2. Clinical approach to xerostomia Dr. Abbas Javadzadeh Dr. Atessa Pakfetrat Associate Professor of Oral medicine Department Mashhad Dental School Dr. Abbas Javadzadeh Dr. Atessa Pakfetrat Associate Professor of Oral medicine Department Mashhad Dental School

3. َ Xerestomia is a symptom not a diagnosis or disease Xerestomia is a symptom not a diagnosis or disease

6. Clinical evaluation of xerostomia 1.Subjective or objective signs and symptom

10. 2. Permanent or temporary? Acute or chronic? Clinical course? Clinical evaluation of xerostomia

11. 3. Symptoms of salivary gland dysfunction Clinical evaluation of xerostomia

12. 4. Associated diseases

13. 5. History Review of system PMH, PDH Clinical evaluation of xerostomia

14. Etiology 1-Iatrogenic Drugs Radiation chemotherapy 2- Developmental Salivary gland agenesis

15. 3- Water/metabolite loss Impaired fluid intake Hemorrhage Vomiting/diarrhea

16. 4- Systemic disease Sjogren syndrome Renal failure Diabete Granulomatose diseases HIV infection Malnutrition Late stage liver disease GVHD Primary Biliary cirrhosis Chronic Active Hepatitis Vasculitis, …..

17. 5- Psychological Factors Affective disorders 6- Local factors Decreased mastication Smoking Mouth breathing 7- Rarities Amyloidosis Bell’s palsy Cystic fibrosis hemochromatosis

18. Para clinic ImagingSerologic tests Biopsy Sialometry Salivary gland function test ……..

19. Treatment Systemic stimulationSymptomatic Treatment of associated diseases Psychological Treatment and consult Drug substitution Non-Drug Stimulation

20. بوی باران ، بوی سبزه ، بوی خاک شاخه های شسته ، باران خورده ، پاک آسمان آبی و ابر سپيد برگهای سبز بيد عطر نرگس ، رقص باد نغمه و بانگ پرستوهای شاد خلوت گرم کبوترهای مست نرم نرمک ميرسد اينک بهار خوش بحالِ روزگار … خوش بحالِ چشمه ها و دشتها خوش بحالِ دانه ها و سبزه ها خوش بحال غنچه های نيمه باز........................................