A Comparison of Pilocarpine and Cevimeline in the Treatment of Xerostomia to Prevent Dental Caries
BACKGROUND
Xerostomia, also known as dry mouth, is the inability to keep the mouth wet with saliva.1 Patients with xerostomia have a higher prevalence of oral hygiene problems, specifically dental caries, than patients who have normal salivary gland function.2 Dental caries can lead to more serious oral health problems including gingivitis, tooth loss, and abscess formation. Typically, xerostomia is caused by physiologic aging, Sjogren’s syndrome, or it can be drug or raditaion-induced.3 The natural aging body has decreased parasympathomimetic output including saliva production. Sjogren’s syndrome is an autoimmune disease that attacks the salivary
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Some cons to stimulant drug therapy is that they must be taken three times a day in order to effectively stimulate saliva excretion. This may prove and adherence challenge, especially in the elderly population who are at a higher risk of developing xerostomia. Also, common side effects of pilocarpine and cevimeline are excessive sweating, diarrhea, and headache. Specifically in the treatment of Sjogren’s syndrome, immune system modulators may have to be used as well as other medications and the extra burden of an additional medication for dry mouth is not seen as a benefit for patients.7
In the dental practice, Sjogren’s syndrome xerostomia is seen at an increasing rate as patients are getting older, subject to polypharmacy, and receiving radiation therapy to treat metastatic disease. This puts dental patients at a higher risk of developing dental caries and spiraling toward an overall decrease in oral health as well as a decrease in general well-being and lifespan. Delay in diagnosis and treatment of Sjogren’s syndrome xerostomia can lead to an earlier incidence of these adverse health
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One such study that provides promising results was conducted by Aframian, Helcer, Livni, and Markitziu and concluded that treatment with pilocarpine helped stimulate a significant amount of saliva in patients with salivary glands impaired by radioactive iodine treatment for thyroid cancer.9 However, this was a small study with only five patients and did not go on to analyze the patient’s incidence of dental caries after treatment with a control group.
There are no studies comparing the efficacy of pilocarpine and cevimeline to a control group receiving no saliva stimulants or salivary substitutes in the effectiveness in treating xerostomia in order to reduce the incidence of dental caries in patients. I hypothesize that both pilocarpine and cevimeline will have a greater salivary stimulation than patients receiving either no salivary treatment or treatment with a salivary substitute and will therefore reduce the amount of dental caries that are experienced.
[7]Similarly they are contraindicated in patients with low caries risk, teeth with shallow self cleansing grooves, patients with good oral hygiene maintenance,
The etiology of burning mouth syndrome is varied and often difficult to decipher clinically. The following factors have been cited as having possible etiologic significance:
...s little information about the possible benefits of the study or the side effects. The side effects proved to be significant (gastrointestinal complains, headache, and an elevation of alanine aminotransferase), while the benefits were minimal. This situation emphasizes the need for a balanced approach when it comes to drug clinical trials.
15-Mutneja. P, Dhawan. P, et al. Menopause and the oral cavity. Indian Journal of Endocrinology and Metabolism (2010); 16(4): 548-551.
The medication given to the children is a trial and error situation. The right drug could take years to find. The children taking this drug feel like test subjects when their pediatrician/psychotherapists must monitor them for compliance to the medication. Side effects differ from each individual, ranging from nervous breakdowns, inadequacy, mania, delusions, physical harm, self harm and possible attempted suicide. These symptoms can be treated with even more medication. Other side effects include: headache, stomach ache, dry mouth, constipation, gas, weight loss/gain, and acne. These symptoms might go away or are tolerable. New symptoms are hard to determine whether or not they are due from a new illness, the drugs, or just natural hormone development.
Not only do they face the obvious challenges with their memory but also often have diminished physical ability and when one adds the possibility of xerostomia from medication it only makes the situation worse. Dental professionals should strive to do the best they can to help all people. Practicing dentistry should not be limited to the people who can take care of themselves. It is clear that people are living longer in the world today and with that comes mental and physical deficits. Oral health care does not become less valuable because a person suffers from life threatening diseases, it should continue to maintain its importance. Many of the problems our geriatric population face can be linked directly to lack of proper nutrition and loss of joy from being able to eat certain foods. Furthermore, oral diseases can cause the manifestation of systemic ailments that ultimately will lead to certain health decline. If people do not consider oral hygiene a priority then it is up to Dental professionals to convince them and encourage them to take responsibility. The general populous has neglected the geriatric population, but health care providers seem to be at the forefront by keeping them in focus. Dental health care providers have a duty to be apart of our older populations
Most side effects go away after a while, but not always. Some common side effects are nausea, loss of appetite, headaches, dry mouth, dizziness, moodiness, trouble sleeping, and tics. If you change the times of when you take your medicine or what you eat with it then that can cause more side effects. The medication should be taken with food and you should eat throughout the day and drink plenty of fluids. Depending upon your side effects and the results from your medication, the doctor might change
and loss of appetite caused by the disease itself and by treatment with AZT and
therapy (CBT), relaxation training and techniques, dental fear and anxiety in children, adolescents and adults could be better treated in the future. Works Cited Gordon, D., Heimberg, R. G., Tellez, M., & Ismail, A. I. (2013). A critical review of approaches to the treatment of dental anxiety in adults. Journal of Anxiety Disorders, 27, 365-378. Gao, X., Hamzah, S., Yung-Yiu, C. K., McGrath, C., & King, N. M. (2013).
After the accumulation of calculus to a certain thickness, the oppression of gums lead to inflammation of the gums, resulting in periodontal disease, resulting in bad breath.
However, on the a recent visit dated 23/12/13 the patient’s gingival condition had deteriorated, presenting with an increased plaque scores of 34% and bleeding scores to 63%. Intra oral examination also showed generalised oedema and erythema throughout in the mouth in response to this increase in plaque bacteria. The presence of supra-gingival calculus on lower anterior teeth and both sites of upper buccal molars and the patients BPE now reads 212 /121, putting the patients caries risk at a ‘High’ status.
Cappelli, D. P., & Mobley, C. C. (2008). Prevention in clinical oral health care. St. Louis, Mo: Mosby Elsevier.
“Gingivitis.” Magill’s Medical Guide, 4th Rev. ed.. 01 Dec. 2008. eLibrary. Web. 15 Oct. 2010.
Dental disease, caries are the warning signals for other health complications and development of diabetes, obesity and coronary heart disease. Undernutrition condition associated with high intake of sugar may lead to risk of dental caries. Dental caries affect people physically as well pschycologically and influences how they grow, enjoy their life, look, speak, taste food and socialize themselves. During severe caries they experience pain, discomfort, eating and sleep disturbance, loss of school days and costs of treatment. There is a wealth of evidence that sugars are undoubtedly the most important factors in the development of dental caries. Another factor of dental caries occur because of demineralization of enamel and dentine by organic acids formed by bacteria in dental plague through the anaerobic metabolism of sugar obtained for the diet. Organic acid increased the solubility of hydroxyapatite (main inorganic constituent of tooth enamel and bone) in the dental hard tissues and demineralization occurs. Saliva is supersaturated with calcium and phosphorus at PH 7 promotes remineralization. If the oral PH varies high in for sufficient time then complete remineralization of enamal may occur.If the acid challenge is too high however demineralization dominates then enamel become more porous and a carious lesion will developed. Frequency
Maintaining oral health is extremely important not only for your mouth, but for your overall health (Wallace, Taylor, Wallace & Cockrell, 2010). Poor oral health impacts a person’s quality of life and general health, It causes pain which could result in poor nutrition (Griffin, Jones, Brunson, Griffin & Bailey, 2012). The residents at Menarock aged care have a private dentist from Alpha dental that visits the facility when prompted, although some resident’s families take them to their own family dental professional.