The subjective feeling of oral dryness is

termed as xerostomia.

Xerostomia is a symptom not diagnosis or

disease.

It is basically termed as clinical

manifestation of salivary gland

dysfunction.

Classified as-

TEMPORARY CAUSES-• Psychological

• Blockage of duct calculi

• Sialoadenitis

• Drug therapy

PERMANENT CAUSES-

• Salivary gland aplasia

• Sjogren’s syndrome

• Radiotherapy

• Other systemic disorders

• Surgical desalivation

PHYSIOLOGICAL-

• This includes anxiety & depression.

• These causes decrease in salivary flow rate.

DUCT CALCULI-

• Blockage of minor salivary glands.

• Commonly submandibular gland is blocked.

• Can produce dryness, along with pain and

swelling in the gland.

• If untreated may cause permanent xerostomia.

SIALOADENITIS-

• Inflammation of the salivary gland can reduce

secretion.

• Acute infections such as mumps & post operative

parotitis.

• Chronic infections include swelling of gland.

DRUG THERAPY-

• Anticholinergic.

• Sympathomimetic agents.

(antihistamines, bronchodilators,

antidepressants)

• Produces diureses dehydration xerostomia.

SALIVARY GLAND APLASIA-

• Congenital absence of one or more major salivary

glands.

• Rare condition.

• Unknown etiology.

SJOGREN’S SYNDROME-

• Combination of dry mouth, dry eyes & rheumatoid

arthritis.

• Females commonly affected.

• Age = 40-50 years.

• Swelling of salivary glands may also develop.

RADIATION THERAPY-• Therapeutic radiography of head & neck tumors.

• Saliva: thickened, altered electrolytes, pH↓,

secretion of immunoglobulins↓.

• Glandular atrophy fibrosis or replaced by fatty tissue.

• Atrophy due to ↓ vascularity of gland.

OTHER SYSTEMIC DISORDERS-• Diabetes mellitus as a result of polyurea.

• Anaemia.

• Vitamin A, riboflavin, nicotinic acid deficiency.

• Brain tumors

• Diarrhoea etc.

There is lack of saliva.

Duct calculi may lead to unilateral dryness

with pain& swelling on the affected gland.

Sjogren’s syndrome produce bilateral swelling

accompanied by lymph node enlargement in

many cases.

Dry or burning sensation.

The mucosa appears dry, sometimes inflamed,

often pale.

On tongue there is atropy of papillae,

inflammation, fissuring & crackling.

In severe cases areas of denudation are seen.

Soreness of mucous membrane.

Ulceration.

Caries due to decrease salivary flow rate.

Speaking difficulty.

Abnormaily in taste.

Eliminate etiological factors such as drug, calculi etc.

Promote salivary secretion by using sugar free chewing gums.

Patient must drink plenty of water.

Artificial saliva is avaliable these day. Composition-

• Carboxymethylcellulose.

• Sorbitol.

• Potassium Chloride.

• Sodium Chloride.

• Calcium Chloride.

• Dipotassium hydrogen phosphate.

SYNONYMS-

• Sicca syndrome.

• Gougera sjogren syndrome.

Described by Hernik Sjogren in year 1933.

It’s a chronic autoimmune disorder.

In sjogren’s syndrome the body’s defense system

turns against itself & attacks glands that produce

moisture.

Sjogren’s syndrome is described as a triad

consisting of:-

• Keratoconjunctivitis sicca (dry eye sundrome).

• Xerostomia (dry mouth).

• Rheumatoid arthritis.

PRIMARY SJOGREN’S SYNDROME-

• Comprises of dry mouth & dry eyes.

• Not associated with any connective tissue

disease.

SECONDARY SJOGREN’S SYNDROME-

• Comprises dry mouth and dry eyes.

• Associated with disease such as rheumatoid

arthritis & other disorders such as

polymyositis(inflammation of muscles),

scleroderma.

The causes of sjogren’s syndrome are known.

Genetic.

Hormonal.

Infections.

In many cases sera antisalivary duct antibody is seen.

Associated with HLA(human leukocyte antigen) system.

HLA-DR3 & HLA-B8 are associated only with primary form of disease.

HLA-DRw52 is assosiated with both the forms.

Predominates in females.

F:M = 10:1.

Children, young adults & older age people are affected.

Dryness of moth and eyes due to hypofunction of salivary & lacrimal glands.

Painful & burning sensation of oral mucosa.

Secretor glands of nose, larynx, pharynx & tracheobroncial tree are involved with dryness.

Parotid gland enlargement.

Lymphadenopathy

Purpura.

Kidney involvement.

Myositis.

Schirmer's test - more than 10 mm of moisture on the filter paper

in 5 minutes is normal.

ESR (Erythrocyte Sedimentation Rate)-increased in sjogren’s syndrome.

AntiSalivary duct antibodies- elevated.

Immunoglobulins- elevated.

Sialography- radiographic examination of

the salivary glands.

It usually involves the injection of a small

amount of contrast medium into the salivary

duct of a single gland, followed by routine X-

ray projections.

Demonstrate the formation of puncture,cavity

defects filled with radiopaque contrast media.

These filling defects produce ‘cherry blossom’

or ‘branchless fruit laden tree’ appearance.

No satisfactory treatment.

Symptomatic treatment.

Keratoconjunctivitis – treated by ocular

lubricants like artificial saliva.

Xerostomia – treated by oral lubricants.

For dental caries oral hygiene & fluoride

application is indicated.

No specific treatment for enlargement of

salivary glands.

Sometimes surgery is done in patients with

discomfort.