Xerostomia. A neglected symptom

Sreebny, Leo M.

doi:10.1001/archinte.147.7.1333

Cited by 141 publications

(124 citation statements)

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“…Recent studies (20,45) demonstrated that the uremic salivary dysfunction is associated with glandular atrophy, fibrosis, and accumulation of fibrillar components, which suggest that uremic salivary dysfunction is not only a functional disturbance but also an organic change. Pilocarpine exerts its effect through cholinergic stimulation of saliva from residual salivary gland tissues, and an increase of a relatively modest amount of saliva seems to be sufficient to overcome the xerostomia (40). Although pilocarpine alleviated the subjective feeling of xerostomia, thirst, and the stress of fluid restriction in our 2-wk interventional trial period, the objective reduction in IDWG was minimal; it took 8 to 12 wk to demonstrate a significant reduction in IDWG.…”

Section: Discussionmentioning

confidence: 70%

“…We also found that hyperdipsic patients had extremely low baseline UWS (0.09 ml/min in the pilot study [ Figure 3]; 0.11 and 0.09 ml/min in each group, respectively, in the interventional trial [ Tables 4 and 6]), which was comparable with that of patients who received radiotherapy for head and neck tumors (0.113 ml/min) (39). Such low flow rates indicate massive salivary gland damage (approximate 75% of total salivary glandular tissue) (40). The results suggest a high prevalence of severe salivary gland dysfunction in HD patients, especially in hyperdipsic ones.…”

Section: Discussionmentioning

confidence: 75%

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Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Sung¹,

Kuo²,

Guo

et al. 2005

Journal of the American Society of Nephrology

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Decreased salivary flow rate causes xerostomia (symptoms of oral dryness) in patients who undergo hemodialysis (HD); however, whether it thus contributes to thirst and excess interdialytic weight gain (IDWG) remains undetermined. In the observational study, 3 mo of data of 90 stable HD patients were collected, and sensations of thirst and xerostomia were assessed by 100-mm visual analog scales (VAS). Multivariate analyses revealed that the VAS oral dryness score was an independent determinant for thirst, daily IDWG, and IDWG%. Unstimulated whole salivary flow rate (UWS) was measured in 45 participants and was negatively correlated with VAS oral dryness score (r ‫؍‬ ؊0.690, P < 0.001), daily IDWG (r ‫؍‬ ؊0.361, P ‫؍‬ 0.016), and daily IDWG% (r ‫؍‬ ؊0.302, P ‫؍‬ 0.045). In the interventional trial, the test drug was 5 mg of oral pilocarpine solution or placebo. Three types of interventions for reducing thirst (the urge to drink) and interdialytic weight gain (IDWG) are identified in the literature: dialysis protocol related (increasing frequency and varying sodium concentration) (6 -9), pharmaceutical (angiotensin-converting enzyme inhibitors [ACEI]) (10 -13), and dietetic interventions (10,14). However, no definite effectiveness could be shown (5), which might be explained by the fact that many of the underlying mechanisms for thirst and drinking behavior remain unknown.Known dipsogenic factors (factors that cause thirst and high fluid intake) in HD patients include high sodium intake, potassium depletion, increased blood urea, sugar and angiotensin II (Ang II) levels, and psychologic factors (2,3,5,10 -16). Another potential dipsogenic factor is the reduction of salivary flow rate. Recently, Brunstrom et al. (17) demonstrated that healthy volunteers consume more water and drink more frequently in the xerostomic state, which is induced by decreasing saliva in the oral cavity. Because xerostomia (symptoms of oral dryness), which is caused by the reduction of salivary flow, is prevalent among HD patients (18 -23), it is conceivable that the decreased salivary flow leads to thirst and excess IDWG. Some observational studies (24,25) have described an association between xerostomia and IDWG in HD patients; however, other known dipsogenic factors (e.g., blood urea, Ang II, sugar level) were not controlled in those studies. In addition, no interventional trial in the literature indexed by Medline has demonstrated the impact of the decreased salivary flow on IDWG. Therefore, whether the decreased salivary flow influences fluid intake in HD patients remains undetermined.We conducted a 3-mo prospective observational study followed by a trial of pilocarpine-a parasympathomimetic agent that has been shown effectively to increase salivary flow in radiation-induced xerostomia or Sjö gren syndrome (26 -29)-to determine whether the reduction of salivary flow contributes to exaggerated thirst and excess IDWG in HD patients and whether pilocarpine can alleviate it.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 75%

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Sung¹,

Kuo²,

Guo

et al. 2005

Journal of the American Society of Nephrology

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“…Pour un diagnostic précis et objectif de l'hyposialie, la méthode de Sreebny et Valdini [3] a été utilisée (Tab. I).…”

Section: éValuation De La Xérostomieunclassified

“…The orientation of new irradiation techniques of the head and neck to partially spare the salivary glands opens potential avenues of research and innovation for years to come. Tableau I. Modalités de la sialométrie [3]. Table I.…”

Section: éValuation De La Xérostomiementioning

confidence: 99%

Évaluation quantitative de la secrétion et du pouvoir tampon de la salive au cours de la radiothérapie des cancers des voies aéro-digestives supérieures au Sénégal

Lecor

Dia-Tine

Gaye

et al. 2013

Med Buccale Chir Buccale

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Résumé -Introduction. La radiothérapie, ou utilisation des rayonnements ionisants pour détruire le tissu cancé-reux, représente un des traitements de base pour les cancers des voies aéro-digestives (VADS). Elle doit détruire les cellules cancéreuses, tout en épargnant au mieux les organes ou tissus sains avoisinants. L'objectif de cette étude était d'évaluer les effets de la radiothérapie sur la fonction des glandes salivaires chez des patients traités pour un cancer des VADS. Matériel et méthodes. Une étude transversale descriptive a été réalisée sur 33 patients atteints d'un cancer des VADS et traités dans le service de radiothérapie de l'Hôpital Aristide Le Dantec de Dakar (Sénégal). La xérostomie, les débits salivaires non stimulé et stimulé ainsi que le pH salivaire ont été évalués, avant (T0), pendant (T), et un mois après la fin de la radiothérapie (T1). Les données ont été statistiquement analysées et exploitées en utilisant le logiciel SPSS. Résultats. L'âge des patients variait de 18 à 69 ans. Les patients ayant plus de 60 ans représentaient 45,5 % de la population étudiée. Les hommes constituaient la majorité de l'échantillon (54,5 %). Avant la radiothérapie, aucun signe de xérostomie n'a été observé chez les patients : tous avaient un débit salivaire normal. Pendant les séances de radiothérapie, tous les patients se sont plaints de sécheresse buccale : 19 avaient une hyposialie modérée et 13 avaient une hyposialie sévère. La xérostomie et l'hyposialie sévère ou modérée étaient statistiquement associées à la dose de radiothérapie (p < 0,005). À T0, tous les patients avaient un pH neutre. À T1, 28/33 patients avaient un pH salivaire inférieur à 5,5, évoquant une hyposialie. Conclusion. L'orientation vers de nouvelles techniques d'irradiation de la tête et du cou pour épargner partiellement les glandes salivaires ouvre des voies potentielles de recherche et d'innovation pour les années à venir.Abstract -Quantitative evaluation of the secretion and buffer capacity of saliva during radiotherapy for cancers of the upper aerodigestive tract in Senegal. Introduction. Radiation therapy is a common treatment for head and neck cancers, which uses ionizing radiation, to destroy cancerous tissue. Its purpose is the sterilization of cancer cells while sparing the best surrounding healthy tissue or organs. The objective of this study was to evaluate the effects of radiotherapy on salivary gland function in patients treated for head and neck cancer. Material and methods. A descriptive cross-sectional study was performed repeatedly in 33 patients with head and neck cancer and treated with radiotherapy department of the Aristide Le Dantec Hospital in Dakar (Senegal). Xerostomia, salivary flow unstimulated and stimulated saliva and pH were measured before (T0), during (T), and one month after radiotherapy (T1). The data were statistically analyzed and evaluated using the SPSS software. Results. The extreme age of patients was 18 and 69 years. People over 60 years old accounted for 45.5% of the population. Men constitut...

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“…Na maioria dos casos a xerostomia faz parte de um quadro sistêmico, podendo estar associada à sintomas extra-orais, como ressecamento da pele, vagina e olhos 9,12 . As causas mais comuns de xerostomia são: doenças autoimunes, destacando-se entre elas a Síndrome de Sjögren, o uso de medicamentos que diminuem o fluxo de saliva e a irradiação das glândulas salivares 2,5 .…”

Section: Introductionunclassified

Proposta de um método prático de sialometria

Pupo

Liquidato

et al. 2002

Rev. Bras. Otorrinolaringol.

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A proposal for a practical method of sialometry Resumo / SummaryIntrodução: A xerostomia é uma queixa subjetiva que pode ou não estar relacionada à diminuição da salivação. Deve, porém, ser sempre investigada, pois está freqüentemente associada a doenças sistêmicas, incluindo a síndrome de Sjögren. Apesar de não haver padrão universal que caracterize a hipossalivação, consideramos a sialometria importante para avaliação do tratamento, através da realização de exames seriados em um mesmo paciente. Analisando as técnicas de sialometria já descritas, optamos por adaptar e padronizar o método de Bolwig e Rafaelsen (1972) por considerá-lo o mais prático e fidedigno e visando à partir de então a sua utilização em larga escala. Objetivo: Avaliar os resultados de método submúltiplo de sialometria. Material e método: Foram avaliados 10 sujeitos, 5 sem sintomatologia de xerostomia que formam considerados compatíveis e 5 com xerostomia. Foram submetidos ao método de sialometria com algodão pré e pós estimulados. Os resultados foram comprovados. Resultados: Todos os pacientes apresentaram melhora da saliva mensurável pelo método pós-estimulado. Conclusões: O método utilizado se mostrou de fácil realização e fidedigno.

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Xerostomia. A neglected symptom

Cited by 141 publications

References 51 publications

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Decreased Salivary Flow Rate as a Dipsogenic Factor in Hemodialysis Patients

Évaluation quantitative de la secrétion et du pouvoir tampon de la salive au cours de la radiothérapie des cancers des voies aéro-digestives supérieures au Sénégal

Proposta de um método prático de sialometria

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