Download Diseases of the Salivary Glands

Diseases of the
Salivary Glands
Salivary glands and Saliva
There are a lot of
salivary gland
diseases, to bo
treated only
surgically (ex.. cysts
and salivary gland
stones).
The dentist must know
the anatomy and
physiology of the
salivary glands.
The saliva
It is a secretum of
exocrine glands, needs
for the integrity of the
oro-facila tissues.
Saliva is a complex
solution having
protecting function.
Phisical features of the saliva
Parotid gland produce
serous, the sublingual
gland mucinous and the
submandibular produce
mixed saliva.
Decrease in the quantity
cause clinical and social
problems for the
patients.
The main part of amylase
are produced by the
parotid gland, the blood
group antigens by the
small salivary glands.
Salivary glands
The biggest Parotid is
arrow-headed, behind of
the ramus mandibulae,
innervate by the facial
nerve. The saliva
through the Stenon duct
running in front of the
masseter muscle get
into the mouth.
Its lead into the mouth is
covered by a small
papilla.
The mass of the two
submandibular glands are
the half of parotid can be
find between the corpus
mandible and m.
mylohyoideus, produce
mucinous saliva its get into
the mouth beside of frenum
linguae.
Smallest the sublingual
salivary gland produce
mixed saliva, and get into
the mouth by the
Caruncula, more than one.
Examination of salivary glands
The parotis is cowered by
the ramus mandibulae,
by this way it can be
palpate behind the bone.
If there are any swelling
or pain must be
differentiate from
masseter or TMJ
diseases.
If we press the skin over
the ducts the secretion
can help in the
diagnosis.
Volumetric saliva quantitation
(sialometry)
Measurable the resting and
stimulated saliva
quantity, and also the
parotid saliva (CarlsonCrittenden cap).
All big salivary glands are
canulable.
It was shown out that 50%
decline of saliva can
cause xerostomia.
The quantity of resting
saliva 0.3 ml/min. the
stimulated saliva 1.2
ml/min.
Salivary gland examinations
X-ray:
Salivary gland stone can
shown by this method.
Sialography:
Salivary duct system
become visible by this
method (Söjgren,s
syndrome, salivary gland
stones).
Scintigraphy:
The salivary glands
concentrate isotopes
(ex.. 99Tcm).
Ultrasound, MRI.
Sialochemistry, Biopsy
There are many diseases in
which worthy to study
the chemical
constituents of the
saliva.
Measurable: drug,
hormone, antibody level,
sodium, potassium,
calcium, although the
diagnostic value rather
small.
Small salivary gland biopsy
can be use for the
diagnosis of Sjögren’s
syndrome.
Diseases of the
Salivary Glands
Sialoadenitis
More frequent as a result of
bacterial or viral
infections, than as a
result of allergy or
irradiation.
The salivary flow decrease.
Mainly the big salivary
glands are affected, but
in small glands also
occur.
(nicotinic palatal
stomatitis).
Epidemic Parotitis
MUMPS
Caused by an RNA
(paramyxovirus), most
frequently parotid glands
are affected.
Beside of salivary gland
pain stomach pain also
develops accompanied
by fever, epididimitis,
orchitis and the
submandibular gland
could be affected.
After healing lifelong
immunity develop.
Epidemic infections evolve.
Therapy: symptomatic.
Sialoadentitis
Other virus also can cause
inflammation in the
salivary glands
(cytomegalovirus,
Coxakie).
The bacterial infections
are frequently caused by
the stricture of the duct
(ex.. stone). In this form
an only gland is affected
(the swelling is painful)
and radiate to the
temporal region.
The aperture reddish and
swollen.
Predisposing factor of
sialadenitis decrease
the quantity of saliva.
It helps the ascending
infections from the oral
cavity to the salivary
glands.
There are swollen lymph
nodes in the neck.
Therapy:
Antibiotics
(if it is possible after
culture).
Sialosis
Sialoadenosis is a nonpainful, non-tumor-like
salivary gland swollen.
Could be cause by a lot of
drug (antirheumatic, iodine
containing and adrenergic
activators). In generally
reversible.
Frequently develop as a
complication of hormonal
diseases: diabetes,
acromegaly, but chronic
alcohol consumption too.
Diagnosis: labor test and
biopsy.
Necrotising Sialometaplasia
A seldom, tumor-like
disease develops rather
in men and smokers.
It is a problem of the
palatal, small salivary
glands vasculature
(infarction of salivary
glands).
Histology: keratinized
epithelial metaplasia
and pseudoepithelioma
in the ducts.
Heal spontaneously in 8
weeks.
Necrotizáló sialometaplasia
NECROTIZÁLÓ SIALOMETAPLASIA
Salivary gland swelling and tumors
The swelling associate
mainly to sarcoidosis
and HIV infection.
The tumors include the
total sphere of benign
and malignant tumors.
Diseases as a result of changing
saliva quantity
Xerostomia:
Xerostomia is a subjective
sense, caused by the
salivary gland
hypofunction.
Salivary deficiency can be
caused by the decrease
of salivary gland mass,
the lesion of secretory
neuron innervation,
some drugs and general
medicine diseases.
Xerostomia patients must
be follow for a long
period of time, because
it could be a sign of
serious systemic
diseases (ex.. irradiation
of head and neck
malignant tumors).
Most frequently: drug Sid
effect, which is in most
cases reversible.
Saliva quantitation
Symptoms of xerostomia:
Thirst, complication in the
mastication of dry
meals, problem in the
denture stabilization, to
force the patients to
drink.
The main complaints are:
burning mouth, taste
disorder.
The lip is scaled.
Questions for salivary gland hypofunction
Management of xerostomy and
salivary gland hypofunction
The treatment depends on
the severity of
xerostomy or the
affection of salivary
glands.
Where: there is saliva
production: xlilitol,
where it is very low:
pilocarpin or other
parasympatomymetic
material, but where
there is no functioning
salivary gland not worth
the drug treatment.
Renewal of saliva with any
plastic material
ameliorate the patients
subjective complaints.
These materials contain:
carboxicellulose and
mucin, some contains
fluoride for prevention of
caries.
If the xerosotmia patients
have had teeth follow
him/her monthly.
Alcohol containing rinsing
material forbidden.
Sögren,s syndrome
SJÖGREN SYNDROMA
SJÖGREN SYNDROMA
FÉLOLDALI
PAROTIDECTOMIA UTÁN
Autoimmune disease of the
exocrine glands mainly in
the salivary and lachrymal
glands.
Autoantibodies are produced
against the acetylcholine
receptors of the glandular
cells, but autoantibodies
against striated duct also
has been found.
Until the glandular tissue
seems to be health, it
means a good prognosis,
when impair the prognosis
become worsen.
In the primary form (SSA)
the salivary and
lachrymal glands are
affected, if it is
combined with an other
connective tissue
diseases (SLE, RA) it is
the secondary form
(SSB).
It is a disease mainly in
females about 40 years.
Their frequency in England
1-3%.
Swelling of the salivary
glands are painful in
inflammation, and non
painful in Sjögren,s
syndrome.
Keratoconjunctivitis sicca
in the eye.
Possible the Non-Hodgkin
disease.
Diagnosis
Sialomatry, scintigraphy
with 99Tcm,
autoradiography can
help, sometimes small
salivary gland biopsy or
MRI need for diagnosis.
There are a lot of
techniques with high
specificity, but low
sensitivity.
Labortests
Increased immunoglobulin
levels, positive RF, ANA,
SSA and SSB
autoantibodies.
Exclusion of other diseases
(ex.. diabetes), blood
picture, endocrine
examinations.
Schirmer test: over 5 mm/5
min.
Therapy
There is no adequate
treatment schedule, but
the symptoms are well
controllable.
There are Sjögren,s
syndrome patients
helping groups, which
can give good advices to
the patients.
Overproduction of saliva
Its name: sialorrchea or
ptyalinism really seldom.
Two main cause:
hypersecretion and
neuromuscular dysfunction.
Frequent complaints of new
denture bearing patients.
In erosive oral diseases and in
tumors the saliva
production also increase.
Cholinesterase also increase
the saliva production.
Therapy: stop the cause, and
Atropine.