PAPER

XEROSTOMIA

Dosen Pembimbing :

Drs. Ronny Ralin.M.kes

Firda Aristia I1D114250

Afifah Rahmiati I1D114251
Nuril Fajriani I1D114252
Anshori Rohimi I1D114253
Yusfa Ainah I1D114254
Eka Febrianty I1D114255
M Ridho Pratama I1D114256
Zaldy Aria Fikri I1D114257
Jeanyvia Anggreyni I1D114258
Maziatul Ulya I1D114259
Khairunnida I1D114260

FAKULTAS KEDOKTERAN GIGI

UNIVERSITAS LAMBUNG MANGKURAT

2016

1. Introduction
 Xerostomia (dry mouth) Defined by Dr. Huchinson,1898. Is not a disease but a
symptom caused by many factors. . Dr. Ronald Not all people who complains of xerostomia
actually has salivary gland dysfunction.
1.1 Salivary glandula
Parotid gland
major source when eating
serous acini only
Submandibular gland
serous (primarily) + mucous acini
Sublingual gland
only 2-3% of saliva
mucous (primarily) + serous
Minor salivary gland
mucous (primarily)
1.2 Function of Saliva
Lubrication
Initial digestion of food
Modulate the oral flora
Immune mechanism: IgA, IgG, IgM.
Anti-microbial: lysozyme, peroxidase, lactoferrin, agglutinins.
Buffering action: tooth remineralization
2. Symptoms & Signs
2.1 Symptoms:
Oral dryness (most common)
Halitosis
Burning sensation
Loss of sense of taste
Difficulty in swallowing
Tongue tends to stick to the palate
Decreased retention of denture
2.2 Signs:
 Saliva pool disappear
Mucosa: dry or glossy
Duct orifices: viscous and opaque saliva
Tongue:
glossitis fissured red with papilla atrophy
Angular cheilitis
Rampant caries: cervical or cusp tip
Periodontitis
Candidiasis
3. Etiology
Aging
Foods & drugs
Systemic factors
Radiotherapy
Other salivary gland diseases
3.1 Aging:
Dry mouth: >50y/o:10%, >65y/o:40%.
46% of 341 subjects (98M, 243F) had noticed subjective xerostomia, more
frequent in women.
3.2 Foods: alcohol, coffee, coco cola, smoke

3.3 Drugs:
o Anti-depressants
o Anti-histamine
Cimitidine
o Anti-cholinergic
o Anti-HTN (sympathomimetic drugs)
o Anti-inflammatory
3.4 Systemic factors:
Emotions: nervousness , excitation, depression, stress..
Encephalitis(radang otak), brain tumors, stroke, Parkinsons dis.
 Dehydration: diarrhea, vomiting, polyuria of diabetes
Anemia, nutrition deficiency.
3.5 Radiotherapy
Acini atrophy fibrosis or replaced by fatty tissue
Serous acini: more sensitive to R/T
Saliva: thickened, altered electrolytes, pH,
secretion of immunoglobulins
>1000rad (2-3wk): felt oral dryness
>4000rad: irreversible change
3.6 Other salivary gland diseases:
Obstruction or infection of gland
Benign or malignant tumor
Excision of gland or congenital missing

4. Diagnosis
A. History taking
B. Symptoms & clinical examination
C. Special investigations
Salivary flow rate, SFR
Salivary scintiscanning
Sialochemical analysis & laboratory values
Labial biopsy
Sialography
Salivary Flow Rate (Sialometry)
Stensons duct
Methods:
Resting flow, 10min
Stimulated flow, 10min: citric acid
Results:
Resting flow <0.1ml/minxerostomia
 Stimulated flow<0.5ml/minirresponsive xerostomia
Basic, sensitive, time-consuming
Salivary Scintiscanning
TC99 sodium pertechnetate
Empty: 10.20.30.40.50.80 min
Uptake of TC99 by salivary gland: functional acinar tissue is present
High sensitivity, non-invasive
Sialochemical Analysis
Saliva:
Na+, K+, IgA, amylase, albumin.
Sjogrens syndrome: have diagnostic value
Laboratory Values
Sjogrens syndrome
Elevated ESR, IgG, RF
Positive auto-antibodies : anti-nuclear, ANA
anti-SS-A, anti-Ro
anti-SS-B, anti-La
Labial Biopsy
Chisolm & Mason, 1968:
Minor salivary gland & major gland: high relation
Focus: 50 lymphocytes & plasma cells
1 focus / 4 mm2: SS is diagnosed.

Parotid gland:
- Slight acinar destruction
- Dense lymphocytic infiltrate
- Early proliferation of ductal cells
Sialography
Instillation of radiopaque fluid into
Identification of non-calcified sialoliths & tumors
Unsuitable for diagnosis of xerostomia
 Diagnosis
History taking
Symptoms & clinical examination
Special investigations
- Salivary flow rate, SFR
Stimulated flow
- Salivary scinti scanning
- Sialochemical analysis & laboratory values
- Labial biopsy
- Sialography
5. Management
Dietary & environmental considerations
Preventive Dental Care Measures
Saliva stimulatants
Saliva substitutes
5.1 Dietary & Environmental Considerations
5.1.1 Dietary:
Avoid drugs that may produce xerostomia
Avoid dry & bulky foods
High fluid intake & rinsing with water
Avoid alcohol, smoking and sugar
Take protein and vitamin supplements
5.1.2 Environment:
Maintain optimal air humidity in the home
Use Vaseline to protect the lips
5.2 Preventive Dental Care Measures
Smooth sharp cusps, occlusal grooves or fissures, irregular fillings.
Check and adjust the denture.
OHI.
Topical fluoride with carrier use.
Fluoride rinses & chlorhexidine rinses.
Antifungal medications:
 Denture: Miconazole gel,amphotericin or nystatin ointment
Topical: Nystatin, amphotercin suspension or fluconazole.
5.3 Saliva Stimulatants
Chewing gums
Diabetic sweets
Sialagogues:
Pilocarpine
5~10 mg, tid
Bradycardia, sweating, flushing, urgency of urination, GI upset
Pyridostigmine
5.4 Salivary Substitutes
Carboxy-methyl-cellulose or mucin
Saliva Orthana: contains fluoride.
Mixture of glycerin & citric acid
Natural oral antimicrobial contents: H2O2