Barbe Anna Greta
Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Kerpener Str. 32, 50931, Cologne, Germany.
Drugs Aging. 2018 Oct;35(10):877-885. doi: 10.1007/s40266-018-0588-5.
Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient's situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being.
由于药物摄入和多重用药的高患病率，药物性口干和唾液分泌减少将日益成为老年患者的口腔健康问题，对吞咽困难、龋齿发病率、营养不良和生活质量等其他症状产生复杂的负面影响。鼓励所有医疗保健专业人员调查其患者的口干症状，因为在日常临床实践中很容易进行诊断。这篇实用文章还综述了现有的治疗选择，包括尽可能改用口干副作用较少的产品或减少剂量，以及考虑所有影响因素和口腔症状治疗的多学科、以预防保健为导向的方法。此外，还讨论了几种局部用药和唾液替代品，它们可能会缓解症状，但在可用性和实用性方面需要根据每个患者的情况进行仔细调整，并且要知道治疗成功与否因人而异。还讨论了创新方法，如口腔内电刺激或在口腔黏膜上局部应用抗胆碱酯酶。治疗口干最常用的药物治疗选择是毛果芸香碱（一种具有强大毒蕈碱、胆碱能唾液分泌刺激特性的拟副交感神经药）和西维美林（一种奎宁环类似物，其治疗作用和副作用与毛果芸香碱相似）。这些药物治疗选择是在老年患者的背景下描述的，其中包括恶心、呕吐、支气管收缩等高度普遍的胆碱能副作用需要由相关医疗保健专业人员进行全面监测。为药物性口干患者提供这些治疗选择将有助于改善他们的口腔健康，从而维持更好的生活质量、总体健康状况和幸福感。
