Chevalier Marlene, Sakarovitch Charlotte, Precheur Isabelle, Lamure Julie, Pouyssegur-Rougier Valerie
Laboratory of Oral Health and Aging, Faculty of Dentistry, University Nice Sophia Antipolis , Nice , France.
Acta Odontol Scand. 2015 May;73(4):267-73. doi: 10.3109/00016357.2014.923108. Epub 2015 Jan 20.
Polypharmacy is a common cause of xerostomia. This study aimed to investigate whether xerostomia could be an adverse drug event of mouthwashes, when they are used for longer than 2 weeks by patients taking polypharmacy.
This cross-sectional observational study included 120 hospitalized patients (60 middle-aged and 60 elderly patients), taking polypharmacy (≥4 drugs daily) and at risk of drug-induced xerostomia. Xerostomia was assessed by questioning participants.
A total of 62.5% of patients complained of xerostomia. In the middle-aged group (mean age=44.0 (8.7) years; 35.0% women) xerostomia seemed independently associated to mouthwashes, at the limit of significance (OR=5.00, 95% CI=0.99-25.3, p=0.052). Active principles in mouthwashes were mainly quaternary ammonium compounds (91.9%). Mouthwashes may disturb the healthy balance of the biofilm moisturizing the oral mucosa. The biofilm contains mucins, salivary glycoproteins with oligosaccharides side chains able to sequester water and endogenous bacteria surrounded by a glycocalyx. Oral bacteria are fully susceptible to quaternary ammonium (chlorhexidine, hexetidine, cetylpyridinium chloride) and to other antiseptics used in mouthwashes, such as betain, resorcin, triclosan, essential oils and alcohol. However, caregivers currently recommend such dental plaque control products to patients suffering from xerostomia in order to reduce the risk of caries and periodontitis.
This study is the first report that use of antiseptic mouthwashes for more than 2 weeks could worsen xerostomia in patients taking polypharmacy. Oral care protocols should avoid this iatrogenic practice, particularly when xerostomia alters the quality-of-life and worsens malnutrition.
多种药物联合使用是口干症的常见原因。本研究旨在调查当服用多种药物的患者使用漱口水超过2周时，口干症是否可能是漱口水的不良药物事件。
这项横断面观察性研究纳入了120名住院患者（60名中年患者和60名老年患者），他们服用多种药物（每日≥4种药物）且有药物性口干症风险。通过询问参与者来评估口干症情况。
共有62.5%的患者抱怨有口干症。在中年组（平均年龄 = 44.0（8.7）岁；35.0%为女性）中，口干症似乎与漱口水独立相关，接近显著水平（OR = 5.00，95%CI = 0.99 - 25.3，p = 0.052）。漱口中的活性成分主要是季铵化合物（91.9%）。漱口水可能会扰乱滋润口腔黏膜的生物膜的健康平衡。该生物膜含有粘蛋白、带有能够结合水的寡糖侧链的唾液糖蛋白以及被糖萼包围的内源性细菌。口腔细菌对季铵盐（氯己定、己脒定、西吡氯铵）以及漱口中使用的其他防腐剂如甜菜碱、间苯二酚、三氯生、精油和酒精完全敏感。然而，目前护理人员向患有口干症的患者推荐此类牙菌斑控制产品，以降低龋齿和牙周炎的风险。
本研究是首份报告指出，服用多种药物的患者使用抗菌漱口水超过2周可能会使口干症恶化。口腔护理方案应避免这种医源性做法，尤其是当口干症改变生活质量并加重营养不良时。
