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Objectives Medication-induced salivary gland dysfunction (MISGD) causes significant morbidity resulting in decreased quality of life. This systematic review assessed the literature on the prevalence, diagnosis, treatment, and prevention of MISGD.Materials and methods Electronic databases were searched for articles related to MISGD through June 2013. Four independent reviewers extracted information regarding study design, study population, interventions, outcomes, and conclusions for each article. Only papers with acceptable degree of relevance, quality of methodology, and strength of evidence were retained for further analysis.Results There were limited data on the epidemiology of MISGD. Furthermore, various methods were used to assess salivary flow rate or xerostomia. Preventive and therapeutic strategies included substitution of medications, oral, or systemic therapy with sialogogues, use of saliva substitutes or of electro-stimulating devices. Although there are promising approaches to improve salivary gland function, most studies are characterized by small numbers and heterogeneous methods.Conclusions Physicians and dentists should identify the medications associated with xerostomia and salivary gland dysfunction through a thorough medical history. Preferably, health care providers should measure the unstimulated and stimulated whole salivary flow rates of all their patients so that these values can be used as a baseline to rate the complaints of patients who subsequently claim to experience xerostomia or salivary gland dysfunction as well as the possibilities of effectively treating this condition.Clinical relevance MISGD remains a major burden for the population. This systematic review provides a contemporary in-depth description of the diagnosis and treatment of MISGD.

A 56-year old man complained of oral dryness, impaired speech, eating and swallowing food. The past history and physical examination revealed that his current medication including tramadol, amitriptyline and simvastatin may cause his condition. Furthermore, a tendency to snoring and being stress possibly suggesting dry mouth would contribute the uncomfortable state. Investigations showed that the patient had true xerostomia without related systemic issues. Because of the complex reasons for the condition, a multidisciplinary approach was required in its prevention in order to achieve long-term stability.

Objectives: Use of certain drugs is the most common aetiology of xerostomia. Systemic sialogogues provide a longer effect than topic ones, but also induce relevant side effects. Topical sialogogues, as malic acid, allow a safe use as they induce no systemic side-effects or pharmacological interactions, being especially interesting in cases of mild hyposalivation and oral dryness, mainly the chronic use of xerostomizing drugs. The aim of this study was to evaluate the clinical effect of 1% malic acid in patients affected by xerostomia due to antihypertensives or antidepressants. Study Design: 10 patients with drug-induced xerostomia were prospectively evaluated before and after using malic acid spray during three weeks. Xerostomia Inventory (XI) was used to evaluate subjective improvement. Unstimulated and stimulated salivary flow rates were determinated. Results: Severity significantly decreased, from 38.22 to 31.00 points (p = 0.011) after using the product. 77.8% of subjects did not complain about xerostomia at the end and 66.6% achieved an improvement > 6 points. Unstimulated flow rate singnificantly increased, from 0.163 to 0.226 mL/min (p = 0.021) at the third week. Conclusions: 1% malic acid spray induces some improvement in the management of mild and reversible xerostomia. Carrying out of randomized controlled trials is justified according to this study.

Objectives Medication-induced salivary gland dysfunction (MISGD) causes significant morbidity resulting in decreased quality of life. This systematic review assessed the literature on the prevalence, diagnosis, treatment, and prevention of MISGD. Materials and methods Electronic databases were searched for articles related to MISGD through June 2013. Four independent reviewers extracted information regarding study design, study population, interventions, outcomes, and conclusions for each article. Only papers with acceptable degree of relevance, quality of methodology, and strength of evidence were retained for further analysis. Results There were limited data on the epidemiology of MISGD. Furthermore, various methods were used to assess salivary flow rate or xerostomia. Preventive and therapeutic strategies included substitution of medications, oral, or systemic therapy with sialogogues, use of saliva substitutes or of electro-stimulating devices. Although there are promising approaches to improve salivary gland function, most studies are characterized by small numbers and heterogeneous methods. Conclusions Physicians and dentists should identify the medications associated with xerostomia and salivary gland dysfunction through a thorough medical history. Preferably, health care providers should measure the unstimulated and stimulated whole salivary flow rates of all their patients so that these values can be used as a baseline to rate the complaints of patients who subsequently claim to experience xerostomia or salivary gland dysfunction as well as the possibilities of effectively treating this condition. Clinical relevance MISGD remains a major burden for the population. This systematic review provides a contemporary in-depth description of the diagnosis and treatment of MISGD.

Pilocarpine induces a profuse flow of saliva, and it may re-establish saliva production in cases of drug-induced oral dryness. The aim of the study (a sub-study to the previous trial investigating the pilocarpine fluid effects in individuals suffering from drug-induced dry mouth) was to search for saliva quality changes induced by the treatments. Sixty-five individuals were enrolled in a randomized, double-blind, placebo-controlled trial. The subjects received tramadol to induce oral dryness. Secretion rate was measured before and after tramadol, and then after pilocarpine, placebo, or no treatment. All saliva was analyzed for its protein and IgA content in the pilocarpine (n=15) and placebo groups (n=12). At baseline, the flow of saliva was 0.47±0.05ml/min, the protein output 0.17±0.2mg/min and the IgA output 0.022±0.002mg/min. After tramadol treatment (50mg 3×/day over two days), the flow was reduced by 64%, protein output by 52% and the IgA output by 38%. While placebo treatment did not affect any of the variables, the flow was 120%, the protein output 193% and the IgA output 83% of the baseline characteristics after pilocarpine treatment (5mg). Thus, the pilocarpine-induced increase in the flow rate in the state of tramadol-induced oral dryness results in saliva with a well preserved protein concentration but with a decrease in IgA concentration. However, compared to baseline, there was neither a decrease in output nor in concentration of IgA.

It is well known that cytokines are involved in the homeostasis of oral cavity and that altered levels of either serum and/or salivary cytokines have been found in certain oral/systemic diseases. So far, cytokines in connection with xerostomia have been investigated in patients with Sjogren's syndrome. We wanted to find out whether drugs themselves influence salivary glands, which would result in altered cytokine level or whether xerostomia itself of different causes leads to the changes in salivary cytokine levels. Therefore, the aim of this study was to evaluate levels of salivary interleukin-6 (IL-6) and tumor necrosis factor (TNF)-alpha in 30 patients with drug-induced xerostomia, age range 29-84 and mean 63.9 years. Control group consisted of 30 healthy participants, age range 30-82 years and mean age 65.2 years. Enzyme-linked immunoassay was performed on commercially available kits. Statistical analysis was performed by use of Student's test. No significant differences in salivary IL-6 and TNF-alpha between patients with drug-induced xerostomia when compared with the healthy controls were found (P < 0.05). We might conclude that drugs do not induce damage to the salivary glands which could be seen in altered salivary IL-6 and TNF-alpha levels and that xerostomia itself, induced by drugs does not alter levels of the investigated salivary cytokines.

Introduction : With better health care facilities and nutritional levels the average life expectancy of Indian population has been on the rise over the years. Most of the geriatric population is under long-term medication. Aim : The aim of this study was to evaluate the synergistic effect of multiple xerostomia drugs. Materials and Methods : Unstimulated saliva was measured in 60 geriatric patients, and xerostomia questionnaire and quality-of-life scale were also administered. Results : There was a very highly significant reduction in the salivary flow rates of patients under multiple xerostomia-inducing drugs. Conclusion : The synergistic effect of the xerostomia inducing medication could be the possible factor responsible for reduced salivary flow in elderly individuals using such drugs

Background and purpose: Pilocarpine, a muscarinic cholinergic agonist, has been shown to improve symptoms of oral dryness and to increase salivary output in patients with xerostomia. The aim of this study was to assess and compare the short-term and long-term effects of orally administered pilocarpine-hydrochloride (PHC) on minor salivary glands and whole saliva production in patients with decreased salivary flow. Materials and methods: Eighteen patients with xerostomia (12 with drug-induced xerostomia, 6 with diagnosed Sjögren’ s syndrome) were included in two consecutive single blind placebo controlled experiments. Experiment 1 comprised 7 repeated labial and palatal minor salivary glands flow measurements (in time intervals of 15-30 min.) and 5 repeated measurements of whole saliva (every 30 min.), from the baseline up to 2 h after single oral administration of 5 mg of PHC. Experiment 2 was designed to evaluate a possible presence of long-term effect of PHC on salivary flow rate. In this experiment, patients were instructed to take 5 mg of PHC, 3 times a day for 5 weeks. Minor salivary gland measurements were performed on weekly basis and whole saliva was measured on the baseline and at the end of 5-weeks treatment. In both experiments the flow rate of minor salivary glands was measured on lower lip and palate by means of Periotron™ 8000 and whole saliva was collected in calibrated test tubes. Dexpanthenol drops were used as placebo. Results: Experiment 1 showed that PHC increased salivary output in every patient. The differences were statistically significant, both compared to baseline and to placebo controls (p