From the Guidelines
Sialadenitis should be managed with a multidisciplinary approach, focusing on symptomatic relief using topical therapies, and considering systemic therapies for active systemic disease, as recommended by the European League Against Rheumatism (EULAR) 1.
Key Recommendations
- The first therapeutic approach for dryness should be symptomatic relief using topical therapies, with a focus on oral and ocular dryness management 1.
- Systemic therapies, such as glucocorticoids and immunosuppressive agents, may be considered for the treatment of active systemic disease, with the goal of minimizing disease activity and improving quality of life 1.
- A baseline evaluation of salivary gland function is recommended before starting treatment for oral dryness, to guide treatment decisions and monitor disease progression 1.
Diagnosis and Assessment
- The diagnosis of Sjögren's syndrome, a common cause of sialadenitis, can be established using a combination of clinical and histological criteria, including the presence of focal lymphocytic sialadenitis and autoantibody detection 1.
- The focus score, which measures the number of foci of lymphocytic infiltration per 4 mm² of salivary gland tissue, is a key diagnostic criterion, with a score of ≥1 focus/4 mm² indicating Sjögren's syndrome 1.
Treatment and Management
- Treatment of sialadenitis should focus on relieving symptoms, such as pain and dryness, and preventing complications, such as infection and glandular damage 1.
- Topical therapies, such as artificial tears and ocular gels/ointments, can help manage ocular dryness, while salivary stimulants and substitutes can help manage oral dryness 1.
- Systemic therapies, such as glucocorticoids and immunosuppressive agents, may be necessary to control active systemic disease and prevent organ damage 1.
Prevention and Prognosis
- Good oral hygiene, adequate hydration, and regular dental check-ups can help prevent sialadenitis and its complications 1.
- Early diagnosis and treatment of Sjögren's syndrome and other underlying conditions can help improve prognosis and quality of life 1.
From the FDA Drug Label
INDICATIONS AND USAGE Pilocarpine hydrochloride tablets are indicated for 1) the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; and 2) the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome. The FDA drug label does not answer the question.
From the Research
Definition and Causes of Sialadenitis
- Sialadenitis refers to inflammation or infection of the salivary glands, which can be caused by a broad range of processes including infectious, obstructive, and autoimmune factors 2.
- The condition can affect both major and minor salivary glands, and its pathogenesis has changed over time, with a greater focus on chronic inflammatory diseases 3.
Diagnosis and Management
- History and physical examination play important roles in directing management, while imaging is often useful to establish a diagnosis 2.
- Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt urgent referral to head and neck surgery or a visit to the emergency department 2.
- Family physicians can play an important role in the diagnosis and management of sialadenitis, and prompt recognition and treatment of the condition can prevent the development of complications 2.
Treatment Options
- The use of antibiotics along with fluid hydration and electrolyte management has almost eliminated the development of fulminating acute suppurative parotitis in hospital surgical patients 3.
- Sialendoscopy and other emerging minimally invasive techniques are being used for the therapy of sialolithiasis and other obstructive salivary gland diseases, and conservative therapeutic measures are especially relevant for daily practice 4.
- The management of sialadenitis has evolved over time, with a greater focus on chronic inflammatory diseases and the use of new diagnostic and therapeutic algorithms 3, 4.