Oral lesions

3.  The subjective feeling of oral dryness is
termed as xerostomia.
 Xerostomia is a symptom not diagnosis or
disease.
 It is basically termed as clinical
manifestation of salivary gland
dysfunction.

4. Classified as-
 TEMPORARY CAUSES-
• Psychological
• Blockage of duct calculi
• Sialoadenitis
• Drug therapy
 PERMANENT CAUSES-
• Salivary gland aplasia
• Sjogren’s syndrome
• Radiotherapy
• Other systemic disorders
• Surgical desalivation

5.  PHYSIOLOGICAL-
• This includes anxiety & depression.
• These causes decrease in salivary flow rate.
 DUCT CALCULI-
• Blockage of minor salivary glands.
• Commonly submandibular gland is blocked.
• Can produce dryness, along with pain and
swelling in the gland.
• If untreated may cause permanent xerostomia.

6.  SIALOADENITIS-
• Inflammation of the salivary gland can reduce
secretion.
• Acute infections such as mumps & post operative
parotitis.
• Chronic infections include swelling of gland.
 DRUG THERAPY-
• Anticholinergic.
• Sympathomimetic agents.
(antihistamines, bronchodilators,
antidepressants)
• Produces diureses  dehydration  xerostomia.

7.  SALIVARY GLAND APLASIA-
• Congenital absence of one or more major salivary
glands.
• Rare condition.
• Unknown etiology.
 SJOGREN’S SYNDROME-
• Combination of dry mouth, dry eyes & rheumatoid
arthritis.
• Females commonly affected.
• Age = 40-50 years.
• Swelling of salivary glands may also develop.

8.  RADIATION THERAPY-
• Therapeutic radiography of head & neck tumors.
• Saliva: thickened, altered electrolytes, pH↓,
secretion of immunoglobulins↓.
• Glandular atrophy fibrosis or replaced by fatty
tissue.
• Atrophy due to ↓ vascularity of gland.
 OTHER SYSTEMIC DISORDERS-
• Diabetes mellitus  as a result of polyurea.
• Anaemia.
• Vitamin A, riboflavin, nicotinic acid deficiency.
• Brain tumors
• Diarrhoea etc.

9.  There is lack of saliva.
 Duct calculi may lead to unilateral dryness
with pain& swelling on the affected gland.
 Sjogren’s syndrome produce bilateral swelling
accompanied by lymph node enlargement in
many cases.
 Dry or burning sensation.
 The mucosa appears dry, sometimes inflamed,
often pale.
 On tongue  there is atropy of papillae,
inflammation, fissuring & crackling.
 In severe cases areas of denudation are seen.

10.  Soreness of mucous membrane.
 Ulceration.
 Caries due to decrease salivary flow rate.
 Speaking difficulty.
 Abnormaily in taste.

11.  Eliminate etiological factors such as drug,
calculi etc.
 Promote salivary secretion by using sugar
free chewing gums.
 Patient must drink plenty of water.
 Artificial saliva is avaliable these day.
 Composition-
• Carboxymethylcellulose.
• Sorbitol.
• Potassium Chloride.
• Sodium Chloride.
• Calcium Chloride.
• Dipotassium hydrogen phosphate.

13.  SYNONYMS-
• Sicca syndrome.
• Gougera sjogren syndrome.
 Described by Hernik Sjogren in year 1933.
 It’s a chronic autoimmune disorder.
 In sjogren’s syndrome the body’s defense system
turns against itself & attacks glands that produce
moisture.
 Sjogren’s syndrome is described as a triad
consisting of:-
• Keratoconjunctivitis sicca (dry eye sundrome).
• Xerostomia (dry mouth).
• Rheumatoid arthritis.

15.  PRIMARY SJOGREN’S SYNDROME-
• Comprises of dry mouth & dry eyes.
• Not associated with any connective tissue
disease.
 SECONDARY SJOGREN’S SYNDROME-
• Comprises dry mouth and dry eyes.
• Associated with disease such as rheumatoid
arthritis & other disorders such as
polymyositis(inflammation of muscles),
scleroderma.

16.  The causes of sjogren’s syndrome are known.
 Genetic.
 Hormonal.
 Infections.
 In many cases sera antisalivary duct antibody
is seen.
 Associated with HLA(human leukocyte
antigen) system.
 HLA-DR3 & HLA-B8 are associated only with
primary form of disease.
 HLA-DRw52 is assosiated with both the
forms.

17.  Predominates in females.
 F:M = 10:1.
 Children, young adults & older age people
are affected.
 Dryness of moth and eyes due to
hypofunction of salivary & lacrimal glands.
 Painful & burning sensation of oral mucosa.
 Secretor glands of nose, larynx, pharynx &
tracheobroncial tree are involved with
dryness.
 Parotid gland enlargement.
 Lymphadenopathy

18.  Purpura.
 Kidney involvement.
 Myositis.

19.  Schirmer's test - more than 10 mm of moisture
on the filter paper
in 5 minutes is normal.
 ESR (Erythrocyte Sedimentation Rate)-
increased in sjogren’s syndrome.
 AntiSalivary duct antibodies- elevated.
 Immunoglobulins- elevated.

20.  Sialography- radiographic examination of
the salivary glands.
 It usually involves the injection of a small
amount of contrast medium into the salivary
duct of a single gland, followed by routine X-
ray projections.
 Demonstrate the formation of puncture,cavity
defects filled with radiopaque contrast media.
 These filling defects produce ‘cherry blossom’
or ‘branchless fruit laden tree’ appearance.

21.  No satisfactory treatment.
 Symptomatic treatment.
 Keratoconjunctivitis – treated by ocular
lubricants like artificial saliva.
 Xerostomia – treated by oral lubricants.
 For dental caries oral hygiene & fluoride
application is indicated.
 No specific treatment for enlargement of
salivary glands.
 Sometimes surgery is done in patients with
discomfort.