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DABOM: Salivary Gland Disorders and Xerostomia

DABOM · Work through your exam, one topic at a time.

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Salivary Gland Disorders and Xerostomia

Domain 5 tests the difference between the symptom of dry mouth and objective salivary hypofunction, the workup of salivary swelling, and the systemic causes of gland dysfunction. The exam favors questions about medication review, Sjögren syndrome criteria, and complications of hyposalivation.

Xerostomia versus hyposalivation

  • Xerostomia is the subjective sensation of dry mouth; hyposalivation is objective reduction in flow.
  • Unstimulated whole salivary flow below 0.1 mL/min and stimulated flow below 0.7 mL/min indicate hyposalivation.
  • Common causes include anticholinergic and antidepressant medications, radiation, Sjögren syndrome, diabetes, HIV, HCV, sarcoidosis, amyloidosis, dehydration, and anxiety.
  • Complications include caries, candidiasis, dysphagia, dysgeusia, and denture intolerance.

Sjögren syndrome

  • Dry eyes and mouth, fatigue, and arthralgia are typical.
  • Tests include anti-Ro/La, ANA, rheumatoid factor, Schirmer test, ocular staining, sialometry, salivary gland ultrasound, and labial minor salivary gland biopsy with focus score at least 1.
  • Exclude HCV, HIV, sarcoidosis, and lymphoma; patients with Sjögren have increased lymphoma risk.

Salivary swelling

  • Sialolithiasis usually affects the submandibular gland and causes meal-related pain and swelling; ultrasound or CBCT confirms.
  • Sialadenitis may be bacterial, viral, or obstructive; Staphylococcus aureus is common in bacterial cases.
  • Mucocele is an extravasation phenomenon of the lower lip; excision is curative.
  • Ranula arises in the floor of mouth and may be treated by marsupialization.
  • Pleomorphic adenoma is the most common benign tumor; malignancy is suggested by pain, fixation, or nerve palsy.

Worked example

A 58-year-old woman reports dry mouth, parotid enlargement, and fatigue. Review medications and screen for anti-Ro/La, Schirmer test, sialometry, and labial biopsy; test for HCV and HIV. If Sjögren is confirmed, manage caries prevention with fluoride, treat candidiasis, use pilocarpine or cevimeline if not contraindicated, and monitor for lymphoma.

Traps that cost marks

  • Assuming all dry mouth is Sjögren syndrome.
  • Ignoring medications as the cause.
  • Not testing for HIV or HCV.
  • Failing to measure salivary flow objectively.
  • Missing persistent gland enlargement that suggests lymphoma.