Effektiviteten av läkemedelsbehandling för att minska muntorrhet och förebygga karies

Sammanfattning: Background: Dry mouth (xerostomia) is a common symptom which is connected with hypofunction of salivary glands induced by transient physiological conditions, pathology or as a side effect of drugs or radiation. Xerostomia almost always develops after destruction of salivary glands in connection with the treatment of head and neck cancer with ionizing radiation. Certain autoimmune diseases such as Sjogren's syndrome can also give dry mouth symptoms. The use of anticholinergic drugs and certain antihistamines may also cause a decrease in salivation. Aging is another factor that can induce salivary gland hypofunction due to physiological changes and/or use of medications. The treatment goals for patients with dry mouth is to relieve symptoms, prevent or ameliorate the consequences of salivary dysfunction, and treating the underlying disease. Treatments to improve function include saliva stimulation and saliva substitutes with fluoride. The systemic drugs bromhexine and pilocarpine are tested as saliva stimulants. Pilocarpine (Salagen) is a non-selective muscarinic agonist that increases the secretion of saliva. The purpose of this thesis was to investigate the effect of drug treatments to reduce dry mouth and prevent tooth decay, with the help of scientific articles. Results showed that in patients with some remaining unstimulated salivary flow rate daily treatments with a fluoride concentration of 0.42% F was enough to prevent tooth decay to a large extent. Use of 1.23% F-gel was not better than the 0.42% gel treatment. Casein derivatives complexed with calcium phosphate could be an alternative to fluoride treatment. Salivary secretion increased significantly after mouth rinse with 1% or 2% pilocarpine with a plateau between 45 and 75 minutes. 2% pilocarpine solution also increased the sense of salivary flow. Dry mouth was improved in 12.1; 63.6; 69.7 % of the patients who received Salagen tablets (5mg pilocarpine hydrochloride), 3mg or 5mg pilocarpine lozenge, respectively, compared with 42.4 % of patients receiving placebo lozenge. Mouth wash with pilocarpine 0.1% increased secretion from minor salivary glands and whole unstimulated saliva secretion compared to 0.9% saline mouthwash. The effectiveness in relieving subjective dry mouth was not significantly different between the solutions. Conclusions: Patients with unstimulated salivary flow <0.1 ml / min have a higher risk of caries lesions compared to unstimulated salivary flow> 0.1 ml / min. Patients with stimulated salivary flow <0.5 ml / min have a higher risk of caries lesions compared to stimulated salivary flow >0.5 ml / min. Mouthwash with pilocarpine solutions at concentrations of 1-2% pilocarpine induce a significant objective and subjective dose dependent increase in salivary flow. Pilocarpine lozenge produced the better clinical responses and a faster subjective improvement of dry mouth than Salagen tablets.