Causes of Xerostomia

Organic cauases

· Sjogrens syndrome

· Irradiation

· Mumps

· HIV infection

· HCV infection

· Sarcoidosis

· Amyloid

· Iron deposition(haemochromatosis,thalassaemia)

Funtional causes

· Dehydration

· Fluid deprivation or loss

· Haemorrhage

· Persistent diarrhoea and or vomiting

· Psycogenic(anxiety states,depression)

· Drugs

Drugs

· Diuretic overdose

· Drugs with antimuscarinic effect

Atropine,ipratropium,hyoscine and other analogues

Tricyclic and some other antidipressants

Antiemetics(including anti histamines and phenothiazenes)

Neuroleptic,particularly phenothiazenes

· Some older antihypertensives(ganglion blockers and clonidine)

· Drugs with sympathomimetic actions

'cold cures' containingg ephidrine,etc.

Decongestants

Bronchodilators

Appetite supressants particularly amphetamines

Mucous extravasaton cyst and Mucous retention cyst

Mucous extravasation cyst(Mucoceles)

· Affect the minor salivary glands,particularly of the lip

· Often form in lower lip,sometimes in floor of the mouth(Ranula)

· They are obviously cystic,hemispherical,fluctuant and bluish.

· Saliva leaking from the damagedducts into the superficial surrounding tissues excitesand inflammatory reaction

· The pools of saliva gradually coalese to form a rounded collection of fluid surrounded by compressed connective tissue without epithelium

Mucous retention cyst

· Mucocele cannot be distinguished from a retention cyst clinically.

· Remnants of the minor mucous salivary glands are visible together with their dilated ducts,the epithelium of which is the epithelial lining of the cyst.

Necrotizing sialometaplasia

Necrotizing Sialometaplasia

A rare condition in which there is ulceration usually in a smoker in the palate,which heals spontaneously over several weeks.Association with salivary gland infractions.histology can be confusing,since it has been appearance resembling neoplasia(Pseudo epitheliomatous hyperplasia)

· Affects mainly minor glands of the palate

· Painless,ulcerated swelling,the margins are irregular and heaped up or everted.

· Chronic inflammation in the minor salivary glands and necrosis of acini

· Duct tissues undergoes squamous metaplasia and proliferates to produce a pseudomembranous appearance

Sjogren's syndrome

Sjogren's Syndrome

· Assosiation of dryness of the mouth of dryness of the eyes(+rheumatoid arthritis)

Primary Sjogrens syndrome(Sicca syndrome)

· Dry mouth+Dry eyes , not associated with any connective tissue disease

Secondary Sjogrens syndrome

· Dry mouth+Dry eyes , associated with rheumatoid arthritis or other connective tissue disease

Oral effects of sjogrens syndrome

· Discomfort

· Difficulties with eating and swallowing

· Disturbed taste sensation

· Disturbed quality of speech

· Predisposition to infection

Clinical features

· In established cases oral mucosa often dry,red,shiny,parchment like

· Tongue-typically red,atrophic papillae,dorsum of the tongue become lobulated coblestone appearance

· Candidal infections are common

· Later generalized erythema of the mucosa occur

· Infective suppurative parotitis may occur

Occular effects of sjogrens syndrome

· Failure of tear secretion

· Failure of clearance of foreign particles from the cornea and conjunctiva(keratoconjinctivitis sicca)

· Griity sensation of the eyes and inflammation

· Risk of impairment or loss of sight

Aetiology & Pathology

· Autoimmune disease

· The disease is systemic and affects all exocrine glands including those of the skin,vagina,lung and pancreas.

· Lymphocytes(CD4) infiltrate the glands and cluster around duct replacing acinar cells

· Progressive destruction of secretory acini

· Proliferation of some duct tissues as epimyoepithelial islands(myoepithelial syeloadenitis)

· Finally destruction of acini and replacement of the whole gland by dense lymphocytic infiltrate

· Auto antibodies-Salivary duct antibodies,Rheumatoid factor,SS-A,SS-B,Rheumatoid arthritis precipitin

Chronic sialadenitis

Chronic sialadenitis

· Usually a complication of duct obstrution

· Usually unilateral and asympomaic or with intermittant painful swelling of the gland

Pathology

· There are varying degrees of destruction of acini,duct dilatation,Chronic inflammatory cell infiltration predominantly lymphoplasmacytic

· Extensive interstitial fibrosis and squamous cell metaplasia in duct epithelium

· Calculus formation may be seen in dilated ducts