XEROSTOMIA

Oedijani-Santoso
Bagian/SMF Gigi dan Mulut
FK Undip/RSUP dr Kariadi
Semarang

Anatomy and Physiology

Salivary gland

XEROSTOMIA=DECREASED
SALIVARY SECRETION =
ASIALORRHEA
- physiologic in the aged
- psychic stimuli ------ depressive
- dehydration states
- drug that depress parasymphatetic
activity, antihistamines,
decongestants, muscle relaxants
- irradiation of the head & neck
- Tobacco use : smoking , chewing

SYMPTOMS
- Dryness of all the oral mucosal
surfaces including the lip and throat
difficulty chewing, swallowing and
speaking
- the mucosa sensitive to spicy and
coarse food
- A changed sense of taste
- Problems wearing dentures

- Long term effect :

Gum Disease
Tooth Decay
Trouble Eating
Difficulty Speaking
Painful Tongue
Inflammation
& Other Health Risks : fungal infection
- cause xerostomia as well, such as
Sjgren's syndrome, diabetes,
Parkinson's disease, HIV/AIDS & other
illnesses.

CLINICAL EXAMINATION
- Mucosal dryness
- lips cracked, peeling, atrophy
- buccal mucosa pale and corrugated
- Tongue smooth, reddened with loss
papillation
- increase erosion and caries (decay
on root surface)
- Increase prevalence and severity of
periodontal disease

Tongue Smooth with loss papillation

Lips cracked and atrophy

Cervical Caries and Severe Periodontal disease

POST RADIOTHERAPY

- Salivary tissue, serous acini, is highly

vulnerable to radiation damage, and the
parotid glands are damaged most readily.
- The conventional treatments for oral
carcinoma a rapid decrease in flow
occurs during the first week of
radiotherapy, with an eventual
approximate 95% reduction

- The early response atrophy of the

secretory cells without inflammation
induced apoptosis
- the late response with inflammation
induced necrosis.
- Serous acini are affected earlier than
mucinous acini thick viscous secretion
- Saliva production rapidly reduced
50% in after 1 week std radiation

- After 5 weeks of radiotherapy

salivary flow virtually ceases and rarely
completely recovers.
- The sensation of dry mouth after a
few months - year a result of
compensatory hypertrophy of
unirradiated salivary gl tissue.
- After 6-12 month, little further
improvement occurs.

- The degree of xerostomia degree of

exposure of the salivary tissue.
- Xerostomia the parotid glands are
involved.
- Mantle, unilateral, and bilateral fields
of radiation can be associated with a
reduction in salivary flow of 30-40%, 5060%, and approximately 80%,
respectively.

- Radiotherapy to the nasopharynx

damages both of the parotid gl
severe and permanent xerostomia.
- Radiotherapy to a salivary tumor
avoid the contralateral gland and not
cause severe xerostomia.
- Radiotherapy of oral cancer normally
avoid at least part of the parotid
glands xerostomia tends not to be
severe

- Xerostomia discomfort and loss of

taste and appetite.
- Xerostomia, with secondary
symptoms of increased dental caries,
difficulty in chewing, swallowing and
speaking, and an increased incidence
of oral candidiasis significant effect
on the quality of life

STIMULATION OF
SALIVARY FUNCTION
Residual salivary tissue stimulated
pharmacologic stimuli (cholinergic
agents) Pilocarpine
parasympathomimetic agent effect at
the muscarinic cholinergic receptor of
acinar cells relieving symptoms and
improving salivation (5 mg/3x daily)
Sugar-free chewing gum may be a useful
stimulus

SYMPTOMATIC
TREATMENT
- Frequent of sipping water during
eating, and often need to keep water by
their bedsides
- Saliva substitutes contain
carboxymethylcellulose or
hydroxyehtylcellulose, mucins and
constituents enamel remineralization
lubrication, surface wetting, microorg,
pleasant taste, long duration, low cost

Advise xerostomia patients :

- to avoid agents such as
medications (antihistamine,
decongestant), caffeine, tobacco,
and alcohol that may further
impair salivation.
- Breathe through your nose, not
your mouth

Steps to protect the teeth help

the dry mouth condition:
- Brush with a fluoride toothpaste and
floss the teeth.
- Use a fluoride rinse or brush-on fluoride
gel before bedtime.
- See the dentist at least twice yearly to
have teeth examined and plaque
removed prevent tooth decay and
period disease

SJOGREN'S SYNDROME
- A patients with eye, throat, nasal,
skin, or vaginal dryness, in addition to
xerostomia systemic condition
- people who get Sjogren's syndrome
are older than 40.
- Nine of 10 are women.
-Sjogren's syndrome is an
autoimmune disease

- A chronic autoimmune disease : the

body's white blood cells destroy the
exocrine glands, specifically the salivary
and lacrimal glands saliva and tears
- The cause of Sjgrens syndrome is
unknown, it is believed to be under the
influence of a combination of genetic,
environmental, and several other factors,
as is the case with many other
autoimmune disorders.

Pathway Implicated in the Pathogenesis of Sjogrens syndr

RISK FACTORS
= Age. Sjogren's syndrome is usually
diagnosed in people older than 40.
= Sex. Women are much more likely to
have Sjogren's syndrome.
= Rheumatic disease. It's common for
people who have Sjogren's syndrome
to also have a rheumatic disease
such as rheumatoid arthritis or lupus.

Genetic factors
- high prevalence of autoimmune
disorders in families of Sjgrens
syndrome is linked with a genetic
predisposition
- Studies on the polymorphisms of
human leukocyte antigen (HLA)-DR and
HLA-DQ gene regions in Sjgrens
syndrome patients show differential
susceptibility to the syndrome due to
different types of the resulting
autoantibody production

Hormonal factors
=high prevalence in women, sex
hormones, especially estrogen affect
humoral and cell-mediated immune
responses affecting susceptibility to the
syndrome.
= Androgens are generally considered
to prevent autoimmunity.
= mice models suggest estrogen
deficiency stimulates presentation of
autoantigens, inducing Sjogrens
syndrome-like symptoms

Environmental (exogenous) factors

= Viral proteins, engulfed molecules
degraded self-structures initiate
autoimmunity Sjgrens syndrome
= Epstein-Barr virus, hepatitis C, and
human T-cell leukemia virus-1 infectious
agents in Sjgrens syndrome
= Damaged self-structures targeted for
apoptosis exposed to the immune
system, triggering autoimmunity in
exocrine glands autoimmune responses

COMPLICATIONS
= Dental cavities. Saliva helps protect
the teeth from the bacteria that cause
cavities. Dry mouth caries
= Yeast infections. Dry mouth more
likely to develop oral thrush, a yeast
infection in the mouth.
= Vision problems. Dry eyes can lead
to light sensitivity, blurred vision and
corneal ulcers.

LESS COMMON
COMPLICATIONS

= Lungs, kidneys or liver. Inflammation

pneumonia, bronchitis or other problems
in the lungs; problems with kidney
function; and may cause hepatitis or
cirrhosis in the liver.
= Lymph nodes. A small percentage of
people with Sjogren's syndrome develop
cancer of the lymph nodes (lymphoma).
= Nerves. May develop numbness,
tingling and burning in the hands and feet
(peripheral neuropathy).

Symptoms of Sjogrens
syndrome

Primary Symptoms
Dry Eye
Gritty, sandy feeling, stinging
feeling
Dry Mouth
Dry, cracked tongue
Sore throat
Burning throat
Difficulty talking
Difficulty swallowing
Difficulty chewing dry food
Change in sense of taste/smell
Increase in cavities
Mouth sores
Cracked lips

Other Symptoms
Swollen parotid glands
Nausea
Dry skin
Joint pain
Dry nose
Reflux
Muscle pain
Fatique
Muscle weakness
Low-grade fever
Vaginal dryness
Neuropathy
Dizziness

Dental care
= Xerostomia ideal environment for
the proliferation of bacteria cavities
preventive dental treatment
= Treatments: topical fluoride
application to strengthen tooth enamel
and frequent teeth cleanings
= Cavities must also be treated
This treatment regimen is the same as
that used for all xerostomia patients,
such as those undergoing head and
neck radiation therapy

MEDICATIONS
= Increase production of saliva.
Drugs such as pilocarpine
(Salagen) and cevimeline (Evoxac)
can increase the production of
saliva, and sometimes tears.
Side effects may include sweating,
abdominal pain, flushing and
increased urination.

= arthritis symptoms : nonsteroidal antiinflammatory drugs (NSAIDs) or other

arthritis medications.
= Yeast infections : antifungal
medications.
= Prescription eyedrops : aren't helpful
= Hydroxychloroquine (Plaquenil), a drug
designed to treat malaria, is often helpful :
suppress the immune system, such as
methotrexate, also may be prescribed.

TO HELP WITH DRY

MOUTH
= Increase fluid intake. Drinking lots of
fluids, particularly water, helps to reduce
dry mouth.
= Stimulate saliva flow. Sugarless gum
or hard candies can boost saliva flow.
Because Sjogren's syndrome increases
the risk of dental cavities, limit sweets,
especially between meals. Lemon juice
in water also can help stimulate saliva
flow.

= Try artificial saliva. Saliva replacement

products often work better than plain
water because they contain a lubricant
that helps the mouth stay moist longer.
These products may come as a spray or
lozenge.
= Use nasal saline spray. A nasal saline
spray can help moisturize and clear
nasal passages can breathe freely
through the nose. A dry, stuffy nose can
increase mouth breathing.

ORAL HEALTH
Dry mouth increases the risk of dental
cavities and tooth loss :
= Brush the teeth and floss after every
meal.
= Schedule regular dental appointments,
at least every six months.
= Use daily topical fluoride treatments
and antimicrobial mouthwashes.

SELAMAT
BELAJAR
SUKSES
SELALU