Artificial Salivary Preparations

By Dr Rabia
 CONTENTS
• Definition Of Xerostomia
• Mechanism Of Xerostomia
• Causes Of Xerostomia
• Prevention Of Xerostomia
• Treatment Of Xerostomia
• Complications
• Sjogren`s Syndrome
• Treatment
 Definition Of Xerostomia
• Xerostomia, also known as Dry mouth, is
dryness in the mouth, which may be
associated with a change in the composition
of saliva, or reduced salivary flow, or have no
identifiable cause.
• This symptom is very common and is often
seen as a side effect of many types of
medication.
• Xerostomia is commonly associated with
reduction in salivary gland output termed as
salivary gland hypofunction.

• The symptoms may be reported by patients

with apparently normal salivation who have
changes in saliva composition.
 Mechanism of xerostomia
• The underlying mechanisms of systemic disease-related
xerostomia are:
• Reduced salivary products
• Change in composition of saliva
• Autoimmunity
• Granuloma formation
• Fibrosis
• Dehydration
• Deposition of proteinaceous substances
• Bacterial infection
• Side-effects of medications
 Drugs that cause xerostomia
• Anticholinergic drugs: atropine, atropine derivatives and atropine
substitutes
• Antihypertensives
• Tricyclic antidepressants
• Antihistamines
• Anticonvulsants
• Antipsychotics
• Antiemetics
• Chemotherapy
• Narcotics
• Diuretics
• Proton pump inhibitors
 Prevention of xerostomia
• A dry mouth is common and can often be prevented by
following prevention measures:
• Drink 2 L (2 qt) of water a day. This is the same as eight glasses
of water.
• Use a humidifier in your home, especially in the bedroom.
• Breathe through your nose rather than through your mouth.
• Do not take medicines that cause a dry mouth. These include
diuretics, antihistamines, and decongestants. Your doctor can
help you find a different medicine.
• Avoid caffeinated beverages, tobacco, and alcohol, all of which
increase dryness in your mouth.
 General Palliative/Preventive
Interventions
• Management of xerostomia and
hyposalivation include lifestyle
modifications.Various palliative and preventive
measures including
• Pharmacologic treatment with salivary
stimulants
• Topical fluoride
• Saliva substitutes
• Sipping water or sugarless, caffeine-free drinks.
• Sucking on ice chips.
• Using lip lubricants frequently (e.g., every 2 hours).
• Chewing sugar-free gum or sucking on sugar-free
candy.
• Avoiding salty or spicy food or dry, hard-to-chew foods.
• Avoiding irritants such as alcohol (including alcohol-
containing mouth rinses5), tobacco, and caffeine.
• Using a humidifier at night.
 Management of xerostomia
• The goals of treating xerostomia include
• Identifying the possible cause
• Relieving discomfort and preventing complications (e.g.,
dental caries and periodontal infections).
• Xerostomia may be alleviated by use of saliva substitutes and
other palliative measures.
• Lifestyle tips (e.g., chewing sugar-free gum) and other
dental/oral health specific recommendations (e.g., brushing
teeth gently at least twice a day with fluoridated toothpaste)
may help provide relief from or prevent adverse sequelae of
dry mouth.
• Dry mouth can be relieved by:
• 1¬Frequent sips of cold drinks,sucking pieces of ice
or sugar free fruit drops.
• 2¬Artificial saliva of natural pH and containing
electrolytes corresponding approximately to the
composition of saliva.
• 3¬Pilocarpine nitrate tablets 5mg orally, three times
a day with or after meal.They are particularly useful in
xerostomia following irradiation of head and neck
cancer.
 Artificial Saliva/Saliva
Substitutes/Oral Moisturizers
• Artificial saliva products are available with or without
prescription. 
• They typically contain a combination of
carboxymethylcellulose and glycerin to increase viscosity,
as well as buffering and flavoring agents (e.g., sorbitol,
xylitol), and calcium and phosphate ions; however, they do
not contain the digestive and antibacterial enzymes or
other proteins and minerals of biologic saliva.
• Some products also contain fluoride. A prescription-only
product, is a supersaturated calcium phosphate rinse
available as powder for reconstitution
 Salivary Stimulants
• Salivary stimulants should be considered in patients with
residual salivary gland function.
• Sugar-free chewing gum, candies, and mints can be used to
stimulate salivary output.
• The FDA has approved the oral secretagogues pilocarpine
and cevimeline hydrochloride to treat symptoms of dry
mouth.
• Pilocarpine is typically administered at a dose of 5 mg three
times a day for at least 3 months and cevimeline is
prescribed at a dose of 30 mg three times a day for at least
3 months
 Complications of Hyposalivation
• 1¬ Dental caries
• 2¬Oral candidiasis
• 3¬Burning sensation
• 4¬Constant sore throat
• 5¬Difficulty speaking and swallowing
• 6¬Hoarseness
• 7¬Gum diseases
 Sjogren's syndrome
• Sjogren's syndrome is a disorder of your immune system identified
by its two most common symptoms — dry eyes and a dry mouth.
• Complications
• The most common complications of Sjogren's syndrome involve
your eyes and mouth.
• Dental cavities. Because saliva helps protect the teeth from the
bacteria that cause cavities, you're more prone to developing
cavities if your mouth is dry.
• Yeast infections. People with Sjogren's syndrome are much more
likely to develop oral thrush, a yeast infection in the mouth.
• Vision problems. Dry eyes can lead to light sensitivity, blurred vision
and corneal damage.
 Treatment

• Decrease eye inflammation. Prescription eyedrops such as

cyclosporine (Ristases) or lifitegrast (Xiidra) may be recommended
by your eye doctor if you have moderate to severe dry eyes.
• Increase production of saliva. Drugs such as pilocarpine and
cevimeline can increase the production of saliva, and sometimes
tears. Side effects can include sweating, abdominal pain, flushing
and increased urination.
• Hydroxychloroquine (Plaquenil), a drug designed to treat malaria,
is often helpful in treating Sjogren's syndrome. Drugs that
suppress the immune system, such as methotrexate also might be
prescribed