Update knowledge of dry mouth- A guideline for dentists

Effect of Pilocarpine Mouthwash on Salivary Flow Rate in Patients with Xerostomia: A Systematic Review and Meta-Analysis

Statement of the Problem

Xerostomia is a subjective sensation of dry mouth considered as a complex state affecting multiple oral functions. Pilocarpine may be a useful medication for the treatment of xerostomia, but its side effects limit its use under certain conditions. Recent studies have focused on the pilocarpine mouthwash as an alternative.

Purpose

We have undertaken this study to review the latest available scientific evidence systematically, concerning the effects of pilocarpine mouthwash on salivary flow rate in patients with xerostomia.

Materials and Method

An electronic search for randomized controlled trials published in English until September 2021 related to pilocarpine mouthwash and salivary flow rate in patients with dry mouth was performed in PubMed/Medline, Web of Science, Google Scholar, Embase, and Scopus. A random-effects meta-analysis was conducted to evaluate the relationship between the groups.

Results

Two papers with 86 patients were selected for the final review based on strict eligibility criteria. According to the results of the meta-analysis, the mean visual analogue scale in the patient treated with pilocarpine mouthwash was 0.88 unit lower than that of the control group in the fourth week follow; however, it was not statistically significant (pooled mean difference=-0.88, 95% CI = (-2.72; 0.95), p= 0.34).

Conclusion

It seems that the use of pilocarpine mouthwash can increase the salivary flow rates; however, no optimal dose and application regimen can currently be suggested due to the high heterogeneity of the data. Regarding the relief of the symptoms using pilocarpine mouthwash, the existing evidence does not support its effectiveness.

A retrospective study of drugs associated with xerostomia from the Australian Database of Adverse Event Notifications

OBJECTIVES

Xerostomia is a subjective sensation of dry mouth associated with many medications and increases the risk of tooth decay and other oral complications. The aim of this study was to identify unreported medications associated with dry mouth from the Australian Database of Adverse Event Notifications (ADAEN) from the Therapeutic Goods Administration (TGA) in Australia.

METHODS

This was a descriptive retrospective study. A request was made to the TGA to provide all reports associated with dry mouth. De-identified reports were provided from the commencement of the database in 1971 until June 2020. Drugs were divided into established drugs that are associated with xerostomia in the primary literature and secondary drugs not reported in the primary literature.

KEY FINDINGS

There were 1927 individual case reports for dry mouth associated with medications. Of these, there were 1379 reports of established (primary) drugs and 1481 reports of secondary drugs associated with xerostomia. Dry mouth was found to be associated with many medication classes; analgesics, cardiovascular and gastrointestinal drugs had the greatest number of secondary drugs reported.

CONCLUSIONS

A comprehensive list of suspected medications associated with xerostomia has been established. This adds to the growing catalogue of medications associated with dry mouth, where several medications have not previously been identified in the primary literature.

Artificial Saliva for Therapeutic Management of Xerostomia: A Narrative Review

In clinical practice, xerostomia or oral dryness is a chronic disease condition encountered by most dentists and dental hygienists, which often causes a negative impact on the oral health-related quality of life of the affected individual. Xerostomia is caused due to salivary gland dysfunction. It is related to reduced salivary secretion or the absence of saliva flow, more frequently, exhibits qualitative changes in saliva proteins and immunoglobulin concentrations that arise due to salivary gland dysfunction. This condition causes discomfort and interferes with normal oral activities, and affected individuals are at high caries risk. There are several options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. This review explores the current status of therapeutic management of patients affected by xerostomia and hyposalivation using artificial saliva.

Oral health in older adults

The UK population is rapidly ageing, and this is set to continue for many more years. Consequently, this projects a number of health problems and challenges that need to be addressed. Functional impairment and age-related diseases have a significant impact on oral health, leading to a poor quality of life. Dental diseases become more prevalent in older adults, partly as a result of their poor general health, medication side effects and, in some instances, due to limited access to good dental care. Healthcare staff should be aware of these problems and ensure that individuals are given the correct advice, care and treatment. This article outlines what is known about oral health among older adults and highlights some of the common health conditions that affect oral health status in this population. Community nurses are well placed to educate and empower older adults in maintaining good oral health.

Classification criteria for secondary Sjögren's syndrome. Current state of knowledge

Dryness of mucosa and eyes is the most recognizable symptom of Sjögren’s syndrome (SS). Secondary SS (sSS) is diagnosed when symptoms of SS coexist with other systemic connective tissue disease. The sSS is often identified based on the symptoms of dryness in the presence of other connective tissue disease, making the diagnosis of sSS very subjective. The goal of this work was to summarize previously used and current criteria for the diagnosis of sSS. Classification criteria for sSS, which are universally accepted standards, do not exist. The diagnosis of sSS still depends on the experience of the investigator. Histopathological examination of minor salivary glands appears to be crucial for characterization of patients with sSS due to a specific picture of the disease and repeatability of the test.

Effects of a Novel Formulation on Oral Biofilm, pH Buffering, and Gingival Health in Patients with Dry Mouth

Goal

To identify in patients with dry mouth the effects of a novel test agent (Oral Essentials Hydrating Formula Mouthwash, Beverly Hills, CA) versus a control agent (Biotène Dry Mouth Oral Rinse, GlaxoSmithKline Consumer Healthcare L.P., Moon Township, PA, USA) versus no treatment on dry mouth, plaque, salivary pH and buffering capacity, gingival health, and tooth sensitivity.

Materials and Methods

In this cross-over study, ten subjects with dry mouth used test and control dry mouth interventions, as well as no dry mouth intervention in randomized sequence. Plaque Index, Gingival Index, Sulcus Bleeding Index, Plaque staining, and photographs were recorded at baseline and end of each study arm. Salivary volume, pH, and buffering capacity were also recorded at these time points. Additionally, subjects completed a questionnaire for dry mouth and dentinal sensitivity at each visit.

Results

Reductions in plaque presence and clinical indices were similar after use of test or control products (p < 0.05). Saliva volume and pH buffering improved significantly after use of test and control products (p < 0.05).

Conclusions

The effects of a novel dry mouth intervention are similar to those of an existing OTC remedy and are significantly better than no intervention.

The Impact of Hyposalivation on Quality of Life (QoL) and Oral Health in the Aging Population of Al Madinah Al Munawarrah

Hyposalivation (HS) affects aging individuals by causing pain and discomfort in the oral cavity. The aim here was to determine the impact of hyposalivation and the saliva pH on the quality of life and caries status of geriatrics population. A total of 138 male outpatients attending the Taibah University College of Dentistry (TUCoD) dental clinic were included in the study. The saliva flow, pH, Quality of Life (QoL), and caries status were recorded. The QoL was measured using the Arabic version of the Oral Health Impact Profile-14 (OHIP-14), and the caries status was recorded using the Decayed, Missed, Filled Teeth (DMFT) index. The mean age was 67.5 years and 64% were classified as having hyposalivation. The older respondents tended to have a lower saliva flow and pH compared to their younger counterparts. There was a significant inverse association (p = 0.02) between the caries status and mean saliva flow rate. There was also a significant (p < 0.001) positive correlation between caries and the OHIP-14 scores (Spearman’s ρ = 0.293). The prevalence of hyposalivation was relatively high and there was an inverse relationship between the age, the saliva flow, and pH. Those with more caries reported significantly poor QoL.