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CR Mouth
Dry mouth, or xerostomia, is a common disease state characterized primarily by a decrease in saliva production. As a result, patients also experience mouth ulcers, difficulty in swallowing and talking, and altered taste. Since saliva washes bacteria from the teeth, changes in salivary flow increase the numbers of bacteria that build up on the teeth. This leads to the formation of cavities, a common side effect of xerostomia. Additionally, xerostomia can cause other oral diseases such as mucositis.
The treatment of xerostomia follows four steps: (1) increasing existing saliva flow, (2) replacing lost secretions, (3) protecting the teeth from caries development, and (4) decreasing sugar intake. Saliva flow can be stimulated by cholinergic agonists or through the use of sugar-free candy or chewing gum. Lost secretions can be replaced with a saliva substitute. These substitutes are available commercially, but they can also be compounded. The formation of caries can be prevented with increased oral hygiene, and regular dental check-ups. Daily fluoride use is also recommended. Sugar consumption has a destructive effect on the teeth, which may already be suffering from an increased susceptibility to caries. The most common treatment for stimulation of salivary flow is pilocarpine, a cholinergic agonist that increases bodily secretions. Pilocarpine is commercially available in an oral solution, gel, and also as an oral tablet (Salagen?). In clinical studies, pilocarpine was shown to significantly decrease dryness of the mouth. A study comparing the results of pilocarpine and an artificial saliva (Saliva Orthana?) found that, although the artificial saliva was, as a spray, easier to use (spray vs. tablet), the pilocarpine produced greater relief of symptoms. The use of pilocarpine caused few side effects, the most significant of which was sweating.
Central Drugs recommends the following formulations for Chronic Dry Mouth:
Pilocarpine 10 mg/ml Oral Spray
Pilocarpine Capsules
Pilocarpine HCL 2mg Troche
Pilocarpine HCL 10 mg/ml Oral Solution |
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