Persistent Dry Mouth Research Articles

Does lower dose pilocarpine have a role in radiation-induced xerostomia in the modern radiotherapy era? A single-center experience based on patient-reported outcome measures

PurposeThis study aims to investigate the efficacy of lower dose pilocarpine in alleviating late dry mouth symptoms in head and neck cancer patients received radiotherapy.MethodsEighteen head and neck cancer patients experiencing persistent dry mouth were enrolled in this study. All participants started pilocarpine treatment a median of 6 months post-radiotherapy. Initially, patients received pilocarpine at 5 mg/day, with a gradual increase to the recommended dose of 15 mg/day. A Patient-Reported Outcome Measurement (PROMs) questionnaire assessed symptoms’ severity related to hyposalivation.ResultsAll patients reported symptomatic dry mouth above grade 2 before starting the medication. Pilocarpine treatment continued based on patients’ self-assessment, with a median duration of 12 months (range, 3–36 months). The median daily maintenance dose was 10 mg (range, 5 to 20 mg). Total PROMs scores significantly decreased following medication, from 13 points (range 7–18 points) to 7 points (range 4–13 points) (p = 0.001). Significant improvements were observed in questions related to dry mouth (p < 0.001), water intake during eating (p = 0.01), carrying water (p = 0.01), taste (p < 0.001), and water intake during speech (p < 0.001). Initial and maintenance doses of pilocarpine were lower, and the duration of pilocarpine usage was shorter in patients treated with intensity-modulated radiation therapy compared to conformal radiotherapy (12 months vs. 25 months, p = 0.04).ConclusionPilocarpine may be considered at doses lower for late-term dry mouth. With modern radiotherapy techniques effectively preserving the parotid gland, short-term use may be recommended in these patients. Future studies may enhance the development of a more robust patient selection criteria model.

Natural Mucilage From Phoenix dactylifera L. as an Alternative for Artificial Saliva

The sensation of dry mouth is a clinical illness known as xerostomia. Treatment is necessary for alleviating symptoms in patients who experience either transient or persistent dry mouth. It is essential to develop artificial saliva for this purpose. The fruit of the Phoenix dactylifera is edible and has been used in food. Its mucilage from dried fruits was extracted by soaking in distilled water and precipitated with 90% v/v ethanol. The mucilage of P. dactylifera was used for producing artificial saliva and was combined with other components including proteins and electrolytes. The translucent light brown gel solution was seen in the artificial saliva using P. dactylifera mucilage. The measured relative density ranged from 1.02 to 1.15 g/mL. Artificial saliva had to become more viscous with the addition of P. dactylifera mucilage and its concentration. Their pH values ranged between 6.98 and 7.15. The produced artificial saliva had a wetting time ranging from 7.53 to 9.70 min, which is similar to the typical human saliva. Artificial saliva could form a film in the mouth after certain periods. It was found that artificial saliva exhibited many adsorption bands corresponding to various biomolecules, such as protein, carbohydrate, and lipid, and had a unique peak at 275 nm. The results of this investigation suggest that a formulation including mucilage from P. dactylifera may be utilized to treat xerostomia patients by temporarily lubricating and hydrating their mouths when they experience persistent dry mouth.

Factors Associated With Phantom Odor Perception Among US Adults

Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data. To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition. In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey. Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status. Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists. Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51). An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.

GADD153 as a novel molecular fingerprint for Sjögren’s syndrome

Scientific objective Sjogren’s syndrome (SS) is a systemic autoimmune disease characterized by chronic focal leukocyte infiltration and inflammation of exocrine glands including salivary glands thereby resulting in persistent dry mouth and consequent increased risk for dental caries and periodontal disease. Assessment of leukocyte infiltration into minor salivary glands of lower lip biopsy samples is commonly used to aid with diagnosis of SS; however, this approach may identify 60-80% of those afflicted with the disease thereby requiring use of additional diagnostic tests/markers which relies on a better understanding of the pathogenesis of SS. Endoplasmic reticulum (ER) stress response is a pivotal regulator of inflammation and cell death. An integral component of ER stress-induced apoptosis is expression of the growth arrestand DNA damage-inducible protein 153 (GADD153). Thus, we tested the hypothesis that SS is associated with increased salivary gland expression of GADD153 and increased leukocyte infiltration thereby contributing to inflammation and cell death.

Lacrimo-auriculo-dento-digital syndrome

The Lacrimo-auriculo-dento-digital (LADD) syndrome is an autosomal dominant inheritance pattern with marked variability of inheritance. It is characterized by abnormalities of lacrimal and/or salivary system, anomalies of ears, teeth and limbs. Persistent dry mouth and enamel hypoplasia cause serious dental effects. Here, a case of LADD syndrome, its clinical spectrum and accompanying therapeutic challenges is discussed.

A Prospective Study of Salivary Gland Function in Lymphoma Patients Receiving Head and Neck Irradiation

To determine the radiation dose-response relationship on salivary dysfunction and quality of life (QOL) over time in patients with lymphoma receiving radiation therapy (RT) to the head and neck (H&N). We conducted a prospective study on salivary-gland function in lymphoma patients receiving RT to the H&N. Fifteen patients were enrolled on the study. Dose-volume histograms and mean doses to the salivary glands were generated. Radiation-related toxicities and H&N-specific QOL were assessed before treatment and at prespecified time points posttreatment. Factors predicting a decrement in QOL were explored using Fisher's exact test. During RT, 47% of patients experienced Grade >or= 2 acute toxicity of the salivary gland, mucous membrane, or both. QOL scores improved over time, but up to one third of patients continued to have persistent oral symptoms at 2 years. At 6 months, a mean dose to at least one of the parotids of > 31 Gy was significantly associated with persistent dry mouth (100% vs. 17%, p = 0.02) and sticky saliva (100% vs. 25%, p = 0.04); a mean dose of > 11 Gy to the minor salivary glands was significantly associated with persistent sticky saliva (100% vs. 25%, p = 0.04), although the difference was no longer significant at 1 year. Limiting the mean parotid dose to <or= 31 Gy and mean minor salivary gland dose to <or= 11 Gy in lymphoma patients treated to the H&N may help reduce the risk of subacute xerostomia.

A Client’s View

You have accessThe ASHA LeaderASHA News1 May 2005A Client’s ViewBoard Recognition Brings “Comfort and Confidence” Marty Mash Marty Mash Google Scholar More articles by this author https://doi.org/10.1044/leader.AN2.10062005.25 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Consumers need to be able to locate a board-recognized specialist in swallowing and swallowing disorders (BRS) to help with their particular problems. At 34, I was diagnosed with Stage IV squamous cell carcinoma of the tongue. I didn’t drink or smoke. Following the initial shock of my diagnosis, I mustered my strength and continued on. I had simultaneous chemotherapy and radiation treatments that engendered several problems-swallowing difficulty and persistent dry mouth. Through the weeks and months of my treatments, swallowing became increasingly difficult, but somehow I was able to continue. Upon completing my treatments, I was scheduled for a surgical procedure to remove part of my tongue, and knew I would need some very specialized training to relearn how to swallow. Board-recognized specialists were not available at the time of my surgery and so I didn’t have that option. I was fortunate to find a highly qualified clinician, who is currently a charter board-recognized specialist in swallowing and swallowing disorders. The swallowing treatment that I received, my family support, and my determination prevented me from having to have a feeding tube. I now take all my nutrition by mouth. This was the one part of my disease that, with help, I was able to control! Consumers will strongly support the plan to encourage SLPs to become recognized specialists in specific areas. The designation of Board-Recognized Specialist that is being offered by the Specialty Board on Swallowing and Swallowing Disorders will allow consumers with swallowing problems the ability to identify those who have demonstrated excellence in their field. As in any field, specialization and recognition from the industry and peers will give the consumer the comfort and confidence of knowing that their health care or the health care of their loved ones will be in highly competent hands. Author Notes Marty Mash, is the consumer member of the Specialty Board for Swallowing and Swallowing Disorders. “We are very fortunate to have Marty on our board,” says board member Bonnie Martin-Harris. “He keeps us focused on the goals of the Specialty Recognition process.” Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 10Issue 6May 2005 Get Permissions Add to your Mendeley library History Published in print: May 1, 2005 Metrics Downloaded 51 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationLoading ...

A third study on the use of orally administered anhydrous crystalline maltose for relief of dry mouth in primary Sjögren's syndrome.

To examine the safety and efficacy of anhydrous crystalline maltose for treatment of dry mouth and other symptoms of dryness in patients with primary Sjögren's syndrome. Anhydrous crystalline maltose was delivered orally as a 200-mg lozenge given three times daily over a 24-week period to a total of 100 subjects. All participants had prominent complaints of persistent dry mouth associated with primary Sjögren's syndrome. Patients were examined at baseline and every 6 weeks of treatment. Patients were seen in outpatient clinics at a total of 27 sites within the United States. Unstimulated whole saliva output, a measure of basal salivary gland function, was determined at each visit. Symptoms associated with oral and ocular dryness were assessed at the same time with the use of 100-mm visual analogue scales. Safety was assessed by physical examination and laboratory studies. During this clinical trial, a majority of evaluable subjects (39/76) demonstrated an increase in unstimulated whole saliva output, and the treatment exhibited an excellent safety profile. The anhydrous crystalline maltose treatment led to significant improvement in several subjective measures of oral and ocular comfort. In this study, anhydrous crystalline maltose lozenges administered three times daily for 24 weeks improved salivary output and decreased complaints of dry mouth and eyes in patients with primary Sjögren's syndrome. Side-effects were minimal, and treatment was without significant adverse events. These results are similar to the benefits observed in two prior studies reported by the authors. This safe and simple intervention appears to provide clinical benefit to primary Sjögren's syndrome patients with distressing dry mouth symptoms.

Evaluation of dosing interval and optimum dose of cibenzoline.

Fifteen patients with ventricular premature complexes (VPCs) were included in this open study designed to assess the relative efficacy of bid (two times daily) and tid (three times daily) dosing regimens for cibenzoline as compared with qid (four times daily) administration. Patients started therapy with qid administration; this was followed in sequence by tid and bid administration at the maximum effective total daily dose determined during the qid administration. Of the nine patients evaluated for efficacy for suppression of VPCs, eight demonstrated a 75% or greater suppression of VPCs with cibenzoline administered qid (total daily dose of 130-325 mg). This effectiveness was maintained in four patients with a bid regimen and in three with a tid regimen. All four patients who had ventricular tachycardia (VT) had a decrease in the number of VT episodes while receiving cibenzoline (only one of these patients had satisfactory suppression of VPCs at the same dosage regimen). Twelve patients continued to receive extended therapy with cibenzoline for up to two years, as this was considered to be the optimum antiarrhythmic treatment for these patients. Two patients had to be removed from the study and two had the dosage lowered because of adverse reactions (dry mouth, blurred vision, dizziness, congestive heart failure) although in one instance, the congestive heart failure was subsequently considered to be unrelated to cibenzoline. One patient was able to complete the short-term phase of the trial, but was not given extended treatment because of persistent dry mouth. Two patients had treatment discontinued during the extended therapy phase because of adverse reactions (fever, nausea, vomiting, asthenia).(ABSTRACT TRUNCATED AT 250 WORDS)