Transcript ISHIK UNIVERSITY FACULTY OF DENTISTRY Oral Pharmacology

ISHIK UNIVERSITY
FACULTY OF DENTISTRY
Drug Effects on Salivary Glands and Saliva
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Saliva is produced in and secreted from salivary
glands.
The basic secretory units of salivary glands are
clusters of cells called an acini. These cells secrete a
fluid that contains water, electrolytes, mucus and
enzymes, all of which flow out of the acinus into
collecting ducts.
Drug Effects on Salivary Glands and Saliva
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Saliva consists of two components that are secreted by
independent mechanisms.
First a fluid component which includes ions, produced
mainly by parasympathetic stimulation
secondly a protein component released mainly in
response to sympathetic stimulation
Salivary gland secretion is mainly under autonomic
nervous control, although various hormones may also
modulate salivary composition. Secretion appears to be
dependent on several modulatory influences which act
via either a cyclic AMP or calcium dependent pathway.
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Parasympathetic stimulation produces copious saliva
of low protein concentration while sympathetic
stimulation produces little saliva but of high protein
concentration and may thus give a sensation of
dryness.
Functions of Saliva
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Lubrication and binding: the mucus in saliva is
extremely effective in binding masticated food into
a slippery bolus that (usually) slides easily through
the esophagus without inflicting damage to the
mucosa. Saliva also coats the oral cavity and
esophagus, and food basically never directly
touches the epithelial cells of those tissues.
Functions of Saliva
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Solubilises dry food
Oral hygiene: The oral cavity is almost constantly
flushed with saliva, which floats away food debris and
keeps the mouth relatively clean. Flow of saliva
diminishes considerably during sleep, allow populations
of bacteria to build up in the mouth -- the result is
dragon breath in the morning. Saliva also contains
lysozyme, an enzyme that lyses many bacteria and
prevents overgrowth of oral microbial populations.
Functions of Saliva
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Initiates starch digestion
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Provides alkaline buffering and fluid
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Evaporative cooling
Salivary Gland Disorders
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Certain diseases and disorders, as well as certain
drugs, can cause the salivary glands to malfunction
and thus decrease saliva production.
Diseases include Parkinson's disease, human
immunodeficiency virus (HIV) infection, Sjögren's
syndrome, depression, and chronic pain.
Drugs that decrease saliva production include
certain antidepressants, antihistamines,
antipsychotics, sedatives, methyldopa, and diuretics.
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The salivary glands often malfunction after a
person has had chemotherapy or head and neck
radiation for the treatment of cancer.
Dry mouth due to radiation is usually permanent,
especially if the radiation dose is high; that due to
chemotherapy is usually temporary.
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However, not all cases of dry mouth are caused by
salivary gland malfunction.
Drinking too little liquid and breathing through the
mouth can dry the mouth.
Anxiety or stress can also result in a dry mouth.
The mouth may also dry somewhat as a person
ages, although this is probably due to the greater
likelihood of taking a drug that causes dry mouth
than to the aging process itself.
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an inadequate amount of saliva leads to more
cavities, especially in the roots of teeth.
Dry mouth, if its severe, can also lead to difficulty
speaking and swallowing.
Salivary Gland Swelling: Salivary gland swelling can
occur when one of the ducts that carry saliva from
the salivary gland to the mouth is blocked. Pain may
occur, especially during eating.
Dry Mouth
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Dry mouth has a variety of possible causes.
Common habits such as
tobacco smoking,
 alcohol use (including in mouthwashes) and
 use of beverages containing caffeine (coffee, some soft
drinks) can cause some oral dryness. A wide range of
drugs can give rise to oral dryness.
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Dry mouth is a common complaint in the elderly
mainly as consequence of the large number of
drugs used
Causes of dry mouth
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Iatrogenic
Drugs
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Irradiation
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Graft vs host disease
Disease
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Salivary gland disease
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Salivary aplasia (agenesis)
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Sjogren’s syndrome
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Sarcoidosis
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Cystic fibrosis
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Primary biliary cirrhosis
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Infections
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HIV
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Hepatitis C
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Human T lymphotropic virus 1 (HTLV-1)
Dehydration
Psychogenic
Drugs associated with dry mouth
Tricyclics antidepressants
 Muscarinic receptor antagonists for treatment
of overactive bladder
 Alpha receptor antagonists for treatment of urinary
retention
 Antipsychotics such as phenothiazines
 Diuretics(Amiloride)
 Antihistamines (cetirizine)
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Drugs associated with dry mouth
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Antihypertensive agents (Amlodipine, captopril,…)
Antidepressants (serotonin agonists, or
noradrenaline and/or serotonin re-uptake blockers)
Appetite suppressants
Decongestants and cold cures
Bronchodilators (Ipratropium)
Antidiarrhoeal drugs (Loperamide)
PPI (omeprazole, Lansoprazole)
Drugs associated with dry mouth
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Skeletal muscle relaxants (baclofen)
Antimigraine agents
Benzodiazepines, hypnotics, opioids and drugs of
abuse
H2-antagonists and proton pump inhibitors
Retinoids
Anti-HIV drugs such as dideoxyinosine (DDI) and
protease inhibitors
Treatments
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Change medication that cause dry mouth
Recommend products that moisturize mouth:
artificial saliva or moisturizers to lubricate mouth
Prescribe medication that stimulates saliva
(pilocarpine(salagen), Cevimeline(Evoxac))
Protect teeth: To prevent cavities: fluoride trays by
dentist, using chlorhexidine mouth wash to control
cavities.