XEROSTOMIA

XEROSTOMIA. BY MARSHAL CRRI MOHAN CRRI DEPARTMENT OF PROSTHODONTICS.

CONTENTS. INTRODUCTION CONDITION HISTORY PATHOLOGY MEDICATION TECHNIQUE.

INTRODUCTION. Xerostomia is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva. Hyposalivation may occur with the use of medications, as a complication of connective tissue and autoimmune diseases, with radiation therapy to the head and neck, or with a number of other conditions. Patients initially may be unaware that a reduction in salivary flow is occurring unless some of its complications, such as an increase in cervical dental caries, becomes apparent..

CONDITION. Xerostomia - Dry Mouth Tobacco use Dehydration Nerve damage Reduction or absense of Saliva Sign of an underlying disease or condition : Sjogren's syndrome, HIV / AIDS, Alzheimer's disease, Diabetes, Cystic fibrosis, Rheumatoid arthritis, Hypertension, Parkinson's disease, Stroke and Mumps. Side effect of certain medications.

HISTORY-DRUGS CAUSING XEROSTOMIA. Anticholinergic Agents: atropine belladonna benztropine oxybutynin Scopolamine Antidepressant and Antipsychotic Agents Selective serotonin-reuptake inhibitors: citalopram fluoxetine paroxetine.

Diuretic Agents: chlorothiazide furosemide hydrochlorothiazide Triamterene Antihypertensive Agents: captopril clonidine clonidine/chlorthalidone enalapril guanfacine lisinopril methyldopa.

PATHOPHYSIOLOGY. Saliva is produced by the parotid, submandibularand sublingual glands, as well as by hundreds of minor salivary glands that are distributed throughout the mouth. Daily salivary output is estimated to be approximately one liter per day, and flow rates can fluctuate by as much as 50 percent with diurnal rhythms. Salivary flow iscategorized as unstimulated, or resting, and stimulated,as occurs when an exogenous factor isacting on the secretory mechanisms. Both the parasympathetic and sympatheticnervous systems innervate the salivary glands. Parasympathetic stimulation induces more watery secretions, whereas the sympathetic system produces a sparser and more viscous flow..

Therefore, a sensation of dryness may occur, for example, during episodes of acute anxiety or stress, which cause changes in salivary composition owing to predominant sympathetic stimulation during such periods. Symptoms of a lack of saliva or oral dryness may be precipitated by dehydration of the oral mucosa,which occurs when output by the major and/or minor salivary glands decrease and the layer of saliva that covers the oral mucosa is reduced..

MANAGEMENT:. PALLIATIVE RECOMMENDATIONS Avoid the use of alcoholic beverages and mouth rinses. Mouth rinses containing alcohol may desiccate the oral mucosa and worsen xerostomic symptoms. Use a humidifier at night. Use salivary flow stimulants such as –sugarless chewing gum; –Biotène Dry Mouth Gum (Laclede, Rancho Dominguez, Calif.); –XyliFresh (Leaf, Espoo, Finland); –sugarless hard candies; –Salix Lozenges.

SALIVA SUBSTITUTES/ORAL LUBRICANTS These over-the-counter agents are formulated as solutions, sprays orgels. Formulations have multiple contents including carboxymethylor hydroxymethylcellulose, electrolytes and flavoring. Most salivary substitutes provide relief for only a limited time. They are most useful when used immediately before bedtime or speaking. There are few data to indicate superiority of any of the products; selection therefore should be based on availability and personal preference. Moi-Stir (Kingswood Laboratories, Indianapolis) MouthKote (Parnell Pharmaceuticals, Larkspur, Calif.) ORALbalance (Laclede) Salivart (Xenex Laboratories, Coquitlam, British Columbia,Canada) Xero-Lube (Colgate Oral Pharmaceuticals, Canton, Mass.).

CHOLINERGIC DRUGS Cholinergic drugs may alter cardiac conduction, and their use should be avoided in patients who have significant heart disease. These parasympathomimetic stimulating agents are contraindicated for patients who have uncontrolled asthma, narrow-angle glaucoma and acute iritis. Visual impairment has been noted, particularly in an environment with reduced lighting.), 30 mg three times per day Cevimeline (Evoxac, Daiichi Pharmaceutical Co., Montvale, N.J. Pilocarpine (Salagen, MGI Pharma, Minneapolis), 5–10 milligrams,three or four times per day.

TECHNIQUE. FUNCTIONAL RESERVOIR TECHNIQUE.

Steps in fabrication of conventional complete denture are similar up to the try‐in stage. Palatal contours are recorded using tissue conditioning material at the try‐in appointment (GC Soft Liner, GC Corporation, Japan) The trial denture with its modified palatal contours is duplicated in alginate (Ruthinium Alginate, Ruthinium Dental Products Pvt. Ltd., India) and a working cast is poured in Type III Dental Stone (Goldstone, Asian Chemicals, India). A template of 1‐mm thick thermoplastic material (BIOPLAST ® , India) is fabricated on this working cast which serves as a guide for salivary reservoir designing . The tissue conditioning material on the palatal surface of the trial denture is removed. The reservoir walls and lid rim are built with sprue wax (3 mm YETI Dentalprodukte GmBH, Germany) . A slight undercut must be created on the inner aspect and a groove is made on the external surface of the lid rim using a Le Cron carver. These two features facilitate attachment for the flexible lid of the reservoir. The reservoir volume must be assessed at this stage by injecting a known quantity of liquid using a calibrated syringe. The trial denture is waxed‐up, invested, and processed in the conventional manner ..

The denture is finished and polished and then duplicated using alginate to obtain a second working cast made of Type III Dental Stone (Goldstone, Asian Chemicals, India). The reservoir lid is fabricated with a 2‐mm flexible thermoplastic sheet (BIOPLAST ® ) on the second working cast of the denture . The reservoir space must be blocked out with the help of plaster, while the undercut on the inner aspect of the reservoir lid rim must be relieved before fabricating the reservoir lid. A 0.8‐mm release hole is made on the most dependent portion using a straight fissure bur. This permits the slow and continuous release of the salivary substitute. The reservoir lid is snapped to close the reservoir and is filled with salivary substitute (methyl cellulose – wet mouth, ICPA) using a calibrated syringe through the release hole . The salivary substitute is released when the tongue creates pressure in the anterior portion of the palate The functional maxillary salivary reservoir complete denture is ready to be inserted ..

SPLIT DENTURE TECHNIQUE.

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