Management of xerostomia.

Xerostomia (dry mouth) is an unpleasant condition that is common after radiotherapy to the head and neck, although it may have other causes. A review of the management of xerostomia, as well as the prevention and management of the oral soft tissue and dental complications resulting from xerostomia, is provided.     

Forced eruption: part II. A method of treating nonrestorable teeth--Periodontal and restorative considerations.

In selected cases, forced eruption may be a useful approach in treating isolated nonrestorable teeth as a result of trauma, caries, or iatrogenic dentistry. This paper has presented the biologic rationale, objectives, technics and clinical cases to demonstrate the principle. Evaluation has been made of potential difficulties which may develop with the technic and areas for future research have been identified.     

Modern restorative management of patients with congenitally missing teeth: 2. Orthodontic and restorative considerations

Managing edentulous spaces in patients with congenitally missing teeth demands careful planning and, often, a multidisciplinary approach. Orthodontic tooth movement can be considered to close spaces as well as improve the distribution of available teeth. In this second paper, the advantages of a collaborative approach are discussed.     

Acupuncture treatment of patients with radiation-induced xerostomia

Xerostomia is a common and usually irreversible side effect in patients receiving radiation therapy (> 50 Gy) for head and neck cancer. Of 38 patients with radiation-induced xerostomia, 20 in the experimental group were treated with classical acupuncture and 18 patients in the control group received superficial acupuncture as placebo. Within both groups the patients showed significantly increased salivary flow rates after the acupuncture treatment. In the experimental group 68% and in the control group 50% of the patients had increased salivary flow rates at the end of the observation period. Among those patients who had had all their salivary glands irradiated, 50% in both groups showed increased salivary flow rates (> 20%) by the end of the observation period of 1 year. The study indicates that among the patients who had increased salivary flow rates already after the first 12 acupuncture sessions, the majority had high probability of continual improvement after the completion of acupuncture treatment. The improved salivary flow rates usually persisted during the observation year. The changes observed in the control group were somewhat smaller and appeared after a longer latency phase. Significant differences for salivary flow rates could be observed only within each group, and there were no statistically significant differences between the groups. There were no differences in the improvement of salivary flow rates between those patients who were irradiated within a year before the acupuncture treatment and those who had received radiation therapy several years earlier. The results indicate that acupuncture might be a useful method for the treatment of radiation-induced xerostomia, and that superficial acupuncture should preferably not be used as placebo acupuncture.     

The effect of acupuncture on salivary flow rates in patients with xerostomia.

Of 21 patients with severe xerostomia, 11 were treated with acupuncture and 10 patients received placebo acupuncture. Those patients who received acupuncture treatment showed increased salivary flow rates during and after the acupuncture treatment. The improved salivary values persisted during the observation year, whereas the patients who received placebo acupuncture showed some improvement of salivary flow rates only during the actual treatment. The results of the present study indicate that acupuncture may be a useful adjunct for the stimulation of salivary flow in some patients with xerostomia.     

Modern restorative management of patients with congenitally missing teeth: 3. Conventional restorative options and considerations

Restoration of spaces in hypodontia patients needs to take into account many factors including, the number of missing teeth, the distribution of space, the size of the teeth, and the age of the patient. This paper considers adhesive and conventional bridgework, as well as removal alternatives for the restoration of spaces. The various merits of each are discussed, together with treatment planning considerations for such cases.     

Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy

Abstract

Objective. Polypharmacy is a common cause of xerostomia. This study aimed to investigate whether xerostomia could be an adverse drug event of mouthwashes, when they are used for longer than 2 weeks by patients taking polypharmacy. Materials and methods. This cross-sectional observational study included 120 hospitalized patients (60 middle-aged and 60 elderly patients), taking polypharmacy (≥4 drugs daily) and at risk of drug-induced xerostomia. Xerostomia was assessed by questioning participants. Results. A total of 62.5% of patients complained of xerostomia. In the middle-aged group (mean age = 44.0 (8.7) years; 35.0% women) xerostomia seemed independently associated to mouthwashes, at the limit of significance (OR = 5.00, 95% CI = 0.99–25.3, p = 0.052). Active principles in mouthwashes were mainly quaternary ammonium compounds (91.9%). Mouthwashes may disturb the healthy balance of the biofilm moisturizing the oral mucosa. The biofilm contains mucins, salivary glycoproteins with oligosaccharides side chains able to sequester water and endogenous bacteria surrounded by a glycocalyx. Oral bacteria are fully susceptible to quaternary ammonium (chlorhexidine, hexetidine, cetylpyridinium chloride) and to other antiseptics used in mouthwashes, such as betain, resorcin, triclosan, essential oils and alcohol. However, caregivers currently recommend such dental plaque control products to patients suffering from xerostomia in order to reduce the risk of caries and periodontitis. Conclusion. This study is the first report that use of antiseptic mouthwashes for more than 2 weeks could worsen xerostomia in patients taking polypharmacy. Oral care protocols should avoid this iatrogenic practice, particularly when xerostomia alters the quality-of-life and worsens malnutrition.     

Post-radiotherapy xerostomia in patients with oral cancer. Changes in salivary inorganic components and immunoglobulins]

Following therapeutic doses of irradiation to the salivary glands the glandular tissues suffer an early degeneration of the serous cells and focal necrosis of the parenchyma. Xerostomia is present and persist for a time, depending upon the dose of irradiation.     

Fungiform papillae density in patients with burning mouth syndrome and xerostomia

Objective: The aim of this study was to analyze fungiform papillae density in patients with burning mouth syndrome (BMS) and xerostomia. Study design: In this cross-sectional clinical study, sixty patients were included (20 with BMS, 20 with xerostomia and 20 healthy controls). The fungiform papillae density was analyzed over a small region on the anterior tip of the tongue with the aid of a digital camera. The number of papillae was measured in an area of 19 mm2. Results: The patients with BMS showed significantly higher fungiform papillae density than the patients with xerostomia; though no statistically significant differences were recorded versus the control group. In the BMS group, 65% of all cases presented a density of 71-90 papillae (within an area of 19 mm2), while 10% had more than 90 papillae. On the contrary, 70% of the patients with xerostomia had fewer than 70 papillae in the studied area. Conclusions: The digital camera offers a rapid, noninvasive and relatively simple way to study fungiform papillae density. The patients with BMS have higher fungiform papillae density than the patients with xerostomia. Key words:Tongue, fungiform papillae, burning mouth syndrome, xerostomia.