Cause Of Xerostomia Research Articles

Adipose derived or bone-marrow derived mesenchymal stem cell treatment for hyposalivation: protocol for a systematic review and network meta-analysis

BackgroundSalivary hypofunction leads to debilitating oral symptoms and has major complications for overall quality of life. Two of the most frequent causes of xerostomia are radiotherapy in the head and neck and Sjögren’s syndrome. Only symptomatic treatment is available today. An increasing number of both preclinical and clinical studies have suggested that mesenchymal stem cell (MSC) transplantation treatment can increase the salivary flow rate and ameliorate symptoms of xerostomia. However, both adipose-derived and bone marrow–derived MSCs are used, although they differ in important ways. The primary objective of this study is an indirect comparison of the change in the unstimulated salivary flow rate after intervention between patients treated with adipose-derived or bone marrow–derived MSCs.MethodsThis systematic review and network meta-analysis will search for eligible studies in the MEDLINE, EMBASE, and Cochrane CENTRAL register of Controlled Trials. Eligible studies are as follows: clinical studies including human patients with salivary hypofunction due to either radiotherapy or Sjogren’s syndrome who were subsequently treated with either adipose-derived MSCs or bone marrow–derived MSCs. Studies with no control group will be excluded. The search phrase has been peer-reviewed following the PRESS guidelines. The primary outcome is the change in the unstimulated salivary flow rate after treatment with either adipose-derived or bone marrow–derived MSCs. Secondary outcomes are as follows: change in patient reported outcomes, methods of intervention administration, number of injected MSCs, and safety. Data from included studies will be pooled and compared with a fixed-effects or random effects model dependent on signs of heterogeneity, presented with a forest plot, and indirectly compared with a meta-regression in a network meta-analysis. Risk of bias will be assessed with the tools ROBINS-I or RoB-2 depending on type of study.DiscussionBoth adipose-derived and bone marrow–derived MSCs are used today for experimental treatment of salivary hypofunction in humans as no direct or indirect comparisons have been made. Therefore, an evaluation of the effect of adipose-derived vs bone marrow–derived MSC treatment is needed to support future decision-making on the type of MSC used in a clinical trial.Systematic review registrationPROSPERO ID CRD42024527183.

Clinical outcomes of NBF gel application in managing mucositis associated with xerostomia

BackgroundXerostomia, or dry mouth, can be a temporary or persistent symptom resulting from various factors, such as medication use, therapeutic radiation, chemotherapy, autoimmune conditions (e.g., Sjögren’s syndrome), and hormonal imbalances. Xerostomia often leads to associated mucositis, which significantly impacts patients’ quality of life. The nano-bio-fusion (NBF) gingival gel, a gel-type functional toothpaste containing vitamins C, E, propolis, and herbal extracts in a nano-emulsion state, has shown potential in accelerating the healing of oral mucosal lesions.MethodsA total of 127 patients (102 females, 25 males) with persistent xerostomia were treated from 2018 to 2023. Of these, 32 patients were treated exclusively with NBF Gel, while 95 patients received NBF Gel in combination with other medications, such as pilocarpine. The underlying causes of xerostomia included irradiation and chemotherapy (12 patients), medication (40 patients), hormonal imbalance (28 patients), and Sjögren’s syndrome (47 patients). NBF Gel was applied 2–3 times daily to the tongue and oral mucosa. Treatment effectiveness was evaluated through physical examinations and a patient-reported scale ranging from 1 (no improvement) to 10 (complete improvement), focusing on the healing of mucosal lesions rather than saliva production.ResultsBoth treatment groups showed significant improvements in the healing of xerostomia-associated mucositis, particularly in severe cases with visible lesions. Patients treated with NBF Gel reported improved symptoms related to mucosal health, while those who received combination therapy also experienced reduced side effects of pilocarpine due to dose reduction. The most substantial improvements were observed in patients with drug-induced and hormonally-caused xerostomia-related mucositis. No adverse side effects from NBF Gel were reported during the study.ConclusionNBF gingival gel proved to be beneficial in accelerating the healing of mucositis associated with xerostomia, regardless of the underlying cause, including medication use, radiotherapy, chemotherapy, hormonal imbalances, and Sjögren’s syndrome. It presents a promising adjunctive treatment to improve mucosal health and quality of life for patients suffering from xerostomia-associated mucositis.

Management of Xerostomia in Elderly Patients with Edentulous and Hypertension: Case Report

Xerostomia is defined as a subjective complaint in patients who have a dry mouth. The causes of xerostomia can be classified as systemic or local. Xerostomia can often develop as a side effect of certain medications. Case Report: A 72-year-old male patient came in complaining that his mouth felt dry at night and woke up because his throat felt dry and he had to drink. Patients also feel compelled to drink when swallowing food. The patient can only eat soft foods because all his teeth have been removed and he does not use dentures. The patient has a history of hypertension and is taking amlodipine and Hydrochlorothiazide which are taken once a day in the morning. Discussion: Identification of xerostomia was carried out using the Fox (1987) questionnaire with the results of xerostomia and measurement of saliva flow rate when the patient's indication was 0.56 mL/minute which was not hyposalivation but was still given treatment with GC dry mouth gel for subjective complaints. After the patient used dry mouth gel for 2 weeks, saliva flow rate measurements showed an increase to 0.6 mL/minute and there was improvement in the xerostomia questionnaire. Conclusion: The use of dry mouth gel can reduce subjective complaints and increase the rate of saliva flow in elderly patients who take hypertension drugs in the form of calcium channel blockers and diuretics

The Validity and Reliability of the Persian Version of the Xerostomia Inventory Questionnaire.

Reduced saliva production or changes in the quality of saliva are major causes of xerostomia as a perceptual disease. This study aimed to measure validity and reliability of the Persian version of the xerostomia inventory (XI) questionnaire. This cross-sectional study was performed in Kerman in 2021. The sample size for this study was 100 people. To test the discriminant validity of XI, 50 healthy people (control group) and 50 people undergoing or recovering from laryngeal radiation (xerostomia group) were chosen. Cronbach's alpha coefficient was used to determine internal consistency, and the intra-cluster correlation (ICC) coefficient was used to determine test-retest reliability after two weeks. To evaluate the concurrent validity, the relationship between the total score of the questionnaire and the golden question, which was defined as "How often do you have dry mouth?" was measured. Cronbach's alpha and ICC coefficient for the total XI score were 0.84 and 0.95, respectively. The mean ages of patients in the radiotherapy group and the healthy participants were 59±7.5 and 41.1±6.6 years, respectively. Participants who were having or had had laryngeal radiotherapy had a significantly higher mean total XI score than healthy individuals (p< 0.001). The Persian version of the Xerostomia Inventory is a valid and reliable tool for assessing xerostomia.

Common Drugs Causing Xerostomia

Saliva is need for maintaining a healthy mouth environment and general health.Many factors can affect the volume and compositions of saliva. Xerostoma which refers to a subjective sensation of dry mouth, is derived from the Greek words "xeros" (ξηρός), which means "dry," and "stoma" (στόμα), which means "mouth." Reduced salivary flow and altered salivary gland composition and function are the outcomes of xerostomia.Symptoms of xerstomia include dryness or a feeling of stickiness in your mouth. Saliva that seems thick and stringy, bad breath and having hard time chewing, speaking and swallowing. There are many different causes of xerostomia, which include medicine, aging, cancer therapy, nerve damage and tabaco and alcohol use. The most common drugs causing xerstomia anticholinergic drugs, antidepressant drugs, diuretics, calcium channel blocker and beta-blockers. Different mechanism of causing xerostomia cytotoxic drugs by direct damage to salivary gland, antidepressant drugs by their anticholinergic side effects, and diuretic by excreting more fluid and electrolytes.

Modes and Mechanisms of Salivary Gland Epithelial Cell Death in Sjogren's Syndrome.

Sjogren's syndrome is an autoimmune disease in middle and old-aged women with a dry mucosal surface, which is caused by the dysfunction of secretory glands, such as the oral cavity, eyeballs, and pharynx. Pathologically, Sjogren's syndrome are characterized by lymphocyte infiltration into the exocrine glands and epithelial cell destruction caused by autoantibodies Ro/SSA and La/SSB. At present, the exact pathogenesis of Sjogren's syndrome is unclear. Evidence suggests epithelial cell death and the subsequent dysfunction of salivary glands as the main causes of xerostomia. This review summarizes the modes of salivary gland epithelial cell death and their role in Sjogren's syndrome progression. The molecular mechanisms involved in salivary gland epithelial cell death during Sjogren's syndrome as potential leads to treating the disease arealso discussed.

Common Precipitating Factors of Xerostomia in Elderly

AbstractXerostomia is a subjective sign of dry mouth t may or may not be accompanied by objective signs of hyposalivation. The condition of xerostomia has been associated with increasing age in line with the aging process, with a global prevalence of 30%. in the elderly aged 65 years and above. This can have an impact on the health and quality of life of the elderly. Also, xerostomia is the most common symptom in patients during periods of anxiety, stress, depression, radiotherapy, chemotherapy, and systemic diseases, as well as in individuals who have a history of polypharmacy or who use certain drugs. This study aimed to review the most recent available evidence regarding the most common causes of xerostomia in the elderly. The PCC strategy (population, context, and concept) was used as a guide for retrieving the relevant articles for this scoping review. Two databases were systematically searched using PubMed and Scopus. The draft of the scoping review and assessment of the methodological quality of the trials was carried out following the criteria of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A total of 12 trials were identified that met the previously defined selection and quality criteria; 9 related to medicine, and 4 included populations in which xerostomia was a systemic disease, rheumatic disease, radiation therapy to the head or neck region, nutrition, and psychological factors. The common precipitating factor of xerostomia in the elderly is medicine. Drugs that are more commonly found to cause xerostomia are gastrointestinal drugs, psychotropic drugs, and antihypertensive drugs.

Examination of age-related changes in the submandibular glands of male mice.

Salivary gland hypofunction adversely affects the oral environment and daily life by causing dry mouth (xerostomia). Senescence-related atrophy of salivary gland tissues is one cause of xerostomia, and it is particularly common among the elderly. However, the underlying mechanism is poorly understood, and no treatment has been established. Therefore, we examined age-related changes in senescence-associated secretory phenotype (SASP) factors, which regulate stemness and cellular senescence, in mouse submandibular glands. We analyzed the submandibular glands of 6-week-old (young group, n = 6) and 82-week-old mice (aged group, n = 6). We performed salivary flow rate measurements, histological analysis including immunohistochemistry, and quantitative real-time PCR. The salivary flow rate was significantly lower in the aged group than in the young group. In addition, immunostaining and quantitative real-time PCR illustrated that aquaporin-5 and α-amylase expressions were significantly decreased in aged mice, indicating salivary gland hypofunction. c-Kit and cytokeratin 5 expressions were also significantly decreased in this group, suggesting that the regenerative abilities of the submandibular glands were reduced because of decreased stem and progenitor cell counts. Furthermore, the levels of p16INK4a and p21 (the senescence markers) and TGF-β1 and IL-6 (SASP factors) were significantly increased in mice, suggesting that senescence had been promoted. The decreased numbers of stem and progenitor cells and increased levels of SASP factors might be associated with age-related changes in mouse submandibular glands. These results might facilitate the development of treatments for senescence-related submandibular gland hypofunction.

ETIOPATHOGENESIS OF XEROSTOMIA: A CONCISE REVIEW

Xerostomia, or dryness in mouth is usually concerned with decrease in the amount of saliva flow causing severe discomfort to the patients. As saliva is the most beneficial fluid which play a very important role in the sensation of flavour perceived in the mouth and lubrication of tongue. Along with this it also contributes in defending of the oral mucous membranes by providing bactericidal action such as proteolytic enzymes, lysozyme, lacto-peroxidase and IgA, IgG antibodies.The significant risk factors for xerostomia may be systemic or be iatrogenic– demonstrated by many types of pharmacologically active agents or chemotherapy, ionized radiation which is used as adjuvant in destroying malignant cells and aging issues. The related syndrome to this group include Sjogren’s syndrome manifested primarily by lacrimal and salivary glands inflammation producing various clinical symptoms. This is a typical problem for diabetes patients which is correlated with inadequate salivary flow followed by alterations in the microcirculation. Several treatment strategies for the management of such condition include medications for lubrication of mucosa and saliva substitutes. But, understanding the primary cause of xerostomia enables quicker diagnosis and a most effective treatment strategy. The intent of this article is to briefly review the etiology of xerostomia along with risk factors.

Salivary Gland Diseases: A Retrospective Clinicopathological Study of 159 Cases

Background Salivary gland diseases include a variety of conditions (inflammatory, immunological, infectious, or neoplastic pathologies). Salivary gland diseases hold the interest of clinicians and pathologists due to their varied clinical presentation and histological diversity. In this study, we aimed to assess the various aspects of clinical and pathological characteristics of salivary gland diseases. Methodology We reviewed the records of patients with various salivary gland diseases at Ramadi Teaching Hospital, Rashid Hospital, Razi Hospital, and Zuhur Hospital in Iraq. The study covered the years 2010 to 2021. Results Of 159 patients, there were 61.64% female patients. The age group most affected was 51-60 years (26.4%). The most involved salivary gland was the parotid (44.65%). Swelling was seen in 74% of the patients. Obstructive lesions were seen in 52.2% of patients. Obstructive pathologies occurred exclusively in the age group 51-60 years, infective cases involved the age group 71-80 years (64.3%), and tumors affected the age group 41-50 years (77.4%). Women were affected more than men by all pathologies. The parotid gland was mostly affected by tumors (32/71), while other glands were mostly affected by obstructive lesions (17/18). A significant association was found between salivary gland pathologies with age and the affected gland. The most common clinical entity of the obstructive lesions was xerostomia (20.1%). While pleomorphic adenoma was the most common tumor (n = 40/50). The most common cause of xerostomia was smoking (31.2%) and the least cause was antidepressants (9.4%). Conclusions Salivary gland diseases were mostly seen in women and in the age group 51-60 years. Parotid was the most involved gland. A three-quarter of the cases presented with swelling and obstructive pathologies comprise above 50% of causes. The age and the involved gland can determine the type of salivary gland diseases. Xerostomia was the common clinical entity of obstructive pathologies. The most common tumor was pleomorphic adenoma and the most common cause for xerostomia was smoking.

A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study to Evaluate the Efficacy of AqualiefTM Mucoadhesive Tablets in Head and Neck Cancer Patients Who Developed Radiation-Induced Xerostomia

Simple SummaryXerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a clinical study with a new product, AqualiefTM, in patients treated with curative radiotherapy for HNC. The results show that AqualiefTM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent population of patients treated with placebo. Moreover, no serious, treatment-related adverse events were observed. These encouraging results suggest that AqualiefTM may become a promising tool for the treatment of radiotherapy-related xerostomia. In addition, the results also suggest that AqualiefTM may have positive effects in the maintenance of oral health.Xerostomia, the subjective complaint of dry mouth, is caused by therapeutic interventions or diseases. Nowadays, radiotherapy (RT) in patients with head and neck cancer (HNC) stands out as one of the most important causes of xerostomia. Currently available therapies for the treatment of xerostomia are still less than optimal and xerostomia still represents an unmet clinical need. In this article, we present the results of a prospective clinical study with a new product, AqualiefTM, in patients treated with curative RT with or without chemotherapy for HNC. AqualiefTM is based on two main ingredients, carnosine and karkadé, which have acid buffering and antioxidant properties. The study was performed on 30 patients, with 4 of the patients being lost during the study period. Each patient received randomly one of the two treatments, AqualiefTM or placebo, for 8 days. After a 10-day wash-out period, each patient received the other treatment for a further 8 days. The results show that AqualiefTM stimulated salivation in these patients and reduced the pH drop that was observed in an equivalent placebo-treated population of patients. Moreover, no serious, treatment-related adverse events were observed. AqualiefTM has shown positive results, although with limitations due to unsuccessful trial accrual. Therefore, it may be further investigated as a tool for the treatment of RT-related xerostomia.

Ксеростомия как причина нарушения пищеварения

Xerostomia (dryness in the mouth) arises due to inadequate saliva secretion associated with various conditions of the body and, in particular, of the salivary glands. The diagnosis and treatment of xerostomia does not receive due attention in the Russian Federation, whereas saliva forms the food bolus and is responsible for the first stage of food digestion. The causes of xerostomia are varied, and therefore its treatment meets with considerable difficulties. One of the methods of treating xerostomia is replacement therapy, but it is rarely and insufficiently administered in RF. The authors give a detailed description of the clinical picture of a dry mouth in 80 patients, who received a multicomponent formulation «Xerostom » as substitution therapy. The study showed that the best results were obtained by using gel and spray. Key words:salivary glands, xerostomia, saliva substitutes

The results of using xerostom mouthwash in complex treatment of patients with xerostomia

Introduction. Xerostomia is a permanent or temporary feeling of dryness of the oral cavity. It can be objective or subjective and is characterized by complaints of dryness of the oral cavity, discomfort when talking and eating, as well as a decrease in free saliva, which significantly impairs the quality of life. The diverse causes of xerostomia, including diseases of the salivary glands, long-term use of homeopathic, cardiac, etc. remedies, consequences of radiation therapy, etc.&#x0D; Materials and methods. Treatment of patients with xerostomia is mainly symptomatic, using salivozameniteli. In the Russian Federation, various saliva substitutes are presented by foreign companies. Among them, stands out a set (line) of salivozamenitele Xerostom. Therefore, we conducted a study of the effectiveness of the rinse aid, and also studied its antibacterial properties in patients with true xerostomia.&#x0D; Conclusion. It was found that the Xerostom rinse aid was effective in 70% of patients. At the same time, the rinse aid did not have antibacterial properties in relation to gram-positive aerobic S. Aureus and gram-negative anaerobic Klebsiella pneumonia.

Secretory process: the role of age, autoimmunity and endocrinopathy

Xerostomia is a common occurrence in older people, impairing their quality of life. When salivary gland function goes below 50%, patients show oral mucosal dryness and consequent problems on speaking and eating. They present oral health impairment. Their quality of life is compromised too. The prevalence of xerostomia is reported to be approximately 30% in people over 65 years old. Drug-induced xerostomia is the most common cause of dry mouth in elderly, because many older adults are taking at least one medication that causes salivary dysfunction. Among the autoimmune disease that can cause xerostomia, Sjogren’s syndrome (SS) is the most representative one in elderly. Dryness of oral mucosa and eyes is the main symptom of the disease. The “Elderly onset primary Sjogren’s Syndrome” (EopSS) is a common disease in Caucasian population, with a global incidence of 3% but a geographic variability. Patients with SS are frequently misdiagnosed, and physicians treat each symptom individually, unaware of underlying systemic disease. The control of symptoms with substitution of saliva and tears is recommended; therapies with anti-CD20 and Interferon-α are useful in patients with residual glandular function and salivary flow. Among the endocrinopathies, diabetes mellitus (DM) is the most common cause of xerostomia in older patients. Hyposalivation increases in diabetic patients with low metabolic control, which can cause more severe side effects in relation to oral health. Xerostomia may be produced by changes in salivary composition (caused by diabetes complications such as neuropathy, angiopathy, and metabolic failure) instead of changes in salivary quantity. Treating diabetes itself, maintaining good glycaemic values, can allay xerostomia in those patients. Doctors and dentists have to be aware of the various oral manifestations of diabetes in order to make an early diagnosis and treatment, avoiding further complications.

Distinct Salivary Gland Features in Sjögren's Syndrome and Lupus Erythematosus Sialadenite.

Primary Sjögren's syndrome (pSS) is an important cause of xerostomia, and the presence of this symptom in lupus erythematosus (LE) is usually referred to as secondary SS. Although these diseases share many clinical and laboratory aspects, the histopathological changes of minor salivary glands (MSG) have been widely evaluated to determine whether this damage is specific for each disease. Based on this query, the aim of this study was to analyze morphological findings of minor salivary glands in pSS or LE. Two groups of 30 (MSG) from patients with pSS and LE were histopathologically evaluated, and the results were statistically analyzed using the two-tailed Fisher exact test. The morphological changes were distinct among the groups and statistically significant. In pSS, the most evident features were the focal lymphocytic ductal aggression, with the focus score ≥1 and the periductal fibroplasia, while in LE, perivascular inflammatory infiltrate, spongiosis of ductal cells not associated with the exocytosis, and hyalinization of the periductal basement membrane were detected. These results indicated that in each disorder, MSG have their specific morphological changes, which lead to xerostomia, and the impairment of MSG in LE is probably due to a lupus sialadenitis.

Pathogenesis and Management of Xerostomia

Xerostomia, or dry mouth, is mainly caused by systemic disease, biological aging, and drug-induced side effect. The innervations underlying the three major salivary glands and numerous minor salivary glands differ substantially. The trafficking of aquaporin-5 (AQP5), which is specifically expressed in salivary glands, is regulated by the autonomic nerves. Upon the stimulation of the cholinergic nerve, AQP5 travels to apical and lateral plasma membranes, nuclei, and saliva. In this review article, I will describe the subcellular localization of AQP5 in relation to the causes of xerostomia. Ways of managing xerostomia, in particular the use of functional foods and salivary secretagogues, are also discussed.

Salivary scintigraphy for Sjögren's syndrome in patients with xerostomia: A retrospective study.

The value of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome remains controversial. The primary aim of this study was to estimate the diagnostic accuracy of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome among 237 patients with xerostomia. We retrospectively compared eight scintigraphy parameters between 106 Sjögren patients and 131 non-Sjögren patients. Seven of the eight parameters were significantly decreased in patients with Sjögren; however, their diagnostic accuracy was low, with areas under the curves (AUCs) ranging from 0.58 (95% CI 0.50-0.65) to 0.63 (95% CI: 0.55-0.70). The prestimulatory oral activity index allowed discrimination between primary and secondary Sjögren's syndrome (AUC 0.73, 95% CI: 0.62-0.84), and the secretion velocity for parotid glands allowed discrimination between patients with Sjögren and burning mouth syndrome (AUC 0.71, 95% CI 0.59-0.82). The accuracy of scintigraphy parameters for the diagnosis of Sjögren's syndrome among patients with xerostomia was low; however, some functional indices appeared to assist discrimination between primary and secondary SS patients and between subgroups of patients with different causes of xerostomia.

The use of drugs for the treatment of xerostomia – brief review

Inadequate production of saliva causes an oral imbalance that has a great impact on the individual's quality of life. Diseases of various types are responsible for impaired production of saliva and dry mouth, as happens in xerostomia. It is usually associated with hypofunction of the salivary glands, which shows signs of dryness on oral mucosa, and other morphological features in the oral cavity. Saliva is composed of water and 1% of electrolytes and immunoglobulins, enzymes and other proteins. Its fluid component, which contains ions, is mainly produced by parasympathetic stimulation, while the protein component, produced in the acinar secretory vesicles, is released by sympathetic stimulation. The use of certain drugs is a major cause of xerostomia. Among these we found analgesics, anticonvulsants, antihistamines, antihypertensives, diuretics and antidepressants. The treatment is mainly done by saliva substitutes such as sodium chloride, potassium chloride, monopotassium phosphate and dipotassium phosphate. However, in some cases, stimulants, such as citric acid and sodium citrate, or even topical salivary substitutes can be effective. Furthermore, the use of specific oral care products is well accepted by the patients. The treatment is selected according to the ability of the glands to produce saliva. It is still not fully known what mechanism of action drugs that cause hyposalivation, dry mouth or changes in saliva composition use. Yet, it is important to know the side effects of prescribed drugs.

The fight against malnutrition in older adults: new aproaches in dentistry

A minimal oral treatment aiming a clean and comfortable mouth could be very helpful in malnutrition control of dependent elderly persons. In such a case, it is necessary and generally it is enough to perform dental scaling and/or extractions with anxiolytic premedication (oral or rectal diazepam). Most of times, such minimal dental care can be performed at bedside, avoiding patient's stress and displacement to a dental surgery. The nursing staff can reassure the residents and their families on the absence of dentures, because saliva would be even more important than teeth. Actually, there is a tight relation between oral health, saliva, drugs, food texture and nutritional state of person. The notion of saliva includes two important criteria: 1) saliva-bacteria in the saliva, 2) fluid saliva-oral biofilm covering mucous membranes. All factors which change saliva secretion or inhibit oral bacteria community may lead to malnutrition. Several studies performed in hospital geriatric wards and in retirement homes allowed us to identify the following iatrogenic causes for malnutrition: 1) inappropriate preservation of teeth or dentures which may lead to oral reservoir (Candida albicans yeast-hyphal transition, antibiotic resistance genes transfer); 2) excessive uses of antiseptic mouthwashes for oral hygiene (leading to oral biofilm inhibition which is a cause of xerostomia); 3) drugs crushed in food (alteration of food taste and alteration of the oral biofilm); 4) exclusive recourse to a soft or mixed texture of food (alternative solutions exist, such as texture-adapted protein rich cookies). All these iatrogenic practices raise the possibility of formation of thick microbial communities in the mouth. This would explain why, despite attentive oral care, most of nurses and nurse's aides feel that in retirement homes the oral hygiene of the many residents is insufficient.

Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy

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.