Terapia farmacológica y avances terapéuticos en xerostomía e hiposalivación / Pharmacological therapy and therapeutic advancesin xerostomy and hyposalivation

La saliva juega un rol determinante en el mantenimiento y función de los tejidos orales, donde un decremento en los niveles del flujo salival conllevan a una hiposalivación o hiposialia, trayendo consigo una serie de características que propician un ambiente ideal para la instalaciónde microorganismos oportunistas y condiciones nocivas para la saludoral y sistémica de los pacientes. Hoy en día existen múltiples causas que conllevan a una hiposialia, entre ellas el síndrome de Sjõgren, la radioterapia de haz externo, entre otras, los cuales se han puesto a prueba mediante sialogogos farmacológicos como pilocarpina, cevimelina, betanecoly carbacolina, además de alternativas terapéuticas para revertir los signos obtenidos por la hiposalivación y mitigar los síntomas de xerostomía. El objetivo del presente es realizar una revisión de literatura sobre el tratamiento farmacológico en hiposalivación y xerostomía ensíndrome de Sjõgren y radioterapia de haz externo.

Saliva plays a determinant role in the maintenance and function of oral tissues, where a decrease in salivary flow levels leads to hyposalivation or hyposialia, bringing with it a series of characteristics that provide anideal environment for the installation of opportunistic microorganisms and conditions harmful to the oral and systemic health of patients.Today there are many causes that lead to hyposialia, including Sjögren’ssyndrome, external beam radiotherapy, among others, which have beentested by pharmacological sialogogs such as pilocarpine, cevimelin, betanecol and carbacoline, in addition to therapeutic alternativesto reverse the signs obtained by hyposalivation and to mitigate the symptoms of xerostomia. The objective of the present is to make a reviewof the literature on the pharmacological treatment in hyposalivation and xerostomia in Sjögren’s syndrome and external beam radiotherapy.

Reporte preliminar sobre el efecto de un sustituto salival a base de manzanilla (Matricaria chamomilla) y linaza (Linum usitatissimum) en el alivio de la xerostomía en adultos mayores / Preliminary report on the efficacy of a chamomile (Matricaria chamomilla) and linseed (Linum usitatissimum) based saliva substitute formulated for the relief of xerostomia in the elderly

Introducción: La xerostomía es una condición crónica que afecta a un alto porcentaje de adultos mayores, que deben ser tratados paliativamente mediante el uso de sustitutos salivales; sin embargo estos productos no se encuentran disponibles en el mercado nacional. Objetivos Evaluar la eficacia de un nuevo sustituto salival a base de manzanilla y semillas de linaza en la disminución de la sintomatología asociada a xerostomía en individuos adultos mayores. Metodología Se incluyeron 34 voluntarios adultos mayores con xerostomía de diverso origen. Un nuevo sustituto salival a base de manzanilla y semillas de linaza y un sustituto convencional a base de carboximetilcelulosa fueron testados en un ensayo clínico aleatorizado, cruzado, con período de blanqueamiento. Resultados El 100 por ciento de los sujetos presentó sensación de boca seca, el 58,8 por ciento sensación de saliva espesa, el 52,9 por ciento necesitaba beber líquidos para deglutir los alimentos y tenía sensación de dificultad para tragar. La sensación de ardor lingual se registró en el 23,5 por ciento de los individuos. Las enfermedades más frecuentes en la muestra analizada fueron la hipertensión arterial y la artritis. Los resultados del ensayo clínico indican que el sustituto salival a base de manzanilla y semillas de linaza disminuye significativamente la sensación de boca seca y la sensación de saliva espesa (test de Wilcoxon p < 0,05). Conclusión El nuevo sustituto salival a base de manzanilla y semillas de linaza es efectivo en el alivio de la sintomatología asociada a xerostomía en adultos mayores, por lo que puede contribuir a mejorar la calidad de vida de la población afectada por esta condición.

Introduction: Xerostomia is a common chronic health condition that affects a great number of elderly people. Palliative treatment, such as salivary substitutes should be used, but these products are not accessible in the Chilean market. Objectives To evaluate the efficacy of a new Chamomile and linseed based saliva substitute in the reduction of xerostomía-associated symptomatology in elderly people. Methodology Forty elderly subjects presenting with xerostomia of various origins were selected. Chamomile and linseed based saliva substitute and a carboxymethylcellulose based conventional artificial saliva were tested using a double-blind, randomized, cross-over clinical trial with an intervining wash out period. Results All (100 percent) of subjects had a sensation of dry mouth, and 58.8 percent mentioned a sensation of thick saliva, 52.9 percent needed to drink liquids to swallow, and with a sensation of swallowing difficulty. Burning tongue sensation was recorded in 23.5 percent of the patients. The most frequent pathologies in the sample were arterial hypertension and arthritis. Results of the clinical tests showed that Chamomile and linseed based saliva substitute significantly relieves the sensation of dry mouth and the sensation of thick saliva (Wilcoxon test P < .05). Conclusion New chamomile and linseed based saliva substitute was effective in relieving xerostomia symptoms in elderly people, and could improve the quality of life of population affected by this condition.

The role of xerostomia in burning mouth syndrome: a case-control study / O papel da xerostomia na sindrome da ardencia bucal: estudo caso controle

Objective : To assess the efficacy of anti-xerostomic topical medication (urea 10%) in patients with burning mouth syndrome (BMS). Method : Thirty-eight subjects diagnosed with BMS according to the International Association for the Study of Pain guidelines were randomized to either placebo (5% sodium carboxymethylcellulose, 0.15% methyl paraben, and 10% glycerol in distilled water qsp 100 g) or treatment (urea 10%) to be applied to the oral cavity 3-4 times per day for 3 months. The patients were evaluated before and after treatment with the following instruments: the EDOF-HC protocol (Orofacial Pain Clinic – Hospital das Clínicas), a xerostomia questionnaire, and quantitative sensory testing. Results : There were no differences in salivary flow or gustative, olfactory, or sensory thresholds (P>0.05). Fifteen (60%) patients reported improvement with the treatments (P=0.336). Conclusion : In conclusion, there were no differences between groups, and both exhibited an association between reported improvement and salivation. .

Objetivo : Avaliar a eficácia do uso de medicação tópica anti xerostomica (ureia 10%) em pacientes com síndrome de ardência bucal. Método : Trinta e oito sujeitos diagnosticados com síndrome de ardência bucal de acordo com os critérios da Associação Internacional para Estudo da Dor foram randomizados para grupo placebo (5% de carboximetilcelulose de sódio, 0,15% de metilparabeno e 10% de glicerol em água destilada qsp 100g) ou grupo tratamento (ureia 10%) para ser aplicada na cavidade oral 3-4 vezes ao dia, durante três meses. Os pacientes foram avaliados antes e depois do tratamento: protocolo EDOF-HC, questionário de xerostomia, testes sensitivos quantitativos. Resultados : Não houve diferenças no fluxo salivar, limiares gustativos, olfativos e somestésicos (Mann-Whitney P>0,05). Quinze (60%) dos pacientes tiveram melhora com o tratamento (P=0,336, oneway ANOVA ). Conclusão : Em conclusão não houve diferenças entre os grupos, ambos apresentaram uma associação entre melhora e salivação. .

Boca seca, mucositis, problemas dentales y del gusto en la alimentación del niño con cáncer / Dry mouth, mucositis, dental problems and taste power in children with cancer

En niños con cáncer, la quimioterapia y la radioterapia de ciertos tumores de cabeza y cuello, reducen la producción de saliva generando sensación de boca seca, ulceraciones bucales y mucositis. Los problemas dentales se resumen en caries, boca seca y endurecimiento de los músculos de la cara. Así mismo, la quimioterapia, la radiación y el cáncer mismo, ocasionan cambios en el sentido del gusto del niño con cáncer. Todos estas circunstancias se reflejan en el bajo consumo de nutrientes y desarrollo a futuro de desnutrición para lo cual es necesario estar alerta y proponer medidas preventivas.

In children with cáncer, chemotherapy and radiotherapy of ceratin tumors of the head and neck, reduce the production of saliva causing dry mouth, mouth ulcers and mucositis. Dental problems of children with cancer are summarized in caries, dry mouth and tightening of the muscles of the face. Likewise, chemotherapy, radiation and the cancer itself, cause changes in taste of the child with cancer. All these circumstances are reflected in the low nutrient intake and future development of malnutrition for which it is necessary to be vigilant and to suggestpreventive measures.

Evaluation of the efficacy of zinc sulfate in the prevention of chemotherapy-induced mucositis: a double-blind randomized clinical trial

Oral mucositis is a serious complication of chemotherapy that results in painful debilitating inflammation, necessitating the administration of analgesics. There is no cure for mucositis. Some studies have evaluated the effect of zinc sulfate on mucositis. The present study aims to evaluate the effect of oral zinc sulfate on prevention of mucositis, xerostomia, and pain induced by chemotherapy. This double-blind, randomized controlled trial was carried out on 50 adult patients who underwent chemotherapy during 2008-2009. Patients were divided in two groups. Patients in the intervention group were administered three, 220 mg zinc sulfate capsules daily until the end of their chemotherapy treatment. Patients in the placebo group received three placebo capsules daily, which were similar in shape, taste, and color to the zinc sulfate capsules. Data were analyzed by SPSS version 17 software, using the independent samples t-test, Mann-Whitney U and Friedman tests. The incidence of grade 3 mucositis was lower in the zinc sulfate group. In the first follow up, grade 3 mucositis was detected in 10% of patients. In the placebo group, grade 3 mucositis was seen in 46.6% of patients. By the fourth follow up, grade 3 mucositis was detected in 3.33% of patients in the intervention group and in 20% of patient in the placebo group. At the end of the study there was no grade 3 mucositis detected in the zinc sulfate group, whereas there were 3.57% of patients in the placebo group with grade 3 mucositis. The results also showed that zinc sulfate decreased the effects of xerostomia and pain in patients under chemotherapy treatment. It can be concluded that zinc sulfate might decrease the intensity of mucositis

Pilocarpina no tratamento de xerostomia em pacientes submetidos à iodoterapia: estudo piloto / Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study

Xerostomia é uma queixa tardia frequente associada à iodoterapia. Terapias para o tratamento desta morbidade podem proporcionar melhora na qualidade de vida dos pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. OBJETIVOS: Relatar a experiência com o uso da pilocarpina no tratamento de xerostomia em pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. MATERIAL E MÉTODOS: Cinco pacientes preencheram os critérios de inclusão e receberam 5mg de pilocarpina, 3 vezes ao dia, por uma semana. Os efeitos colaterais do medicamento e a resposta subjetiva à queixa de xerostomia após o tratamento foram avaliados. DESENHO DO ESTUDO: Trata-se de um estudo prospectivo, não-randomizado. RESULTADOS: Sudorese foi o efeito colateral mais comum com o uso da pilocarpina, seguido por cansaço e dor de cabeça. Dois pacientes relataram alívio da xerostomia com o uso da medicação, mas somente um paciente foi capaz de tolerar os efeitos colaterais. CONCLUSÕES: Pilocarpina parece aliviar os sintomas de xerostomia em pacientes submetidos à iodoterapia, já que o medicamento é capaz de estimular o fluxo salivar. No entanto, os efeitos colaterais observados inviabilizam seu uso por recusa por parte dos pacientes em continuar a terapia por períodos mais longos.

Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. CONCLUSIONS: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation.

Effect of oral pilocarpine on post-irradiation xerostomia in head and neck cancer patients: a single-center, single-blind clinical trial.

OBJECTIVE: The authors determined the efficacy and safety of oral pilocarpine tablet in symptomatic relief of post-radiation xerostomia in head and neck cancer patients. MATERIAL AND METHOD: Thirty-three radiation-induced xerostomia patients were enrolled in a single-blind method to receive placebo 1-tablet three times daily in the first month and then oral pilocarpine (5 mg) 1-tablet three times daily for the next three months. Patients were evaluated for subjective symptomatic relief of xerostomia using questionnaires. Objective findings of xerostomia were also evaluated at the same time by two radiation oncologists. RESULTS: All 33 patients had received radiotherapy doses at least 4000 cGy to the parotid glands. Improvement of xerostomia symptoms was observed, with a mean total subjective xerostomia score improvement at the first 4 weeks of oral pilocarpine treatment (p = 0.001), and later throughout the present study. Objective xerostomia score also showed statistically significant improvement at the same time point. Adverse effects of pilocarpine included sweating, nausea, palpitation, and tearing, with sweating as the most common side effect. Adverse effects of placebo included mild headache, nausea, and vomiting. CONCLUSION: Oral pilocarpine was effective and well tolerated in the treatment of radiation-induced xerostomia symptoms.

Manejo do paciente com hipossalivação / Management of hyposalivation patients

Inúmeras alterações sistêmicas, assim como uso de medicamentos poderão levar a um quadro de hipossalivação. Por sua vez, a redução do fluxo salivar propicia desconforto e aumenta a susceptibilidade a processos infecciosos. Para diminuir a morbidade causada pela hipossalivação propõe-se o uso de substitutos salivares e técnicas para o aumento do fluxo salivar, cuja indicação irá depender do fator etiológico e da gravidade da hipossalivação.

Many systemic conditions or impairments as the use of drugs may cause hyposalivation. When saliva is reduced, discomfort and infectious processes may occur as consequences. Salivary substitutes and some techniques for increasing salivary flow rates may be used in order to reduce morbidity from hyposalivation. The type of treatment will rely on the etiologic factors and severity of hyposalivation.