Functional disorders of_salivary_glands

FUNCTIONAL
DISORDERS OF
SALIVARY GLANDS
- Deepthi.B

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Definition
SIALORRHEA is
defined as
increase in
salivary secretion.
Other names:
ptyalism,hypersalivation,
drooling

0.5-0.7% of all children
born are diagnosed with
cerebral palsy.
10-37% of patients with
cerebral palsy have been
reported with drooling
because of neurologic
impairment
Reportedly, 10% of
Swedish, 37% of
Belgian, and 13% of
Indian children with
cerebral palsy have
severe drooling.
Epidemiology

Etiology
1. Rabies
2. Pellagra
3. GERD
4. Anxiety
5. Pancreatitis
6. Liver disease
7. Sjogren's syndrome
1. clozapine
2. pilocarpine
3. ketamine
4. physostigmine
5. Neostigmine
Conditions causing sialorrhea Medications causing sialorrhea
Substances causing sialorrhea
1. Mercury
2. copper
3. organophosphates
Neurologic conditions associated
1. Cerebral palsy
2. Parkinson's disease
3. Wilson's disease

Customer
Convince
Pathogenesis
Primary sialorrhea
 Hypersecretion of salivary glands occurs as an adverse effects of
tranquilizers, anticholinesterase , anticonvulsants, antipsychotics.
 That increase activity at the muscarinic receptors of the
secretomotor pathway and result in hypersecretion.
Reference:
Freudenreich O. Drug-induced sialorrhea. Drugs Today (Barc).
2005;41(6):411-418. doi:10.1358/dot.2005.41.6.893628

Customer
Convince
Pathogenesis
Secondary sialorrhea
 Due to impaired neuromuscular control with
dysfunctional voluntary oral motor activity that
leads to an overflow of saliva from the mouth.
 Most patients who drool have impaired oral
neuromuscular control due to cerebral palsy or severe
mental retardation
 Impairment of the oral phase of deglutition secondary to
neuromuscular disorders, trauma, surgical resection, or facial nerve
paralysis can result in spillage of saliva from the oral cavity.
Reference: Sialorrhea in children with cerebral palsy☆,☆☆,Bruno Leonardo Scofano Diasa *
,Alexandre Ribeiro Fernandesb ,Heber de Souza Maia Filhoc

Clinical features
 Hypersalivation can cause drooling, which can produce social embarrassment and a
severe impairment in the quality of a person’s life.
 In severe cases, a partial or total blockage of the airway can occur, producing
aspiration of oral contents and possibly aspiration pneumonia.
 Hypersalivation can also lead to perioral irritations, malodor, and traumatic
ulcerations that can become secondarily infected by fungal or bacterial organisms.

Diagnosis
 Clinical history
 Motivation, physical, and cognitive ability to try to reduce
sialorrhea
 Neurological examination (including state of alertness, cranial
nerves, overall motor skills, posture, and tone)
 Orofacial assessment (signs of upper airway obstruction)
 Oral hygiene, dental occlusion and health, labial sealing
 Presence of GERD
 Presence and assessment of dysphagia

Diagnosis
Objective methods to
measure sialorrhea
1) Thomas- Stonnel and Greenberg scale
Method :
Direct observation of the examiner quantified
through a severity scale.
Description:
1 - Dry lips (no sialorrhea);
2 - Wet lips (mild sialorrhea);
3 - Wet lips and chin (moderate sialorrhea);
4 - Wet clothing around the neck (severe sialorrhea);
5 - Wet clothing, hands, and objects (profuse
Sialorrhea)

Objective methods to
measure sialorrhea
2) Sochaniwskyj's technique
Method:
Saliva collection and use of its own formula for quantification.
Description:
Collection of saliva that leaked through the mouth and reached
the chin, using a glass, for a 30-minute period.

Treatment
Non pharmacological
therapy:
Exercises are used to
attempt to normalize
muscle tone, stabilize
body ,head position,
promote jaw stability ,
lip closure, increase oral
sensation, and promote
swallowing.
Pharmacological
therapy:
1)Anticholinergics
2)Botulinum toxin -
RimabotulinumtoxinB
(Myobloc)
 Radiotherapy
 Surgical therapy
1. Transtympanic
neurectomy
2. Excision of
submandibular
glands with bilateral
parotid duct ligation

Definition
Xerostomia is also known
as dry mouth .It is the
subjective sensation of dry
mouth with objective
evidence of decreased
salivary flow.
XEROSTOMIA
Reference: Xerostomia: An overview Jitender Reddy Kubbi, Loka Ravali
Reddy, Lakshmi Srujana Duggi, Harisha Aitha

Etiology
 Anticholinergic agents: Atropine, scopalamine.
 Antidepressants and antipsychotics: Citalopram, fluoxetine.
 Antihypertensive agents: Captopril, clonidine.
 Diuretic agents: Chlorothiazide, frusemide.
 Analgesic agents: Opioids: Codeine, meperidine.
 Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen.
Drugs induces
XEROSTOMIA

Clinical features
EFFECTS OF XEROSTOMIA ON ORAL
FUNCTION :
 Patient also get difficulty in
swallowing, eating dry food, speech
 Tingling sensation
 Extensive cervical caries
 Depapillation and cobblestone pattern
 Gingival hyperplasia

• Burning sensation
• Food sticks to mucosa
• Oral health problems / Tissue alterations
• Angular chellitis (corner of lips)
• Candidiasis
• Caries
• Halitosis
• Loss of filiform papillae on tongue
• Mucositis
• Oral lesions
• Pain
• Periodontal disease
• Redness of the tongue
• Taste alteration
• Tooth sensitivity

EFFECTS OF XEROSTOMIA ON NORMAL
FUNCTIONS :
 Hypofunction of other secretory
glands
 Blurred vision
 Ocular dryness
 Itching, burning sensation in eye
 Dryness of pharynx and skin

CLINICAL SIGNS OF XEROSTOMIA:
 Dryness of lining oral mucosa
 Oral mucosa appears thin,pale and feels dry
 Tongue -depapillated, inflamed, fissuring, cracking, denudation
 Increased incidence of dental caries
CANDIDIASIS:
 Psuedomembranous candidiasis will be seen
 The reason is absence of normal cleansing and antimicrobial activity
of saliva
RESIDUAL SALIVA:
 Residual saliva which remains foamy,thick and roapy.

Diagnosis
 Patient's detailed history
 In mouth mirror test, back of the mouth mirror is drawn along
the buccal mucosa and the friction is registered accordingly.
 Wafer test is a semi-quantitative test in which the time taken
for dissolution of wafer is noted in minutes and is recorded in
grades to screen for xerostomia.
 Dyness of the lips and buccal mucosa, absence of saliva
production during gland palpation, and increased DMFT

Sialography:
It is the radiographic visualization of salivary gland
following retrograde instillation of soluble contrast material into the
ducts.
 The normal ductal architecture has a leafless tree appearance.
 Non opaque sialoliths appears as voids
 Sialectasis is the appearance of focal collection's of contrast
medium within the gland,seen in cases of sialedenitis & Sjogren's
syndrome.
 It detects ductal obstruction,stenosis & stricture,size of tumors,
salivary fistula.
 Bacteriostatic effect and used in drainage of ductal debris and
mucus plug

Scintigraphy :
Radioactive isotope is injected and traced by gamma
camera.uptake of isotope by the gland increase in case of acute
inflammation and decrease in case of chronic inflammation.
Evaluates salivary function
Ultrasonography :
 Detect stones
 Detecting space occupying lesions
 Differentiate a cystic lesion from a solid mass
 Differentiate intrinsic lesion from extrinsic mass

Treatment
Preventive measures :
 oral hygiene
 A low-sugar diet
 Topical fluoride
 Neutral pH
 1% sodium fluoride

Salivary stimulation:
 Frequent meals
 Ingestion of lemonade or acid drinks,
 Sugar-free chewing gums, mints, and
candies
 Sialogogues that directly stimulate salivary
glands are Pilocarpine, Cevimeline,
Bethanecol etc.
 Electrostimulation may increase the
salivary flow in patients with Sjogren's
syndrome

Topical agents:
1. Lubricating gels
2. Mouth washes
3. Lozenges
4. Mucin spray -
irradiation
cases
Systemic agents:
1. pilocarpine is 5 mg given 4
times daily or 10 mg given
thrice daily.
2. Cevimeline 30 mg thrice
daily
3. Bromhexine (32-48 mg
daily)
4. Infusion of infliximab for 1
year reduces xerostomia
significantly.
Immunological
agent's:
Parenteral and
IMadministration
of interferon-α
increases the
salivary
andlacrimal flow
inSjogren's
syndrome.

Salivary substitutes:
 luborant (which contains
lactose peroxidase,
glandosane)
 saliva orthona (an oral
spray containing porcine
mucin)
 biotene (contains
components like
polyglycerol methacrylate,
lactoperoxidase, glucose
oxidase)
 Salivix pastilles - used as
local salivary stimulant
Immunosuppressants:
 Cyclosporine
 cyclophosphamide
 thalidomide
Corticosteroids:
Corticosteroid
irrigation - with
prednisolone 2
mg/ml in normal
saline is clinically
helpful by
increasing the
salivary flow rates
in early stages of
disease. [5]

Prosthodontic management:
Dentures should be cleaned with chlorhexidine solution 0.2% overnight or
chlorhexidine gel 1% two times a day.
Salivary pacemakers:
1. Neuroelectrostimulation increases salivary secretion, and thus
the device salitron has been introduced.
2. Dental implant based intraoral device is a miniature
neuroelectrostimulating device to be implanted into the oral
cavity
3. It generates frequent stimuli, does not interfere with regular
oral functions, senses the wetness/dryness of the mouth, and
can be controlled by the patient via remote control

Dental implant based
salivary pacemaker
Occlusal view of the device
implanted

Acupuncture :
Acupuncture is known to increase
parasympathetic action, causing a release in
neuropeptide and stimulating salivary flow and
secretions, thereby reducing the incidence of
xerostomia.
Benzodiazepines such as ketazolam 15-30 mg at
bed time, followed by gradual dose reduction is
advised.
Avoid irritants such as coffee, alcohol, or tobacco
smoking.
Psychological factors :

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