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Drugs & Aging

, Volume 35, Issue 10, pp 877–885 | Cite as

Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management

  • Anna Greta BarbeEmail author
Therapy in Practice

Abstract

Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient’s situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being.

Notes

Compliance with Ethical Standards

Funding

No funding was received for the preparation of this manuscript.

Conflict of interest

AG Barbe has no conflicts of interest.

References

  1. 1.
    Ezeh AC, Bongaarts J, Mberu B. Global population trends and policy options. Lancet. 2012;380(9837):142–8.  https://doi.org/10.1016/S0140-6736(12)60696-5.CrossRefPubMedGoogle Scholar
  2. 2.
    Villa A, Wolff A, Aframian D, Vissink A, Ekström J, Proctor G, et al. World Workshop on Oral Medicine VI: a systematic review of medication-induced salivary gland dysfunction: prevalence, diagnosis, and treatment. Clin Oral Investig. 2015;19(7):1563–80.  https://doi.org/10.1007/s00784-015-1488-2.CrossRefPubMedGoogle Scholar
  3. 3.
    Turner MD. Hyposalivation and xerostomia: etiology, complications, and medical management. Dent Clin N Am. 2016;60(2):435–43.  https://doi.org/10.1016/j.cden.2015.11.003.CrossRefPubMedGoogle Scholar
  4. 4.
    Potulska A, Friedman A. Controlling sialorrhoea: a review of available treatment options. Expert Opin Pharmacother. 2005;6(9):1551–4.  https://doi.org/10.1517/14656566.6.9.1551.CrossRefPubMedGoogle Scholar
  5. 5.
    Sreebny L. Saliva in health and disease: an appraisal and update. Int Dent J. 2000;50(3):140–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003;134(1):61–9 (quiz 118–119).CrossRefPubMedGoogle Scholar
  7. 7.
    Watanabe S, Dawes C. The effects of different foods and concentrations of citric acid on the flow rate of whole saliva in man. Arch Oral Biol. 1988;33(1):1–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Pedersen AM, Bardow A, Jensen SB, Nauntofte B. Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion. Oral Dis. 2002;8(3):117–29.CrossRefPubMedGoogle Scholar
  9. 9.
    Heintze U, Birkhed D, Bjorn H. Secretion rate and buffer effect of resting and stimulated whole saliva as a function of age and sex. Swed Dent J. 1983;7(6):227–38.PubMedGoogle Scholar
  10. 10.
    Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38(3):236–40.  https://doi.org/10.1159/000077760.CrossRefPubMedGoogle Scholar
  11. 11.
    van der Putten GJ, Brand HS, Schols JM, de Baat C. The diagnostic suitability of a xerostomia questionnaire and the association between xerostomia, hyposalivation and medication use in a group of nursing home residents. Clin Oral Investig. 2011;15(2):185–92.  https://doi.org/10.1007/s00784-010-0382-1.CrossRefPubMedGoogle Scholar
  12. 12.
    Atkinson JC, Wu AJ. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc. 1994;125(4):409–16.CrossRefPubMedGoogle Scholar
  13. 13.
    Fischer D, Ship JA. The effect of dehydration on parotid salivary gland function. Spec Care Dent. 1997;17(2):58–64.CrossRefGoogle Scholar
  14. 14.
    Murray Thomson W, Chalmers JM, John Spencer A, Slade GD, Carter KD. A longitudinal study of medication exposure and xerostomia among older people. Gerodontology. 2006;23(4):205–13.  https://doi.org/10.1111/j.1741-2358.2006.00135.x.CrossRefPubMedGoogle Scholar
  15. 15.
    Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM. Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2010;38(5):422–35.  https://doi.org/10.1111/j.1600-0528.2010.00554.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol. 2011;39(3):276–88.  https://doi.org/10.1111/j.1600-0528.2010.00588.x.CrossRefPubMedGoogle Scholar
  17. 17.
    Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(1):52–60.  https://doi.org/10.1016/j.oooo.2011.11.014.CrossRefPubMedGoogle Scholar
  18. 18.
    Nederfors T, Isaksson R, Mornstad H, Dahlof C. Prevalence of perceived symptoms of dry mouth in an adult Swedish population–relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol. 1997;25(3):211–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Villa A, Polimeni A, Strohmenger L, Cicciu D, Gherlone E, Abati S. Dental patients’ self-reports of xerostomia and associated risk factors. J Am Dent Assoc. 2011;142(7):811–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Gil-Montoya JA, Barrios R, Sanchez-Lara I, Carnero-Pardo C, Fornieles-Rubio F, Montes J, et al. Prevalence of drug-induced xerostomia in older adults with cognitive impairment or dementia: an observational study. Drugs Aging. 2016;33(8):611–8.  https://doi.org/10.1007/s40266-016-0386-x.CrossRefPubMedGoogle Scholar
  21. 21.
    Barbe AG, Heinzler A, Derman S, Hellmich M, Timmermann L, Noack MJ. Hyposalivation and xerostomia among Parkinson’s disease patients and its impact on quality of life. Oral Dis. 2017;23(4):464–70.  https://doi.org/10.1111/odi.12622.CrossRefPubMedGoogle Scholar
  22. 22.
    Habbab KM, Moles DR, Porter SR. Potential oral manifestations of cardiovascular drugs. Oral Dis. 2010;16(8):769–73.  https://doi.org/10.1111/j.1601-0825.2010.01686.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Nonzee V, Manopatanakul S, Khovidhunkit SO. Xerostomia, hyposalivation and oral microbiota in patients using antihypertensive medications. J Med Assoc Thai. 2012;95(1):96–104.PubMedGoogle Scholar
  24. 24.
    Hunter KD, Wilson WS. The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Arch Oral Biol. 1995;40(11):983–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth. Gerodontology. 1986;5(2):75–99.CrossRefPubMedGoogle Scholar
  26. 26.
    Wolff A, Joshi RK, Ekström J, Aframian D, Pedersen AM, Proctor G, et al. A guide to medications inducing salivary gland dysfunction, xerostomia, and subjective sialorrhea: a systematic review sponsored by the world workshop on oral medicine VI. Drugs R D. 2017;17(1):1–28.  https://doi.org/10.1007/s40268-016-0153-9.CrossRefPubMedGoogle Scholar
  27. 27.
    Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867–78.  https://doi.org/10.1001/jama.2008.892.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Aliko A, Wolff A, Dawes C, Aframian D, Proctor G, Ekström J, et al. World workshop on oral medicine VI: clinical implications of medication-induced salivary gland dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(2):185–206.  https://doi.org/10.1016/j.oooo.2014.10.027.CrossRefPubMedGoogle Scholar
  29. 29.
    Villa A, Abati S. Risk factors and symptoms associated with xerostomia: a cross-sectional study. Aust Dent J. 2011;56(3):290–5.  https://doi.org/10.1111/j.1834-7819.2011.01347.x.CrossRefPubMedGoogle Scholar
  30. 30.
    Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904.  https://doi.org/10.1111/j.1532-5415.2012.03942.x.CrossRefPubMedGoogle Scholar
  31. 31.
    van der Putten GJ, de Baat C, De Visschere L, Schols J. Poor oral health, a potential new geriatric syndrome. Gerodontology. 2014;31(Suppl 1):17–24.  https://doi.org/10.1111/ger.12086.CrossRefPubMedGoogle Scholar
  32. 32.
    Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing—consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl 18):S135–44.  https://doi.org/10.1111/jcpe.12681.CrossRefPubMedGoogle Scholar
  33. 33.
    Murray Thomson W. Epidemiology of oral health conditions in older people. Gerodontology. 2014;31(Suppl 1):9–16.  https://doi.org/10.1111/ger.12085.CrossRefGoogle Scholar
  34. 34.
    Hayes M, Da Mata C, Cole M, McKenna G, Burke F, Allen PF. Risk indicators associated with root caries in independently living older adults. J Dent. 2016;51:8–14.  https://doi.org/10.1016/j.jdent.2016.05.006.CrossRefPubMedGoogle Scholar
  35. 35.
    Ikebe K, Matsuda K, Kagawa R, Enoki K, Yoshida M, Maeda Y, et al. Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol. 2011;56(10):991–6.  https://doi.org/10.1016/j.archoralbio.2011.03.019.CrossRefPubMedGoogle Scholar
  36. 36.
    Semba RD, Blaum CS, Bartali B, Xue QL, Ricks MO, Guralnik JM, et al. Denture use, malnutrition, frailty, and mortality among older women living in the community. J Nutr Health Aging. 2006;10(2):161–7.PubMedGoogle Scholar
  37. 37.
    Hatch JP, Shinkai RS, Sakai S, Rugh JD, Paunovich ED. Determinants of masticatory performance in dentate adults. Arch Oral Biol. 2001;46(7):641–8.CrossRefPubMedGoogle Scholar
  38. 38.
    N’Gom PI, Woda A. Influence of impaired mastication on nutrition. J Prosthet Dent. 2002;87(6):667–73.CrossRefPubMedGoogle Scholar
  39. 39.
    Samnieng P, Ueno M, Shinada K, Zaitsu T, Wright FA, Kawaguchi Y. Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai. Community Dent Health. 2012;29(1):117–23.PubMedGoogle Scholar
  40. 40.
    Rogus-Pulia NM, Gangnon R, Kind A, Connor NP, Asthana S. A pilot study of perceived mouth dryness, perceived swallowing effort, and saliva substitute effects in healthy adults across the age range. Dysphagia. 2017.  https://doi.org/10.1007/s00455-017-9846-7.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Brochier CW, Hugo FN, Rech RS, Baumgarten A, Hilgert JB. Influence of dental factors on oropharyngeal dysphagia among recipients of long-term care. Gerodontology. 2018.  https://doi.org/10.1111/ger.12345.CrossRefPubMedGoogle Scholar
  42. 42.
    Kikutani T, Yoshida M, Enoki H, Yamashita Y, Akifusa S, Shimazaki Y, et al. Relationship between nutrition status and dental occlusion in community-dwelling frail elderly people. Geriatr Gerontol Int. 2013;13(1):50–4.  https://doi.org/10.1111/j.1447-0594.2012.00855.x.CrossRefPubMedGoogle Scholar
  43. 43.
    van der Maarel-Wierink CD, Meijers JM, De Visschere LM, de Baat C, Halfens RJ, Schols JM. Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement. Int J Nurs Stud. 2014;51(6):875–81.  https://doi.org/10.1016/j.ijnurstu.2013.10.016.CrossRefPubMedGoogle Scholar
  44. 44.
    van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res. 2011;90(12):1398–404.  https://doi.org/10.1177/0022034511422909.CrossRefPubMedGoogle Scholar
  45. 45.
    Nadig SD, Ashwathappa DT, Manjunath M, Krishna S, Annaji AG, Shivaprakash PK. A relationship between salivary flow rates and Candida counts in patients with xerostomia. J Oral Maxillofac Pathol. 2017;21(2):316.  https://doi.org/10.4103/jomfp.JOMFP_231_16.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Adachi M, Ishihara K, Abe S, Okuda K. Professional oral health care by dental hygienists reduced respiratory infections in elderly persons requiring nursing care. Int J Dent Hyg. 2007;5(2):69–74.  https://doi.org/10.1111/j.1601-5037.2007.00233.x.CrossRefPubMedGoogle Scholar
  47. 47.
    Pound MW, Drew RH, Perfect JR. Recent advances in the epidemiology, prevention, diagnosis, and treatment of fungal pneumonia. Curr Opin Infect Dis. 2002;15(2):183–94.CrossRefPubMedGoogle Scholar
  48. 48.
    Barbe AG, Deutscher DHC, Derman SHM, Hellmich M, Noack MJ. Subjective and objective halitosis among patients with Parkinson’s disease. Gerodontology. 2017.  https://doi.org/10.1111/ger.12293.CrossRefPubMedGoogle Scholar
  49. 49.
    Koshimune S, Awano S, Gohara K, Kurihara E, Ansai T, Takehara T. Low salivary flow and volatile sulfur compounds in mouth air. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(1):38–41.  https://doi.org/10.1067/moe.2003.S1079210403001628.CrossRefPubMedGoogle Scholar
  50. 50.
    Tod AM, Kennedy F, Stocks AJ, McDonnell A, Ramaswamy B, Wood B, et al. Good-quality social care for people with Parkinson’s disease: a qualitative study. BMJ Open. 2016;6(2):e006813.  https://doi.org/10.1136/bmjopen-2014-006813.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Bergdahl M. Salivary flow and oral complaints in adult dental patients. Community Dent Oral Epidemiol. 2000;28(1):59–66.CrossRefPubMedGoogle Scholar
  52. 52.
    Pajukoski H, Meurman JH, Halonen P, Sulkava R. Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(6):641–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Acharya S, Hagglin C, Jontell M, Wenneberg B, Ekström J, Carlen A. Saliva on the oral mucosa and whole saliva in women diagnosed with burning mouth syndrome. Oral Dis. 2018.  https://doi.org/10.1111/odi.12918.CrossRefPubMedGoogle Scholar
  54. 54.
    Hoffman HJ, Cruickshanks KJ, Davis B. Perspectives on population-based epidemiological studies of olfactory and taste impairment. Ann N Y Acad Sci. 2009;1170:514–30.  https://doi.org/10.1111/j.1749-6632.2009.04597.x.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Boyce JM, Shone GR. Effects of ageing on smell and taste. Postgrad Med J. 2006;82(966):239–41.  https://doi.org/10.1136/pgmj.2005.039453.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Lovat LB. Age related changes in gut physiology and nutritional status. Gut. 1996;38(3):306–9.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Rawal S, Hoffman HJ, Bainbridge KE, Huedo-Medina TB, Duffy VB. Prevalence and risk factors of self-reported smell and taste alterations: results from the 2011–2012 US National Health and Nutrition Examination Survey (NHANES). Chem Senses. 2016;41(1):69–76.  https://doi.org/10.1093/chemse/bjv057.CrossRefPubMedGoogle Scholar
  58. 58.
    Mata CD, Allen F. Time for routine use of minimum intervention dentistry in the elderly population. Gerodontology. 2015;32(1):1–2.  https://doi.org/10.1111/ger.12178.CrossRefPubMedGoogle Scholar
  59. 59.
    Barbe AG, Bock N, Derman SH, Felsch M, Timmermann L, Noack MJ. Self-assessment of oral health, dental health care and oral health-related quality of life among Parkinson’s disease patients. Gerodontology. 2017;34(1):135–43.  https://doi.org/10.1111/ger.12237.CrossRefPubMedGoogle Scholar
  60. 60.
    Nagler RM. Salivary glands and the aging process: mechanistic aspects, health-status and medicinal-efficacy monitoring. Biogerontology. 2004;5(4):223–33.  https://doi.org/10.1023/B:BGEN.0000038023.36727.50.CrossRefPubMedGoogle Scholar
  61. 61.
    Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc. 1987;115(4):581–4.CrossRefPubMedGoogle Scholar
  62. 62.
    Thomson WM, van der Putten GJ, de Baat C, Ikebe K, Matsuda K, Enoki K, et al. Shortening the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(3):322–7.  https://doi.org/10.1016/j.tripleo.2011.03.024.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Radfar L, Masood F. Review of sialadenosis for clinicians. J Okla Dent Assoc. 2013;104(5):32–3.PubMedGoogle Scholar
  64. 64.
    Osailan S, Pramanik R, Shirodaria S, Challacombe SJ, Proctor GB. Investigating the relationship between hyposalivation and mucosal wetness. Oral Dis. 2011;17(1):109–14.  https://doi.org/10.1111/j.1601-0825.2010.01715.x.CrossRefPubMedGoogle Scholar
  65. 65.
    Krief G, Deutsch O, Zaks B, Wong DT, Aframian DJ, Palmon A. Comparison of diverse affinity based high-abundance protein depletion strategies for improved bio-marker discovery in oral fluids. J Proteom. 2012;75(13):4165–75.  https://doi.org/10.1016/j.jprot.2012.05.012.CrossRefGoogle Scholar
  66. 66.
    Wu AJ, Ship JA. A characterization of major salivary gland flow rates in the presence of medications and systemic diseases. Oral Surg Oral Med Oral Pathol. 1993;76(3):301–6.CrossRefPubMedGoogle Scholar
  67. 67.
    Nederfors T. Xerostomia and hyposalivation. Adv Dent Res. 2000;14:48–56.CrossRefPubMedGoogle Scholar
  68. 68.
    Sreebny LM, Valdini A. Xerostomia. A neglected symptom. Arch Intern Med. 1987;147(7):1333–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Kleiner SM. Water: an essential but overlooked nutrient. J Am Diet Assoc. 1999;99(2):200–6.  https://doi.org/10.1016/S0002-8223(99)00048-6.CrossRefPubMedGoogle Scholar
  70. 70.
    DGAZ. Gesund im Alter—auch im Mund; 2018. https://dgaz.org/2016-06-22-13-34-30/informationsmaterialien-pflege/gesund-im-mund-auch-im-alter. Accessed 24 Aug 2018.
  71. 71.
    Visvanathan V, Nix P. Managing the patient presenting with xerostomia: a review. Int J Clin Pract. 2010;64(3):404–7.  https://doi.org/10.1111/j.1742-1241.2009.02132.x.CrossRefPubMedGoogle Scholar
  72. 72.
    Jordan RA, Bodechtel C, Hertrampf K, Hoffmann T, Kocher T, Nitschke I, et al. The Fifth German Oral Health Study (Funfte Deutsche Mundgesundheitsstudie, DMS V)—rationale, design, and methods. BMC Oral Health. 2014;14:161.  https://doi.org/10.1186/1472-6831-14-161.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Hahnel S, Behr M, Handel G, Burgers R. Saliva substitutes for the treatment of radiation-induced xerostomia—a review. Support Care Cancer. 2009;17(11):1331–43.  https://doi.org/10.1007/s00520-009-0671-x.CrossRefPubMedGoogle Scholar
  74. 74.
    Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R. Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011;12:CD008934.  https://doi.org/10.1002/14651858.cd008934.pub2.CrossRefGoogle Scholar
  75. 75.
    van der Reijden WA, Vissink A, Veerman EC, Amerongen AV. Treatment of oral dryness related complaints (xerostomia) in Sjogren’s syndrome. Ann Rheum Dis. 1999;58(8):465–74.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Barbe AG, Schmidt-Park Y, Hamacher S, Derman SH, Noack MJ. Efficacy of GUM(R) Hydral versus Biotene(R) Oralbalance mouthwashes plus gels on symptoms of medication-induced xerostomia: a randomized, double-blind, crossover study. Clin Oral Investig. 2017.  https://doi.org/10.1007/s00784-017-2096-0.CrossRefPubMedGoogle Scholar
  77. 77.
    Alajbeg I, Falcao DP, Tran SD, Martin-Granizo R, Lafaurie GI, Matranga D, et al. Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(6):773–81.  https://doi.org/10.1016/j.oooo.2012.01.012.CrossRefPubMedGoogle Scholar
  78. 78.
    Strietzel FP, Lafaurie GI, Mendoza GR, Alajbeg I, Pejda S, Vuletic L, et al. Efficacy and safety of an intraoral electrostimulation device for xerostomia relief: a multicenter, randomized trial. Arthritis Rheum. 2011;63(1):180–90.  https://doi.org/10.1002/art.27766.CrossRefPubMedGoogle Scholar
  79. 79.
    Khosravani N, Birkhed D, Ekström J. The cholinesterase inhibitor physostigmine for the local treatment of dry mouth: a randomized study. Eur J Oral Sci. 2009;117(3):209–17.  https://doi.org/10.1111/j.1600-0722.2009.00632.x.CrossRefPubMedGoogle Scholar
  80. 80.
    Iwabuchi Y, Katagiri M, Masuhara T. Salivary secretion and histopathological effects after single administration of the muscarinic agonist SNI-2011 in MRL/lpr mice. Arch Int Pharmacodyn Ther. 1994;328(3):315–25.PubMedGoogle Scholar
  81. 81.
    Wiseman LR, Faulds D. Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs. 1995;49(1):143–55.CrossRefPubMedGoogle Scholar
  82. 82.
    Takakura AC, Moreira TS, Laitano SC, De Luca Junior LA, Renzi A, Menani JV. Central muscarinic receptors signal pilocarpine-induced salivation. J Dent Res. 2003;82(12):993–7.  https://doi.org/10.1177/154405910308201211.CrossRefPubMedGoogle Scholar
  83. 83.
    Schneyer CA, Hall HD. Autonomic pathways involved in a sympathetic-like action of pilocarpine on salivary composition. Proc Soc Exp Biol Med. 1966;121(1):96–100.CrossRefPubMedGoogle Scholar
  84. 84.
    Braga MA, Tarzia O, Bergamaschi CC, Santos FA, Andrade ED, Groppo FC. Comparison of the effects of pilocarpine and cevimeline on salivary flow. Int J Dent Hyg. 2009;7(2):126–30.  https://doi.org/10.1111/j.1601-5037.2008.00326.x.CrossRefPubMedGoogle Scholar
  85. 85.
    Navazesh M. Methods for collecting saliva. Ann N Y Acad Sci. 1993;694:72–7.CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Operative Dentistry and Periodontology, Centre of Dental MedicineUniversity of CologneCologneGermany

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