Modulation of Salivary Gland Function Flashcards
Acute or chronic reduced salivary flow may be due to:
Mechanical blockage, dehydration, emotional stress, infection of the salivary glands, local surgery, avitaminosis, diabetes, anemia, connective tissue disease, congenital factors, radiation therapy, Sjogren’s syndrome, medications.
Drug induced xerostomia is a concern because:
- older adults take more prescription and non-prescription drugs
- Over 400 medications are implicated in causing xerostomia
- oral health impact of xerostomia is consequential
Drug categories implicated in causing xerostomia include:
sympathomimetics, diuretics, cardiovascular meds, anticholinergics, tricyclic antidepressants, antihistamines, psychotropic agents, antiparkinson agents, antineoplastic drugs, muscle relaxants.
Herbal preparations that can induce xerostomia:
St. John’s wort, Gingko Biloba
Factors contributing to increased caries susceptibility:
-decreased titers of antimicrobial substances and loss of mineralizing components and shift to more cariogenic bacteria.
Caries in xerostomic pts most likely to occur near:
gingival margins and on exposed root surfaces.
Xerostomia presents clinically with:
Periodontal problems, altered taste sensation, mouth soreness
Xerostomia is associated with:
oral pain, increased oral infections, difficulty speaking, chewing and swallowing.
Xerostomia tx is important to:
keep mouth moist, prevent caries, candida infections, and provide palliative relief.
Palliative measures for xerostomia include:
- sipping water
- avoiding mouth rinses with alcohol
- ice melting
- limit caffeine
- humidifying sleeping area
- vaseline on lips
Rx Saliva Substitute:
Sodium Carboxymethylcellulose 0.5%
- 8 fl oz
- rinse prn
Commercial saliva substitutes:
Xero-lub, Salivart, Moi-Stir, Orex
Rx fluoride therapy:
Stannous fluoride gel 0.4%
- 24 ml
- 5-10 mins/day in carrier (5-10 drops)
What should be considered if poorly tolerated taste or ceramic restorations present?
Use of neutral pH sodium fluoride gel 1%
Rx neutral sodium fluoride gel:
- 1%
- 24 ml
- 1 drop/tooth in tray, 5 mins daily
- Avoid rinsing/eating 30 mins.
No more than ____ NaF should be dispensed in one container.
264 mg
24 ml is approx:
2 week supply of gel
Antifungal Rx
Nystatin (topical) or Fluconazole (systemic)
Saliva stimulants like _____ may temporarily stimulate salivary flow.
sugarless gum or dissolving mints
Parasympatholytics
decrease saliva secretion
Parasympathomimetics
increase saliva secretion
meds that decrease saliva
- Propantheline
- Methantheline
- Glycopyrolate
- Atropine
meds that increase saliva secretion
- Pilocarpine
- Bethanechol
- Cevimelin
A muscarinic receptor agonist that is FDA approved
Pilocarpine
Pilocarpine, Bethanechol, and Cevimeline are
Parasympathomimetic drugs
Doses of pilocarpine
Initial divided doses of 15 mg/day in 5 mg doses, can be up to 30 mg/day
Pilocarpine side effects on glands
significant increase in parotid, submandibular, and sublingual secretions
Pilocarpine effect depends on
residual salivary gland function
T or F: Pilocarpine has no significant effect on blood pressure/heart rate
T
Pilocarpine contraindications:
asthma and complete loss of salivary gland function
Side effects of Pilocarpine:
sweating, chills, nausea, and dizziness
Does prophylactic use of pilocarpine decrease reduction in severity of xerostomia…
Maybe?
Used in divided doses of 75-200 mg/day without complaints of GI upset and a reduced tendency for sweating:
Bethanechol
Treatment of Sjogren’s syndrome: 30 mg tid
Cevimeline
Pilocarpine activates the _____________ receptor in the _______ membrane of the _________ cell to form saliva
muscarinic, basal, acinar
Parasympatholytic drugs should be used for
transient modulation
Parasympatholytic drugs are
antisialogoges
Competitive antagonists for the muscarinic receptors therefore will reduce salivary gland secretion
Parasympatholytic
Contraindications of parasympatholytic drugs:
glaucoma, cardiovascular disease, and prostate hypertrophy
Side effects of parasympatholytic drugs
Blurred vision, drowsiness, tachycardia, decreased intestinal or bladder smooth muscle action.
T or F: Side effects of parasympatholytics can occur after single dose used in dental practice.
T
Propatheline, methantheline, and glycopyrolate are examples of
Parasympatholytic drugs
Atropine like drug that may be useful in inhibition of salivation before a dental procedure
Propantheline
Dose of propantheline
Adults: 15 mg 30-40 mins before appt. Second tab can be given if needed.
-Children should be half dose
Alternative drug that has same effects as propantheline but thought to have more intense side effects:
Methantheline
Dosage of Methantheline
50 mg or 100 mg before appt
A quaternary amine of the anticholinergic class similar to propantheline but greater per mg potency and a longer duration of action:
Glycopyrolate
Has less sedative effect and CNS effect than scopolamine and has a better therapeutic index than atropine as a antisialogog:
glycopyrolate
Cardiac side effects are considered less frequents than for atropine
Glycopyrolate
T or F: I added this card so there would be exactly 50 cards in this set.
T
