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  2. 2. Salivary Gland Dysfunction and Xerostomia (Dry Mouth)<br />
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  4. 4. XEROSTOMIA<br />Xerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva.<br />
  5. 5. XEROSTOMIA<br />It affects17-29%of samples populations based on self-reports or measurements of salivary flow rates.<br />More prevalent inwomen.<br />Can cause significant morbidity and a reduction in a patient’s perception ofquality of life.<br />
  6. 6. SALIVA<br />It keeps the teeth healthy by providing a lubricant, calcium and a buffer.<br />It also helps to maintain the health of the gums, oral tissues (mucosa) and throat.<br />It also plays a role in the controlof bacteria in the mouth.<br />
  7. 7. It helps to cleanse the mouth of food and debris. <br />It provides minerals such as calcium, fluoride, and phosphorus.<br />It helps in swallowing anddigesting food.<br />
  8. 8. Lack of saliva will make the mouth more prone to disease and infection.<br />Lead to a burning feeling.<br />
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  12. 12. Antimicrobial Factors in Human Whole Saliva<br />Non-immunoglobulin FactorsOrigin<br />Lysozyme Salivary glands, crevicular fluid (PMNs)<br />Lactoferrin Salivary glands, crevicular fluid (PMNs)<br />Salivary peroxidase Salivary glands<br /> SCN- Salivary glands, crevicular fluid<br /> H2O2 Salivary glands, crevicular fluid (PMNs),<br /> bacterial and yeast cells<br />Myeloperoxidase Crevicular fluid (PMNs)<br /> Cl- Salivary glands, crevicular fluid<br />Agglutinins, aggregating proteins Salivary glands<br />Histidine-rich polypeptides Salivary glands<br />Proline-rich proteins Salivary glands<br />Immunoglobulin Factors<br />Secretory IgA Salivary glands<br />IgA, IgG, IgM Crevicular fluid<br />
  13. 13. Ionizing radiation can injure the major and minor salivary glands which may lead to atrophy of the secretory components and results in varying degrees of temporary or permanent xerostomia.<br />Toxic substanaces in chemotherapeutic agents.<br />
  14. 14. <ul><li>Diabetes mellitus: Patients with poor glycemic control, are more likely to complain of xerostomia and may have decreased salivary flow.</li></li></ul><li>Dry Mouth With Strawberry Tongue<br />
  15. 15. Severe Dry Mouth (Strawberry Tongue)<br />
  16. 16. Other Conditions<br />Anxiety or Depression <br />HIV<br />Diabetes, Type 1 or 2 <br />AIDS<br />Primary Biliary Cirrhosis <br />Bone Marrow Transplantation <br />Vasculitis <br />Graft-vs.-Host Disease<br />Chronic Active Hepatitis <br />Renal Dialysis<br />
  17. 17. Salivary Gland Dysfunction and Xerostomia<br />Clinical Appearance:<br /><ul><li>Oral mucosa appears dry, pale, or atrophic.
  18. 18. Tongue may be devoid of papillae with fissured and inflamed appearance.
  19. 19. New and recurrent dental caries.
  20. 20. Difficulty with chewing, swallowing, and tasting may occur.
  21. 21. Fungal infections are common.</li></li></ul><li>Pale Fisured Tongue Due To Severe Dry Mouth<br />
  22. 22. Moderate Xerostomia<br />
  23. 23. Warning Signs in<br />Xerostomia<br />1. Dry, burning mouth and throat<br />Dry, cracking lips, especially in the corners. The cracks may be tender and/or bleed<br />Problems with denture wearing<br />
  24. 24. Problems eating and swallowing food<br />Difficulty with speech due to mouth soreness.<br />6. Increased caries and periodontal disease<br />
  25. 25. Diagnosis of Xerostomia<br />It has been estimated that a 50% reduction in salivary secretion needs to occur before the xerostomia becomes apparent.<br />An affirmative response to at leastone of the fivefollowing questions about symptoms has been shown to correlate with a decrease in salivary flow:<br />
  26. 26. 1. Does your mouth usually feel dry?<br />2. Does your mouth feel dry when eating a meal?<br />Do you have difficulty swallowing dry food?<br />Do you sip liquids to aid in swallowing dry food?<br />
  27. 27. 5. Is the amount of saliva in your mouth too little most<br /> of the time, or don’t you notice it?<br />When unstimulated salivary flow is less than0.12 to 0.16 ml/minute,a diagnosis of hypofunction is established.<br />
  28. 28. MANAGEMENT<br />The general approach to treating patients with hyposalivation and xerostomia is directed atpalliative treatment for the relief of symptoms and prevention of oral complications:<br />
  29. 29. Consult with physicianto decrease drug dose, alter drug dosages, or substitute one xerostomic medication for a similar-acting drug with fewer salivary side effects.<br />
  30. 30. Symptomatic Treatments:<br />Sip water frequently all day long<br />Let ice melt in the mouth<br />Restrict caffeine intake<br />Avoid mouth rinses containing alcohol<br />Humidify sleeping area<br />Coat lips with lubricant.<br />
  31. 31. Coat the lips with a petroleum jelly like Vaseline, Blistex, or lanolin.<br />Maintain good oral hygiene. Floss daily.<br />Brush at least twice a day.<br />Use toothpaste with fluoride andalcohol free (e.g. Biotene toothpaste).<br />
  32. 32. Avoid Tobacco use, spicy, salty, and highlyacidic foods that irritate the mouth.<br />
  33. 33. Saliva Substitutes:<br />Rx:<br />Sodium carboxymethyl cellulose* 0.5% aqueous solution [OTC]<br />Disp: 8 fl. Oz.<br />Sig: Use as a rinse as frequently as needed.<br />*Generic carboxymethyl cellulose solutions may be prepared by a pharmacist.<br />
  34. 34. Commercial Salivary Substitute<br />Commercial oral moisturizing gels (OTC) includes:<br />OralBalance.<br />XERO-Lube<br />Salivart<br />Moi-Stir Orex<br />Optimoist<br />
  35. 35. Commercial Oral Moisturizing Gels [OTC]:<br />Laclede Oral Balance<br />
  36. 36. Oral Balance Ingredients<br />Polyglycerylmethacrylate <br /> (moisturizing agent)<br />Lactoperoxidase (antibacterial)<br />Glucose Oxidase (antibacterial)<br />Lysozyme (antibacterial)<br />
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  39. 39. Saliva Stimulants:<br />The use of sugar free gum, lemon drops or mints are conservative methods to temporarily stimulate salivary flow in patients with medication xerostomia or with salivary gland dysfunction.<br />
  40. 40. Rx:<br />Biotine chewing gum [OTC]<br />Disp: 1 package<br />Sig: Chew as needed. Due to problems of abrasion of the mucosa under the denture and potential adhesion of the gum to the denture, use caution if the patient has removable dentures.<br />
  41. 41. Rx:<br />Pilocarpine HCl (Salagen) Tablets 5 mg<br />Disp: 21 tablets<br />Sig: Take 1 tablet tid 1/2 hour prior to meals. Dose may be titrated to 2 tablets tid.<br />Some authors recommend using 1 tablet of pilocarpine 4-5 times daily.<br />
  42. 42. Rx:<br />Pilocarpine HCL solution <br />1 mg/ml<br />Disp: 100 ml<br />Sig: Take 1 teaspoonful tid.<br />
  43. 43. Pilocarpin HCl<br />May need 2-3 months to determine effectiveness.<br />Side effects include sweating and diarrhea.<br />Avoid in patients with narrow angle glaucoma, severe asthma, pulmonary diseases.<br />
  44. 44. Rx:<br />Cevimeline (Evoxac) Capsules 30 mg<br />Disp: 21 tablets<br />Sig: Take 1 tablet tid.<br />
  45. 45. Rx:<br />Bethanechol (Urecholine) tablets 25 mg<br />Disp: 30 tablets<br />Sig: Take 1 tablet up to 5 times daily.<br />
  46. 46. Conditions Affecting the Tongue<br />
  47. 47. Conditions Affecting the Tongue<br />Geographic tongue<br />Hairy tongue<br />Fissured tongue<br />Varices<br />Vitamin deficiencies<br />
  48. 48. Benign Migratory Glossitis (Geographic tongue)<br />Etiology:<br /><ul><li>Unknown
  49. 49. May be associated with psoriasis and Reiter’s syndrome.</li></ul>Appearances:<br /><ul><li>Changing pattern of erythematous patches on the tongue dorsum caused by atrophy of the filiform papillae.</li></li></ul><li>Geographic Tongue<br />
  50. 50. Hairy Tongue<br />Etiology:<br /><ul><li>Antibiotics
  51. 51. Tobacco
  52. 52. Chlorhexidine
  53. 53. Food debris
  54. 54. Oral candidiasis</li></li></ul><li>
  55. 55. Black/Brown Hairy Tongue<br />
  56. 56.
  57. 57. Brown Hairy Tongue<br />
  58. 58. Hairy Tongue<br />Treatment:<br /><ul><li>Proper oral hygiene and tongue brushing.
  59. 59. If a fungal infection is suspected, perform a fungal culture and use topical antifungal.</li></li></ul><li>Fissured Tongue<br />Etiology:<br /><ul><li>Unknown
  60. 60. Appearance:
  61. 61. Numerous small furrows and fissures on the dorsum of the tongue. May be attributed to trauma, vitamin deficiencies, salivary gland dysfunction.</li></li></ul><li>
  62. 62. Nutritional Deficiencies<br /><ul><li>Etiology
  63. 63. Vitamin B1, B2, B6, B12 and folic acid deficiency.
  64. 64. Appearance
  65. 65. Loss of filiform papillae produce a painful erythematous and granular appearing tongue.
  66. 66. Eventually papillae atrophy leaving a smooth/bald tongue.</li></li></ul><li>