Dr. Aida Abaz Quka
Neurology
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Patient's Query
Hello doctor,
A month ago, I was tested for Sjogren's syndrome based on my symptoms. Early Sjogren's panel CA-6 (carbonic anhydrase VI) was positive. However, the lip biopsy was negative. Everything else was normal. I then remembered my Botox treatment for bruxism two months ago. One month after the treatment, I started having all these problems where I could not produce saliva. The injections were supposed to be in my maxillary muscles, but I think they could have been injected into my parotid glands. Could this be the reason for the saliva problems? I have been taking tablets Ambien for sleep, Duloxetine for depression, and Cevimeline to help produce saliva. Can you please help me?
Hello,
Welcome to icliniq.com.
I understand your concern and would like to explain that your symptoms could be related to the Botox injections as they may persist up to six months after the injection. On the other hand, the tablet Duloxetine can cause dry mouth due to its anticholinergic adverse effects. It would help if you discussed the above issues with your doctor. I hope you will find this information helpful. I remain at your disposal in case of further questions whenever you need me. All the best.
Patient's Query
Hello doctor,
Thank you for the response. So, if the Botox was injected into the parotid gland, is it possible for all my salivary glands to stop working? Will the Botox spread that much? My doctor is currently reducing my Duloxetine to get off of it. So I am only taking 6.5 mg now. But I have been on Duloxetine for five months before the saliva problems.
Hello,
Welcome back to icliniq.com.
The parotid glands are the major salivary glands. For this reason, Botox injection in these glands can cause a significant decrease in saliva and thus a dry mouth. Anyway, only time will show if this is a temporary effect of Botox on your salivary glands. There is no time correlation with tablet Duloxetine, so this is less likely the cause. Anyway, I agree with stopping it as it may contribute to this clinical situation. If you have any other questions, please do not hesitate to ask me again. Thank you.
Patient's Query
Thank you doctor,
Can carbonic anhydrase VI antibody level that tested high could be formed as a response to the Botox? Also, I read that the submandibular gland makes most of the saliva. Is it possible that they could have hit anything to stop all saliva when they injected it into my masseter? It has been two months, and I am worried it might not be from the Botox.
Hello again,
Welcome back to icliniq.com.
It seems to be an autoimmune disorder considering the presence of antibodies. Botox may have some influence in this situation, but the presence of antibodies indicates that it is not just due to Botox.
Patient's Query
Thank you doctor,
Do you have a recommendation of what to look into? I did the early Sjogren's panel, and it came back as just carbonic anhydrase VI being slightly elevated. But there is not enough data to correlate just with Sjogren's. Then I did the lip biopsy with an ENT to confirm Sjogren's, and it came back negative. They also retested SSA and SSB for Sjogren's, which were negative. I am taking Evoxac to make saliva, but the dryness is getting worse. All blood work came back healthy and normal. Any recommendations on what else I can even test that could cause this? My salivary glands look like all are completely paralyzed.
Hello again,
Welcome back to icliniq.com.
Considering all these tests, we can not get the right conclusion about the main cause. Sometimes these antibodies are present before Sjogren disease is found in the biopsy. But I recommend gradually stopping Duloxetine, continuing with Exovac, and following these tips.
Practice good oral hygiene, including brushing your teeth with fluoride toothpaste twice daily. Avoid sugary food and drinks, and avoid snacking between meals. Use an antibacterial mouthwash. Drink plenty of water. Regularly chew sugar-free chewing gum or suck on ice cubes. Use lip balm if your lips are dry and cracked. Avoid alcohol. Read our tips for cutting down on alcohol. Stop smoking if you smoke. Have a dental check-up at least every six months. Avoid medicines that can cause a dry mouth.
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Neurology
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