World Workshop on Oral Medicine<scp>VI</scp>: a systematic review of medication‐induced salivary gland dysfunction

Villa, Alessandro; Wolff, Ändy; Narayana, Nagamani; Dawes, C.; Aframian, Doron J.; Pedersen, Anne Marie Lynge; Vissink, Arjan; Aliko, Ardita; Sia, Ying Wai; Joshi, Revan Kumar; McGowan, Richard; Jensen, Siri Beier; Kerr, A. Ross; Ekström, Jørgen; Proctor, Gordon

doi:10.1111/odi.12402

Cited by 90 publications

(118 citation statements)

References 149 publications

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“…We did not find any differences between the patients with OLP/OLL and generalised stomatitis with and without contact allergies in terms of prevalence and severity of xerostomia. It is well-known that certain systemic diseases and the intake of certain medications as well as the number of diseases and medications are associated with xerostomia [28, 48–51]. In our study, 65.3% of the patients reported daily intake of medication and 32.6% had an intake of more than 2 different agents on a daily basis, which is reflecting the medication intake in the background population.…”

Section: Discussionsupporting

confidence: 50%

“…In our study, 65.3% of the patients reported daily intake of medication and 32.6% had an intake of more than 2 different agents on a daily basis, which is reflecting the medication intake in the background population. Several of the medications taken by the participants in our study are known to be “xerogenic” [27, 28]. This might explain the difference in the reports of xerostomia between the patients and the healthy controls.…”

Section: Discussionmentioning

confidence: 96%

“…However, it is still debatable whether the complaints of dry mouth and other sicca symptoms should be ascribed the OLP/OLL alone or whether they reflect a pathogenic association to systemic autoimmune diseases in which xerostomia and salivary gland dysfunction are common clinical manifestations. We have previously shown that only 15% of the 45% OLP patients who complained about xerostomia, actually had hyposalivation (i.e., an unstimulated whole saliva flow rate below ≤0.10 ml/min), and this could be related to a daily intake of cardiovascular medications including antihypertensives known to cause xerostomia and/or hyposalivation [18, 27, 28]. A study on salivary gland function and morphology showed that 87% of 39 patients with OLP had a low or very low unstimulated whole saliva flow rate, whereas the chewing-stimulated whole saliva flow rate, the buffering capacity and the salivary pH level were normal.…”

Section: Introductionmentioning

confidence: 99%

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Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis

et al. 2017

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BackgroundTo examine if patients with oral lichen planus, oral lichenoid lesions and generalised stomatitis and concomitant contact allergy have more frequent and severe xerostomia, lower unstimulated and chewing-stimulated saliva and citric-acid-stimulated parotid saliva flow rates, and higher salivary concentration of total protein and sIgA than cases without contact allergy and healthy controls.MethodsForty-nine patients (42 women, aged 61.0 ± 10.3 years) and 29 healthy age- and gender-matched subjects underwent a standardised questionnaire on general and oral health, assessment of xerostomia, clinical examination, sialometry, mucosal biopsy and contact allergy testing.ResultsNineteen patients had oral lichen planus, 19 patients had oral lichenoid lesions and 11 patients had generalised stomatitis. 38.8% had contact allergy. Xerostomia was significantly more common and severe in patients (46.9%) than in healthy controls, whereas the saliva flow rates did not differ. The patients had higher sIgA levels in unstimulated and chewing-stimulated saliva than the healthy controls. The total protein concentration in saliva was lower in the unstimulated saliva samples whereas it was higher in the chewing stimulated saliva samples from patients when compared to healthy controls. The differences were not significant and they were irrespective of the presence of contact allergy.ConclusionXerostomia is prevalent in patients with oral lichen planus, lichenoid lesions and generalised stomatitis, but not associated with salivary gland hypofunction, numbers of systemic diseases or medications, contact allergy, age, or gender. Salivary sIgA levels were higher in patients than in healthy controls, but did not differ between patient groups. The total salivary protein concentration was lower in unstimulated saliva samples and higher in chewing-stimulated saliva samples in patients than in healthy controls, but did not differ between patient groups. Our findings do not aid in the discrimination between OLP and OLL and these conditions with or without contact allergic reactions.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis

et al. 2017

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“…This approach is considered the most precise method of describing the dry mouth . Currently, there are a number of studies that have examined the association between drugs and xerostomia, whereas, at the same time there is a lack of studies focusing on the association between drugs and salivary secretion …”

Section: Discussionmentioning

confidence: 99%

“…It is well known that anticholinergic drugs cause hyposalivation and xerostomia, either by directly affecting muscarinic receptors in the salivary glands or by a secondary effect through the central nervous system . Yet, little is known about the association between the anticholinergic burden caused by all the drugs used and salivary secretion or xerostomia.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic burden and dry mouth among Finnish, community‐dwelling older adults

et al. 2017

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Common Oral Conditions

Stoopler,

Villa,

Bindakhil

et al. 2024

JAMA

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ImportanceDry mouth, oral candidiasis, and recurrent aphthous ulcers are 3 of the most common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity.ObservationsIn a meta-analysis of 26 population-based cohort and cross-sectional studies, the global prevalence of dry mouth symptoms was 23% (95% CI, 18% to 28%), placing individuals at risk of oral candidiasis, dental caries, dysgeusia, masticatory/speech impairment, and oropharyngeal dysphagia. Dry mouth is associated with using more than 3 oral medications per day (odds ratio [OR], 2.9 [95% CI, 1.4 to 6.2]), head and neck radiation, and Sjögren disease. Symptoms may include difficulty swallowing and speaking, thirst, and halitosis. Dry mouth is associated with an 11.5% (95% CI, 3.6% to 27%) higher risk of oral candidiasis, based on a meta-analysis of 6 observational cohorts. Management of dry mouth includes mechanical salivary stimulants, oral moisturizers, and/or systemic sialagogues. Oral candidiasis is an opportunistic fungal infection caused by overgrowth of the Candida genus with C albicans, which accounts for 76.8% of infections. The prevalence of oral candidiasis is higher in patients who are immunosuppressed, for example, those with HIV (35% [95% CI, 28% to 42%]) and those with salivary gland hypofunction (OR, 3.02 [95% CI, 1.73 to 5.28]). Common risk factors associated with oral candidiasis include use of antibiotics (P = .04) and oral mucosal disorders such as lichen planus. Oral burning and dysgeusia are common symptoms of oral candidiasis. Treatment includes addressing risk factors and use of topical and/or systemic antifungal medications. Recurrent aphthous stomatitis is characterized by symptomatic round or oval oral ulcers, which are covered by a gray-white fibrin layer and encircled by an erythematous ring. A meta-analysis of 10 case-controlled studies revealed an increased risk of recurrent aphthous stomatitis associated with polymorphism of IL-1β (+3954C/T) (OR, 1.52 [95% CI, 1.07 to 2.17]) and IL-1β (−511C/T) (OR, 1.35 [95% CI, 1.09 to 1.67]). Another meta-analysis of 9 case-control studies reported that patients with recurrent aphthous stomatitis had a higher frequency of nutritional deficiencies, including vitamin B12 (OR, 3.75 [95% CI, 2.38 to 5.94]), folic acid (OR, 7.55 [95% CI, 3.91 to 14.60]), and ferritin (OR, 2.62 [95% CI, 1.69 to 4.06]). Recurrent aphthous stomatitis can be associated with systemic diseases. A meta-analysis of 21 case-control studies revealed that celiac disease is associated with a higher incidence of recurrent aphthous stomatitis (25% vs 11%; OR, 3.79 [95% CI, 2.67 to 5.39]; P &lt;.001). Topical corticosteroids are first-line agents to manage recurrent aphthous stomatitis; however, systemic medications may be necessary in more severe cases.Conclusions and RelevanceDry mouth, oral candidiasis, and recurrent aphthous ulcers are common oral conditions that may be associated with patient discomfort, decreased quality of life, and morbidity. First-line treatment includes over-the-counter sialagogues for dry mouth, topical antifungals for oral candidiasis, and topical corticosteroids for aphthous ulcers. Oral conditions that do not improve with first-line treatment may require treatment with systemic medications.

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World Workshop on Oral MedicineVI: a systematic review of medication‐induced salivary gland dysfunction

Cited by 90 publications

References 149 publications

Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis

Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis

Anticholinergic burden and dry mouth among Finnish, community‐dwelling older adults

Common Oral Conditions

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