SalivaIt is a watery secretion in the mouth produced
by the salivary glands that aids in the digestion
It serves as an aid to swallowing and digestion
by moistening and softening food.
• Types of salivary glands• 1- parotid glands :
• Major source when eating
• Serous acini only
• 2-submandibular glands:
• The most responsible when no stimuli
• Serous (primarily) + mucous acini
• 3-sublingual glands:• Only 2-3% of saliva
• mucous (primarily) + serous
• 4-minor salivary glands:
• Only mucous
Salivary GlandAn exocrine gland in the mouth that secrete saliva.
under normal physiological conditions.
• 1- parotid glands.2-submaxillary (submandibular) glands
Salivary glandSalivary glands are made up of secretory acini and ducts.
The basic secretory units of salivary glands are clusters of cells called an acini .
There are two types of secretions - serous and mucous.
The acini can either be serous, mucous, or a mixture of serous and mucous.
• A serous acinus secretes proteins in an isotonic watery fluid.• A mucous acinus secretes mucin-lubricants
• In mixed serous – mucous acinus, the serous acinus forms a serous demilune around mucous acinus
Function of Saliva:• It keeps the teeth healthy by providing a lubricant, calcium and a buffer.
• It also helps to maintain the health of the gums, oral tissues (mucosa) and throat.
• It also plays a role in the control of bacteria in the mouth.
4. It helps to cleanse the mouth of food and debris.5. It provides minerals such as calcium, fluoride, and phosphorus.
6. It helps in swallowing and digesting food.
Lack of saliva will make the mouth more prone to disease and infection. Lead to a burning feeling.
DIAGNOSIS AND MANAGEMENT OF XEROSTOMIA IN THE ELDERLY PATIENTSalivary Gland Dysfunction and Xerostomia (Dry Mouth)
XEROSTOMIAXerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva
It affects 17-29% of samples populations based on self-reports or measurements of salivary flow rates.
More prevalent in women.
Can cause significant morbidity and a reduction in a patient’s perception of quality of life
Causes of xerostomiaIonizing radiation: can injure the major and minor salivary glands which may lead to atrophy of the secretory components and results in varying degrees of temporary or permanent xerostomia.
Toxic substanaces in chemotherapeutic agents.
3.Side effect of certain medications . Dry mouth is a common side effect of many prescription and nonprescription drugs, including drugs used to treat depression, anxiety, pain, allergies, and cold
4.Aging: Xerostomia affects 30% of patients older than 65 years and up to 40% of patients older than 80 years; this is primarily an adverse effect of medication(s), although it can also result from comorbid conditions such as diabetes, Alzheimer’s disease, or Parkinson’s disease
5.Sjögren disease: (formerly known as Sjögren syndrome)19 is the second most common autoimmune connective-tissue disease19 and is the systemic condition most frequently associated with salivary dysfunction and xerostomia
6.Nerve damage: Dry mouth can be a result of nerve damage to the head and neck area from an injury or surgery.
7.Dehydration: Conditions that lead to dehydration, such as fever, excessive sweating, vomiting, diarrhea, blood loss, and burns can cause dry mouth.
8.Surgical removal of the salivary glands.9.Lifestyle: Smoking or chewing tobacco can affect how much saliva you make and aggravate dry mouth. Breathing with your mouth open a lot can also contribute to the problem.
10.Diabetes mellitus: Patients with poor glycemic control, are more likely to complain of xerostomia and may have decreased salivary flow.
Other Conditions•Anxiety or Depression
•Diabetes, Type 1 or 2
•Primary Biliary Cirrhosis
•Bone Marrow Transplantation•Graft-vs.-Host Disease
•Chronic Active Hepatitis
Signs and SymptomsXerostomia can cause the following complications:
• a sticky, dry, or burning feeling in the mouth
• trouble chewing, swallowing, tasting, or speaking
• altered taste or intolerance for spicy, salty, or sour foods or drinks
• a dry or sore throat
• cracked, peeling, or atrophic lips
• a dry, rough tongue• mouth sores
• an infection in the mouth
• halitosis (bad breath)
• inability to retain dentures or otherwise poorly fitting removable prostheses
Diagnosis of Xerostomia:it has been estimated that a 50% reduction in salivary secretion needs to occur before the xerostomia becomes apparent.
An affirmative response to at least one of the five following questions about symptoms has been shown to correlate with a decrease in salivary flow:
• Does your mouth usually feel dry?
• Does your mouth feel dry when eating a meal?
3. Do you have difficulty swallowing dry food?4. Do you sip liquids to aid in swallowing dry food?
5. Is the amount of saliva in your mouth too little most of the time, or don’t you notice it?
• When unstimulated salivary flow is less than 0.12 to 0.16 ml/minute, a diagnosis of hypofunction is established.
Patients should be counseled on lifestyle tips for relieving dry mouth; these include:• sipping water or sugarless, caffeine-free drinks
• sucking on ice chips
• using lip lubricants frequently (e.g., every 2 hours)
• chewing sugar-free gum or sucking on sugar-free candy9
• avoiding salty or spicy food or dry, hard-to-chew foods9
• avoiding sticky, sugary foods
• avoiding irritants such as alcohol (including alcohol-containing mouth rinses5), tobacco, and caffeine
• drinking fluids while eating carefully
• using a humidifier at night
Dental and oral health-specific recommendations:• brush teeth gently at least twice a day with fluoridated toothpaste
• floss teeth every day
• schedule dental visits at least twice a year (with yearly bitewing radiographs)
• use of a prescription-strength fluoride gel (0.4% stannous fluoride, 1.0% sodium fluoride) daily to help prevent dental decay
• prompt treatment of oral fungal or bacterial infections• application of 0.5% fluoride varnish to teeth
• dental soft- and hard-tissue relines of poorly fitting prostheses and use of denture adhesives
Management:Stimulation of salivary production
• Chewings of gums.
• Citric acid containing lozenge
Systemic stimulations.• Bromhexine-mucolytic and mucokinetic agent
• Anethole trithoione-neurostimulator
• Pilocarpine-cholinergic parasympathatic agents
• Increase secretion by exocrine glands and can affect sweat salivary lacrimal glands
Avoidance of certain thingsLike dry foods such as cookies. Toast. Crackers.
Sticky things .chocolates .pasty .peanut butter.
Symptomatic teatment• Salivary substitute
Commonly contain carbomethyl cellulose or hydroxyethylcelluloseor lubricant. and variety of artificial sweetners preservative and chloride or fluoride salts
• Artificial saliva