DOCSLIB.ORG

A Clinical Guide on Causes, Effects and Treatments Guy Carpenter Editor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Clinical Guide on Causes, Effects and Treatments Guy Carpenter Editor Guy Carpenter Editor Dry Mouth A Clinical Guide on Causes, E ects and Treatments Dry Mouth Guy Carpenter Editor Dry Mouth A Clinical Guide on Causes, Effects and Treatments Editor Guy Carpenter Department of Salivary Research Kings College London Dental Institute London UK ISBN 978-3-642-55153-6 ISBN 978-3-642-55154-3 (eBook) DOI 10.1007/978-3-642-55154-3 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2014953246 © Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica- tion does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publica- tion, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Contents Part I Background Topics 1 Introduction . 3 Guy Carpenter Part II Causes 2 Diseases Causing Oral Dryness. 7 Anne Marie Lynge Pedersen 3 Medication-Induced Dry Mouth. 33 Gordon B. Proctor 4 Cancer-/Cancer Treatment-Related Salivary Gland Dysfunction. 51 Andrew N. Davies Part III Effects 5 Oral Dryness, Dietary Intake, and Alterations in Taste. 69 Anja Weirsøe Dynesen 6 Xerostomia and the Oral Microfl ora . 81 Antoon J.M. Ligtenberg and Annica Almståhl 7 Subjective Aspects of Dry Mouth . 103 W. Murray Thomson Part IV Diagnosis 8 Clinical Scoring Scales for Assessment of Dry Mouth . 119 Stephen J. Challacombe, Samira M. Osailan, and Gordon B. Proctor 9 Imaging of Salivary Glands. 133 Bethan Louise Thomas v Part V Treatment 10 New Radiotherapy Techniques for the Prevention of Radiotherapy- Induced Xerostomia . 147 Thomas M. Richards and Christopher M. Nutting 11 Artifi cial Salivas: Why Are They Not More Useful? . 165 Guy Carpenter 12 The Benefi cial Effects of Regular Chewing . 175 Taichi Inui 13 Future Prevention and Treatment of Radiation-Induced Hyposalivation . 195 Robert P. Coppes and Tara A. van de Water Index . 213 Contributors Annica Almståhl , PhD, Dental Hygenist Department of Oral Microbiology and Immunology , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden Guy Carpenter Salivary Research , King’s College London Dental Institute , London , UK Stephen J. Challacombe , PhD, FRC(Path), FDSRCS, FMedSci Department of Oral Medicine , King’s College London, Guys and St Thomas’ Hospital , London , UK Robert P. Coppes , PhD Department of Radiation Oncology and Cell Biology , University Medical Center Groningen , Groningen , The Netherlands Andrew N. Davies , FRCP Palliative Medicine, Palliative Care , Royal Surrey County Hospital , Guildford, Surrey , UK Anja Weirsøe Dynesen , DDS, MSc. Human Nutrition, PhD Department of Odontology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen Nørrebro , Denmark Taichi Inui , PhD Department of R&D, Wm. Wrigley Jr. Company , Chicago , IL , USA Antoon J. M. Ligtenberg , PhD Department of Oral Biochemistry , Academic Centre for Dentistry Amsterdam , Amsterdam , The Netherlands Christopher M. Nutting , MBBS, BSc, MD, PhD, MRCP, FRCR Head and Neck Unit , The Royal Marsden Hospital , London , UK Samira M. Osailan , BDS, PhD Department of Oral Surgery , King Abdulaziz University , Jeddah , Saudi Arabia Anne Marie Lynge Pedersen , PhD, DDS Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark Gordon B. Proctor , BSc, PhD Mucosal and Salivary Biology Division , King’s College London Dental Institute , London , UK vii viii Contributors Thomas M. Richards , BSc, MBBS, MRCP, FRCR Head and Neck Unit , The Royal Marsden Hospital , London , UK Bethan Louise Thomas , BDS, BSc (Hons), PhD, DDMFR RCR Dental and Maxillofacial Radiology , Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust , London , UK Dental Radiology The Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust , London , UK W. Murray Thomson , BSc, BDS, MA, MComDent, PhD Dental Epidemiology and Public Health, Oral Sciences, Faculty of Dentistry , Sir John Walsh Research Institute, The University of Otago , Dunedin , Otago , New Zealand Tara A. van de Water , PhD Department of Radiation Oncology , University Medical Center Groningen , Groningen , The Netherlands P a r t I Background Topics Introduction 1 Guy Carpenter Abstract This book has come about following a symposium organized by the editor to encourage further research into dry mouth and its causes. The symposium was held at the Pan-European meeting of the IADR, and as a consequence, this book is largely based on contributions from Europeans. This may lead to variations compared to US-based books as there are differences in drug prescribing, irradiation protocols, and even diagnostic criteria that may influence the healthcare professional. Using even the most conservative of estimates, this book will still be relevant to the 30 million dry mouth sufferers in the European region. In trying to stimulate research in this fi eld, a more scientifi c than clinical approach has been taken although, of course, the two go hand in hand. Dry mouth is surprisingly a common symptom. For the entire population, it is esti- mated that 10–30 % may experience a troublesome dry mouth with a smaller per- centage suffering serious impact on their quality of life. Salivary secretion is an autonomic refl ex stimulated mainly by taste and chewing. The resting fl ow rate that maintains a hydrated mouth between meals is driven mostly by cortical activity. It is often the decline in the resting rate of salivary secretion that causes most people most problems – particularly at night when cortical activity will be at its lowest. As we discover in the initial chapters, dry mouth can develop from three main causes: by specifi c diseases of the salivary glands (Chap. 2 – Dr Pedersen), as a side effect of head and neck irradiation treatment for cancer (Chap. 4 – Dr Davies), or most commonly as a side effect of prescribed drugs (Chap. 3 – Prof Proctor). One G. Carpenter Salivary Research , King’s College London Dental Institute , Floor 17, Tower wing , London SE1 9RT , UK e-mail: [email protected] © Springer-Verlag Berlin Heidelberg 2015 3 G. Carpenter (ed.), Dry Mouth: A Clinical Guide on Causes, Effects and Treatments, DOI 10.1007/978-3-642-55154-3_1 4 G. Carpenter of the problems with dry mouth is that because it is subjectively reported, it is harder to diagnose than an objective measure, such as salivary fl ow rate. It should follow that dry mouth is caused by decreased saliva production, but this is not always the case. Due to a wide variation in fl ow rates of a normal population, there is little to separate a hyposalivator from an individual with a normal range of salivation. A recent development has been a clinical scoring system to aid general practitioners and healthcare workers to determine the severity of the dry mouth. The Challacombe scale is fully explained by its originator (Chap. 8 – Prof Challacombe) and set within the background of other scoring systems which are notoriously complicated and variable. Within the hospital setting, (Chap. 9 – Dr Thomas) explores some different imaging modalities and recent advances that can be used to identify glan- dular changes that would cause hyposecretion and therefore dry mouth. The rate of change from normal salivation to dry mouth often makes a differ- ence as to when subjects report dry mouth to a clinician. For example, subjects on medication that have xerostomia as a side effect (around 50 % of all drugs have this property) develop dry mouth relatively quickly and are more likely to report dry mouth than subjects with a slow change, perhaps caused by an autoim- mune condition such as Sjögren’s syndrome. To emphasize the point, children born with a lack of salivary glands (aplasia) often do not report dry mouth as a problem probably because they have never known what a normally hydrated mouth feels like. Dry mouth is widely perceived as a minor symptom except by those that suffer from it. This seemingly unjust situation probably occurs because it is not life threatening. Yet the impact on quality of life (Chap. 7 – Dr Thompson) is considerable often leaving patients socially isolated. This is because saliva affects all functions of the mouth and thus a lack of saliva will have an impact on eating, chewing and swallowing leading to a poorer diet (Chap. 5 – Dr Dynesen). Furthermore, the oral health of dry mouth patients is challenged by a change in the oral fl ora.
Load more

Recommended publications
  • The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid
    YM Son, et al Ann Dermatol Vol. 23, Suppl. 3, 2011 http://dx.doi.org/10.5021/ad.2011.23.S3.S310 CASE REPORT The Neumann Type of Pemphigus Vegetans Treated with Combination of Dapsone and Steroid Young-Min Son, M.D., Hong-Kyu Kang, M.D., Jeong-Hwan Yun, M.D., Joo-Young Roh, M.D., Jong-Rok Lee, M.D. Department of Dermatology, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea Pemphigus vegetans is a rare variant of pemphigus vulgaris INTRODUCTION and is characterized by vegetating lesions in the inguinal folds and mouth and by the presence of autoantibodies Pemphigus diseases are a group of autoimmune disorders against desmoglein 3. Two clinical subtypes of pemphigus that have certain common features, and these diseases are vegetans exist, which are initially characterized by flaccid considered to be potentially fatal1,2. Pemphigus vegetans bullae and erosions (the Neumann subtype) or pustules (the is a variant of pemphigus vulgaris and is the rarest form of Hallopeau subtype). Both subtypes subsequently develop pemphigus; Pemphigus vegetans comprises less than 1∼ into hyperpigmented vegetative plaques with pustules and 2% of all pemphigus cases1,3,4. This variant is charac- hypertrophic granulation tissue at the periphery of the terized by flaccid bullae or pustules that erode to form hy- lesions. Oral administration of corticosteroids alone does not pertrophic papillated plaques that predominantly involve always induce disease remission in patients with pemphigus the intertriginous areas, the scalp, and the face; in 60∼ vegetans. We report here on a 63-year-old woman with 80% of all cases, the oral mucosa are also affected5,6.
    [Show full text]
  • Sjogren's Syndrome an Update on Disease Pathogenesis, Clinical
    Clinical Immunology 203 (2019) 81–121 Contents lists available at ScienceDirect Clinical Immunology journal homepage: www.elsevier.com/locate/yclim Review Article Sjogren’s syndrome: An update on disease pathogenesis, clinical T manifestations and treatment ⁎ Frederick B. Vivinoa, , Vatinee Y. Bunyab, Giacomina Massaro-Giordanob, Chadwick R. Johra, Stephanie L. Giattinoa, Annemarie Schorpiona, Brian Shaferb, Ammon Peckc, Kathy Sivilsd, ⁎ Astrid Rasmussend, John A. Chiorinie, Jing Hef, Julian L. Ambrus Jrg, a Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA b Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39th Street, Philadelphia, PA 19104, USA c Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, PO Box 100125, Gainesville, FL 32610, USA d Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA e NIH, Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, Building 10, Room 1n113, 10 Center DR Msc 1190, Bethesda, MD 20892-1190, USA f Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China g Division of Allergy, Immunology and Rheumatology, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA 1. Introduction/History and lacrimal glands [4,11]. The syndrome is named, however, after an Ophthalmologist from Jonkoping, Sweden, Dr Henrik Sjogren, who in Sjogren’s syndrome (SS) is one of the most common autoimmune 1930 noted a patient with low secretions from the salivary and lacrimal diseases. It may exist as either a primary syndrome or as a secondary glands.
    [Show full text]
  • 2017 Oregon Dental Conference® Course Handout
    2017 Oregon Dental Conference® Course Handout Nasser Said-Al-Naief, DDS, MS Course 8125: “The Mouth as The Body’s Mirror: Oral, Maxillofacial, and Head and Neck Manifestations of Systemic Disease” Thursday, April 6 2 pm - 3:30 pm 2/28/2017 The Mouth as The Body’s Mirror Oral Maxillofacial and Head and Neck Manifestation of Ulcerative Conditions of Allergic & Immunological Systemic Disease the Oro-Maxillofacial Diseases Region Nasser Said-Al-Naief, DDS, MS Professor & Chair, Oral Pathology and Radiology Director, OMFP Laboratory Oral manifestations of Office 503-494-8904// Direct: 503-494-0041 systemic diseases Oral Manifestations of Fax: 503-494-8905 Dermatological Diseases Cell: 1-205-215-5699 Common Oral [email protected] Conditions [email protected] OHSU School of Dentistry OHSU School of Medicine 2730 SW Moody Ave, CLSB 5N008 Portland, Oregon 97201 Recurrent aphthous stomatitis (RAS) Recurrent aphthous stomatitis (RAS) • Aphthous" comes from the Greek word "aphtha”- • Recurrence of one or more painful oral ulcers, in periods of days months. = ulcer • Usually begins in childhood or adolescence, • The most common oral mucosal disease in North • May decrease in frequency and severity by age America. (30+). • Affect 5% to 66% of the North American • Ulcers are confined to the lining (non-keratinized) population. mucosa: • * 60% of those affected are members of the • Buccal/labial mucosa, lateral/ventral tongue/floor of professional class. the mouth, soft palate/oropharyngeal mucosa • Etiopathogenesis: 1 2/28/2017 Etiology of RAU Recurrent Aphthous Stomatitis (RAS): Types: Minor; small size, shallow, regular, preceeded by prodrome, heal in 7-10 days Bacteria ( S.
    [Show full text]
  • Oral Manifestations of Systemic Disease Their Clinical Practice
    ARTICLE Oral manifestations of systemic disease ©corbac40/iStock/Getty Plus Images S. R. Porter,1 V. Mercadente2 and S. Fedele3 provide a succinct review of oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease. While the majority of disorders of the mouth are centred upon the focus of therapy; and/or 3) the dominant cause of a lessening of the direct action of plaque, the oral tissues can be subject to change affected person’s quality of life. The oral features that an oral healthcare or damage as a consequence of disease that predominantly affects provider may witness will often be dependent upon the nature of other body systems. Such oral manifestations of systemic disease their clinical practice. For example, specialists of paediatric dentistry can be highly variable in both frequency and presentation. As and orthodontics are likely to encounter the oral features of patients lifespan increases and medical care becomes ever more complex with congenital disease while those specialties allied to disease of and effective it is likely that the numbers of individuals with adulthood may see manifestations of infectious, immunologically- oral manifestations of systemic disease will continue to rise. mediated or malignant disease. The present article aims to provide This article provides a succinct review of oral manifestations a succinct review of the oral manifestations of systemic disease of of systemic disease. It focuses upon oral mucosal and salivary patients likely to attend oral medicine services. The review will focus gland disorders that may arise as a consequence of systemic upon disorders affecting the oral mucosa and salivary glands – as disease.
    [Show full text]
  • Orofacial Granulomatosis
    Al-Hamad, A; Porter, S; Fedele, S; (2015) Orofacial Granulomatosis. Dermatol Clin , 33 (3) pp. 433- 446. 10.1016/j.det.2015.03.008. Downloaded from UCL Discovery: http://discovery.ucl.ac.uk/1470143 ARTICLE Oro-facial Granulomatosis Arwa Al-Hamad1, 2, Stephen Porter1, Stefano Fedele1, 3 1 University College London, UCL Eastman Dental Institute, Oral Medicine Unit, 256 Gray’s Inn Road, WC1X 8LD, London UK. 2 Dental Services, King Abdulaziz Medical City-Riyadh, Ministry of National Guard, Riyadh, Saudi Arabia. 3 NIHR University College London Hospitals Biomedical Research Centre, London, UK. Acknowledgments: Part of this work was undertaken at University College London/University College London Hospital, which received a proportion of funding from the Department of Health’s National Institute for Health Research Biomedical Research Centre funding scheme. Conflicts of Interest: The authors declare that they have no affiliation with any organization with a financial interest, direct or indirect, in the subject matter or materials discussed in the manuscript that may affect the conduct or reporting of the work submitted. Authorship: all authors named above meet the following criteria of the International Committee of Medical Journal Editors: 1) Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) Drafting the article or revising it critically for important intellectual content; 3) Final approval of the version to be published. Corresponding author: Dr. Stefano Fedele DDS, PhD
    [Show full text]
  • Lymphoepithelial Cyst of the Salivary Gland in a Small Ruminant Lentivirus-Positive Goat
    animals Case Report Lymphoepithelial Cyst of the Salivary Gland in a Small Ruminant Lentivirus-Positive Goat Izabella Dolka 1,* , Marek Tomaszewski 2, Daria Wola 2, Michał Czopowicz 3 and Jarosław Kaba 3 1 Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776 Warsaw, Poland 2 The Scientific Society of Veterinary Medicine Students, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159, 02-787 Warsaw, Poland; [email protected] (M.T.); [email protected] (D.W.) 3 Division of Veterinary Epidemiology and Economics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776 Warsaw, Poland; [email protected] (M.C.); [email protected] (J.K.) * Correspondence: [email protected] Received: 7 August 2020; Accepted: 30 August 2020; Published: 1 September 2020 Simple Summary: This study presents the first case of a lymphoepithelial cyst (LEC) adjacent to the salivary gland in a goat seropositive for the small ruminant lentivirus (SRLV). Immunohistochemistry detected the antigen of caprine arthritis-encephalitis virus (CAEV) in the LEC, salivary gland, and lung tissue. In human patients, a LEC of the major salivary gland is an uncommon benign lesion and may be the early clinical manifestation of human immunodeficiency virus (HIV) infection. The present report provides useful information on the comparative aspect of LEC in an animal infected with CAEV, one of the SRLVs usually associated with chronic infection. Although many hypothetic theories were proposed, the etiopathogenesis of LEC is still debated. In this study, we present the histopathological description of LEC, supported by histochemistry and immunohistochemistry.
    [Show full text]
  • Oral Pathology Unmasking Gastrointestinal Disease
    Journal of Dental Health Oral Disorders & Therapy Review Article Open Access Oral pathology unmasking gastrointestinal disease Abstract Volume 5 Issue 5 - 2016 Different ggastrointestinal disorders, such as Gastroesophageal Reflux Disease (GERD), Celiac Disease (CD) and Crohn’s disease, may manifest with alterations of the oral cavity Fumagalli LA, Gatti H, Armano C, Caruggi S, but are often under and misdiagnosed both by physicians and dentists. GERD can cause Salvatore S dental erosions, which are the main oral manifestation of this disease, or other multiple Department of Pediatric, Università dell’Insubria, Italy affections involving both hard and soft tissues such as burning mouth, aphtous oral ulcers, Correspondence: Silvia Salvatore, Pediatric Department of erythema of soft palate and uvula, stomatitis, epithelial atrophy, increased fibroblast number Pediatric, Università dell’Insubria, Via F. Del Ponte 19, 21100 in chorion, xerostomia and drooling. CD may be responsible of recurrent aphthous stomatitis Varese, Italy, Tel 0039 0332 299247, Fax 0039 0332 235904, (RAS), dental enamel defects, delayed eruption of teeth, atrophic glossitis and angular Email chelitis. Crohn’s disease can occur with several oral manifestations like indurated tag-like lesions, clobbestoning, mucogingivitis or, less specifically, with RAS, angular cheilitis, Received: October 30, 2016 | Published: December 12, 2016 reduced salivation, halitosis, dental caries and periodontal involvement, candidiasis, odynophagia, minor salivary gland enlargement, perioral
    [Show full text]
  • Prevalence of Salivary Gland Disease in Patients Visiting a Private Dental
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 01, 2020 PREVALENCE OF SALIVARY GLAND DISEASE IN PATIENTS VISITING A PRIVATE DENTAL COLLEGE 1Dr.Abarna Jawahar, 2Dr.G.Maragathavalli, 3Dr.Manjari Chaudhary 1Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India 2Professor, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences(SIMATS), Saveetha University, Chennai, India 3Senior Lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences(SIMATS), Saveetha University, Chennai, India [email protected] [email protected] [email protected] ABSTRACT: The aim of the study was to estimate the prevalence of salivary gland diseases in patients visiting a private dental college. A retrospective analysis was conducted on patients who visited the Department of Oral Medicine from March 2019 to March 2020.Clinically diagnosed cases of salivary gland diseases which included salivary gland neoplasms, xerostomia, necrotizing sialometaplasia, mucocele, ranula, sjogren’s syndrome, sialodochitis, sialadenitis were included in the study.The details of each case were reviewed from an electronic database.From the study we found that 17 patients were diagnosed with salivary gland disease.The most commonly observed salivary gland disease was mucocele of the lip with a frequency of 41.17% in the study population followed by xerostomia (17.65%).Salivary gland disease can occur due to variable causes and might significantly affect the quality of life and daily functioning.Only with a thorough knowledge of the subject it is possible to detect the diseases of the salivary gland in their early stage and manage them more efficiently.
    [Show full text]
  • Salivary Gland Imaging in Sjogren's Syndrome
    REVIEW Salivary gland imaging in Sjogren’s syndrome Susan I Lemon, Sjogren’s syndrome (SS) is a systemic connective tissue disease characterized by a Steven G Imbesi & progressive immune-mediated impairment of the exocrine glands. The high prevalence in Alexander R Shikhman† the general population of sicca and other symptoms mimicking SS has increased the need †Author for correspondence for accurate tools in its diagnosis. Imaging may be substantially helpful in this regard, as Scripps Clinic, Member of the well as in the assessment of acute and chronic complications of the disease. A future Division of Rheumatology, MS113, 10666 North Torrey, application of salivary imaging in SS may be guiding therapeutics by enabling Pines Road, La Jolla, radiographic monitoring of treatment responsiveness. This review of salivary gland imaging CA 92037, USA in SS summarizes the types of information yielded by currently available modalities and Tel.: +1 858 554 8562; suggests their proper clinical application. It emphasizes recent advances in noninvasive Fax: +1 858 554 6763; imaging, including magnetic resonance sialography, ultrasonography and nuclear [email protected] medicine techniques. Sjogren’s syndrome (SS) is a systemic connective atrophic and, finally, destroyed [8]. Eventually, the tissue disease characterized by a progressive only remaining ductal epithelium consists of iso- immune-mediated impairment of the exocrine lated cell clusters of epithelial and myoepithelial glands [1,2]. Common clinical manifestations of cells surrounded by a dense lymphocytic infiltra- exocrine involvement in SS include keratocon- tion (a benign lymphoepithelial lesion) [9]. These junctivitis sicca, xerostomia and episodic glandu- pathological changes lead to salivary gland hypo- lar swelling.
    [Show full text]
  • Classification of Salivary Gland Disorders
    Salivary Gland Diseases and Disorders Dr. Mahmoud E. Khalifa Prof of OMFS Lecture ILOs At the end of this chapter you should be able to: 1. Distinguish the clinical features of infections of the salivary glands from those in other structures 2. Differentiate on clinical grounds between infection, obstruction, benign and malignant neoplasms of the salivary glands 3. Plan and evaluate the results of the investigation of disorders of the salivary glands 4. List the important/relevant information to be elicited from patients with salivary gland disorders 5. Select cases which require referral for a specialist opinion 6. Describe the causes of a dry mouth and be able to distinguish between organic and functional causes. Anatomy Major glands Minor glands 3 pairs Situated mostly 800 to 1000 in the oral cavity Parotid Submandibular The majority atAlso found in the the junction of pharynx, larynx, the hard and soft trachea, and palates sinuses sublingual Functions These glands function to produce saliva, which serves as Lubricant for speech & swallowing Assists taste Immunologic (antibacterial) Digestive Cleansing properties Based on the type of secretion, the salivary glands may be grouped as: (i) Serous, (ii) Mucous and (iii) Mixed. Parotid gland secretion is serous in nature. The sublingual gland secretes mixed, but predominantly mucous. The submandibular gland secretion is also mixed, but is predominantly serous. The minor glands secrete mucous saliva. Parotid Gland The parotid gland is the largest salivary gland, the secretion of which is serous in nature. It is pyramidal in shape; The base located superficial and apex medially The base is triangular in shape its apex is towards the angle of the mandible, the base at the external acoustic meatus The parotid duct (Stenson‘s duct) Emerges at the anterior part of the gland.
    [Show full text]
  • The Investigation of Major Salivary Gland Agenesis: a Case Report
    Oral Pathology The investigation of major salivary gland agenesis: A case report T.A. Hodgson FDS, RCS, MRCP(UK) R. Shah FDS, RCS S.R. Porter MD, PhD, FDS, RCS, FDS, RCSE Dr. Hodgson is a specialist registrar and professor, and Dr. Porter is a consultant and head of department, Department of Oral Medicine; Dr. Shah is senior house officer, Department of Pediatric Dentistry , Eastman Dental Institute for Oral Health Care Sciences, University College London. Correspond with Dr. Hodgson at [email protected] Abstract Salivary gland agenesis is an extremely uncommon congenital The present report details a child with rampant dental car- anomaly, which may cause a profound xerostomia in children. The ies secondary to xerostomia. Despite having oral disease for oral sequelae includes dental caries, candidosis, and ascending many years, the congenital absence of all the salivary glands sialadenitits. failed to be established until late adolescence, and, therefore, The present report details a child with rampant dental caries appropriate replacement therapy was not instituted, until this secondary to xerostomia. Despite having oral disease for many years, time, to prevent further oral disease. the congenital absence of all the salivary glands failed to be estab- lished until early adulthood. Case report The appropriate investigation and management of the In 1988, a 41/2-year-old Caucasian female was referred to the xerostomic child allows a definitive diagnosis to be made and at- Department of Pediatric Dentistry of the Eastman Dental In- tention focused on the prevention and treatment of resultant oral stitute for Oral Health Care Sciences for the extraction of disease.
    [Show full text]
  • Pharmacotherapy of Salivary Gland Disorders, Fungal Infections and AIDS. SALIVARY GLAND DISORDERS
    Pharmacotherapy of salivary gland disorders, fungal infections and AIDS. SALIVARY GLAND DISORDERS 2 SALIVA physiological exudation of three pairs of salivary glands: parotid submandibular sublingual secreted reflexively composed of the mucous and serous components normal secretion of saliva: at rest (non stimulated) – 0,3 – 0,4 ml/min stimulated (by chewing paraffin cubes) 1 – 2 ml/min 3 DISORDERS SECRETION OF SALIVA Increase the secretion of Reduce the secretion of saliva saliva (without mucosal atrophy) (with mucosal atrophy) Sialoses 4 SALIVARY DYSFUNCTION CLASSIFICATION Pseudo xerostomia (xerostomia spuria) is regarded as a product of vegetative neurosis - no changes in the salivary glands, accompanied by a strong burning sensation of tongue 5 SALIVARY DYSFUNCTION CLASSIFICATION True xerostomia type I (xerostomia vera) can be caused by: neurovegetative system disorders (stress, severe mental experiences, medications) certain infectious diseases (eg. inflammation of the parotid glands) lithiasis of salivary glands diabetes, collagenoses, thyroid diseases vomiting, diarrhea, loss of blood 6 SALIVARY DYSFUNCTION CLASSIFICATION True xerostomia type II is due to degenerative processes affecting salivary glands: Sjögren’s syndrome Mikulicz disease irradiation congenital salivary gland aplasia 7 REDUCE THE SECRETION OF SALIVA Drugs reducing the secretion of saliva: antihypertensive drugs anticholinergic drugs antidepressants sedatives appetite suppressants antihistamines bronchodilators cytotoxic drugs 8 TREATMENT
    [Show full text]