Swelling of salivary secretory organs may consequences due to chronic and acute redness, which arise in certain autoimmune diseases, by canal obstructor due to sialolithiasis and tumours. The incidence of drug induced xerostomia is high in aged people whereas certain other factors such as radiations and viral infections such as Hep. C, HIV and EBV are major aetiologic factors for dry mouth. Cavities incidence besides increases with dry mouth. Malignancy is besides an of import cause of salivary secretory organ expansion.
Salivary secretory organ upsets and form of incidence varies among different age groups. Sialolithiasis ( ague and chronic ) responds better to surgical intervention instead than conservative attacks. Malignant tumours are common among grownups. Topical every bit good as systematic therapies are utile for dry mouth. In future familial technology will turn out to be fruitful in the in salivary secretory organ diseases.
Saliva is glycoprotein in nature and is produced by major and minor salivary secretory organs. Secretion of spit is a automatic map emanating from salivary centres and is dependent on afferent stimulation. Major function of salivary secretory organ is mucin production, which act as a lubricator to maintain the old pit moist. Saliva is besides involved in perceptual experience of gustatory sensation every bit good as bound the bacterial collection and besides assist to keep the unity of enamel.1 If the production of spit is disrupted, so it can take to cavities and several other periodontic diseases.
Normal saliva production is about 500ml per twenty-four hours 2 and saliva flow rate varies in 24-hours, which is dependent upon the demand and physiological province of the patient. Salivary secernment is under the control of autonomic nervous system. Diseases of salivary secretory organs can take to the secretory organ expansion, hurting every bit good as dry mouth. There are many grounds for dry mouth such as Sjorgen ‘s syndrome and exposure to radiations. Certain drugs with anticholinergic effects and adrenergic actions are besides associated with xerostomia.3
Other of import causes of long standing dry mouth are:
Viral infections e.g. HIV, HCV etc.
If xerostomia is prolonged it will hold an unpleasant feeling and therefore impacting the quality of life.4, 5 Some systemic every bit good as local therapies are used late to get the better of xerostomia. Salivary glands upsets vary among different age group i.e. kids and grownups, but some diseases such as parotitis epidemica and cytomegaly can happen in both.6 Choice of antibiotics is different for different age groups. Harmonizing to some surveies, ague and chronic sialadentitis every bit good as secondary redness associated with sialolithiasis are common among different age groups.7, 8, 9 The pathogenesis of certain diseases are still non understood. Curative schemes based on the clinical experience can non be defined due to little figure of patient in each age group. Assorted bacterial and viral infections are related with sialadentitis. The major cause of parotid puffiness is parotitis epidemica 10 and it is more prevailing among the ages of 2 to14. 11
Underliing systemic diseases, such as febrility, desiccation and immunosuppression are frequently related to acute redness of parotid secretory organ. 12, 13
Inflammation of submandibular secretory organ is due to duct obstructor or some inborn anomalousness. Reports about sialolithiasis in submandibular canal and neoplastic alterations in newborn and in grownups are really uncommon.14
For chronic sialadentitis, the etiologic factors are upsets related to secernment and some immunological reactions. Salivary secretory organ upsets could be extrahepatic manifestation of HCV, HIV and EBV. 15, 16, 17, 19
Average day-to-day production of spit is 500ml, decreased production of spit is known as dry mouth.
Several drugs with anticholinergic and adrenergic actions are the powerful causative agents for dry mouth.
Salivary secretory organs are extremely prone to damage after exposure to radiations. In unwritten malignant neoplastic disease intervention the disposal of 60-70 Gy radiations can take to rapid decrease in flow rates and after 5 hebdomads the flow finally ceases.
Chemotherapy used in the intervention of malignant neoplastic diseases can lend towards waterlessness of oral cavity every bit good as production of spit holding a thicker consistence. 20
Sjorgen ‘s syndrome can take to waterlessness of eyes and oral cavity. 21, 22
Sarcoidosis ( 9 % patients ) can take to salivary secretory organ expansion particularly of parotid secretory organ. 23
About 4-8 % of grownups and kids with HCV infection can hold complications associated with salivary secretory organs every bit good as dry mouth. 24, 25
Sialolithiasis is seldom observed in babies and grownups, youngest instance observed in 2years old kid. 26, 27
Salivary secretory organ swelling can be due to malignances. Parotid secretory organ is the most common secretory organ involved in malignances. 28, 29
66.6 % tumours of salivary secretory organ are non-epithelial of which 75-80 % are benign while 20 % are malignant tumors.28, 29
Salivary secretory organ tumours are more common in grownups.
10 % of benign tumours are associated with submandibular secretory organ.
Xerostomia is an unnatural decrease of spit and it result due to certain diseases or by the usage of certain medicine. In a twenty-four hours mean individual produce spit of about 500ml. However flow rates varies when depends upon the demand and physiological province of a patient
Flow rate at remainder in 0.3mlmin
During slumber, is 0.1mlmin
During feeding, is 4.5mlmin
Salivary secernment is dependent upon several normally influences that act through the Ca dependant or cyclic adenosine way manner. Saliva produced under the parasympathetic stimulation have low protein content whereas less saliva green goods under the sympathetic stimulation and have a high protein content. Lesser sum of spit with high protein content can give rise to esthesis waterlessness. 30 Patients who are in dying or down provinces besides report for holding dry oral cavity. Prevalence of cavities is increased among the xerostomic patients.
Etiological factors lending towards dry mouth
Diseases of the salivary secretory organ
Now a twenty-four hours ‘s about 500 medical specialties are associated with xerostomia. Furthermore the interactive consequence of some medicine have been recognized which are more prevailing among the aged people. 31 The chief mechanism for the drug induced dry mouth is due to adrenergic or anticholinergic action. It is more common in patients who are treated for high blood pressure or for some other psychiatric unwellness. Some drugs such as Li, Prilosec, peptidase inhibiter are powerful subscribers towards dry mouth in approximately 7 % of the patients utilizing protease inhibiters may hold xerostomia. 31
Radiations can do harm to salivary secretory organs whereas parotid secretory organs are extremely suspected to damage. 32, 33 If the dosage of the radiation is every bit low as 20 Gy salivary flow will for good discontinue if it is given as the individual dosage in disposal of 60-70Gy can do rapid diminution in the flow during in initial first hebdomad of intervention. There is a direct proportional relationship between grade of exposure to radiation and grade of dry mouth induced. 20 Whereas the partly radiated patients have increase saliva flow rates.
Assorted malignances are treated with the combination of radiation and chemotherapy in a survey of about 127 patients 34, 35 holding an advanced malignant neoplastic disease and dry mouth. Drugs used to handle malignant neoplastic disease can bring forth thick spit which lead to dry esthesis of oral cavity.
Disorders of salivary secretory organs:
Sjorgen ‘s syndrome: 21
It is a chronic immune mediated upset which is characterized by redness of duct gland secretory organs which can take to symptoms of waterlessness. It can be classified as primary disease in which mark and symptoms appears in eyes and oral cavity. It may be classified as secondary SS in which dry mouth and xeropthalmia appears. The cause of disease is profound in lymphocytic infiltrate in salivary secretory organs. 36
Chronic Sarcoidosis can give rise to xerostomia every bit good as salivary secretory organ expansion in upto 9 % of affected patients. The incidence of this disease is greater in parotid secretory organ. 37
4-8 % of striplings and babies with HIV are associated with the salivary secretory organ upsets peculiarly with xerostomia and expansion of salivary secretory organs. 38
Xerostomia is a prevailing among patients infected with HCV and salivary flow rates are besides reduced significantly . 24, 25 Pathologic characteristics of HCV associated sialadentitis are similar but non indistinguishable as those with SS 39, which is associated with a low grade of redness being found in HCV.
Other causes of dry mouth ‘s:
Bilious cirrhosis 40
Cystic fibrosis 41
Diabetess mellitus 42, 43
Salivary secretory organ agenesia, ectodermic dysplasia, and treble A syndrome are the rare causes associated with dry mouth.
Salivary secretory organ tumours:
Salivary secretory organ tumours make up of about 0.3 % of human tumours, 10 % are all of caput and cervix, where as 5 % of such tumours are prevailing among 16 old ages of age.
Parotid secretory organ sialadentitis:
It ‘s seldom observed in kids 19 harmonizing to a survey done on 635 patients ; merely one instance is observed in a 44 twelvemonth old male child, 7 instances reported in 25 old ages. Chronic sialadentitis parotitis is an autoimmune disease. It starts between 3-6 old ages of age and peak incidence in 5-10 old ages of age
Harmonizing to assorted surveies all benign tumours of salivary secretory organs are associated with parotid secretory organ. 29, 44, 45 Ussmiller46 observe the predomination of non epithelial benign tumours in 15 old ages of age
Uncommon in kids and grownups.these can be mucoepidermoid carcinoma, adenoid cystic carcinoma and acintic cell carcinoma, harmonizing to Enerott ( 47 ) 2637 patients were observed and are more commonly prevalent among grownups, 15-25 % malignant in grownups.
Therapies designed for dry mouth includes
Systemic therapy ; drugs like pilocarpine, bethanacol, cevimiline reduces the drug induced dry mouth
Oral attention for patients holding salivary secretory organ upsets unwritten hygiene should be maintained and dental plates should be good fitted
Some topical therapies are besides available for the intervention e.g. Sugar free gums, confects 48, 49 mucosal sprays 50, humidifiers 51
For sialolithiasis, antibiotics and curative doses are required. Inflammation associated with sialadentitis in grownup requires surgical processs.
In future the engineering of familial technology proves fruitful in the intervention of upsets of salivary secretory organs.
Salivary secretory organ upsets are scarce among kids and striplings. Acute and chronic sialadentitis requires surgical intervention in grownups, nevertheless self-generated mending can happen in babies. Parotid secretory organ malignances are more common in grownups. There is a ternary association with HCV, Sjorgen ‘s syndrome and salivary secretory organ lymphoma and the HIV is involved in lymphogenesis. Several systemic and topical therapies are effectual in direction of dry mouth.
However in future cistron therapy and tissue technology can be better intervention options, but the etiology and pathogenesis of the disease should be wholly known. 52