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Classification

Classification. OTHERS Xerostomia Sialorrhea Mucocele Mucous retention Ranula. XEROSTOMIA. Xerostomia. Xerostomia (dry mouth) Is not a disease but a symptom caused by many factors. Function of Saliva. Lubrication Speech Eating Antibacterial action

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Classification

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  1. Classification • OTHERS • Xerostomia • Sialorrhea • Mucocele • Mucous retention • Ranula

  2. XEROSTOMIA

  3. Xerostomia • Xerostomia (dry mouth) • Is not a disease but a symptom caused by many factors.

  4. Function of Saliva • Lubrication • Speech • Eating • Antibacterial action • Buffering action: tooth remineralization • Retention of removable denture

  5. Symptoms & Signs • Symptoms: • Oral dryness (most common) • Halitosis • Burning sensation • Loss of sense of taste or change taste • Difficulty in swallowing • Tongue tends to stick to the palate • Decreased retention of denture

  6. Symptoms & Signs • Signs • Angular cheilitis • Rampant caries: cervical or cusp tip • Periodontitis • Candidiasis • Saliva pool disappear • glossitis

  7. Clinical picture

  8. Clinical picture

  9. Etiology (Causes) • Developmental • Water/Metabolite loss • Iatrogenic • Systemic Diseases • Local factors

  10. Developmental • Salivary gland aplasia

  11. Water/Metabolite loss • Impaired fluid in take • Blood loss (Hemorrhage) • Vomiting / Diarrhea

  12. Iatrogenic • Medication • Radiation therapy

  13. Iatrogenic (Medication) • Anti histamine (Diphenhydramine,chlorpheniramine) • Anti depressant (Amitriptyline) • Anti hypertensive (Reserpine,Methyldopa,furosemide,CCB, heloperidol,chlorothiazide) • Anti cholinergic (Atropine,Scopolamine)

  14. Systemic Diseases • Sjogrens Syndrome • Diabetes mellitus • Diabetes insipidus • Sarcoidosis • HIV infection • Psychogenic disorder

  15. Local factors • Aging • Foods • Emotions • Stress • Mouth breathing

  16. Foods: • alcohol, • coffee, • coco cola, • Smoke.

  17. Diagnosis • History taking • Clinical examination • Investigations • Salivary flow rate (Sialometry) • Salivary scintiscanning • Sialochemical analysis & laboratory values • Labial biopsy • Sialography

  18. Salivary flow rate (Sialometry)

  19. Lashley cup (Sialometry)

  20. Lashley cup (Sialometry)

  21. Management • Dietary & environmental considerations • Preventive Dental Care Measures • Saliva stimulatants • Saliva substitutes

  22. SIALORRHEAPtyalismDrooling

  23. SIALORRHEA • Excess Saliva • The condition in which there is increased Salivary flow

  24. Causes • Ill fitting Denture • New Denture Wearer • Apthous Ulcers • GIT Diseases • Rabies bites • Metal poisoning • Stroke • Hemiplagia--paralysis patient • Sour or Spicy Foods

  25. Causes • Drugs (antipsychotic, Cholinergic drugs) • Mentally retard Patients • Recent surgery • Neuromuscular problems • Large tongue (Macroglossia - Downs syndrome)

  26. Clinical Features • Drooling of Saliva • Soiling of cloths • Ulcers around the corners of mouth • Choking of saliva during speech • Perioral infections • Chin and Neck infection • Respiratory problems

  27. Diagnosis • History Normal 14 months of age • Examination resection of mandible, mental retard, GIT disorders, Drugs • Investigation Sialometry

  28. Management • Identify and Remove the Cause • Non Medical • Medical • Surgical

  29. Management • Non Medical or Physical 1-Self motivation 2-Habit Breaking 3-Physiotherapy 4- Radiotherapy

  30. Management • Medical 1- Glycoprrolate tablet 1 to 2 mg two times a day 2- Scopolamine patches 1.5mg once day

  31. Management • Surgical • Ligation Of duct like Parotid duct • Repositioning of Duct like Submandibular , Parotid S Gland • Excision of Submandibular Gland

  32. Mucocele

  33. MUCOCELE • It is a tissue swelling composed of pooled mucus that escapes into the connective tissue from several excretory ducts

  34. Mucocele • When salivary duct is severed the acinar cells will continue to secrete saliva into the severed duct. • At the site of the cut/severance the secretory product escape into the connective tissue forming a pool of mucus that distends the surrounding tissue

  35. Mucocele

  36. Mucocele ETIOLOGY: • Minor glands of the lip are most prone to severance as a result of injury or biting the mucosa. • Intra oral minor salivary gland can also be effected as result of some irritation as well.

  37. CLINICAL FEATURES • Mostly encountered in children and young adults. • Two third of the Mucocele occur in the 3rd decade of life. • Both males and females are effected equally. • SITE: mucosal surface of the lower lip buccal mucosa floor the mouth ventral surface of the tongue and palate • Clinical appearance of the Mucocele depends on its location within the submucosa

  38. CLINICAL FEATURES • More superficial zones of mucous extravasations presents a fluctuant mass with bluish translucent appearance. • Patient usually feels the Mucocele and the fluctuation in its size • Pain is quite rare . • Initially the Mucocele are well circumscribed but with repeated trauma they become nodular ,more diffuse and firm on palpation.

  39. Clinical picture

  40. Clinical picture

  41. HISTOPATHOLOGY: • Underlying pool of mucin distends the surface epithelium. • The mucin is walled of by the rim of granulation tissue or in long standing cases by condensed collagen. • An epithelial lining is lacking • The mucinous material basophilic or acidophillic and contains neutrophils and large oval foam cells the histocytes . • The base of the mucocele will reveal feeder duct. • Long standing mucoceles will show acinar degeneration with fibrosis and minimal inflammation

  42. HISTOPATHOLOGY:

  43. TREATMENT: • Minor salivary gland mucocele will not resolve on its own it must be surgically excised. • To minimize the chances of recurrence the feeder gland should also be removed.

  44. Mucus retention cyst

  45. Mucus retention cyst • It is a swelling caused by an obstruction of a salivary gland excretory duct resulting in an epithelial lining cavity containing mucus. • Mucus retention cyst is sometimes also referred as Sialocyst.

  46. Mucus retention cyst • The mucus retention cyst is lined by epithelium and rarely occur in the major salivary gland, when they do occur they are multiple i.e. poly cystic disease of the parotid gland

  47. Mucus retention cyst

  48. Mucus retention cyst CLINICAL FEATURES: • Encountered in adults from 3rd -5th decade. • The lesion is painless and fluctuant and bluish in appearance. SITE: Parotid cysts are located in the superficial lobe as fluctuant well defined mass. Floor of the mouth is the most common place. -Lip -Buccal mucosa

  49. Mucus retention cyst HISTOPATHOLOGY: • The epithelium of the cyst is stratified cuboidal or columnar duct like epithelium. • The cytoplasm in the of these cells is either clear or eosinophlic and my show some features mucous differentiation • 70% of these cyst are unilocular rest of the 30% have multilocular pattern.

  50. Mucus retention cyst TREATMENT: • Simple excision is the treatment of choice with caution of rupturing the cystic sacs. • Recurrence is rare.

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