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Salivary Gland Diseases • Presented By: Major Features of Salivary Glands

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Salivary Gland Diseases • Presented By: Major Features of Salivary Glands Salivary Gland Diseases • Presented by: Major Features of Salivary Glands Minor salivary Parotid Sub-mandibular Sub-lingual Gland glands Scattered throughout Largest major Second largest major Smallest of major the tongue, palate and Feature salivary gland salivary gland salivary glands lip Bartholin's duct, Stensen's duct Wharton's duct Small Duct Rivinus ducts Mucous except for Serous Mucous-Serous Mucous-Serous Secretion those in tongue Fat Yes Yes Yes Yes (tongue) Lymphoid Yes None None None tissue Sebaceous Yes None None None Gland Nerve Facial nerve None None None Major Salivary Glands Salivary Glands Innervations • Both parasympathetic and sympathetic stimuli result in an increase in salivary gland secretions. • The sympathetic nervous system also affects salivary gland secretions indirectly by innervating the blood vessels that supply the glands. Wharton’s Duct Classification of SG Diseases 1- Functional Disorders 1) Xerostomia 2) Pytalism 2- Developmental 1) Aplasia 2) Atrasia 3) Aberrancy 3- Infectious (sialadenitis) 1) Viral 2) Bacterial a) Non-specific b) Specific 4- Cystic 1) Mucous retention cyst 2) Mucous extravasation cyst 3) Ranula Classification of SG Diseases 5- Obstructive • Sialolithiasis 6- Autoimmune • Sjogren`s Syndrome 7- Neoplastic 1) Benign a) Pleomorphic Adenoma b) Whartin’s tumor c) Oncyocytoma 2) Malignant a) Malignant Pleomorphic Adenoma b) Adenocystic Carcinoma c) Mucoepidermoid Ca d) Acinic Cell tumor Functional Disorders 1. Xerostomia 2. Ptyalism Xerostomia • Definition: • Means dry mouth • It may be temporary or chronic (persistent) • Temporary xerostomia is of no clinical significance • Persistent xerostomia is of grave consequences • Classification: • Primary, due to defective glands. • Secondary, due to defects outside the glands • Normal Salivary Flow: • 1 – 2 ml/minute , 1 – 2 Liters/Day The protective role of saliva • Contains components that attack the bacteria cause decay • Neutralizes the acids produced by plaque • Contains phosphorus and calcium. • Has anti-fungal properties • Helps to destroy viruses • Moistens food Dry Mouth Includes Dry Skin Skin around mouth become dry and tight. Your lips may become cracked, and sores form at mouth corners. Embarrassing Side Effects NO flushing of food debris, developing persistent bad breath. Culprit for hoarseness or a tickle in the throat. Xerostomia • Causes: • Sjogren’s syndrome • Pyschogenic • Irradiation • Anxiety state • Dehydration • Depression • Fluid deprivation • Drugs • Hemorrhage • Diuretic overdose • Persistent diarrhea or • Atropine, vomiting • Antidepressants • Antihistamines Anxiety Some people may have dry mouth, while others may have excess saliva, both may occur at different times. Anxiety(cont.) • Mouth Breathing – Air has a tendency to dry out the mouth, Often this type of breathing is the response to severe anxiety symptoms • Acid Backup – Those with acid reflux problems may also be more prone to dry mouth. Acid can affect the salivary glands and lead to less saliva and the feeling of a dry mouth. It may also lead to a sticky feeling and bad taste, both of which are considered dry mouth related. Anxiety(cont.) • Fluid Changes When your fight or fight system is activated, your body make take fluids – like saliva and water – and move them to the areas they feel need them more. That may dry out your mouth as well. • Dehydration Those that aren't drinking enough water are more prone to severe anxiety symptoms. Antihistamines • When your body comes into contact with allergic triggers, it makes chemicals called histamines. They cause the tissue in your nose to swell (making it stuffy), your nose and eyes to run, and your eyes to itch. Sometimes you may also get an itchy rash on your skin, called hives. Antihistamines(Cont.) • Antihistamines have antimuscarinic effect. This means that the drug block receptors found on the surface of certain cells, producing the side-effects associated with antihistamines, such as dry mouth, blurred vision and retention of urine. These effects are mainly caused by the older first-generation antihistamines. Antidepressant There are three types of antidepressants that block the action of acetylcholine neurotransmitter. Blocking acetylcholine reduces the production of mucus and saliva secretions causing dry mouth. Nerve damage • Smoking make it worse cause dry mouth Atropine • Drug working by blocking the effect of acetylcholine in N.S, stomach, sgl • Decrease saliva production and secretion of airway prior to surgery • Treatment of stomach spasm • Contra Indication (allergy, asthma, difficulty in swallowing) Sleep Apnea Dry mouth • With aging, or with the progression of obesity, many adults begin to experience sleep apnea. Often, the development of sleep apnea is attributed to a complication known as obstructive sleep apnea, OSA. • With the development of a sleep disorder, such as that involving obstructive sleep apnea, you may notice a variety of health complications, aside from the poor quality of sleep. Sleep Apnea Dry mouth(Cont.) • Dry mouth is attributed to the abnormal movement of your facial muscles and mouth during sleep when apnea is present. Xerostomia - Management qSalivary Stimulants qSalivary substitutions Xerostomia – Management (cont.) • Petroleum jelly - which can be applied to the lips to prevent drying and cracking. • Control caries with fluoride application • Monitor for candidosis (antifungal drugs) • Treat difficulties with dentures Xerostomia – Management (cont.) • Limit your caffeine intake. Caffeine can make your mouth drier. • Don't use mouthwashes that contain alcohol because they can be drying. • Breath through your nose, not your mouth. • Add moisture to the air at night with a room humidifier. Xerostomia Oral Manifestations: 1. Sever dental caries 2. Sever periodontal diseases 3. Atrophied and ulcerated oral mucosa and tongue 4. Superimposed infection, particularly candida albicnans fungus due to changes in oral flora 5. Difficulty in speech, mastication and swallowing 6. Loss of taste 7. Inability to wear dentures Xerostomia - Management 1. Remove the cause if possible 2. Check for any associated drug contributing to xerostomia 3. Frequent small sips of water 4. Prescribe saliva substitutes (artificial saliva) 5. Suggest sugar-free gum 6. Maintain good oral hygiene 7. Chlorohexidine (0.2%) rinses 8. Control caries with fluoride application 9. Monitor for candidosis (antifungal drugs) 10. Treat difficulties with dentures 11. Observe regularly for possible ascending parotitis or chronic sialoadenitis Hypersalivation (Ptyalism) • Definition: Is the condition of excess salivation • Types: 1. True ptyalism In which there is actual increase in the salivary flow and the swallowing mechanism is intact 2. False ptyalism In which the salivary flow is normal while the swallowing mechanism is defective resulting in saliva drooling from the mouth Hypersalivation (Ptyalism) • True ptyalism: Increased salivary flow + Normal swallowing à à no significant effect • False ptyalism: Normal salivary flow + Defective swallowing à à saliva drooling Hypersalivation (Ptyalism) 1. True ptyalism • Not a problem as any excess saliva can be swallowed • Causes: 1) Local reflexes 1.Oral infections e.g. ANUG 2.Oral wounds and ulcers 3.Dental procedures 4.New dentures 2) Systemic e.g. nausea 3) Toxic e.g. iodine and heavy metal poisoning Hypersalivation (Ptyalism) 2.False ptyalism (drooling) • Is more common and causes annoyance to the patient • Causes: 1) Psychogenic 2) Bell’s palsy (facial paralysis or paresis) 3) Parkinson’s disease 4) Stroke Hypersalivation (Ptyalism) Treatment: • Removal of the cause, if possible • Antihistamine as it act as a sedative and can produce dry mouth Acute suppurative parotitis (Acute Bacterial Sialadenitis), (Acute ascending parotitis) • Definition: Acute suppurative inflammation of the parotid • Cause and pathogenesis: • Predisposing factors are xerostomia resulting from postoperative dehydration, irradiation or Sjogren’s syndrome • The causative organisms are staphylococci, streptococci and pneumococci • The mode of infection is ascending i.e. via the duct and rarely blood born. • The disease is now very rare due to the invention of antibiotics and proper post-operative care Acute suppurative parotitis (Acute Bacterial Sialadenitis), (Acute ascending parotitis) • Clinically: • Mainly affect the parotid gland. • Painful swelling of the gland with uplifting of the ear lobe • The overlying skin is red, shiny and tense • In severe cases edema and difficulty in opening the mouth • Purulent discharge or pus from the affected duct • Fever and malaise • Treatment: • Correction of the cause • Antibiotics Acute suppurative parotitis (Acute Bacterial Sialadenitis), (Acute ascending parotitis) Acute suppurative parotitis (Acute Bacterial Sialadenitis), (Acute ascending parotitis) Chronic Sialadenitis • Definition: This is a chronic inflammation of the salivary glands • Cause and pathogenesis: • Usually results form chronic obstruction due to stones • Clinically: • Painless or painful swelling of the affected gland which become worse at mealtime • Histologically: • Atrophy of the acini • Ductal hyperplasia and dilatation. • Lymphocytic infiltration. • Fibrosis of the stroma Mumps (Epidemic Parotitis) • Definition: Acute viral infection of the parotid • Cause and pathogenesis: • The causative virus is paramyxovirus which is RNA. • The mode of infection is droplet infection. • The virus reaches the gland through the duct or more commonly via blood. • One attack produces
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