A Comparison Of Pilocarpine And Cevimeline

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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 …show more content…

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 …show more content…

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.

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