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SALIVARY GLAND RED HERRINGS II - SOMATOFORM DISORDERS
The first salivary gland false positive reported by this NEWSLETTER was masseteric hypertrophy. Another occurs in those patients (a surprising 30%) seen in the Salivary Gland Center (SGC) with no discernible organic salivary gland disease or secretory disturbance. Rather, their complaint appears to be somatoform (psychogenic) in origin.
Most complaints involve xerostomia or sialorrhea. Others are odd - dribbling, constant expectoration or swallowing, xerostomia or sialorrhea localized to one oral area, bitter tasting saliva, milky or thick saliva in spite of a visibly clear aqueous flow, and frothy saliva (oral muscular activity causes salivary aeration -see illustration).
The SGC can calibrate salivary flow from individual glands. When saliva is stimulated (sour candy) and volume measured from each gland in patients with disturbed salivary perceptions, a normal amount is obtained. Stimulation also will override a drug related xerostomia and result in a normal return. Conversely, diseased glands produce a reduced saliva both at rest and when stimulated. Substantiation for normal gland function can be obtained with sialochemistry performed by the SGC.
Accurate early categorization negates invasive, complex and costly procedures. A complaint of dryness often leads to unnecessary biopsies or to investigations for systemic diseases. CT scans, sialography, isotope and sophisticated serum antibody studies, and ophthalmologic consultations can be eliminated. Remember, Ïcommon things occur commonly but sometimes present themselves in an uncommon fashionÓ. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
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Common
patient denominators include histories of emotional disturbance,
often depression, and ingestion of psychotherapeutic medications.
The depression usually manifests itself with suicidal statements,
despondency, intensification of the salivary problems as the day
progresses and difficulty with sleeping. The patient blames xerostomia
for frequent night awakenings when in reality the mental state is
the cause. They often bring detailed written chronologic histories
of symptoms, medical visits and medications (OslerÌs Ïla
maladie du petit papierÓ). Some oral event (dental care,
medication related xerostomia) focuses attention on the mouth. Precipitating
factors also include stressful work, social or family situations.
Concurrently, many patients will demonstrate other oral conditions
thought to have psychogenic aspects- burning mouth, dysgeusia, TMJ
problems, masseteric hypertrophy and bruxing and clenching.