Schubert M M, Izutsu K T
J Dent Res. 1987 Feb;66 Spec No:680-8. doi: 10.1177/00220345870660S213.
Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).
唾液对于维持口腔健康和功能至关重要。在某些情况下，如全身麻醉期间，医学治疗旨在减少唾液分泌，但医源性唾液腺功能障碍的大多数情况代表着不良或不可避免的副作用。唾液功能障碍的临床表现范围从唾液分泌的非常轻微的短暂改变到唾液功能的完全丧失。干扰唾液分泌的最常见治疗形式是药物治疗、癌症治疗（放疗或化疗）和手术治疗。这些治疗可通过多种不同机制影响唾液分泌，包括：破坏与唾液分泌相关的自主神经功能、干扰与唾液分泌相关的腺泡或导管细胞功能、细胞毒性、间接作用（血管收缩/扩张、液体和电解质平衡等）以及对唾液腺和神经的物理损伤。多种药物能够通过模拟自主神经系统作用或直接作用于唾液分泌所需的细胞过程来增加或减少唾液分泌：药物也可通过改变液体和电解质平衡或影响腺体血流间接影响唾液分泌。电离辐射可导致唾液腺永久性损伤，这种损伤表现为腺泡细胞破坏，随后腺体萎缩和纤维化。癌症化疗可导致唾液分泌改变，但这些改变通常要轻得多且只是短暂的。最后，手术和外伤会干扰唾液分泌，原因要么是腺体神经支配中断，要么是腺体组织（包括导管）受到严重物理损伤（或切除）。
