5th Class
Oral Medicine
Lec 6
Dr. Jamal al dewan
BDS , Diploma (oral diagnosis),MSc
(oral med.)
Bacterial Sialadenitis
Acute bacterial sialadenitis refers to
a sudden onset of a swollen and
painful infected salivary gland,
whereas repeated bacterial
glandular infection is termed
chronic bacterial sialadenitis.
Risk factors include
 Dehydration.
 Nerve damage.
 Ductal obstruction.
 Irradiation.
 Surgery under general anesthesia
 Chronic diseases such as diabetes mellitus and
Sjögren’s Syndrome
occurs most frequently in
the parotid glands because :
 The antimicrobial activity of mucin, found in the
saliva of the submandibular and sublingual glands,
 The serous parotid gland saliva also contains less
lysosomes and IgA antibodies.
 Anatomy may also play a protective role; tongue
movements tend to clear the floor of the mouth In
contrast, the orifice of Stensen’s duct is located
adjacent to the molars, where heavy bacterial
colonization occurs.
Clinical Presentation
 Patients usually present with a sudden onset of
unilateral or bilateral salivary gland enlargement
 Patients may complaints of fevers, chills, malaise,
trismus, and dysphagia
 The involved gland is enlarged, warm, painful,
indurated, and tender to palpation
 In approximately 75% of cases, purulent discharge may
be expressed from the orifice.
Treatment
This may involve the use of
antibiotics(penicillin, or
cephalosporin) analgesics, fluids
and glandular massage.
Mumps
 Mumps is an acute viral infection caused by an RNA-
paramyxovirus.
 The virus can be found in saliva and urine and is
transmitted by inhalation of infectious
droplets, by direct contact .
Clinical Presentation
 Mumps typically occurs in children between the ages
of 4 and 6 years.
 Mumps usually presents with one to two days of
malaise, anorexia, and low-grade pyrexia with
headache followed by nonpurulent gland enlargement.
 Glandular swelling usually starting unilateral then
become bilateral over the next few days, lasting about
one week.
 95% of symptomatic cases involve the parotid gland
only, while about 5% of cases involve the bilateral
submandibular and sublingual glands concomitant
with the parotid swelling.
 The salivary gland enlargement is sudden and painful
to palpation with edema affecting the overlying skin
and the duct orifice.
Complications of mumps
 Mild meningitis and encephalitis;
 Deafness, myocarditis, thyroiditis, pancreatitis,
hepatitis, and oophoritis
 Males can experience orchitis, resulting in testicular
atrophy and infertility if the disease occurs in
adolescence or later.
Treatment
The treatment of mumps is
symptomatic and may
involve the use of analgesics
and antipyretics
Sjögren’s Syndrome
 SS is a chronic autoimmune disease characterized by
symptoms of oral and ocular dryness, lymphocytic
infiltration, and exocrine gland dysfunction
 The salivary and lacrimal glands are primarily affected,
but SS can have wide-spread and diverse
manifestations.
 The definitive etiology of SS is unknown, but current
Studies have suggested a hereditary link.
 Primary Sjogren’s syndrome occurs in the absence of
another autoimmune disease, whereas secondary SS
occurs in the setting of autoimmune diseases
Clinical Manifestations
 SS most commonly affects perimenopausal and
postmenopausal women; with a female-to-male ratio
of 9:1.
 SS patients frequently experience fatigue, arthralgias,
myalgias, peripheral neuropathies, and rashes.
 Patients complains of dry eye, dirt or foreign body in
the eye, corneal ulceration and conjunctivitis.
 The patients reported a unilateral or bilateral parotid
gland enlargement
 difficulties in speaking, tasting, and swallowing and
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the need to sip liquids throughout the day.
The mucosa may be pale, dry, painful and sensitive to
spices and heat.
Patients often have dry, cracked lips and angular
cheilitis.
The tongue is often smooth and painful.
An increased caries index
Diagnosis
 The diagnosis is if three of the four objective criteria
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are satisfied
ocular signs
histopathology: focal lymphocytic sialadenitis on a
labial minor salivary gland biopsy
salivary signs
autoantibodies: a positive anti-SSA or anti-SSB or a
positive RF with ANA.
Treatment
 Therapeutic management of SS revolves around
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symptomatic
treatment of glandular manifestations and on the use of
disease-modifying drugs for systemic involvement
Patients with remaining salivary function can stimulate
salivary flow by the use of non pharmacologic agents such
as sugar-free gum or sugar-free candies and muscarinic
agonists like pilocarpine at a dosage of 5 mg four times
daily
Salivary Substitutes
Corticosteroids or other immunosuppressive drugs as
cyclosporine and azathioprine,
Sialorrhea (hypersalivation or
ptyalism)
is defined as an excessive
production of saliva. Sialorrhea
can lead to drooling, which is
defined as excess saliva beyond
the lip margin.
Due to :
 Hyperhydration, infant teething, menstruation and
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nausea.
heavy metal poisoning like mercury.
Neurologic changes such as in a cerebral vascular accident
(CVA)
Drugs such as cholinergic agonist and contraceptive pills.
Minor hypersalivation may result from local irritations,
such as aphthous ulcers, herpes virus infection
and ill-fitting oral prosthesis.
Xerostomia
is dryness in the mouth which may be
associated with a change in the
composition of saliva, or reduced
salivary flow (hyposalivation), or have
no identifiable cause.
True hyposalivation may give the following
signs and symptoms:
Dental caries
Acid erosion.
Oral candidiasis
Ascending (suppurative) sialadenitis
Dysgeusia
Intraoral halitosis
Oral dysesthesia – a burning or tingling
sensation in the mouth.
Saliva that appears thick or ropey.
Mucosa that appears dry.
Dysphagia – difficulty swallowing and chewing
The tongue may stick to the palate, causing a clicking noise
during speech, or the lips may stick together.
Gloves or a dental mirror may stick to the tissues.
Fissured tongue with atrophy of the filiform papillae
erythematous appearance of the tongue.
Difficulty wearing dentures,
generalized mucosal soreness and ulceration of the areas
covered by the denture.
Mouth soreness and oral mucositis.
A need to sip drinks frequently while talking or eating.
Dry, sore, and cracked lips and angles of mouth.
Thirst.
Causes
Medications - many prescription and medications cause dry mouth,
including antihistamines, decongestants, hypertensive medications (for h
Differential diagnosis
blood pressure), Age - even though dry mouth is not a natural .
radiation therapy)
damage the salivary glands, resulting in less saliva being
produced. Chemotherapy can alter the nature of the saliva, as well as how
much of it the body produces.
Injury or surgery - which results in nerve damage to the head and neck area can result in
dry mouth.
Tobacco - either chewing or smoking tobacco increases the risk of dry mouth symptoms.
Dehydration - caused by lack of sufficient fluids.
Exercising or playing in the heat - the salivary glands may become dry as bodily fluids
are concentrated elsewhere in the body. Dry mouth symptoms are more likely if the
exercise or playing continues for a long time.
Some health conditions, illnesses, and habits - such as:
Anxiety disorders
Depression
Poorly controlled diabetes
Sjögren's syndrome
Sleeping with the mouth open
Snoring
Treatment options for xerostomia
Medications - if the dry mouth is thought to be
caused by a medication, the doctor will either alter the
dosage or prescribe another drug which is less likely to
cause dry mouth.
Stimulating saliva production - a medication may
be prescribed, such as pilocarpine (Salagen) or
cevimeline (Evoxac), to stimulate the production of
saliva.
A patient with xerostomia should pay special
attention to oral/dental hygiene. This includes plaque
removal and treatment of gingival infections,
inflammation, and dental caries. Brushing teeth and
flossing regularly is important.
Sipping fluids (non-carbonated, sugarless), chewing
gum, and using a carboxymethyl cellulose saliva
substitute as a mouthwash may help.
Mouthwashes which contain alcohol should be
avoided, because they may worsen dry mouth
symptoms.
Individuals with xerostomia should
avoid:
Chewing or smoking tobacco
Sugary foods or drinks
Acidic foods or drinks
Dry foods
Spicy foods
Excessively hot or cold drinks
Thank
you