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21/05/2018

Kelenjar saliva mayor (1)

Saliva Kelenjar parotis


dan kelainan kelenjar Terdapat sepasang, pada ramus
mandibula bilateral
saliva Sel acini serous
Mensekresikan melalui ductus Stensen
Rangsangan mekanis & kimiawi
Dr. Desiana Radithia, drg., Sp.PM.(K)
Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga Kontribusi 20% dari whole saliva

What we’re going to cover Kelenjar saliva mayor (2)

Kelenjar submandibularis
Definisi saliva
Terdapat sepasang, pada bagian bawah
Mekanisme sekresi saliva mandibular bilateral
Fungsi saliva Mensekresikan melalui ductus Wharton
Xerostomia Sel acini mucoserous
Kelainan kelenjar saliva terkait infeksi Stimulated dan unstimulated
Kontribusi 65-70% dari whole saliva

Definisi Saliva Kelenjar saliva mayor (3)

Cairan tubuh yang kompleks yang Kelenjar sublingualis


disekresi oleh kelenjar saliva mayor dan Terdapat sepasang, pada dasar mulut
minor untuk fungsi tertentu bilateral
Mensekresikan melalui ductus Rivinus (8-
20 muara)
Whole saliva
Sel acini mucoserous
Kombinasi hasil sekresi kelenjar mayor-
Stimulated dan unstimulated
minor, GCF, desquamasi epitel, debris,
komponen darah dan mikroorganisme Kontribusi 5% dari whole saliva

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21/05/2018

Kelenjar saliva minor

800 – 1,000 buah, tersebar di submukosa


Bukal, labial, lingual, palatum, dasar mulut
 Innervasi oleh nervus VII (Facialis)
 Beda dengan yang mayor
Tidak dibungkus oleh jaringan ikat

Kelenjar von Ebner Mekanisme sekresi saliva (1)

Spesifik mengitari papilla circumvallate Rangsangan diterima reseptor, lalu


diteruskan ke pusat rangsang saliva di
Sekresi pure serous medulla
Tugas utama : Mekanis
membasahi papilla secara kontinyu Kimiawi
Produksi enzim pencernaan untuk Memori
hidrolisis lipid  melarutkan partikel Rangsangan direspon melalui
makanan agar bisa dirasakan neurotransmitter sistem saraf otonom

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21/05/2018

Kandungan & fungsi saliva


1. Proteksi jaringan keras & lunak

Lubrication for viscoelasticity


Water, proline-rich glycoprotein & mucin
Buffering
Bicarbonate, phosphate, protein
Remineralization
Proline-rich glycoprotei, statherin, Ca phosphate
ANTI-demineralisasi
Mucin

Kandungan & fungsi saliva


Mekanisme sekresi saliva (2) 2. Proteksi dari mikroorganisme

Sistem saraf otonom Antibakterial


Mucin, lysozyme, lactoferrin, lactoperoxidase,
Parasimpatis histatin, agglutinin, cystatins, VEGh
merangsang flow saliva cair Antifungal
Simpatis sIgA, mucin, histatin
menekan flow, produksi saliva kaya Antiviral
protein sIgA, mucin, cystatin

Kandungan & fungsi saliva


Normal flow rate 3. Membantu sistem pencernaan

 Stimulated  1 – 2 mL/min menghidrolisis karbohidrat menjadi maltose


dan dextrin
 Unstimulated  0.3 – 0.4 mL/min
Enzim amylase; DNAse; RNAse; Lipase; Protease
Membantu menghantarkan rasa kepada
 Sleep  0 – 40 mL in 7 hours taste buds
 Awake Zinc
Approx. 200 mL of stimulated saliva in 54 mins
Membentuk bolus
Approx. 300 mL of unstimulated saliva in 16 hours
Mucin

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21/05/2018

Reversible xerostomia

Disfungsi/hipofungsi kelenjar saliva


Sympthoms reduce when the cause is
Xerostomia eliminated
Therapy focused on stimulating glands to
increase saliva production

Dry mouth syndrome May progress to irreversible when fail to


eliminate cause

common causes of
Definisi reversible xerostomia

 Dehydration  physical activity, fever, diarrhoea


Sindroma mulut kering
 Psychologic  depression, anxiety, stress
Klasifikasi
 Alcohol  drinks, mouthwash
Subjective xerostomia
 Drugs  antidepressants,antipsychotic,
Tanpa disertai hiposalivasi & petanda antihistamin, decongestan, antihypertension,
klinis lain  pure psychological anti-appetite, diuretics
Objective xerostomia  Infection & obstruction  sialadenitis, mucocele
Disertai hiposalivasi & petanda klinis lain  Neuro disorder  autonomic nervus system
disorder

Objective xerostomia irreversible xerostomia

Gejala Petanda klinis


 Bad taste  Dry-looking, sticky
 Burning mouth
mucosa Irreversible glandular damage
 Stringy saliva Acinar cells degeneration
 Sulit mengunyah &
menelan  Depapilasi, mukositis
Glandular atrophy
 Sulit bicara lama  Oral candidiasis
Irreversible damage on innervation and
 Sulit memakai denture  Gingivitis & periodontitis
vascularization
 Halitosis  Cervical caries
 Halitosis

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Common cause of
irreversible xerostomia Sialadenitis

 Degenerative diseases  HT, DM, HIV, CKD


Inflammation may involve major or
 Autoimmune diseases  Sjögren’s syndrome minor salivary glands
 Radiotherapy  involving head-neck regio
Rapid onset of pain and swelling
 Neoplasma  salivary gland tumor suggest acute condition  mostly viral
 Persistent neuro disorder

Management Sialadenitis

 Elimination of cause, if possible


 Stimulate gland’s production, if possible
Bacterial
 Sour / sweet / mint candy or gum
 Cholinergic drugs  pilocarpine, cevimeline Acute bacterial sialadenitis
 Maintain mucosal hydration Chronic bacterial sialadenitis
 Continuous water intake
Viral
 Avoid dry meals
 Use oral moisturizer or artificial saliva Viral sialadenitis
 Treat caries and other mucositis

Acute Bacterial Sialadenitis

 Also known as (a.k.a)


 Acute parotid sialadenitis, ascending parotitis,
suppurative parotitis
 Etiology
Sialadenitis  penicillin-resistant staphylococcus
 Predilection
 80% on parotid gland, unilateral
 Pathogenesis
Salivary disorder due to glandular inflammation
 Bacterial invasion from upper molar through
Stensen’s duct

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Acute Bacterial Sialadenitis Chronic Bacterial Sialadenitis

 Sympthoms  Sympthoms
 Demam, sakit kepala, malaise (flu-like)
Tidak ada demam, atau tidak spesifik
 Rasa sakit terlokalisir pada kelenjar yang
terinfeksi Discontinued pain
 Signs  Signs
 Extra oral: Erythematous oedema, kulit Leukocytosis, namun tidak selalu
mengkilat, tegang, lunak dan nyeri pada
palpasi Recurrent unilateral swelling yang mereda
 Intra oral: muara ductus purulent pada palpasi, dengan sendirinya, disertai pus dari muara
daerah sekitar erythematous ductus Stensen

Management Management

 Kultur pus  Kultur pus


 Identifikasi bakteri dan uji sensitivitas antibiotic  Identifikasi bakteri dan uji sensitivitas antibiotic
 Antibiotik oral sesuai hasil uji  Irigasi ductus dengan erythromycin/tetracyclin 150mg/5mL
 Mostly used: clindamycin 300 mg t.i.d  Antibiotik oral sesuai hasil uji
 Mostly used: clindamycin or erythromycin
 Analgesic-anti-inflammatory drugs
 Analgesic-anti-inflammatory drugs
 Continuous hydration  Continuous hydration
 Oral moisturizer  Oral moisturizer
 Avoid saliva-stimulating meals  Avoid saliva-stimulating meals
 Improve oral hygiene
 Improve oral hygiene

Chronic Bacterial Sialadenitis Viral Sialadenitis

 Sering pada anak-anak debil, lansia, dan  A.k.a. Mumps / Parotitis epidemica
terkait obstruksi/inflamasi kronik
 Sering pada anak-anak hingga dewasa
 Etiology
muda
 infeksi bakteri campuran
 Predilection  Etiology
 80% on parotid gland, unilateral Paramyxovirus
 Pathogenesis  Predilection
 Similar to acute type, but the bacteria infection Parotid (90%) and submandibular (10%)
is low grade  salivary gland destruction over
time bilateral simultaneously

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21/05/2018

Viral Sialadenitis

 Pathogenesis
 Transmitted by droplet
 Incubation period: 2-3 weeks post-exposure
 Sympthoms
 Fever, headache, malaise (flu-like)
 Periauricular pain, swelling within 3 days
 Signs
 Periauricular bengkak, cuping telinga terangkat
 Extreme pain when saliva stimulated

Management

 Therapy
Sympthomatic
Pain relief, anti-inflammatory
Supportive
TKTP, roborantia, rehidrasi, bed rest
Avoid contact with other people,
direct/indirectly
Antibiotic is not obligatory

Management

 Prevention: MMR vaccine


 Self-imiting disease, resolve itself within 2 weeks
 if immunocompetent
 Complication
 Meningitis, encephalitis
 Deafness
 Myocarditis
 Thyroiditis
 Oophoritis
 Infertility