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. SIALORRHEA Ptyalism Drooling

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.

51. Ranula

52. Ranula
Is a term used for mucoceles that occur in the floor of the mouth.
The name is derived form the word rana, because the swelling may resemble the translucent underbelly of the frog.

53. Ranula

54. Ranula

55. Ranula Although the source is usually the sublingual gland,
may also arise from the submandibular duct
or possibly the minor salivary glands in the floor of the mouth.

56. Ranula Presents as a blue dome shaped swelling in the floor of mouth.
They tend to be larger than mucoceles & can cover floor of the mouth & elevate tongue.
Located lateral to the midline, helping to distinguish it from a midline dermoid cyst.

57. Plunging or Cervical Ranula
Occurs when spilled mucin dissects through the mylohyoid muscle and produces swelling in the neck.
Concomitant floor of the mouth swelling may or may not be visible.

58. Plunging or Cervical Ranula

59. Ranula Treatment Marsupialization
Sublingual gland removal via intraoral approach