salivary gland infections

Salivary gland

infections

ميكرو 3س L3

Salivary gland infectionsInflammation of salivary gland – sialadenitis.

Can be viral (majority), bacterial and fungal (minority).

Parotid glands are more commonly infected than submandibular glands while accessory salivary glands are very rare infected.

Majority of sialadenitis seen in adults.

Initiation and progression of salivary gland infections depend upon the virulence of the causative organism and the host resistance.

Dr. Adel Jumaan Binsaad

Xerostomia (Dry Mouth):

Is not a disease but it is symptom of diseases. It can effects the nutritional status, speech, taste,

tolerance to dental prosthesis and increases susceptibility to dental caries.

Causes include:

Medications - antihypertensives, antidepressants, analgesics, diuretics and antihistamines.

Cancer Therapy - Chemotherapeutic drugs change the flow and composition of the saliva.

Radiation treatment that is focused on or near the salivary gland can temporarily or permanently damage the salivary glands.

Sjogren's syndrome - An autoimmune disease, causes xerostomia and dry eyes (xerophthalmia).


Surgery or wounds can damage the nerves that supply sensation. Salivary glands may be left intact, but cannot function normally without the nerves signal.

Other conditions -such as endocrine disorders, stress, depression, and nutritional deficiencies.

Dry leathery tongue

Clinical features• Increase thirst • Difficulty in speech, swallowing & eating dry food• Burning sensation• Fissuring of tongue.• Treatment:

Identify the cause. In many situations, it is difficult to eliminate the causes.

• Palliative treatment: Salagen, special food preparation (moist foods). Artificial saliva. Avoidance of alcohol-based mouth rinses. Use of water and glycerin mixed in a small aerosol

spray bottle. It will be necessary to control the results of xerostomia especially the increase in dental caries.

• Control dental caries: This will outlined in the cariology course.


Sjögren's SyndromeAutoimmune disease in which the immune system attacks the glands and leading to dryness of the eye and the mouth.Predominantly affects salivary, lacrimal & other glands.

It was first described by HENNIK SJOGREN in 1933. It’s most common in white women who are in their 40s and 50s. It may also occur along with other diseases, such as rheumatoid arthritis, lupus, or scleroderma. The most common symptoms of Sjögren's syndrome are dry eyes and mouth that last for at least 3 months. Patient may have itching in eyes.


Treated will focus on symptoms:Artificial teardrops. Mouth lubricants.Saliva substitutes.Steroid medicines to relieve muscle and joint pain. Antirheumatic drugs, such as methotrexate.

Sialorrhea (Increase in saliva flow)Psychosis, mental retardation, certain nuerologicval diseases, rabies, mercery poisoning.

Viral infections

Mumps (endemic parotitis) the most common viral cause of sialadenitis.Aetiology and pathogenesisRNA paramyxovirus which infect circulating lymphocytes. In salivary duct epithelial cells virus replicate leading to periductal oedema and infiltrate. The virus shed in saliva and spread into bloodstream, causing viraemia. EpidemiologySeen in winter and spring.Occur at all ages but most common in childhood. Transmitted via direct contact with saliva and by droplet spread.

Incubation and infectivity14-18 days. Saliva during prodromal period is infectious and up to 2 weeks after the onset of clinical symptoms.Clinical features Pyrexia, sore throat and earache.Pain on chewing.Reddening of the opening of parotid duct.Increased in glandular size.Low salivary flow rate leading to non-specific stomatitis?? and halitosis. Either one or both parotid glands involved, with a delay of up to 5 days.

Either one or both parotid glands involved

Unilateral Bilateral Parotid enlargement

Complications MeningoencephalitisOrchitis Neuritis, myocarditis, thyroiditis and nephritis.

DiagnosisOn clinical groundSerology.Electronic microscopy (examination of saliva collected by cannulation).

Salivary gland disease in HIV infection:May occur and the main presentations of the disease of the major salivary glands are: xerostomia and /or enlargement of the salivary glands.

Other viral infectionsCytomegalovirus – causes cytomegalic inclusion disease??, in newborns, children and adults and has multiple systemic manifestations.

Parainfluenza types 2 and 3, echo and coxsackie viruses – non-specific suppurative sialadenitis ??.

Bacterial infections of salivary glands:

Acute suppurative parotitis (bacterial sialadenitis):•Seen mostly in adults with salivary gland abnormalities and other predisposing factors.•A retrograde infection via salivary duct may occur if the flow of saliva is reduced or stopped.

Predisposing factors:Drugs that reduce salivary flow such as diuretics.Salivary gland abnormalities such as calculus, mucus plug or benign strictures. Dehydration.Sjogren's syndrome.Clinical features1.Unilateral or bilateral swelling of parotid glands. Swelling may extend, involving pre- and postauricular areas.2.Purulent salivary secretions at the duct orifice.3.Fever, chills and leukocytosis.4.Recurrent bouts of acute infection followed by remission may lead to fibrosis.

Treatment Parenteral antibiotic therapy with amoxicillin or erythromycin, guided by culture of pus and sensivity tests.Oral hygiene.Pus aspirated through catheter attached to a syringe or collected aseptically on a cotton-wool swab by milking the duct.Encourage the salivation by increased fluid intake and by sialagogues e.g. lemon juice. In sever cases: surgical drainage of pus.

If acute bacterial parotitis is untreated:1.Extension of inflammation and oedema into the neck leading to respiratory obstruction2.Cellulitis of the face and neck3.Osteomyelitis of adjacent facial bones4.Septicaemia and death

Mycotic InfectionsActinomycosis Caused by Actinomyces israelii.Types:

1. Primary endogenous, ascending infection via salivary ducts. Infection penetrates from mouth into gland and affects it entirely.

2. Secondary when transferred to gland from tissue surrounding, non tender, non fluctuant indurated lesion with formation of multiple fistulae with discharge of sulphur granules.


SIALOGRAPHY: radiographic examination of the salivary glands & their ducts following the injection of a radiographic contrast media.Indications: Done when acute condition has resolved.To identify abnormalities such as calculi, mucus plugs, benign strictures, sialectasia (dilation), Fistulae, neoplasms & other pathology which lead to recurrence of infection. Contraindications:– Severe inflammation of ducts– History of contrast sensitivitySubsequent treatment include duct dilation, removal of duct obstructions or surgical revision of duct.

Fistulae: abnormal passage that connects an abscess, cavity, or hollow organ to the body surface or to another hollow organ.


Large calcified stone


Plain radiograph shows radio opaque stone


Salivary stones80 % occur in the submandibular gland10 % occur in the parotid gland7 % occur in the sublingual gland

Submandibular sialadenitis Less common and most bacterial infections are associated with obstructive duct disease.

Neonatal suppurative parotitis and recurrent parotitis of childhoodRare diseases, of unknown aetiology, and occur in the first decade of life.In recurrent parotitis, child complain of repeated acute episodes of painful parotid gland enlargement.

Rare bacterial infections of salivary glandsEndogenous, ascending infection via salivary ducts e.g. Actinomyces israelii.Reactivation of old lesion e.g. Mycobacterium tuberculosis.Infection via adjacent , contiguous locus e.g. Treponema pallidum.

Common isolates

Less isolates

Rare isolates

Alpha-haemolytic

streptococci

Haemophilus spp.

Neisseria gonorrhoeae

Staphylococcus aureus

Bacteroides spp.

Mycobacterium

tuberculosis

Anaerobic streptococci

Actinomyces spp.

Eikenella spp.

Treponema pallidum

Bacteria commonly isolated from bacterial parotitis

Infective endocarditis

Is the most important disease of relevance to dentistry.

It is the most common fatal complication of dental procedures.

Can be caused by bacteria, fungi, rickettsiae and chlamydiae.

Inflammation of the endocardium of the heart valves, and sometimes the endocardium around congenital defects.

More than 80% of infective endocarditis is caused by streptococci and staphylococci and 35% of cases caused by Streptococcus viridians.

Signs and symptomsfever, loss of weight, anaemia, haematuria, petechiae, splinter haemorrhages, and splenomegaly.

Clinical forms of diseaseClinical forms of disease

acuteacute subacutesubacuteRapidly progressiveRapidly progressive More insidious, chronic, More insidious, chronic,

and progress slowlyand progress slowly

Caused by Caused by Staphylococcus aureus,Staphylococcus aureus,

Streptococcus Streptococcus pyogenes and pyogenes and Streptococcus Streptococcus pneumoniaepneumoniae

Caused by Caused by

Streptococcus viridians Streptococcus viridians Staphylococcus Staphylococcus epidermidis and epidermidis and

Streptococcus faecalis Streptococcus faecalis

Pathogenesis

Infective endocarditis occurs in patients with pathological condition of endocardium. In patients with normal heart valves rarely.

The risk of development of infective endocarditis in a risk patient following dental procedures has been estimated vary between 10% and 90%.

Bacteraemia can occur after dental procedures such as extraction, surgical or non-surgical endodontitics, gingivectomy, root-planing, scaling and flossing, intraligamentary injections and reimplantation of avulsed teeth.

Supragingival and subgingival plaque is the main source microorganisms in dental septicaemias.

These procedures requiring antimicrobial prophylaxis in persons at risk.

Persons at risk who need antibiotic prophylaxis

Any type of heart lesion is susceptible to infection, but antibiotic prophylaxis is imperative for patients with:

Congenital cardiac defectsRheumatic heart diseaseProsthetic cardiac valvesPrevious history of endocarditisHypertrophic cardiomyopathyAortic valve disease (bicuspid valve)

Diagnosis Clinical signs supported by positive blood

culture. Blood should be collected (10 ml prior to

antibiotic treatment) when the temperature rise and cultured under aerobic and anaerobic conditions.

Sensivity test is performed. ECHO cardiography.

Treatment High dose single antibiotic or combination antibiotic therapy on the basis of blood culture.Dentist identified patients at risk from their medical history and from patient’s medical doctor.Patients with cardiac diseases ware cards. Antibiotic and antiseptic prophylaxis Reduction in numbers of organisms before (5 min) the start of dental procedure by irrigating the gingival crevice area with antiseptics such as chlorhexidine gluconate gel 1% or chlorhexidine mouthwash 0.2%.

One hour before dental procedure: Amoxicillin orally 2 gram (4 tab.-500 mg)/ single dose. Alternative is erythromycin.even when antibiotic cover provided, patients at risk should report any unexplained illness due to insidious origin of infective endocarditis.

salivary gland infections

Health & Medicine