| Salivary flow rates were monitored in two patients, treated with acupuncture for post-radiotherapy xerostomia. The flow rates improved after acupuncture and the effect persisted during the 2-year observation period. ( info) |
2/97. xerostomia: a prevalent condition in the elderly. Although xerostomia is associated with aging, studies have determined that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably not a condition of aging, but most likely one of systemic or extrinsic origin. Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva can become thick and viscous and present problems for the elderly. One of the most prevalent causes of xerostomia is medication. Anticholinergics, such as psychotropic agents and antihistamines, and diuretics can dry the oral mucosa. Chronic mouth breathing, radiation therapy, dehydration, and autoimmune diseases, such as Sjogren's, can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis, and thyroid dysfunction. xerostomia can lead to dysgeusia, glossodynia, sialadenitis, cracking and fissuring of the oral mucosa, and halitosis. Oral dryness can affect denture retention, mastication, and swallowing. Dry mouth symptom can be treated with hydration and sialagogues or with artificial saliva substitutes. Because patients are at risk for dental caries, they should be referred to a dentist for preventive care. In patients with sjogren's syndrome and in those who have undergone radiation therapy, pilocarpine has been used recently with good results. ( info) |
3/97. Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes: report of a case and literature review. Tetrasodium and/or tetrapotassium pyrophosphate (Ppi) is the anticalculus component of most tartar control dentifrices on the market today. While pyrophosphates alone are not responsible for hypersensitivity reactions, several modifications which may lead to adverse oral manifestations may occur when pyrophosphates are added to a dentifrice. First, tetrasodium pyrophosphate in a dentifrice forms a slightly alkaline solution upon oral use which could irritate oral membranes. Second, increased concentrations of flavoring agents, known to be sensitizers, are needed to mask the strong bitter taste of pyrophosphates. Third, increased concentrations of detergents, capable of producing hypersensitivity reactions, are necessary to allow the pyrophosphates to become soluble in the dentifrice. Fourth, a pre-existing condition of reduced salivary flow may augment hypersensitivity to tartar control toothpastes. While pyrophosphates have been approved as additives in dentifrices, these compounds along with the increased concentrations of flavorings and detergents and their higher intraoral alkalinity are strongly implicated as the causative factor in certain hypersensitivity reactions. ( info) |
4/97. Chronic ulcerative stomatitis: a case report. BACKGROUND: Certain mucocutaneous diseases present with painful, ulcerative, or erosive oral manifestations. Chronic ulcerative stomatitis is a newly recognized disease of unknown origin which presents clinically with features of desquamative gingivitis. This report marks only the thirteenth case reported in the world literature. A review of previous reports and studies is presented along with a review of immunofluorescence techniques critical to proper diagnosis. These diseases are difficult to diagnose without the use of immunofluorescence techniques. A 54-year-old Caucasian woman presented with a 2- to 3-year history of stomatitis and dry mouth. methods: Direct immunofluorescence revealed a speckled pattern of IgG deposits in the basal one-third of the epithelium, while indirect immunofluorescence confirmed the presence of stratified epithelium-specific antinuclear antigen (SES-ANA), both pathognomonic for chronic ulcerative stomatitis. RESULTS: The patient was successfully treated using topical corticosteroid therapy. ( info) |
5/97. Severe xerostomia in a young man. We describe a previously healthy 24-year-old male waiter who presented with very severe xerostomia, such that he consumed an average of 7 pints of milk a day and seriously considered suicide. There were no other symptoms or signs of exocrine gland dysfunction. We discuss the differential diagnosis, investigation, and his subsequent complete response to therapy, with a review of the literature. ( info) |
| sjogren's syndrome is a chronic inflammatory systemic autoimmune disease mainly affecting the exocrine and, particularly, the salivary and lacrimal glands. The condition usually occurs in adults. In 1994, the criteria for this syndrome were redefined in a multicenter European study. In children, sjogren's syndrome is a rare and probably underdiagnosed disease. To date, sjogren's syndrome in children has only been described in case reports and in the comparative presentation of various study results. So far, no study of a comparative classification into primary and secondary sjogren's syndrome has been carried out in a patient population of any size. sjogren's syndrome should be considered in the differential diagnosis of children with recurrent parotitis, keratoconjunctivitis sicca, or pronounced and early tooth decay associated with xerostomia. In this study of 23 children and adolescents under the age of 16 with the clinical symptoms and laboratory findings of sjogren's syndrome, we differentiate between primary and secondary sjogren's syndrome. The value of the individual methods of assessing the oral and the ophthalmological components and the manifestation of the underlying rheumatic condition are discussed on the basis of the EULAR criteria. The EULAR diagnostic criteria are of limited applicability in children because reliable anamnestic data are frequently lacking. Another problem in diagnosing sjogren's syndrome is the short-term detection of serological alterations and clinical symptoms. Even if young patients do not completely fulfill the required criteria, sjogren's syndrome can be assumed or confirmed in the presence of positive testing for oral and ocular manifestations and recurrent salivary gland enlargement. ( info) |
7/97. The investigation of major salivary gland agenesis: a case report. Salivary gland agenesis is an extremely uncommon congenital anomaly, which may cause a profound xerostomia in children. The oral sequelae includes dental caries, candidosis, and ascending sialadenitits. The present report details a child with rampant dental caries secondary to xerostomia. Despite having oral disease for many years, the congenital absence of all the salivary glands failed to be established until early adulthood. The appropriate investigation and management of the xerostomic child allows a definitive diagnosis to be made and attention focused on the prevention and treatment of resultant oral disease. ( info) |
8/97. Syndromes with salivary dysfunction predispose to tooth wear: case reports of congenital dysfunction of major salivary glands, Prader-Willi, congenital rubella, and Sjogren's syndromes. Four cases-of congenital dysfunction of the major salivary glands as well as of Prader-Willi, congenital rubella, and Sjogren's syndromes-were identified in a series of 500 patients referred for excessive tooth wear. Although there was evidence of consumption of highly acidic drinks, some occlusal parafunction, and unacceptable toothbrushing habits, salivary dysfunction was the salient factor predisposing a patient to tooth wear in these syndromal cases. The 500 subjects have been characterized either as having medical conditions and medications that predispose them to xerostomia or lifestyles in which workplace- and sports-related dehydration lead to reduced salivary flow. Normal salivation, by buffering capacity, clearance by swallowing, pellicle formation, and capacity for remineralization of demineralized enamel, protects the teeth from extrinsic and intrinsic acids that initiate dental erosion. Thus, the syndromes, unrelated in many respects, underline the importance of normal salivation in the protection of teeth against tooth wear by erosion, attrition, and abrasion. ( info) |
| A critical component of the dental hygiene process of care is assessment of the oral and general health conditions of clients. Some clients present with burning and painful sensations in the oral cavity in the absence of any noticeable disease. This condition has been referred to as burning mouth syndrome (BMS), an often complicated condition. Various local, systemic, and psychological factors have been linked with BMS, but its etiology is not fully understood. Yet as many as one million people are affected by it in the united states, and it is an increasingly-common problem in the aging population. Middle-aged women, mostly postmenopausal, are diagnosed with symptoms seven times more frequently than men. Careful diagnosis and treatment are necessary to alleviate the symptoms of this condition. Referral to a physician is warranted in some cases. The purposes of this course are to review the etiologic factors and clinical implications related to this condition and to discuss appropriate dental hygiene interventions. Collaboration among the client, dental hygienist, dentist, and physician provides for interdisciplinary actions that can lead to palliation of symptoms and evaluation of the possible underlying factors contributing to the condition. ( info) |
10/97. An unusual cause of obstructive sialadenitis. A case of bilateral recurrent submandibular sialadenitis is presented in a patient with decreased salivary flow. The condition was caused by trapping of the submandibular papillae between the lingual flange of the denture and the enlarged genial tubercles. Removal of these causes led to resolution of her symptoms. The value of plain radiography, sialography and scintigraphy is discussed. ( info) |