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The Effect of Antisialogogues in Dentistry a Systematic Review with a Focus on Bond Failure in Orthodontics

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The Effect of Antisialogogues in Dentistry a Systematic Review with a Focus on Bond Failure in Orthodontics CLINICAL PRACTICE CRITICAL REVIEW The effect of antisialogogues in dentistry A systematic review with a focus on bond failure in orthodontics Mette A.R. Kuijpers, DDS MSc; Arjan Vissink, DDS, MD, PhD; Yijin Ren, DDS, MSc, PhD; Anne M. Kuijpers-Jagtman, DDS, PhD Downloaded from uccessful bonding of ortho- dontic brackets is a neces- A D A sary part of orthodontic ABSTRACT J ✷ ✷ treatment. Bonding fail- ® Background. The authors conducted a literature C N ures can be caused by O O N review to assess whether there is a reduction of sali- I patient-related factors such as an T T S I A vation with the use of antisialogogues, whether the N U C U inability to open the mouth prop- I N D use of antisialogogues reduces the chair time needed A G E jada.ada.org erly, too much saliva and insuffi- R 1 for dental procedures and whether the use of antisialo- TICLE cient swallowing. Successful gogues reduces bond failure in orthodontics. bonding, however, is influenced pri- Methods. The authors conducted a search for original articles pub- marily by operator factors. A signifi- lished from 1950 to April 2010 by using the following databases: on July 31, 2010 cant factor in unsuccessful bonding Cochrane Collaboration, PubMed, Scopus, EMBASE and ISI Web of is moisture contamination, espe- Knowledge. They included in their review only human studies in which cially with oral fluid. Adequate antisialogogues were used. They validated methodological quality and moisture control is crucial for many evidence grade. dental procedures, from endodontic Results. Twenty-six studies met the inclusion criteria. Twenty-five of and restorative treatments to ortho- these studies were related to the effect of antisialogogues on salivation, dontics. Whereas teeth can be iso- and one study to bond failure. The authors found that there is evidence lated during endodontic and that antisialogogues work, inconclusive evidence that they reduce bond restorative treatment, in ortho- failure, and no evidence that they reduce chair time for dental dontic bonding a larger surface area procedures. needs to remain dry and free from Clinical Implications. Taking into account the systemic effects of saliva contamination. For example, antisialogogues, which exceed the time needed for bracket bonding, the brackets have to be placed on most use of antisialogogues for dental procedures in general is questionable. of the teeth in a dental arch. Mois- Key Words. Antisialogogues; anticholinergics; dental bonding; bond ture contamination is especially dif- failure; orthodontic appliances; dentistry. ficult to avoid in patients who pro- JADA 2010;141(8):954-965. duce a lot of saliva or do not swallow it in a timely manner. The materials used for bonding are Dr. Kuijpers is a postgraduate orthodontic resident, Division d’orthodontie, Faculté de Médécine Den- mainly those that will not bond (or taire, Université de Genève, 19, rue Barthélemy-Menn, 1211 Genève 4, Switzerland, e-mail “mette. [email protected]”. Address reprint requests to Dr. Kuijpers. that bond insufficiently) when the Dr. Vissink is a professor in Oral Medicine, Department of Oral and Maxillofacial Surgery, University etched surface is wet. Even though Medical Center Groningen and University of Groningen, Netherlands. there are hydrophilic materials on Dr. Ren is a professor and the chair, Department of Orthodontics, University Medical Center Groningen and University of Groningen, Netherlands. the market, the best bond strength Dr. Kuijpers-Jagtman is a professor and the chair, Department of Orthodontics and Oral Biology at the still is achieved only when the sur- Radboud University Nijmegen Medical Center, Netherlands. 954 JADA, Vol. 141 http://jada.ada.org August 2010 Copyright © 2010 American Dental Association. All rights reserved. Reprinted by permission. CLINICAL PRACTICE CRITICAL REVIEW TABLE 1 Indications and effects of parasympathicolytic agents with an antisialogogue action.* DRUG TYPE DOSE FOR THERAPEUTIC DRUG CONTRAINDICATIONS INTERACTIONS SALIVARY USES PROPERTIES REDUCTION (ADULT DOSE†) Atropine 0.4-1.6 Parkinson disease; Blocking/inhibiting Glaucoma, prostate Antihistamines, milligrams antidote for rapid acetylcholine action; effects are hypertrophy, myasthenia tricyclic mushroom poisoning dose dependent: low dose— gravis, obstructive antidepressants, and anticholinesterase depresses salivary, lachrymal, disease of monoamine intoxication; control bronchial and sweat secretion, gastrointestinal tract, oxidase of first-degree heart brachycardia; larger dose— asthma, allergy to inhibitors and block; ophthalmology: dilatation of pupils, photo- the drug and possibly phenothiazine mydriasis and phobia, tachycardia, flushing pregnancy tranquillizers cycloplegia skin, reduction in tone and mobility of gastrointestinal tract Scopolamine 0.3-0.6 mg Sedation and amnesia; and urinary retention motion sickness Sedative effect‡ Downloaded from Hyoscyamine 0.125-0.75 mg Control of bradycardia; reduction of salivation and the secretion of gastric acid during general anesthesia; antidote for rapid mushroom poisoning and anticholinesterase intoxication jada.ada.org Methantheline 50-100 mg Peptic ulcers Propantheline 15-30 mg Peptic ulcers Glycopyrrolate 1-2 mg Control of bradycardia; reduction of salivation and the on July 31, 2010 secretion of gastric acid during general anesthesia * Sources: Ponduri and colleagues,8 Rinchuse and colleagues,9 Rinchuse and Rinchuse,10 Sweetman and Martindale,11 Arzneimettel-kompendium der Schweiz,12 Sapkos13 and Yagiela.14,15 † Pediatric dosage is lower (per kilogram). ‡ Scopolamine. face of the tooth is dry during bonding.1-5 ence uncontrollable drooling.6,7 For a short, tem- Reductions in the time needed for dental pro- porary reduction of salivary flow, the remaining cedures, bonding appliances and procedures per- options are either prescribing an antisialogogue formed to maintain a dry working area can make (a drug that reduces, slows or prevents the flow of the bonding procedure less cumbersome for the saliva) or temporarily blocking the main excretory dental practitioner and the patient. Cotton rolls, ducts (for example, with cotton rolls). Antisialo- saliva ejectors, soft-tissue and tongue retractors, gogues have been used in dentistry for many and high vacuum suction can be used to help keep years to reduce salivary flow.8 They usually are the operating field as dry as possible when administered one hour before bonding takes place bonding brackets. However, if a dry operation or a submucosal injection is administered. The field is required to bond brackets successfully and most common antisialogogues are antimuscarinic to decrease the chair time for bonding, reducing and anticholinergic agents. Such agents have an or even stopping salivary flow may be an option. effect on the central nervous system, but also on There are several ways to block or reduce salivary flow, including the use of botulinum toxin and the ABBREVIATION KEY. ADA: American Dental injection and rerouting of the submandibular Association. GCF: Gingival crevicular fluid. IM: ducts. These techniques, however, primarily are Intramuscular. IV: Intravenous. RCT: Randomized long-lasting treatments for patients who experi- controlled trial. JADA, Vol. 141 http://jada.ada.org August 2010 955 Copyright © 2010 American Dental Association. All rights reserved. Reprinted by permission. CLINICAL PRACTICE CRITICAL REVIEW TABLE 2 as antisialogogues are Methodological quality grading criteria.* used, whether the use of antisialogogues reduces GRADE CRITERIA the chair time needed for (VALUE OF EVIDENCE) dental procedures, and A (High) All criteria should be met: whether the use of anti- drandomized controlled trial or prospective study with a well-defined control group sialogogues reduces the ddefined diagnosis and end points failure rate of bonded ddiagnostic reliability tests and reproducibility tests described orthodontic brackets. dblinded outcome measurements B (Moderate) All criteria should be met (if not, grade C): MATERIALS AND dcohort study or retrospective case series with a defined control or METHODS reference group ddefined diagnosis and end points Search strategy. To iden- ddiagnostic reliability tests and reproducibility tests described tify publications, we con- C (Low) One or more of the conditions below should be met: ducted a literature search dlarge attrition of the sample of articles published from dunclear diagnosis and end points 1950 to April 2010 by Downloaded from dpoorly defined patient material using the following data- * Source: Bondemark and colleagues.16 bases: ISI Web of Knowl- edge, the Cochrane Collab- the respiratory, gastrointestinal and cardiovas- oration, PubMed, Scopus and EMBASE. There cular systems.9-12 were no language limitations. Indications for medical use of parasympa- We conducted the literature search in each data- thicolytic agents with an antisialogogue action base using the following concatenated search terms: jada.ada.org are the symptomatic relief of gastrointestinal dis- bond OR bonding OR Dental Bonding (MeSH) OR orders, treatment of mydriasis (dilation of pupils) orthodontics (MeSH) OR orthodontic* OR dentistry and cycloplegia (paralysis of the ciliary muscle of OR dental care (MeSH) AND (saliva (MeSH) OR the eye, resulting in loss of adaptation of the salivation (MeSH) OR antisialogogue OR anti-sali- pupil). In addition, atropine sometimes is used to vation OR salivary OR hyposaliv* OR xerostomi*) on July 31, 2010 dry bronchial and salivary secretion during intu- AND (banthine
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