Salivary gland infections

1. Salivary gland
infections
‫ميكرو‬
‫س‬3 L3

2. Salivary gland infections
Inflammation 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.

5. 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).

6. Dr. Adel Jumaan Binsaad
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

7. 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.

8. Dr. Adel Jumaan Binsaad
Sjögren's Syndrome
Autoimmune 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.

9. Dr. Adel Jumaan Binsaad
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.

10. Viral infections
Mumps (endemic parotitis)
the most common viral cause of sialadenitis.
Aetiology and pathogenesis
RNA 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.
Epidemiology
Seen in winter and spring.
Occur at all ages but most common in childhood.
Transmitted via direct contact with saliva and by droplet
spread.

11. Incubation and infectivity
14-18 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.

12. Either one or both parotid glands involved

13. Unilateral Bilateral
Parotid enlargement

14. Complications
Meningoencephalitis
Orchitis
Neuritis, myocarditis, thyroiditis and nephritis.
Diagnosis
On clinical ground
Serology.
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.

15. Other viral infections
Cytomegalovirus – 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.

16. 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 features
1.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.

17. 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 obstruction
2.Cellulitis of the face and neck
3.Osteomyelitis of adjacent facial bones
4.Septicaemia and death

18. Mycotic Infections
Actinomycosis
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.

19. Dr. Adel Jumaan Binsaad
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 sensitivity
Subsequent 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.

20. Dr. Adel Jumaan Binsaad
Large calcified stone

21. Dr. Adel Jumaan Binsaad
Plain radiograph shows radio opaque stone

22. Dr. Adel Jumaan Binsaad
Salivary stones
80 % occur in the submandibular gland
10 % occur in the parotid gland
7 % occur in the sublingual gland

23. Submandibular sialadenitis
Less common and most bacterial infections are associated
with obstructive duct disease.
Neonatal suppurative parotitis and recurrent
parotitis of childhood
Rare 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 glands
Endogenous, 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.

24. 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

25. 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 symptoms
fever, loss of weight, anaemia, haematuria, petechiae,
splinter haemorrhages, and splenomegaly.

26. Clinical forms of diseaseClinical forms of disease
acuteacute subacutesubacute
Rapidly progressiveRapidly progressive More insidious, chronic, andMore insidious, chronic, and
progress slowlyprogress slowly
Caused by StaphylococcusCaused by Staphylococcus
aureus,aureus,
Streptococcus pyogenes andStreptococcus pyogenes and
Streptococcus pneumoniaeStreptococcus pneumoniae
Caused byCaused by
Streptococcus viridiansStreptococcus viridians
Staphylococcus epidermidisStaphylococcus epidermidis
and Streptococcus faecalisand Streptococcus faecalis

27. 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.

28. 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 defects
Rheumatic heart disease
Prosthetic cardiac valves
Previous history of endocarditis
Hypertrophic cardiomyopathy
Aortic 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.

29. 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.