DOCSLIB.ORG

Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia International Journal of Molecular Sciences Review Artificial Saliva: Challenges and Future Perspectives for the Treatment of Xerostomia Dawid Łysik 1 , Katarzyna Niemirowicz-Laskowska 2, Robert Bucki 3 , Gra˙zynaTokajuk 4 and Joanna Mystkowska 1,* 1 Department of Materials Engineering and Production, Bialystok University of Technology, Wiejska 45C, 15-351 Bialystok, Poland 2 Department of Experimental Pharmacology, Medical University of Bialystok, Szpitalna 37, 15-295 Bialystok, Poland 3 Department of Microbiological and Nanobiomedical Engineering, Medical University of Bialystok, Mickiewicza 2C, 15-222 Bialystok, Poland 4 Department of Integrated Dentistry, Medical University of Bialystok, M. Sklodowskiej-Curie 24a, 15-276 Bialystok, Poland * Correspondence: [email protected]; Tel.: +48-571-443-083 Received: 23 May 2019; Accepted: 28 June 2019; Published: 29 June 2019 Abstract: The chronic sensation of a dry mouth is a disease condition called xerostomia and affects a large part of the population. Xerostomia is associated with decreased secretion, or more often, qualitative changes in saliva proteins and immunoglobulin concentrations that develop as a result of salivary gland dysfunction. Several reasons causing dry mouth were described, and usually, they include taking medications, diseases or radiotherapy. In some situations, when it is difficult to use salivary stimulants or salivary gland damage is irreversible, the only option might seem to be saliva substitutes. The paper presents the most important aspects considering saliva preparations. The rheological and lubricating properties and the reconstruction of the complex saliva structure has been the main purpose of research. The biological properties of saliva preparations were also widely discussed. As part of the work, the antimicrobial effect of three commercial saliva preparations was tested. Finally, inadequate antimicrobial properties against the strains isolated from the oral cavity were demonstrated. The development of salivary substitutes, in particular, the improvement of antimicrobial properties, can be achieved using nanotechnology, including drug delivery systems containing nanocarriers. Keywords: artificial saliva; xerostomia; rheology 1. Introduction Most people who have been upset, anxious or under stress have experienced a dry mouth. This is a subjective feeling of reduced secretion of saliva in the mouth, associated not only with its amount but rather regarding quantitative and qualitative changes in saliva composition. The feeling of dry and cracked lips, sticky and viscous saliva, altered taste and smell, difficulty talking, problems with chewing, tooth caries and their increased erosion, heartburn and reflux exacerbation, oesophagitis, burning tongue, festering and irritating mucous membrane infections are the consequences of salivary gland dysfunction [1]. Living with reduced saliva secretion is not only difficult but also leads to serious health problems such as xerostomia. In such situations, therapeutic methods for stimulation of saliva secretion are used. However, in some cases, salivary gland damage requires continuous use of saliva substitutes [2–4]. The main purpose of this review was an analysis of the most important aspects concerning saliva preparations due to its microbial, rheological and lubrication properties. Int. J. Mol. Sci. 2019, 20, 3199; doi:10.3390/ijms20133199 www.mdpi.com/journal/ijms Int. J. Mol. Sci. 2019, 20, 3199 2 of 17 Int. J. Mol. Sci. 2019, 20, x 2 of 17 2. Xerostomia:2. Xerostomia: Etiology Etiology of of Salivary Salivary Glands Glands Dysfunctions Dysfunctions TheThe chronic chronic sensation sensation of dryof dry mouth mouth leads leads to ato disease a disease entity entity called called xerostomia. xerostomia. The The number number of of undesirableundesirable factors factors aff affectingecting salivary salivary glands, glands, people people su ffsufferingering from from stress, stress, exposed exposed to to many many diseases, diseases, andand aging aging can can make make xerostomia xerostomia a globala global problem. problem. In In prospective prospective population population studies studies [5 ]([5]n (=n 2942,= 2942, adultsadults aged aged 20–59), 20–59), it wasit was shown shown that that regular regular xerostomia xerostomia symptoms symptoms concern concern about about 3.8%, 3.8%, while while irregular,irregular, 12.2% 12.2% of theof the population. population. In In studies studies of of older older people people [6 ]([6]n (=n 600,= 600, over over 70 70 years years of of age) age) in in Japan,Japan, the the hyposalivation hyposalivation problem problem was was observed observed in in 37.3% 37.3% of of patients patients (27.8% (27.8% in in men men and and 47.3% 47.3% in in women).women). In In other other studies, studies, Cardoso Cardoso et et al. al. [7 ][7] found foun thatd that 45.5% 45.5% of disease-freeof disease-free oropharyngeal oropharyngeal cancer cancer survivorssurvivors (n (=n 906)= 906) reported reported problems problems with with dry dry mouth. mouth.Rising Rising interestinterest inin xerostomiaxerostomia andand methods of ofits treatment,treatment, especiallyespecially usingusing artificialartificial saliva,saliva, is is currently currently observed. observed. This This is is clearly clearly visible visible in in the the bibliometricbibliometric data data (Figure (Figure1), according1), according to the to the Web Web of Science of Science database. database. The The term term “xerostomia” "xerostomia" inyears in years 2000–20182000–2018 was was found found in 3671in 3671 publications, publications, which which were were quoted quoted more more than than 70,000 70,000 times, times, while while the the term term “artificial"artificial saliva” saliva" related related to 2757to 2757 publications, publications, which which were were cited cited about about 37,000 37,000 times. times. (a) (b) FigureFigure 1. A1. number A number of articles of articles andcitations and citations regarding regarding the terms: the (aterms:) “xerostomia”, (a) “xerostomia”, (b) “artificial (b) “artificial saliva” accordingsaliva” toaccording the Web to of the Science Web database.of Science database. Interestingly,Interestingly, patients patients complaining complaining of dry of mouth dry sometimesmouth sometimes do not show do anynot objectiveshow any symptoms objective ofsymptoms hyposalivation. of hyposalivation. The diagnosis The of diagnosis xerostomia ofrequires xerostomia a detailed requires medical a detailed history, medical which history, includes which a detailedincludesdescription a detailed ofdescription the symptoms of the (patients symptoms most (patients often complain most often of dry complain mouth, of di ffidryculty mouth, in swallowingdifficulty andin swallowing speaking, and do not speaking, tolerate do acute not andtolerate acidic acute taste), and diseases acidic taste), and thediseases use of and medicines. the use of Nevertheless,medicines. theNevertheless, measurement the of salivarymeasurement flow is theof basissalivary for theflow diagnosis is the ofbasis xerostomia. for the However,diagnosis it of canxerostomia. be a problem However, to determine it can the be amounta problem of salivato determine that is indicative the amount of theof saliva dysfunction that is ofindicative the salivary of the glandsdysfunction [8]. of the salivary glands [8]. TheThe term term saliva, saliva, by default,by default, refers refers to the to the terms terms "whole "whole saliva" saliva" or "mixed or "mixed saliva", saliva", which which are used are used to describeto describe the combined the combined fluids presentfluids present in the oral in the cavity. oral Measurement cavity. Measurement of its quantity of its isquantity a good methodis a good to determinemethod to determine the degree the of drynessdegree of of dryness the mouth, of the while mouth, the while measurement the measurement of salivary of salivary secretion secretion from specificfrom salivaryspecific salivary gland allows gland determination allows determination of its individual of its individual efficiency efficiency [1]. [1]. SalivaSaliva can can be be classified classified as as resting resting (unstimulated) (unstimulated) and and stimulated. stimulated. AA mainmain protectiveprotective function of oforal tissues is is ascribed ascribed to to resting resting saliva saliva since since it it is is present present in in the the oral oral cavity cavity for for about about 14 14hours h a day.a day. StimulatedStimulated saliva saliva is secreted is secreted in the in mouththe mouth for about for about 2 h a day,2 hours and itsa day, role isand mainly its role related is mainly to alimentary related to functions.alimentary The functions. average daily The flow average of whole daily saliva flow varies of whole in health saliva between varies 1in and health 1.5 L. between The unstimulated 1 and 1.5 L. salivaThe flowunstimulated rate is in thesaliva range flow of rate 0.3–0.7 is in mL the per range minute. of 0.3–0.7 Mechanical, mL per chemical minute. orMechanical, psychoneurological chemical or stimulationpsychoneurological increases thestimulation flow rate increases to 1.5–2 the mL flow per minuterate to 1.5–2 [1]. HyposalivationmL per minute [1]. is observedHyposalivation when is restingobserved salivary when flow resting rate decreases salivary flow below rate 0.1 decreas mL peres minute below and0.1 mL stimulated per minute saliva and below stimulated 0.5–0.7 mLsaliva perbelow minute 0.5–0.7 [1,9,10 mL]. Theper salivaryminute [1,9,10].
Load more

Recommended publications
  • Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment
    ISSN: 2572-4193 Philipsen. J Otolaryngol Rhinol 2019, 5:063 DOI: 10.23937/2572-4193.1510063 Volume 5 | Issue 3 Journal of Open Access Otolaryngology and Rhinology REVIEW ARTICLE Dysphagia - Pathophysiology of Swallowing Dysfunction, Symptoms, Diagnosis and Treatment * Bahareh Bakhshaie Philipsen Check for updates Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Denmark *Corresponding author: Dr. Bahareh Bakhshaie Philipsen, Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark, Tel: +45 31329298, Fax: +45 66192615 the vocal folds adduct to prevent aspiration. The esoph- Abstract ageal phase is completely involuntary and consists of Difficulty swallowing is called dysphagia. There is a wide peristaltic waves [2]. range of potential causes of dysphagia. Because there are many reasons why dysphagia can occur, treatment Dysphagia is classified into the following major depends on the underlying cause. Thorough examination types: is important, and implementation of a treatment strategy should be based on evaluation by a multidisciplinary team. 1. Oropharyngeal dysphagia In this article, we will describe the mechanism of swallowing, the pathophysiology of swallowing dysfunction and different 2. Esophageal dysphagia causes of dysphagia, along with signs and symptoms asso- 3. Complex neuromuscular disorders ciated with dysphagia, diagnosis, and potential treatments. 4. Functional dysphagia Keywords Pathophysiology Dysphagia, Deglutition, Deglutition disorders, FEES, Video- fluoroscopy Swallowing is a complex process and many distur- bances in oropharyngeal and esophageal physiology including neurologic deficits, obstruction, fibrosis, struc- Introduction tural damage or congenital and developmental condi- Dysphagia is derived from the Greek phagein, means tions can result in dysphagia. Breathing difficulties can “to eat” [1].
    [Show full text]
  • XEROSTOMIA (Dry Mouth)
    XEROSTOMIA (Dry Mouth) What is xerostomia? Are you constantly thirsty? Do you have difficulty swallowing certain foods? Is your saliva thick, foamy, or dry? If you answered “yes” to any of these questions, you may have xerostomia. Xerostomia is a condi- tion characterized by a decrease in saliva production. This happens when the salivary glands stop working or do not function properly, leaving the mouth dry and uncomfortable. Why is xerostomia a problem? Saliva is important because it helps with the digestion process, prevents tooth decay and gingivitis, and protects and lubricates the tongue and other delicate tissues inside the mouth. Saliva also plays an impor- tant role in helping us taste the foods we eat. Dry mouth sufferers are more likely to develop tooth decay, fungal infection of the mouth, denture sores, gum disease, bad breath, and general irritation and discomfort of the oral tissues. What causes dry mouth? Prescription and over-the-counter medications are the most common cause of dry mouth, contributing to more than 80% of all cases. There are, however, many more factors that can play a role in this condition. Let’s explore all potential factors below: Medications – there are over 350 medications that can contribute to dry mouth • Antiseizure (epilepsy) or Antiparkinsonian • Diuretics (blood pressure): Dyazide, Lasix •Antihypertensives (blood pressure): Atenolol, Tenormin, Inderal • Bronchodilators: Albuterol, Proventil, Ventolin, Beclovent, Vanceril, Pulmicort • Sedatives and tranquilizers • Antidepressants/antianxiety:
    [Show full text]
  • Xerostomia and Hyposalivation (“Dry Mouth”)
    Division of Oral Medicine and Dentistry Xerostomia and Hyposalivation (“Dry Mouth”) What is xerostomia and hyposalivation? What causes hyposalivation? Xerostomia is the sensation of having a dry mouth. Many Te three most common causes of hyposalivation are (but not all) patients who have this sensation will also have a medications, chronic anxiety or depression, and dehydration. noticeable and measurable decrease in the amount of saliva Some medications that cause dry mouth are treatments for in their mouths, a condition referred to as “hyposalivation” sinusitis, high blood pressure (such as “water pills”), anxiety or “salivary gland hypofunction”. Many doctors use the and depression, psychiatric disorders, or a hyperactive bladder. terms “xerostomia” and “hyposalivation” interchangeably Patients on multiple medications are particularly prone to because most (but not all) patients with xerostomia also have getting a dry mouth. An uncommon but important cause of dry hyposalivation. Sometimes your mouth may feel dry without it mouth is radiation therapy for head and neck cancer, during actually being dry (xerostomia without hyposalivation). Saliva which the salivary glands are irreversibly damaged. In diseases not only lubricates the mouth but also helps to fght infections, such as Sjögren syndrome (an autoimmune disease) and chronic so a reduction in the amount of saliva puts you at risk for graf-versus-host disease seen in bone marrow transplant discomfort in the mouth, and also may increase tooth decay recipients, the patient’s own immune system can damage the and yeast infections. salivary glands. Although it is normal to produce less saliva while sleeping, How do we know you have hyposalivation? patients with dry mouth commonly describe their mouths An experienced clinician can usually make the diagnosis by as feeling “parched”, “like sandpaper” or “like a desert” at all listening to the history and examining the patient.
    [Show full text]
  • Culture Advantage Anatomy and Medical Terminology For
    1 Culture Advantage Anatomy and Medical Terminology for Interpreters GASTROINTESTINAL SYSTEM Marlene V. Obermeyer, MA, RN [email protected] ©Culture Advantage http://www.cultureadvantage.org 2 Digestive System Case Study for PowerPoint Presentation Carlos is a 13-year old boy who is brought to the Emergency Department by his parents. Through an interpreter, the physician finds out that Carlos has started complaining of right lower quadrant pain about 16 hours ago. He was unable to eat supper, was nauseated and vomited several times. He is now feeling feverish and has pain all over his abdomen. An IV is started in his arm and he is given IV fluids and antibiotics. He is given medication for pain and given an antiemetic for nausea. He is also examined and interviewed by the physician. The physician obtains blood work that indicates Carlos has an acute infection. A CT scan of the abdomen indicates Carlos has appendicitis. A surgeon is contacted and Carlos is scheduled for emergency appendectomy. The interpreter is asked to translate the surgery consent form that states Carlos is going to have a "laparoscopic appendectomy, possible open laparotomy" and the parents are asked to sign the consent form. By the end of this section, you will learn the meaning of the following words: Acute IV (IV fluid, IV antibiotics) Antiemetic CT scan Appendicitis Appendectomy Laparoscopic appendectomy Open laparotomy ©Culture Advantage http://www.cultureadvantage.org 3 GASTROINTESTINAL SYSTEM TERMINOLOGY Terminology Meaning Terminology Meaning absorption The movement of Alimentary Alimen – nourishment. Refers food from the to the gastrointestinal or small intestine digestive tract into the cells of the body.
    [Show full text]
  • Chapter 10—Prevention
    CHAPTER 10—PREVENTION INTRODUCTION RECOMMENDED PREVENTIVE SERVICES OTHER PREVENTIVE SERVICES TO CONSIDER PREVENTIVE SERVICES NOT INDICATED IN OLDER ADULTS DELIVERY OF PREVENTIVE SERVICES ANNOTATED REFERENCES INTRODUCTION As the population ages and the average active life expectancy increases, issues of primary and secondary prevention become increasingly important. The prevalence of undetected, correctable conditions and comorbid diseases is high in older adults. Moreover, a growing number of older adults are enthusiastic and highly motivated about disease prevention and health promotion. The clinician provides the information and opportunity for preventive care that helps older patients to maintain functional independence for as long as possible. Many findings from research on preventive care and the appropriate components of periodic health examinations are inconclusive. In addition, older persons are typically not included in clinical trials of preventive strategies, which has limited the ability of geriatricians to adjust guidelines for preventive practices for patients aged 65 and older on the basis of new scientific findings. Primary care physicians are consequently compelled to rely on clinical judgment in planning the preventive care of their older patients. A number of factors, including age, functional status, comorbidity, patient preference, socioeconomic status, and the availability of care, affect health care decisions of the older adult. Unlike chronologic age, physiologic age may be determined by self-rated health and overall medical condition. Classifications that are based on life expectancy, physiologic age, and functional status may facilitate medical decision making with older patients. For example, the clinician might strongly recommend fecal occult blood testing (FOBT) to a healthy, functionally independent patient; discuss the potential pros and cons of FOBT and offer the test to a chronically ill, partially dependent patient; and actually recommend against FOBT for a severely frail, demented patient.
    [Show full text]
  • Xerostomia: an Overview
    Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 22 July 2020 Review Xerostomia: An Overview Jeong-Seok Choi1, * 1 Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Republic of Korea. Corresponding author: Jeong-Seok Choi, MD, PhD Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, 27, Inhang-ro, Jung-gu, Incheon 22332, Republic of Korea E-mail: [email protected] Tel: 82-32-890-2438, Fax: 82-32-890-3580 Abstract: (1) Background: Xerostomia is a subjective symptom of dry mouth resulting from various causes, including side effects of medication, systemic disorders, radiation, and Sjögren’s syndrome. Recently, the number of patients afflicted with xerostomia has increased due to an increase in the elderly population and patients on medication.; (2) Methods: A systematic approach is required to determine the etiology and management of xerostomia. This review summarizes recent literatures on the diagnosis and management of xerostomia.; (3) Results: A patient with xerostomia experiences difficulty in chewing, swallowing, speaking, tasting, and maintaining oral hygiene. Xerostomia and hyposalivation are uncomfortable side-effects in many patients. Assessing the function of the salivary gland is essential for selecting an appropriate treatment, improving symptoms, and preventing oral complications. Also, a more systematic approach is required to differentiate the subjective symptoms of the patient from the objective hyposalivation.; and (4) Conclusions: Although there is no standardized treatment for xerostomia, doctors need to endeavor and adapt the various treatments of xerostomia, to unearth the optimal treatment required for the patient. Keywords: Xerostomia; Dry mouth; Salivary hypofunction; Saliva 1.
    [Show full text]
  • Sjögren's Syndrome
    Sjögren's syndrome Author: Doctor Menelaos N. Manoussakis1 Creation Date: November 2001 Update: June 2004 Scientific Editor: Professor Haralampos M. Moutsopoulos 1Department of Pathophysiology, School of Medicine, National University of Athens, 75 Mikras Asias str., 11527 Athens, Greece. [email protected] Abstract Keywords Disease name and synonyms Diagnosis Criteria/Definition Differential Diagnosis Prevalence Clinical Description Management including treatment Etiology Diagnostic methods Unresolved questions References Abstract Sjögren's syndrome (SS) is a chronic autoimmune disorder. It is characterized by dysfunction and destruction of the exocrine glands associated with lymphocytic infiltrates and immunological hyperreactivity. Salivary and lacrimal glands are the most affected, thus leading to mouth and eye dryness. The disorder can occur alone (it is then known as ``primary-SS'') or in association with another autoimmune disease (it is then known as ``secondary-SS''). Prevalence of primary-SS in the general population has been estimated to be around 1 to 3%. Although patients of all ages and of both sexes may be affected, this disorder mostly affects women (9:1 female to male ratio) in their fourth or fifth decade of life. In the majority of patients, SS has an indolent or slowly progressive course with disease confined in exocrine glands. Mild rheumatic complaints have also been reported. At presentation or during the course of the disease, almost one third of the primary-SS patients experiences a more generalized disease, which does not usually evolve to the failure of the affected organ. However, stringent follow-up should be instituted in patients with adverse prognosis predictors such as purpura, low C4-complement levels or mixed monoclonal cryoglobulins.
    [Show full text]
  • Association of Sjogren's and Felty's Syndromes
    Ann Rheum Dis: first published as 10.1136/ard.12.3.212 on 1 September 1953. Downloaded from ASSOCIATION OF SJOGREN'S AND FELTY'S SYNDROMES BY K. J. GURLING King's College Hospital, London (RECEIVED FOR PUBLICATION JULY 31, 1953) Felty (1924) described five cases of chronic In September, 1951, the spleen and liver were found rheumatoid arthritis in which he had also noticed to be enlarged, and as the leucopenia persisted, a diagnosis splenomegaly, a leucopenia with slight anaemia, of Felty's syndrome was suggested. Shortly before this pigmentation of the skin, and lymphadenopathy, time she first noticed irritation of the eyes and lids, though these symptoms were not severe. Her mouth also became features which have recently been reviewed by dry and she had vague sore throats with frequent super- several authors, including Hutt and others (1951), ficial buccal and gingival ulcers. She had also felt tired Ytrehus (1946), and Hatch (1945). Sjogren (1933), and in generally poor health during the previous year. Gougerot (1926), and Houwer (1927) have drawn Previous History.-Recurrent bronchitis with mucoid attention to the association with rheumatoid arth- or muco-purulent sputum. Amenorrhoea since 1939. ritis of kerato-conjunctivitis sicca and xerostomia due to the impairment of both lacrimal and parotid Family Histor*v.-None of arthritis or anaemia. gland function, a well-recognized syndrome vari- GeneralExamination.-In November, 1951, she appear-by copyright. ously named after these three authors though ed pale and anaemic, but otherwise reasonably fit. The to as skin was dry but not pigmented and there were a few most frequently referred Sj6gren's syndrome.
    [Show full text]
  • Reiter's Syndrome
    Reiter’s Syndrome: Clinical Features • Arthritis lower • Uveitis extremities • Oral ulcers • Enthesitis • Keratoderma • Spondylitis • Balanitis • Tenosynovitis • HLA B-27 Positive • Dactylitis (80%) • Urethritis Reactive Arthritis: Laboratory Findings • Clinical !!! (History is vital) • Laboratory (confirmatory) • ESR and CRP - Elevated during acute phase • Negative RF, ANA • Synovial fluid: • High WBC count, (often w/ elevated PMNs) • Gram stain and culture (to exclude septic arthritis) • Throat, stool, or urogenital tract cultures if indicated to isolate causative organism. Reactive Arthritis: Treatment • Infectious Disease: • Refractory Disease • Eliminate “triggering infection” • Remission common in 2 – 6 months • Extra-articular Disease • If recurrence persistence and/flare can used • Typically self-limited DMARD • Topical steroids: keratoderma • Sulfasalazine 2 – 3 gm/day** drug of blennorrhagicum choice • Uveitis: Ophthalmologic Referral • MTX, azathioprine, cyclophosphamide (variable success) • Articular Disease • TNF alpha blocking agents: (variable • NSAIDS (foundation of Tx): success) Indomethacin 150 mg/d • Recurrent “chronic” conditions: Intra- articular corticosteroids (SI joints require US guidance) Rheumatoid Arthritis Rheumatoid Arthritis RA DJD/OA Inflammatory Joint Dx Non-Inflammatory Joint Dx Sym/Bilat MCP & PIP HIPS, Knees, Spine, & DIP Soft Tissue Swell & Ulnar Dev Bony Swelling & Nodes Rheumatoid Nodules & RF No Nodules Erosions, Osteopenia Sclerosis & Osteophytes Synovitis, Ankylosis, & Pannus Reactive Changes:
    [Show full text]
  • Nutritional Guidelines for Symptom Management XEROSTOMIA
    Nutritional Guidelines For Symptom Management XEROSTOMIA DEFINITION: Dryness of the mouth due to lack of normal salivary secretion. Xerostomia can result in dysphagia, taste changes and dental caries. A dry mucosa is more susceptible to pain, infections and irritation. POSSIBLE CAUSES Tumor: Salivary gland tumors may cause some degree of xerostomia if the tumor interferes with the flow of saliva. Radiation: Salivary glands within the field of radiation (including total body irradiation) can be permanently destroyed during therapy. Saliva can be reduced in amount and altered in consistency. Reduction is dependent upon the total dose of radiation and degree of salivary gland involvement in the field of radiation. Flow may be reduced 50% by the end of the first week, and further reduction in volume (up to 100%) may occur. The saliva produced is more mucinous, acidic, and may circulate less easily throughout the mouth. Xerostomia is permanent, although some patients may perceive an improvement in salivary output over time (see Oral Management of the Cancer Patient - A guide for the health care professional, UMKC - School of Dentistry, 1992, p. 10.). Medications: Analgesics, anti-nausea, anti-histamines and anti-anxiety medications can cause xerostomia temporarily. Patients may complain of decreased or viscous saliva. This may be a result of a lowered pH and other alterations of the saliva. The duration of xerostomia is associated with the length of therapy, other medications and the health of the patient. (Oral Management of the Cancer Patient - A guide for health care professionals, UMKC - School of Dentistry, 1992, p. 5). Surgery: Surgical removal of the major salivary glands (parotid and submandular glands) may also result in xerostomia.
    [Show full text]
  • Rand Study Answers Some Questions About the Effects of Ppis
    News Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Rand Study Answers Some Questions about the Effects of drug therapy are much affected hy receiving a PPI. Most PPis respondents elected to take the drug once they had pur­ chased it; only a few seem to have chrmged their decision as Patient package inserts (PPIs) fared well in an FDA-spon a result of the information they received. sored study of alternative designs by the Rand Corporation. The 5. The costs of returned prescriptions are likely to be quite low. Previous estimates of the annual cost of returned pre­ study showed that patients read and understand PPIs, do not scriptions that will result from FDA's proposed labeling report more side effects as a result of reading PPIs, and can ' program have been as high as $87.75 million—a figure based handle fairly lengthy and complex PPIs. on the assumption that for every 60 new prescriptions, PPIs will cause one additional prescription to he returned. These The Rand study was conducted from autumn 1979 through results indicate that this estimate is several orders of mag­ spring 1980 at 69 pharmacies in Los Angeles County, CA. Al­ nitude too high. During the course of the study, only three ternative PPIs were studied for three drugs: erythromycin, prescriptions were returned to pharmacies for cash refunds, conjugated estrogens, and flurazepam. Six variables of PPIs out of more than 2000 prescriptions dispensed with PPIs. Even if pharmacies were to pass on the full costsof returned were included: specificity of instructions, amount of explanation, pr^riptions to the consiuner, the resulting increases in drug writing style, risk emphasis, format, and reduced content prices would he extremely small.
    [Show full text]
  • A New Method for Treating Fecal Incontinence by Implanting Stem
    Sarveazad et al. Stem Cell Research & Therapy (2017) 8:40 DOI 10.1186/s13287-017-0489-2 RESEARCH Open Access A new method for treating fecal incontinence by implanting stem cells derived from human adipose tissue: preliminary findings of a randomized double-blind clinical trial Arash Sarveazad1, Graham L. Newstead2, Rezvan Mirzaei1, Mohammad Taghi Joghataei3, Mehrdad Bakhtiari3, Asrin Babahajian4 and Bahar Mahjoubi1* Abstract Background: Anal sphincter defects are a major cause of fecal incontinence causing negative effects on daily life, social interactions, and mental health. Because human adipose-derived stromal/stem cells (hADSCs) are easier and safer to access, secrete high levels of growth factor, and have the potential to differentiate into muscle cells, we investigated the ability of hADSCs to improve anal sphincter incontinence. Methods: The present randomized double-blind clinical trial was performed on patients with sphincter defects. They were categorized into a cell group (n = 9) and a control group (n = 9). Either 6 × 106 hADSCs per 3 ml suspended inphosphatebuffersaline(treatment)or3mlphosphatebuffer saline (placebo) was injected. Two months after surgery, the Wexner score, endorectal sonography, and electromyography (EMG) results were recorded. Results: Comparing Wexner scores in the cell group and the control group showed no significant difference. In our EMG and endorectal sonography analysis using ImageJ/Fiji 1.46 software, the ratio of the area occupied by the muscle to total area of the lesion showed a 7.91% increase in the cell group compared with the control group. Conclusion: The results of the current study show that injection of hADSCs during repair surgery for fecal incontinence may cause replacement of fibrous tissue, which acts as a mechanical support to muscle tissue with contractile function.
    [Show full text]