Guy Carpenter Editor Dry Mouth A Clinical Guide on Causes, E ects and Treatments Dry Mouth Guy Carpenter Editor Dry Mouth A Clinical Guide on Causes, Effects and Treatments Editor Guy Carpenter Department of Salivary Research Kings College London Dental Institute London UK ISBN 978-3-642-55153-6 ISBN 978-3-642-55154-3 (eBook) DOI 10.1007/978-3-642-55154-3 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2014953246 © Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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While the advice and information in this book are believed to be true and accurate at the date of publica- tion, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Contents Part I Background Topics 1 Introduction . 3 Guy Carpenter Part II Causes 2 Diseases Causing Oral Dryness. 7 Anne Marie Lynge Pedersen 3 Medication-Induced Dry Mouth. 33 Gordon B. Proctor 4 Cancer-/Cancer Treatment-Related Salivary Gland Dysfunction. 51 Andrew N. Davies Part III Effects 5 Oral Dryness, Dietary Intake, and Alterations in Taste. 69 Anja Weirsøe Dynesen 6 Xerostomia and the Oral Microfl ora . 81 Antoon J.M. Ligtenberg and Annica Almståhl 7 Subjective Aspects of Dry Mouth . 103 W. Murray Thomson Part IV Diagnosis 8 Clinical Scoring Scales for Assessment of Dry Mouth . 119 Stephen J. Challacombe, Samira M. Osailan, and Gordon B. Proctor 9 Imaging of Salivary Glands. 133 Bethan Louise Thomas v Part V Treatment 10 New Radiotherapy Techniques for the Prevention of Radiotherapy- Induced Xerostomia . 147 Thomas M. Richards and Christopher M. Nutting 11 Artifi cial Salivas: Why Are They Not More Useful? . 165 Guy Carpenter 12 The Benefi cial Effects of Regular Chewing . 175 Taichi Inui 13 Future Prevention and Treatment of Radiation-Induced Hyposalivation . 195 Robert P. Coppes and Tara A. van de Water Index . 213 Contributors Annica Almståhl , PhD, Dental Hygenist Department of Oral Microbiology and Immunology , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden Guy Carpenter Salivary Research , King’s College London Dental Institute , London , UK Stephen J. Challacombe , PhD, FRC(Path), FDSRCS, FMedSci Department of Oral Medicine , King’s College London, Guys and St Thomas’ Hospital , London , UK Robert P. Coppes , PhD Department of Radiation Oncology and Cell Biology , University Medical Center Groningen , Groningen , The Netherlands Andrew N. Davies , FRCP Palliative Medicine, Palliative Care , Royal Surrey County Hospital , Guildford, Surrey , UK Anja Weirsøe Dynesen , DDS, MSc. Human Nutrition, PhD Department of Odontology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen Nørrebro , Denmark Taichi Inui , PhD Department of R&D, Wm. Wrigley Jr. Company , Chicago , IL , USA Antoon J. M. Ligtenberg , PhD Department of Oral Biochemistry , Academic Centre for Dentistry Amsterdam , Amsterdam , The Netherlands Christopher M. Nutting , MBBS, BSc, MD, PhD, MRCP, FRCR Head and Neck Unit , The Royal Marsden Hospital , London , UK Samira M. Osailan , BDS, PhD Department of Oral Surgery , King Abdulaziz University , Jeddah , Saudi Arabia Anne Marie Lynge Pedersen , PhD, DDS Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark Gordon B. Proctor , BSc, PhD Mucosal and Salivary Biology Division , King’s College London Dental Institute , London , UK vii viii Contributors Thomas M. Richards , BSc, MBBS, MRCP, FRCR Head and Neck Unit , The Royal Marsden Hospital , London , UK Bethan Louise Thomas , BDS, BSc (Hons), PhD, DDMFR RCR Dental and Maxillofacial Radiology , Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust , London , UK Dental Radiology The Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust , London , UK W. Murray Thomson , BSc, BDS, MA, MComDent, PhD Dental Epidemiology and Public Health, Oral Sciences, Faculty of Dentistry , Sir John Walsh Research Institute, The University of Otago , Dunedin , Otago , New Zealand Tara A. van de Water , PhD Department of Radiation Oncology , University Medical Center Groningen , Groningen , The Netherlands P a r t I Background Topics Introduction 1 Guy Carpenter Abstract This book has come about following a symposium organized by the editor to encourage further research into dry mouth and its causes. The symposium was held at the Pan-European meeting of the IADR, and as a consequence, this book is largely based on contributions from Europeans. This may lead to variations compared to US-based books as there are differences in drug prescribing, irradiation protocols, and even diagnostic criteria that may influence the healthcare professional. Using even the most conservative of estimates, this book will still be relevant to the 30 million dry mouth sufferers in the European region. In trying to stimulate research in this fi eld, a more scientifi c than clinical approach has been taken although, of course, the two go hand in hand. Dry mouth is surprisingly a common symptom. For the entire population, it is esti- mated that 10–30 % may experience a troublesome dry mouth with a smaller per- centage suffering serious impact on their quality of life. Salivary secretion is an autonomic refl ex stimulated mainly by taste and chewing. The resting fl ow rate that maintains a hydrated mouth between meals is driven mostly by cortical activity. It is often the decline in the resting rate of salivary secretion that causes most people most problems – particularly at night when cortical activity will be at its lowest. As we discover in the initial chapters, dry mouth can develop from three main causes: by specifi c diseases of the salivary glands (Chap. 2 – Dr Pedersen), as a side effect of head and neck irradiation treatment for cancer (Chap. 4 – Dr Davies), or most commonly as a side effect of prescribed drugs (Chap. 3 – Prof Proctor). One G. Carpenter Salivary Research , King’s College London Dental Institute , Floor 17, Tower wing , London SE1 9RT , UK e-mail: [email protected] © Springer-Verlag Berlin Heidelberg 2015 3 G. Carpenter (ed.), Dry Mouth: A Clinical Guide on Causes, Effects and Treatments, DOI 10.1007/978-3-642-55154-3_1 4 G. Carpenter of the problems with dry mouth is that because it is subjectively reported, it is harder to diagnose than an objective measure, such as salivary fl ow rate. It should follow that dry mouth is caused by decreased saliva production, but this is not always the case. Due to a wide variation in fl ow rates of a normal population, there is little to separate a hyposalivator from an individual with a normal range of salivation. A recent development has been a clinical scoring system to aid general practitioners and healthcare workers to determine the severity of the dry mouth. The Challacombe scale is fully explained by its originator (Chap. 8 – Prof Challacombe) and set within the background of other scoring systems which are notoriously complicated and variable. Within the hospital setting, (Chap. 9 – Dr Thomas) explores some different imaging modalities and recent advances that can be used to identify glan- dular changes that would cause hyposecretion and therefore dry mouth. The rate of change from normal salivation to dry mouth often makes a differ- ence as to when subjects report dry mouth to a clinician. For example, subjects on medication that have xerostomia as a side effect (around 50 % of all drugs have this property) develop dry mouth relatively quickly and are more likely to report dry mouth than subjects with a slow change, perhaps caused by an autoim- mune condition such as Sjögren’s syndrome. To emphasize the point, children born with a lack of salivary glands (aplasia) often do not report dry mouth as a problem probably because they have never known what a normally hydrated mouth feels like. Dry mouth is widely perceived as a minor symptom except by those that suffer from it. This seemingly unjust situation probably occurs because it is not life threatening. Yet the impact on quality of life (Chap. 7 – Dr Thompson) is considerable often leaving patients socially isolated. This is because saliva affects all functions of the mouth and thus a lack of saliva will have an impact on eating, chewing and swallowing leading to a poorer diet (Chap. 5 – Dr Dynesen). Furthermore, the oral health of dry mouth patients is challenged by a change in the oral fl ora.