Abstract
Background and Objective: Hyposalivation and xerostomia can result from a variety of conditions. Diagnosis is based on a combination of medical history, clinical and serological parameters, imaging, and minor salivary gland biopsy when indicated. The Objective was to characterize microscopic changes in minor salivary gland biopsies taken in patients with xerostomia. Materials and Methods: 10-year retrospective analysis of minor salivary gland biopsies, 2007–2017. Histomorphometric analysis included gland architecture, fibrosis, fat replacement, inflammation and stains for IgG/IgG4, when relevant. Results: 64 consecutive biopsies, of which 54 had sufficient tissue for diagnosis of Sjogren’s Syndrome (SS) were included (18 males, 46 females, average age 56 (±12.5) years). Only 12 (22.2%) were microscopically consistent with SS, none stained for IgG4. Medical conditions were recorded in 40 (63%), most frequently hypertension and hyperlipidemia (28% each). Medications were used by 45 (70%), of which in 50% more than one. Xerostomia in non-SS cases was supported by abnormal gland morphology, including acinar atrophy, fibrosis and fatty replacement. All morphological abnormalities are correlated with age, while fatty replacement correlated with abnormal lipid metabolism. Multiple medications correlated with microscopic features which did not correspond with SS. Conclusions: SS was confirmed in a minority of cases, while in the majority fatty replacement, fibrosis and multiple medications can explain xerostomia, and are related to aging and medical conditions. Medical history and auxiliary tests could lead to correct diagnosis in non-SS patients, avoiding biopsy. The necessity of a diagnostic biopsy should be given serious consideration only after all other diagnostic modalities have been employed.
Highlights
Four cases were excluded due to absent clinical data in the hospital medical records, one patient had two biopsies performed during this time period, but only one was included, with a total of 64 samples included in the statistical analysis
For the correlation analysis between clinical parameters and biopsy results for s syndrome (SS), only 54 cases were included, since 10 samples did not contain the minimum number of salivary gland lobules to be acceptable for diagnosis of SS [13]
It is well known that elderly patients consume more medications, some of them with recognized xerogenic effects, findings of the current study suggest that anatomic changes in the structure of salivary glands of elderly patients can explain dry mouth symptoms, beyond the pharmacological effect of the medications used
Summary
Decreased saliva production can cause functional impairment such as changes in taste, halitosis, difficulty in chewing, swallowing and speech. It increases the risk of caries and causes dental sensitivity. The causes for decreased production include old age, side effects of many types of medications, chemotherapy and radiation to the head and neck area. Some autoimmune conditions such as Sjogren’s syndrome (SS) and IgG4 related disease (IgG4RD) and neurological diseases have been associated with hyposalivation [1]. Results: 64 consecutive biopsies, of which 54 had sufficient tissue for diagnosis of Sjogren’s Syndrome (SS) were included (18 males, 46 females, average age 56 (±12.5)
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