Slide 1: Xerostomia and its Management S.Abhiram
IV BDS : Is Xerostomia a specific disease ? Slide 3: The subjective feeling of oral dryness is termed xerostomia.
Xerostomia is a symptom, not a diagnosis or disease.
Also termed as clinical manifestation of salivary gland dysfunction. Causes of Salivary Gland Hypofunction : Causes of Salivary Gland Hypofunction Pharmaceuticals
Psychological factors (affective disorder)
Malnutrition (anorexia, bulimia, dehydration)
Idiopathic disorders Slide 5: Systemic diseases
-Sjögren’s syndrome (primary and secondary)
-Human immunodeficiency virus infection
-Thyroid disease (hyper- and hypofunction)
-Late-stage liver disease Slide 6: Sjögren’s syndrome. Etiology : Etiology Slide 8: Radiation induced
Systemic alterations Radiation induced : Radiation induced External beam radiation
-ionising radiation in head and neck results in pronounced changes
-dose time volume factor
serous acinar cells> mucous cells Slide 10: Sub mand Minor * The above data is only to interpret the relative sensitivity of salivary glands to radiation therapy. Values not to the scale. Slide 11: As the dose increases disorganisation and destruction of acinar cells occur, resulting in their replacement by fibrous or faulty tissues
Both stimulated and un stimulated saliva rate decreases dramatically with increasing radiotherapy. Drug induced : Drug induced Due to unrecognized alterations in saliva composition that lead to the perception of oral dryness in spite of an apparently unchanged volume of saliva
Antispasmodics Systemic alterations : Systemic alterations Nutritional
-iron deficiency anemia
-vitamin A deficiency
Systemic diseases Clinical features : Clinical features Slide 15: Dryness
Sore tongue and lips
Stickiness of the tongue
Abnormalities of taste and smell Management of Xerostomia : Management of Xerostomia Treatment can be divided into four main categories: : Treatment can be divided into four main categories: -preventive therapy
-local or topical salivary stimulation
-systemic salivary stimulation Preventive Therapy : Preventive Therapy topical fluorides
therapies Symptomatic treatment : Symptomatic treatment Patients should be encouraged to sip water
Patients should be cautioned to avoid products containing alcohol, sugar, or strong flavorings
The frequent use of products containing aloe vera or vitamin E should be encouraged. Slide 20: Along with these, there are number of salivary substitutes.
Also called as artificial saliva Composition of artificial saliva: : Composition of artificial saliva: Carboxymethyl cellulose
Dipotassium hydrogen phosphate LOCAL OR TOPICAL STIMULATION : LOCAL OR TOPICAL STIMULATION Chewing will stimulate salivary flow effectively, as will sour and sweet tastes
Electrical stimulation SYSTEMIC STIMULATION : SYSTEMIC STIMULATION Bromhexine is a mucolytic and mucokinetic agent. Bromhexine may stimulate lacrimal function in patients with Sjögren’s syndrome although this is controversial. Anethole trithione
significantly increases saliva flow in mild salivary gland hypofunction.
ineffective in patients with marked salivary gland hypofunction Slide 24: Mechanism
Pilocarpine HCL is a parasympathomimetic drug, functioning as a muscarinic cholinergic agonist. Pilocarpine increases salivary output, stimulating any remaining gland function. Indications
patients with dryness following radiotherapy for head and neck cancers
Sjögren’s syndrome. Pilocarpine HCL is approved specifically for the relief of xerostomia. Slide 25: Adverse effects
Sweating is the most common side effect.
hot flashes, urinary frequency,diarrhea, and blurred vision Dosages: 5.0 to 7.5 mg, given three or four times daily.
Duration of action: 2 to 3 hours.
pulmonary disease, asthma, cardiovascular disease, glaucoma or urethral reflux. Slide 26: Cevimeline HCl
recently approved for the treatment of symptoms of oral dryness in Sjögren’s syndrome.
parasympathomimetic agonist Slide 27: Thank you..! Have a nice day…!