Stimulating the discussion on saliva substitutes: a clinical perspective.

Xerostomia is a significant problem commonly faced by patients and oral health practitioners. There is no cure for this condition, which commonly manifests as a side effect of medications, head and neck irradiation and other systemic conditions, such as Sjögren's syndrome and type 2 diabetes. It may also arise idiopathically. Therefore, treatment is palliative and takes the form of oral lubricants and saliva substitutes which aim to reduce symptoms associated with xerostomia as well as prevent oral disease secondary to it. Recently there has been an expansion of the number and range of products available in Australia for the palliative management of xerostomia. It is imperative then that oral health professionals have a sound understanding of the advantages and disadvantages of using such products as patients tend to be well informed about new products which are commercially available. This article discusses some of the most commonly available products used for the symptomatic relief and preventive management of xerostomia. Amongst the plethora of products available to the patient suffering from xerostomia, no single product or product range adequately reproduces the properties of natural saliva and therefore consideration of patients' concerns, needs and oral health state should be taken into account when formulating a home care regime. With Australia's ageing population and its heavier reliance on medications and treatments which may induce xerostomia, oral health professionals are likely to encounter this condition more than ever before and therefore an understanding of xerostomia and its management is essential to patient care.

Extended formulary nurse prescribing--another saliva substitute roadblock.

United Kingdom family physicians, General Practitioners (GPs), are allowed to prescribe from a Department of Health-approved list of non-medicines (the 'ACBS' list) which includes a majority of proprietary saliva substitutes. Independent nurse prescribing, introduced in 2001, has improved patient access to effective remedies for a wide range of common medical problems. Further qualified 'extended formulary nurse prescribers' have access to a limited range of prescription medicines, and all non-prescription medicines that GPs may currently prescribe. Despite their specified role in the management of oral complications encountered in palliative care, a similar anomaly in NHS rules that prevents dental practitioners from prescribing ACBS listed saliva substitutes also prevents nurses from prescribing them. Sadly, patients are suffering poorer access to simple and effective remedies to conditions such as xerostomia - a condition that has recognised impact on their quality of life.

Difficulties in dental prescribing of saliva substitutes for xerostomia.

The value of salivary substitutes for many elderly patients is indicated by a simple web search which found 2,470 references, with references to prescribing across the globe. To contain the public expense, prescribing medicaments within the National Health Service in England is limited to approved lists. The only salivary substitute currently prescribable by dentists has not been produced for 18 months. It is argued that: the prescription of this symptomatic therapy should be based on potential benefit for the xerostomic patient and not, as now, primarily on the pathological aetiology of the oral dryness. Secondly, that the professional caring for that oral problem--the dentist, is best placed to manage the prescribing as part of the overall management of the patient, independent of any reference to the patients physician that may be appropriate as part of the overall management of the patient.