious history of endocarditisHypertrophic cardiomyopathyAortic valve disease (bicuspid valve)DiagnosisClinical signs supported by positive blood culture.Blood should be collected (10 ml prior to antibiotictreatment) when the temperature rise and cultured underaerobic and anaerobic conditions.Sensivity test is performed.ECHO cardiography.
TreatmentHigh dose single antibiotic or combination antibiotictherapy on the basis of blood culture.Dentist identified patients at risk from their medicalhistory and from patient’s medical doctor.Patients with cardiac diseases ware cards.Antibiotic and antiseptic prophylaxis Reduction in numbers of organisms before (5 min) thestart of dental procedure by irrigating the gingival crevicearea with antiseptics such as chlorhexidine gluconate gel1% or chlorhexidine mouthwash 0.2%. One hour before dental procedure:Amoxicillin orally 2 gram (4 tab.-500 mg)/ single dose.Alternative is erythromycin.even when antibiotic cover provided, patients at riskshould report any unexplained illness due to insidious originof infective endocarditis.