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Xerostomia & Sjogrens syndrome

Oral lesions

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Xerostomia & Sjogrens syndrome

  1. 1.  The subjective feeling of oral dryness is termed as xerostomia.  Xerostomia is a symptom not diagnosis or disease.  It is basically termed as clinical manifestation of salivary gland dysfunction.
  2. 2. Classified as-  TEMPORARY CAUSES- • Psychological • Blockage of duct calculi • Sialoadenitis • Drug therapy  PERMANENT CAUSES- • Salivary gland aplasia • Sjogren’s syndrome • Radiotherapy • Other systemic disorders • Surgical desalivation
  3. 3.  PHYSIOLOGICAL- • This includes anxiety & depression. • These causes decrease in salivary flow rate.  DUCT CALCULI- • Blockage of minor salivary glands. • Commonly submandibular gland is blocked. • Can produce dryness, along with pain and swelling in the gland. • If untreated may cause permanent xerostomia.
  4. 4.  SIALOADENITIS- • Inflammation of the salivary gland can reduce secretion. • Acute infections such as mumps & post operative parotitis. • Chronic infections include swelling of gland.  DRUG THERAPY- • Anticholinergic. • Sympathomimetic agents. (antihistamines, bronchodilators, antidepressants) • Produces diureses  dehydration  xerostomia.
  5. 5.  SALIVARY GLAND APLASIA- • Congenital absence of one or more major salivary glands. • Rare condition. • Unknown etiology.  SJOGREN’S SYNDROME- • Combination of dry mouth, dry eyes & rheumatoid arthritis. • Females commonly affected. • Age = 40-50 years. • Swelling of salivary glands may also develop.
  6. 6.  RADIATION THERAPY- • Therapeutic radiography of head & neck tumors. • Saliva: thickened, altered electrolytes, pH↓, secretion of immunoglobulins↓. • Glandular atrophy fibrosis or replaced by fatty tissue. • Atrophy due to ↓ vascularity of gland.  OTHER SYSTEMIC DISORDERS- • Diabetes mellitus  as a result of polyurea. • Anaemia. • Vitamin A, riboflavin, nicotinic acid deficiency. • Brain tumors • Diarrhoea etc.
  7. 7.  There is lack of saliva.  Duct calculi may lead to unilateral dryness with pain& swelling on the affected gland.  Sjogren’s syndrome produce bilateral swelling accompanied by lymph node enlargement in many cases.  Dry or burning sensation.  The mucosa appears dry, sometimes inflamed, often pale.  On tongue  there is atropy of papillae, inflammation, fissuring & crackling.  In severe cases areas of denudation are seen.
  8. 8.  Soreness of mucous membrane.  Ulceration.  Caries due to decrease salivary flow rate.  Speaking difficulty.  Abnormaily in taste.
  9. 9.  Eliminate etiological factors such as drug, calculi etc.  Promote salivary secretion by using sugar free chewing gums.  Patient must drink plenty of water.  Artificial saliva is avaliable these day.  Composition- • Carboxymethylcellulose. • Sorbitol. • Potassium Chloride. • Sodium Chloride. • Calcium Chloride. • Dipotassium hydrogen phosphate.
  10. 10.  SYNONYMS- • Sicca syndrome. • Gougera sjogren syndrome.  Described by Hernik Sjogren in year 1933.  It’s a chronic autoimmune disorder.  In sjogren’s syndrome the body’s defense system turns against itself & attacks glands that produce moisture.  Sjogren’s syndrome is described as a triad consisting of:- • Keratoconjunctivitis sicca (dry eye sundrome). • Xerostomia (dry mouth). • Rheumatoid arthritis.
  11. 11.  PRIMARY SJOGREN’S SYNDROME- • Comprises of dry mouth & dry eyes. • Not associated with any connective tissue disease.  SECONDARY SJOGREN’S SYNDROME- • Comprises dry mouth and dry eyes. • Associated with disease such as rheumatoid arthritis & other disorders such as polymyositis(inflammation of muscles), scleroderma.
  12. 12.  The causes of sjogren’s syndrome are known.  Genetic.  Hormonal.  Infections.  In many cases sera antisalivary duct antibody is seen.  Associated with HLA(human leukocyte antigen) system.  HLA-DR3 & HLA-B8 are associated only with primary form of disease.  HLA-DRw52 is assosiated with both the forms.
  13. 13.  Predominates in females.  F:M = 10:1.  Children, young adults & older age people are affected.  Dryness of moth and eyes due to hypofunction of salivary & lacrimal glands.  Painful & burning sensation of oral mucosa.  Secretor glands of nose, larynx, pharynx & tracheobroncial tree are involved with dryness.  Parotid gland enlargement.  Lymphadenopathy
  14. 14.  Purpura.  Kidney involvement.  Myositis.
  15. 15.  Schirmer's test - more than 10 mm of moisture on the filter paper in 5 minutes is normal.  ESR (Erythrocyte Sedimentation Rate)- increased in sjogren’s syndrome.  AntiSalivary duct antibodies- elevated.  Immunoglobulins- elevated.
  16. 16.  Sialography- radiographic examination of the salivary glands.  It usually involves the injection of a small amount of contrast medium into the salivary duct of a single gland, followed by routine X- ray projections.  Demonstrate the formation of puncture,cavity defects filled with radiopaque contrast media.  These filling defects produce ‘cherry blossom’ or ‘branchless fruit laden tree’ appearance.
  17. 17.  No satisfactory treatment.  Symptomatic treatment.  Keratoconjunctivitis – treated by ocular lubricants like artificial saliva.  Xerostomia – treated by oral lubricants.  For dental caries oral hygiene & fluoride application is indicated.  No specific treatment for enlargement of salivary glands.  Sometimes surgery is done in patients with discomfort.

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