xerostomia

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Xerostomia and its Management S.Abhiram IV BDS

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Is Xerostomia a specific disease ?

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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 Radiation therapy Oncologic chemotherapy Psychological factors (affective disorder) Malnutrition (anorexia, bulimia, dehydration) Idiopathic disorders

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Systemic diseases -Sjögren’s syndrome (primary and secondary) -Granulomatous disease(sarcoidosis,tuberculosis) -Graft-versus-host disease -Cystic fibrosis -Bell’s palsy -Diabetes -Amyloidosis -Human immunodeficiency virus infection -Thyroid disease (hyper- and hypofunction) -Late-stage liver disease

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Sjögren’s syndrome.

Etiology : 

Etiology

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Radiation induced Drug induced Systemic alterations

Radiation induced : 

Radiation induced External beam radiation Internal radiotherapy -ionising radiation in head and neck results in pronounced changes -dose time volume factor -Radiation sensitivity serous acinar cells> mucous cells

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Sub mand Minor * The above data is only to interpret the relative sensitivity of salivary glands to radiation therapy. Values not to the scale.

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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 Anticonvulsants Antiemetics Antihistaminics Antihypertensives Antispasmodics

Systemic alterations : 

Systemic alterations Nutritional -pernicious anemia -iron deficiency anemia -vitamin A deficiency Fluid loss Developmental Systemic diseases

Clinical features : 

Clinical features

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Dryness Burning sensation Sore tongue and lips Ulceration Stickiness of the tongue Speaking difficulties Swallowing difficulties Caries Oral infections 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 -symptomatic treatment -local or topical salivary stimulation -systemic salivary stimulation

Preventive Therapy : 

Preventive Therapy topical fluorides oral hygiene remineralizing solutions appropriate antifungal 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.

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Along with these, there are number of salivary substitutes. -disadvantages expensive more viscous inconvenient Also called as artificial saliva

Composition of artificial saliva: : 

Composition of artificial saliva: Carboxymethyl cellulose Sorbitol Potassium chloride Sodium chloride Magnesium chloride Calcium chloride 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

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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.

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Adverse effects very common mild. 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. Contraindications pulmonary disease, asthma, cardiovascular disease, glaucoma or urethral reflux.

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Cevimeline HCl recently approved for the treatment of symptoms of oral dryness in Sjögren’s syndrome. parasympathomimetic agonist

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