Term
| Salivary glands are __ glands stimulated by the ___ and inhibited by the __. |
|
Definition
- exocrine
- stimulated by the PNS
- inhibited by the SNS |
|
|
Term
| What type of drugs cause dry mouth? |
|
Definition
| - Anticholinergics (Atropine) |
|
|
Term
| The PNS causes __ __ secretion, while the SNS causes __ __ secretion. |
|
Definition
- thin watery
- thick viscous |
|
|
Term
| The submandibular gland is aka the ___ gland. |
|
Definition
|
|
Term
|
Definition
- Parotid
- Sublingual
- Submandibular |
|
|
Term
| Wharton's ducts are associated with the __ __. |
|
Definition
|
|
Term
| Stenson's ducts are associated with the __ __. |
|
Definition
|
|
Term
|
Definition
1. 97-99% water with a pH of 6.7-7
2. Electrolytes mainly Na+, K+, Cl-, PO4- , HCO3-
3. Salivary amylase
4. Mucin
5. IgA antibodies
6. lysozymes |
|
|
Term
| 70% of saliva comes from the __ __ at a resting state. |
|
Definition
submandibular glands
ingestion of food causes submandibular glands to secrete more |
|
|
Term
| The parotid glands secrete __ __ saliva rich in __ and __ __ __. They are associated with __ ducts. |
|
Definition
- watery serous saliva
- amylase and proline-rich proteins
- stensons ducts |
|
|
Term
| The submandibular secretes more __ saliva and is associated with __ ducts. |
|
Definition
|
|
Term
| The sublingual gland secretes __ saliva and is associated with __ __ __ and the _ __ ___. |
|
Definition
- viscous
- ducts of Rivinus
- duct of Bartholin |
|
|
Term
| The submandibular and sublingual glands are innervated by the __ __ via __ __, which comes from the __ __ __ in the dorsal brainstem and lower medulla. |
|
Definition
- CN VII (facial) via chorda tympani
- superior salivary nucleus |
|
|
Term
| The parotid gland is innervated by __ __ which is from the __ __ __. |
|
Definition
- CN IX (glossopharyngeal)
- inferior salivatory nucleus |
|
|
Term
| The second largest salivary gland: |
|
Definition
| Submandibular Salivary Gland |
|
|
Term
| The submandibular gland is the second largest salivary gland. It is recessed immediately below the __. The __ and __ nerves OVERLY the gland. It is connected to __ __ which opens adjacent to the lingual frenulum. |
|
Definition
- mandible
- hypoglossal and lingual
- Wharton's ducts |
|
|
Term
| The sublingual glands open into the mouth along the top of the __ __ located on the floor of the mouth under the tongue. |
|
Definition
|
|
Term
| The largest salivary gland: |
|
Definition
|
|
Term
| Gland most prone to bacterial sialadenitis: |
|
Definition
|
|
Term
| 3 types of bacterial sialadenitis: |
|
Definition
1. Neonatal sialadenitis
2. Acute bacterial sialadenitis
3. Chronic sialadenitis |
|
|
Term
| What nerve bisects the Parotid gland? |
|
Definition
|
|
Term
| The parotid gland lies over the __ __. |
|
Definition
|
|
Term
| Stensen's ducts are aka __ __ that open out adjacent to to the maxillary __ __. Milking the parotid will expel drop at duct. |
|
Definition
- Parotid Papilla
- second molar |
|
|
Term
| Minor salivary glands are involved in symptoms of __, __, and __ __. |
|
Definition
- xerostomia
- stomatodynia
- denture intolerance |
|
|
Term
| Minor salivary glands aka __ __ are crucial to retain __ __ __. |
|
Definition
- Palastine glands
- maxillary full dentures
There are no connections between secretory rates of major and minor salivary glands. |
|
|
Term
|
Definition
| smell food> mouth starts watering |
|
|
Term
| The PNS controls the salivary glands. Both __ and __ receptors are used to stimulate the __ __ in the __. Action potentials return to the __ __ __ via cranial nerves __ and __. The saliva released is __ and contains __ __. |
|
Definition
- pressure and chemoreceptors
- salivatory nuclei in the medulla
- extrinsic salivary glands via CN VII and IX
- serous and contains salivary amylase |
|
|
Term
| 7 main functions of saliva: |
|
Definition
- Protection
- Buffering
- Digestion
- Antimicrobial
- Maintenance of tooth integrity
- Tissue repair
- Taste |
|
|
Term
| Saliva protection explained: |
|
Definition
lubricant (glycoprotein)
barrier against noxious stimuli; microbial toxins and minor traumas
washing non-adherent and acellular debris
formation of salivary pellicle
calcium-binding proteins: tooth protection; plaque |
|
|
Term
| Saliva buffering explained: |
|
Definition
Buffering (phosphate ions and bicarbonate)
bacteria require specific pH conditions
plaque microorganisms produce acids from sugars |
|
|
Term
| Saliva Digestion explained: |
|
Definition
neutralizes esophageal contents
dilutes gastric chyme
forms food bolus
brakes starch |
|
|
Term
| Saliva Antimicrobial explained |
|
Definition
lysozyme hydrolyzes cell walls of some bacteria
lactoferrin binds free iron and deprives bacteria of this essential element
IgA agglutinates microorganisms |
|
|
Term
Saliva Maintenance of tooth integrity
calcium and phosphate ions
ionic exchange with tooth surface |
|
Definition
|
|
Term
Saliva Tissue repair
bleeding time of oral tissues shorter than other tissues |
|
Definition
|
|
Term
Saliva tasteTaste
solubilizing of food substances that can be sensed by receptors
trophic effect on receptors |
|
Definition
|
|
Term
| Sialadenitis is __ of the __ __. |
|
Definition
| - inflammation of the salivary glands |
|
|
Term
| Possible causes of Sialadenitis: |
|
Definition
- Infection: viral/bacterial
- Systemic disease: Sjogren'sy, sarcoidosis
- Stones in the salivary duct |
|
|
Term
| Common causes of Parotiditis: |
|
Definition
- Mumps
- Sjogren's Syndrome
- Bacterial infection (usually Staph. aureus)
- Blocked salivary duct
- Stone in salivary duct |
|
|
Term
| Acute bacterial parotiditis symptoms: |
|
Definition
- PROGRESSIVE PAINFUL SWELLING
- CHEWING AGGRAVATES PAIN |
|
|
Term
| Acute viral parotiditis aka __ symptoms. |
|
Definition
- Mumps
- pain and swelling lasts 5-9 days
- Moderate malaise
- anorexia
- fever
- usually bilateral |
|
|
Term
| HIV parotitis is when there is ___ swelling of the gland and the patient is otherwise ___. |
|
Definition
- nonpainful
- asymptomatic |
|
|
Term
| Sjogren's syndrome is a type of parotitis. Symptoms include: |
|
Definition
- recurrent/chronic swelling of one or both parotid glands
- dry eyes
- dry mouth
- no apparent cause
- frequently associated with autoimmune diseases
- discomfort is modest in most cases |
|
|
Term
| Sarcoidosis is a type of parotitis in which there is __ __ swelling of the parotid glands. |
|
Definition
|
|
Term
| Acute parotitis symptoms: |
|
Definition
- Antibiotics
- Rehydration stimulating salivary flow
- Possible IND |
|
|
Term
| Sialolithiasis aka __ __ __ are most common in the __ __ b/c __ __ is longer and more tortuous than other ducts. There is pain and swelling associated with __ usually from duct obstruction. |
|
Definition
- salivary gland stones
- Submandibular gland
- Wharton's duct
- eating |
|
|
Term
| Sialolithiasis management: |
|
Definition
- milk the duct and look at saliva for infection
- palpate duct, may be able to feel and possibly express stone
- maintain hydration |
|
|
Term
| Most common organsim causing infection with sialolithiasis is : |
|
Definition
|
|
Term
| Best image for sialolithiasis: |
|
Definition
|
|
Term
| Mumps is a danish word that means mumbling, which results from the __ __ and __. |
|
Definition
- glandular inflammation
- trismus |
|
|
Term
| Mumps is caused by __ __, which is an __ __. It is rapidly inactivated by __ _, __, and __ __. It is transmitted by __ __. It can also cause __. |
|
Definition
- Paramyxovirus, RNA virus
- chemical agents, heat, and ultraviolet light
- respiratory droplets
- orchitis |
|
|
Term
| The diagnosis of mumps is based on __ of __, and parotid __ and __. |
|
Definition
- history of exposure
- parotid swelling and tenderness |
|
|
Term
| acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting more than 2 days without other apparent cause |
|
Definition
|
|
Term
Reservoir Human, Asymptomatic infections may be transmitted
Transmission Respiratory drop nuclei
Temporal pattern Peak in late winter and spring
Communicability Three to four days after onset of active disease |
|
Definition
|
|
Term
| Common complications of mumps: |
|
Definition
Parotitis (after puberty, 30-70%)
Orchitis (after puberty, 20-50%, Mumps orchitis follows the development of parotitis by 4-7 days, 70% unilateral.)
Mastitis (after puberty, 20-30%)
Aseptic meningitis (<10%)
CSF pleocytosis |
|
|
Term
| Rare complications of mumps: |
|
Definition
Orchitis sterility
Encephalitis (~0.01%-0.02%)
Thyroiditis, pancreatitis (4%)
Pancreatitis (2-5%)
Deafness (0.005%, 1/20,000)
Spontaneous abortion, 1st trimester infection (~25%) |
|
|
Term
|
Definition
Maintain hydration
Soft food
Non-acidic foods/bevarages
Analgesics and antipyretics are given to control pain and fever - acetominophen
Bed rest |
|
|
Term
| How does saliva play a role in dental health: |
|
Definition
- remineralizes enamel
- buffers cariogenic acids
- removes food residue
- inhibits bacterial growth |
|
|
Term
|
Definition
Definition
Decreased saliva production
Physiology: Saliva plays vital role in dental health
Re-mineralizes enamel
Buffers cariogenic acids
Removes food residue
Inhibits bacterial growth |
|
|
Term
|
Definition
- sensation of dry mouth
- oral burning/soreness
- sensation of loss/altered taste
- erythematous pebbled or cobblestoned or fissured tongue
- atrophy of filliform papillae
- white curd like patches on mucosa? |
|
|
Term
|
Definition
- Sjogren's syndrome
- Radiation to head/neck
- HIV
- Post salivary gland surgery
- Amyloidosis
- Diabets Mellitus
- Chronic active hepatitis
- Granulomatous disease: Sarcoidosis, Tuberculosis, Leprosy |
|
|
Term
| Medications that cause Xerostomia: |
|
Definition
- TCAs
- Antispasmodics
- SSRIs
- Neuroleptics
- Antiparkinsons drugs
- Lithium
- Central adrenergic agonists (Clonidine)
- Diuretics
- Antihistamine
- Bronchodilators (muscarinic antagonists) |
|
|
Term
|
Definition
- fluoride supplement
- avoid sugar
- frequently sip fluids
- avoid caffeine, alcohol, smoking
- drink while eating
- sugar free saliva stimulants (xylitol)
- alcohol free mouth rinses
- salivary secretagogues |
|
|
Term
| __ is a salivary secretagoge approved for Sjogrens and postradiation of the head/neck. |
|
Definition
|
|
Term
| ___ is also approved for treatment of Sjogrens syndrome. |
|
Definition
|
|
Term
| Salivary secretagogues are _____. |
|
Definition
| - anticholinesterases (Pilocarpine, Cevimaline) |
|
|
Term
| Most common immunological disease of the salivary glands: |
|
Definition
|
|
Term
| Sjogren's Syndrome is an __ __ __ disorder, most frequent in __ in their __. |
|
Definition
- autoimmune connective tissue
- women in their 50s |
|
|
Term
| With Sjogren's Syndrome their is __ __ leading to difficulty __ and __. Secondary __ __ occur, __ __, and __ in the salivary ducts. __ and __ may be diminished. |
|
Definition
- decreased saliva leading to difficulty chewing and swallowing
- Secondary candida infections
- tooth decay
- calculi
- taste and smell |
|
|
Term
| Sjogren Syndrome is autoimmune d/o characterized by __ and __. If these two are combined with exocrine gland dysfunction, the triad is known as __ __. |
|
Definition
- xerostomia
- xeropthalmia
- sicca complex |
|
|
Term
|
Definition
| - xeropthalmia + xerostomia + exocrine gland dysfunction |
|
|
Term
| Keratoconjuctivitis sicca is when there is atrophy of the __ __ of the __ __ causing dessication of the __ and ___. Diminished _ __ is caused by __ ___ __ of the lacrimal gland parenchyma. |
|
Definition
- epithelium of the lacrimal glands
- dessication of the cornea and conjunctiva
- tear production
- lymphocytic cell replacement |
|
|
Term
| Acute causes of drooling: |
|
Definition
- epiglottitis
- neoplasm
- abscess |
|
|
Term
| Chronic causes of drooling: |
|
Definition
| - neurologic (cerebral palsy), most common, usually related to head control |
|
|
Term
|
Definition
|
|
Term
|
Definition
- decreased swallowing and saliva clearance
- excess saliva production
- neuromuscular disease
- anatomic abnormalities |
|
|
Term
| Causes of excess saliva production: |
|
Definition
- Pregnancy = Ptyalism Gravidarum
- Excessive starch intake
- GI causes: Gastric distention or irritation, GERD
- Neuromuscular disorders
Cerebral Palsy
Bilateral Facial Nerve Palsy
Cerebrovascular Accident
Myasthenia Gravis
Rabies
- Miscellaneous Causes
Radiation therapy
Macroglossia
Dental malocclusion |
|
|
Term
| Drugs that cause excess saliva production: |
|
Definition
- Clozapine
- Pilocarpine
- Mercury poisoning
- Arsenic poisoning
- Antimony (treats parasitic infections)
- Iodide
- Bromide |
|
|
Term
| Causes of difficulty swallowing: |
|
Definition
- Infections: tonisilits, peritonsillar abscess, epiglottitis, mumps
- Bone lesions: jaw fracture or dislocation |
|
|
Term
| Management of excess salivation: |
|
Definition
Treat specific causes as below
General measures to reduce Saliva
Tooth brushing and mouthwash has drying effect
Reduce starch intake from diet
Anticholinergic Medications (if refractory to above)
Glycopyrrolate
Adults: 0.5 to 2 mg PO qd to tid prn
Children: 0.04 mg/kg PO qd to tid prn
Scopolamine patch 1.5 mg applied every 72 hours prn |
|
|
Term
| What class of drugs could be used to control excess saliva production? Give an example. |
|
Definition
| Anticholinergics- Glycopyrrolate |
|
|
Term
| Excess salivation management: |
|
Definition
Treat cause, ie
Nausea with Antiemetics
Treat Gastroesophageal Reflux
Neuromuscular causes
Speech pathology (e.g. swallowing mechanism)
Occupational therapy (e.g. head-back wheelchair)
Oral diseases including dental malocclusion
Dentist or orthodontist
Macroglossia or Tonsillar Hypertrophy
Otolaryngology |
|
|
Term
|
Definition
Rare
Location – parotid gland, sublingual gland, submandibular gland, and some minor salivary glands
Slow growing
Found on palpation
Check facial nerve – wrinkle brow, squeeze eyes shut, puff cheeks
Types
Benign or malignant – surgical |
|
|
Term
| Benign salivary neoplasms are usually ___. |
|
Definition
|
|
Term
| Symptoms of a malignant salivary neoplasm: |
|
Definition
- pain
- rapid growth
- CN VII symptoms
- skin fixation |
|
|
Term
| The __ gland is most likely to get a salivary gland tumor, usually benign. |
|
Definition
|
|
Term
| The smaller salivary glands are more likely to get __ tumors. |
|
Definition
|
|
Term
| Most common tumor of parotid gland: |
|
Definition
| - Benign Mixed Tumor aka Pleomorphic Adenoma |
|
|
Term
| Tumor that occurs most frequently in the tail of the parotid gland of white middle aged males. |
|
Definition
| Warthin's Tumor aka Papillary Cystadenoma Lymphomatosum |
|
|
Term
| Any solid assymetric mass is __ until proven otherwise. |
|
Definition
cancer
12% of asymptomatic neck masses are cancer- 80% of those are squamous cell carcinoma |
|
|
Term
| The salivary gland tumor usually presents as an enlarging mass __ and/or __ angle of the __ or within the __ __. |
|
Definition
- anterior and/or inferior angle of the mandible
- submandibular triangle |
|
|
Term
| Benign salivary gland tumors are often __. |
|
Definition
|
|
Term
| characteristics of salivary gland tumor suggesting malignancy: |
|
Definition
- rapid growth
- skin fixation
- CN palsies (VII or XII) |
|
|
Term
| First line diagnostic test for salivary gland tumors: |
|
Definition
| Fine needle aspiration biopsy |
|
|
Term
Often asymptomatic, but may show rapid tumor enlargement, pain, trismus, or facial nerve palsy
FNA has 95% sensitivity in salivary gland neoplasms. Any patient with a salivary gland mass should undergo FNA
Incisional biopsy is contraindicated due to tumor seeding |
|
Definition
|
|
Term
| __ __ is contranindicataed with salivary gland tumors due to tumor seeding. |
|
Definition
|
|
