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SBL4- Xerostomia dry

mouth
Thursday 16 March 2017 rd

Group 1.1

Cara Chan, Izabela Sasin, Amran Husain, Manal Abumahlula, Krishan Navsariwala,
Iqra Choudhry, Meenakshi Mandi, Yousuf Ibrahim, Ameen Hussein
Who are we?

Group 1.1

Cara Chan, Izabela Sasin, Amran Husain, Manal Abumahlula, Krishan


Navsariwala, Iqra Choudhry, Meenakshi Mandi, Yousuf Ibrahim,
What will we be talking about
today?

1. Scenario (Ameen)
2. Ionising radiation (Izabela)
3. Radiography in a dental clinic
(Yousuf)
4. Effects of radiation (Iqra)
5. Saliva (Meenakshi)
6. Saliva and oral health (Krishan)
7. Xerostomia (Amran)
8. Artificial saliva (Manal)
9. Oral hygiene (Ameen & Cara)
10. Conclusion (Cara)
Scenario
During the year after radiation therapy to the neck, face and head, your
uncle increasingly complains that he finds eating hard food painful, and that
he constantly has to drink lots of water because his mouth feels dry. When
he cleans his teeth, his gums bleed quite noticeably. Your uncle also
complains of difficulty speaking. A number of your family have noticed that
he has developed halitosis and it has been suggested that he visits the
dentist.

On inspection of the oral cavity, the dentist was able to discern visual
evidence of tooth decay. In addition, the mucosa and periodontal tissues
show signs of inflammation and infection, including oral candidiasis.
The dentist also performs a salivary production test. The result is < 0.1
mL/saliva/minutes. The dentist tells your uncle he is suffering from dry
mouth.

When he comes home, your uncle is confused and he asks you, as a dental
student, to explain what has happened to him. Why does a dry mouth
result in all of these problems with his teeth and soft tissues? The dentist told
him he has to take something called artificial saliva and that he has to be
very particular about his oral hygiene, but he cannot remember what the
specific advice was.
onising Radiation

Radiation- energy
emitted from a source

Ionising radiation
removes an electron from Figure 1: Atom Ionisation (Medical Radiation,
2012)
an atom
There are two forms of
ionising radiation:

Waves- X-rays and


gamma rays

Particle- electrons,
protons(World
2017)
Health Organization,

Figure 2: Electromagnetic spectrum (Mirion Technologies,


Radiography in a Dental
Clinic

Figure 3 : Commonly used X-ray machine


within a dental clinic (Asomerville, 2008)

Figure 4: Mechanism of creating the X-ray


(Josepino, 2010)
Effects of radiation

Direct
damage:
Radiation - Cells in
directly salivary glands
hits DNA can be
damaged

- Develop dry
mouth/xerosto
Indirect mia
damage:
Radiation
hits water
molecules
Figure 5: An illustration comparing the Figure 6:
direct and indirect actions of radiation Xerostomia (Lewis
(Desouky et al., 2015) and Lamey, 2011)
Saliv
a
Fluid produced by salivary glands and have a protective role in
the mouth.
Agglutination of bacteria

Kill or inhibit the growth of


microorganisms

Mucins

Figure 8: Salivary glands and ducts


Figure 7: Agglutination of an
(Parotidsurgerymd, 2017)
immunoglobulin to bacteria (Midlands
Technical College, 2017)
Saliva and Oral Health

Figure 9: Salivary proteins present in saliva


(Anderson, Paul. (2017). Lecture OB16: Saliva)
Xerostomia
Eating and Buffering Antimicrobial
speaking - Lack of buffer activities
- Difficulty in eating components - Bad breath
- Lack of lubrication - Mouth more
acidic - Increased
- Difficulty in bacteria
speaking - Increased
tooth decay - Can lead to
- Reduction in oral gum disease
digestion
What is Artificial Saliva?
Relieves dry mouth and throat
Prevents irritation & bacterial growth
Neutral pH
Contains electrolytes
Absence of digestive or antibacterial
enzymes
Different formulations available

Figure 11: An example of an


over-the-counter saliva substitute
(Beautiful Smiles, 2013).

Figure 10: Chemical composition of an artificial saliva


solution
ORAL HYGIENE
1. Brushing:
ADVICE
- 2x day with fluoridated toothpaste (> 1350
ppm fluoride)
- Spit not rinse

2. Brushing technique:
- 45 degree angle (modified bass)
- Covering all surfaces
- Approximately 2 minutes
- Electric brushing with rotating head

3. Visits to dentist/hygienist:
- Advice
- Full dental cleaning

4. Smoking cessation:
Nicotine replacement therapy Figure 12. Proper brushing technique using modified bass
technique (Dentaltoolkit, 2016)
5. Medications:
Evaluate as some cause dry mouth
ORAL HYGIENE ADVICE
6. Diet:
Avoid high sugar/acidic foods
& drinks e.g. fruit juices &
fizzy drinks
Limit snacking between meals
& before bed
Snacks Raw fruit &
vegetables
Drink plenty of water
Limit acid attacks < 4 per day
Balanced diet
Figure 13: Percentage macronutrients of a balanced diet
7. Dental Care Products: (toolkit, 2016)
Toothpastes (fluoridated) & mouthwash clean teeth
and prevent bad breath (halitosis)
Interdental brushes & floss help when brush is not
available removes packed food & plaque build-up
Sugar-free gum stimulates saliva production
increasing cleansing action of saliva
Conclusion
Patient has dry mouth (xerostomia) following
cancer H&N radiotherapy
Radiotherapy results in damaging effect on salivary
glands
Saliva flow rate can return to normal within a year
Saliva contains many components important for
normal oral function
Artificial saliva is used to alleviate symptoms in
xerostomia
Patients with xerostomia need to maintain good oral
hygiene to minimise risks e.g. rampant caries
(cavities) & gum disease
References
Medical Radiation, (2012). Ionising an atom. [image] Available at:
http://www.medicalradiation.com/wp-content/uploads/ionization_gross.jpg
[Accessed 8 Mar. 2017].
Mirion Technologies, (2017). Electromagnetic spectrum. [image] Available at:
https://www.google.co.uk/url?
sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi
Tm8zd4sfSAhUB6xoKHTHLD3sQjRwIBw&url=http%3A%2F%2Fwww.nordion.com
%2Fsocial-responsibility%2Fradiation-safety
%2F&bvm=bv.149093890,d.ZGg&psig=AFQjCNFmHNjSNqrCnEv3-
JNIOYpVkte6jg&ust=1489091747114313[Accessed 8 Mar. 2017].
World Health Organization. (2017). What is Ionizing Radiation?. [online] Available
at: http://www.who.int/ionizing_radiation/about/what_is_ir/en/ [Accessed 8 Mar.
2017].
MIDLANDS TECHNICAL COLLEGE. 2017. Agglutination. [image] Available:
http://classes.midlandstech.edu/carterp/Courses/bio225/chap18/figure_18_05_lab
eled.jpg [Accessed 25 Feb. 2017].
PAROTIDSURGERYMD. 2017.Salivary glands and ducts. [image] Available:
https://www.parotidsurgerymd.com/education/articles/parotid-salivary-gland-
info/img/parotid-gland-info.jpg [Accessed 28 Feb. 2017].
Thanks for listening
Any
questions?