Diagnosis of Salivary Gland Diseases and Dysfunction (DOM 8250-2024) PDF

Diagnosis of Salivary gland Diseases and dysfunction DOM 8250-2024 Nov. 4, 2024 Shin-Mey R. Y. Geist, DDS, MS, FDS RCSEd Diplomate, American Board of Oral Medicine ICD-10-CM  ADA’s CDT 2024 selected codes K11.7 Disturbances of salivary secr...

Diagnosis of Salivary gland Diseases and dysfunction DOM 8250-2024 Nov. 4, 2024 Shin-Mey R. Y. Geist, DDS, MS, FDS RCSEd Diplomate, American Board of Oral Medicine ICD-10-CM  ADA’s CDT 2024 selected codes K11.7 Disturbances of salivary secretion K11.8 Other diseases of salivary glands  Learning Objectives Be able to Diagnose salivary gland diseases-review Oral Pathology course content of salivary gland diseases  Learning Objectives Contd. Be able to Describe the difference between resting and stimulated saliva and their contributors Describe the facts that make it important to diagnose hyposalivation Describe the difference between the nomenclature of “xerostomia” and “hyposalivation” Identify the risk factors (causes) of hyposalivation Recognize oral manifestations of hyposalivation (clinical signs) Describe the methods for diagnosing hyposalivation Describe the laboratory diagnostic criteria of hyposalivation Describe the significance and complications of hyposalivation Normal submental evaluation-University of Iowa Normal exam with a submandibular duct dilated by ingestion of sour candy- University of Iowa  Ranula is a clinical term that also includes mucus extravasation phenomenon and mucus retention cyst, but it occurs specifically in the floor of the mouth. Purulent drainage from left Wharton’s (submandibular) duct associated with acute suppurative sialadenitis (photo courtesy of David Cognetti, MD)  Mucus extravasation phenomenon and mucus retention cyst (mucocele) Various type of lower lip mucocele: size, depth, number, etc. “A sialolith is a salivary stone, while sialolithiasis is the condition of having a salivary stone that blocks the salivary glands” (Google AI) Dr. Ágota Ádám Feb. 22, 2018  Salivary glands and saliva Three major salivary glands contribute to about 90% of whole saliva. Minor salivary glands contribute to about 10% of whole saliva Saliva is composed of approximately 99% water and 1 % proteins and electrolytes.  Saliva The daily production of saliva of reference range (defined by healthy population) is between 0.5 and 1.5 liters. The submandibular glands are the major contributors to resting (unstimulated) saliva (Approximately 65-70% ), and the parotid glands are the major contributors to stimulated saliva. Insufficient stimulated saliva affect tasting, chewing, swallowing, self- cleansing, and other functions.  Some evidence-supported facts that make it important to diagnose hyposalivation: 1. Saliva plays important roles in oral and general health by preventing dental caries; bacterial and fungal infection; assisting eating, speech, digesting; providing complete denture retention and other functions. 2. A variety of medical conditions and medications alter salivary secretion and composition. 3. Xerostomia and salivary gland hypofunction (hyposalivation) are common in the general population 4. Aging per se has no significant clinical impact on salivary secretion. Hyposalivation in elderly must seek other causes than aging.  Some evidence supported facts make it important to diagnose hyposalivation: contd. 5. The most common cause of salivary gland hypofunction in the elderly population is Polydrugs taking. There are more than 400 medications known to cause xerostomia or hyposalivation 6. Xerostomia and salivary gland hypofunction are not always present concurrently. 7. Dental caries and oral candidiasis are the most common complications associated with salivary gland hypofunction (hyposalivation). 8. Xerostomia and salivary gland hypofunction (hyposalivation) affect the quality of life.  Xerostomia vs hyposalivation Xerostomia: subjective sensation; a symptom Hyposalivation: reduced salivary flow; an objective finding and diagnosis (based on criteria of measuring salivary flow or other signs.) A person complains xerostomia may not have hyposalivation, a person with hyposalivation may not complain or states xerostomia. Many patients have both complaint of xerostomia and reduced salivary flow.  Xerostomia vs hyposalivation contd. Xerostomia (dry mouth) This term refers to a symptom and should be reserved for a patient's subjective feeling of oral dryness. The terms salivary hyposalivation and xerostomia are often incorrectly used interchangeably. Hyposalivation (hypoptylism) Hyposalivation is defined as a diminished secretion of saliva. It may be associated with many factors alone or in combination, such as dehydration, radiation therapy of the salivary gland regions, anxiety, menopause, use of certain drugs, vitamin deficiency (proposed Vitamin E deficiency), inflammation or infection of the salivary glands, or Fontana variousM, 2010 Defining Dental syndromes (eg,Caries for 2010 Sjögren and Beyond[SS]). syndrome  How can oral health care providers determine if patients have hyposalivation? Navazesh M. How can oral health care providers determine if patients have dry mouth? J Am Dent Assoc, 134 (5) (2003), pp. 613- 618 Answer: Based on health history (including medication history) and clinical findings Diagnosis of hyposalivation starts with Health History: use follow-up questions for the health questionnaire regarding salivary glands Does the amount of saliva in your mouth seem to be too little, too much or you do not notice it? Do you have any difficulties swallowing? Does your mouth feel dry when eating a meal? Do you sip liquids to aid in swallowing dry food? Do you have problem eating crackers? Have you had radiation therapy of head and neck region? (Radiation doses of 23 to 25 Gy are the threshold for salivary glands, above which permanent salivary gland destruction occurs.) Are you taking any medication? For what reason? Navazesh M. 2003  Salivary gland Dysfunction Salivary gland dysfunction – Hyperfunction: sialorrhea – Hypofunction: hyposalivation – insufficient saliva flow – may or may not manifest as dry mouth (xerostomia), because of dry mouth is a symptom – studies show patients may not notice dry mouth until more than 50% of saliva is lost – Need objective findings or tests to reach the diagnosis of hyposalivation (clinical signs or laboratory saliva measurement)  Signs of hyposalivation: During Oral examination one should look for : Mouth mirror stick to the buccal mucosa during oral examination Thin and atrophic mucosa Limited saliva flow from sublingual caruncles and parotid papillae Disappearing of filliform and fungiform papillae Dental decays in the cervical, interproximal surfaces, and cusp tips Oral candidiasis without other contributing factors Loss of lingual papillae can be signs of hyposalivation, but not always, needs to differentiate hyposalivation with other conditions, e.g., pernicious anemia, B12 deficiency, GVHD, etc. Incisal edge, cusp tip, and cervical decays is a sign of hyposalivation Incisal edge, cusp tip, and cervical decays is a sign of hyposalivation Incisal edge, cusp tip, and cervical decays is a sign of hyposalivation Incisal edge, cusp tip, and cervical decays is a sign of hyposalivation Labial cervical decays or labial cervical cavities What is the pattern of carious lesions of this patient?  Causes of hyposalivation Systemic diseases – SS, RA, SLE, HIV-salivary gland disease , DM, HCV infection, sarcoidosis, cystic fibrosis, and others. Head and Neck cancer radiation therapy involving major salivary glands Medication induced– this is the most common cause of hyposalivation  The most common Cause of hyposalivation--medications Medications – More than 400 medications have been reported to induce xerostomia or salivary gland hypofunction as potential side effects. Antidepressants, antipsychotics, antihistamines, antihypertensives, and sedatives, Anti-reflux agents: proton-pump inhibitors, are the drug categories most commonly associated with salivary gland hypofunction or xerostomia. – Polydrugs taking has significant impact on hyposalivation  Hyposalivation and hypertension medications Xerostomia, hyposalivation, and increasing number of oral microbial were more prevalent in hypertensive patients taking antihypertensive medications. Level of mutans streptococci, Lactobacilli spp. and Candida spp. is higher in hypertensive patients taking antihypertensive medications Nonzee V, 2012  Information needed for make diagnosis of hyposalivation History questionnaire-looking for the symptoms Medical conditions Medication history Oral exam-looking for the signs Saliva quantitative measuring of salivary flow (Laboratory evidence for hyposalivation) When measure of saliva flow, salivary gland hypofunction is considered as 1. whole unstimulated saliva < 0.1 g/minute (that is 0.1mL/minute), or 2. whole chewing stimulated saliva