Dentaltown March 2013 - (Page 119)

hygiene and prevention perio reports Four Steps to Identify Early Salivary Gland Hypofunction The importance of saliva to oral and overall health is often overlooked by those outside the dental profession. Saliva is important for protection of hard and soft tissues, enamel mineralization and remineralization and digestion. Xerostomia is the subjective feeling of dry mouth and hyposalivation is the objective measure of salivary flow. Aging is not responsible for reduced salivary flow, but the medications taken by the elderly do cause xerostomia. The following four steps help clinicians detect early signs of salivary gland hypofunction. First, ask questions about dry mouth with a visual analog scale for scoring: Do you have too much or too little saliva in your mouth? Do you have difficulty swallowing? Does your mouth feel dry while eating? Do you sip liquids to help swallow dry foods? Second, review medical history and body systems. Sjogren’s syndrome, rheumatoid arthritis, scleroderma, hypothyroidism, depression and eating disorders all impact salivary flow. Tobacco, alcohol and drug use will all affect salivary flow. Third, complete a thorough clinical evaluation. How does the patient appear to you? Examine and palpate the salivary ducts. Are they enlarged or tender? Can you elicit saliva with palpation? Does the saliva pool? Visually check oral tissues for dryness. Use a tongue blade against the buccal mucosa to test for dryness. Check hard tissues for caries. Look at the lips for signs of dry, chapped or fissured appearance. Is the tongue dry, erythematous, lobulated or fissured? Fourth, based on findings of the first three steps, further diagnostic tests may be needed. These tests range from measuring salivary flow to surgical biopsy of a salivary gland. Perio Reports Vol. 25, No. 3 Clinical Implications: Several clinical steps provide valuable information in detecting salivary gland hypofunction. n www.hygienetown.com t Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science. Navazesh, M.: How Can Oral Health Care Providers Determine if Patients Have Dry Mouth? JADA 134: 613-620. 2003. Measuring Saliva in Clinical Practice Biomarkers in saliva provide diagnostic information on oral, ovarian and breast cancer; HIV infection; Sjogren’s Syndrome; and dental caries and periodontal disease. Saliva is also used to measure alcohol and illegal drug use and nicotine and cotinine levels associated with tobacco use. Physiologic changes associated with pregnancy and depression can also be detected in saliva. Saliva collection can be from one or a mixture of glands and stimulated or unstimulated. Major salivary glands provide 90 percent of saliva, with minor glands providing the remaining 10 percent. Whole saliva is contaminated with food, micro-organisms and gingival crevicular fluid and consists of 99 percent water and one percent proteins and salts. Total daily output is between 0.5 liters and 1.5 liters. Minor salivary glands provide lubrication and protection for mucosal tissues. Unstimulated saliva is primarily from the submandibular glands and is both serous and mucous in nature. Stimulated saliva is from the parotid gland primarily and is completely serous in nature. The sublingual gland contribution to either stimulated or unstimulated saliva is minimal. Reduced salivary flow negatively impacts the quality of life by causing difficulty with speaking, eating, swallowing and tasting. Objective measures are needed to accurately determine xerostomia. Salivary flow is simulated with gum base, paraffin wax, rubber bands and citric acid, and is collected by the patient spitting all saliva into a collection cup. Unstimulated salivary flow is collected from the mouth by having the patient tip his or her head forward and with an open mouth, allowing all salvia to run out of the mouth and into the collection container. Clinical Implications: Dental practices have a variety of clinical means to measure salivary flow. n Navazesh, M., Kumar, S.: Measuring Salivary Flow: Challenges and Opportunities. JADA 139; (suppl 2): 35S-40S, 2008. continued on page 120 dentaltown.com « MARCH 2013 119 http://www.hygienetown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown March 2013

Dentaltown.com Highlights
Howard Speaks: Dentistry Could Come Back with a Vengeance
Professional Courtesy: I’m No Anti-Dentite
Continuing Education Update
Second Opinion: Should Endodontists Place Implants?
Needle Stick Question
Am I the Only One Who Didn’t Know How to Use My Loupes?
The Patient Blames Me for Cracking His Tooth
Corporate Profile: {KöR}
CAD/CAM Materials
Dentaltown Research: Cosmetic Dentistry
Do-it-Yourself Finance, Part IV: Savings and Investing
Product Profile: Centrix
Keep Them Coming Back
You Should Know: Likeable Dentists
Multimodality Endodontics
Endodontics for the Recent Graduate: Instrumentation
Continuing Education Porcelain Veneers: From Case Selection to Cementation
8½ Tips for Dental Safety Checklists
How Prepared Are You For a Medical Emergency?
Dental Stem Cell Preservation and the Dawning of Regenerative Oral Medicine
Product Profile: Ivoclar EvoCerem
Narrow Diameter Implant Overdentures with Locator Attachments
In This Issue: Zeroing in on Xerostomia
Perio Reports
Ad Index
Profile in Oral Health: Substances for Targeting Xerostomia
Dentally Incorrect

Dentaltown March 2013