Xerostomie – Ätiologie, Klinik, Diagnostik und Therapie

S. Hahnel; R. Bürgers; G. Handel

doi:10.1055/s-0028-1085939

ZWR - Das Deutsche Zahnärzteblatt, Table of Contents

ZWR - Das Deutsche Zahnärzteblatt 2008; 117(7/08): 349-356
DOI: 10.1055/s-0028-1085939

Fortbildung

Parodontologie
© Georg Thieme Verlag Stuttgart · New York

Xerostomie – Ätiologie, Klinik, Diagnostik und Therapie

Xerostomia – Aetiology, Clinical Manifestations, Diagnosis and TreatmentS. Hahnel¹ , R. Bürgers¹ , G. Handel¹

¹Poliklinik für Zahnärztliche Prothetik, Universitätsklinikum Regensburg

Abstract

Xerostomie ist ein Krankheitsbild, mit dem der praktisch tätige Zahnarzt zunehmend konfrontiert wird. Die Ursachen reichen von der Einnahme systemisch wirkender Medikamente bis hin zu Autoimmunerkrankungen; ebenso können die klinischen Symptome äußerst vielfältig sein. Aus diesen Gründen gestalten sich Diagnose und Therapie der Krankheit oft schwierig. In der vorliegenden Übersichtsarbeit soll ein Überblick über Ätiologie und Klinik der Xerostomie sowie über potenzielle Therapiekonzepte gegeben werden.

A steadily increasing number of people is suffering from xerostomia. The reasons for xerostomia are manifold, reaching from the side effects of systemic drugs to autoimmune diseases. The clinical manifestations may be manifold, too. Thus, diagnosis as well as treatment of xerostomia may be complex. The aim of this article is to give a review on the etiology and clinical manifestations of xerostomia as well as potential therapeutical concepts.

Schlüsselwörter:

Xerostomie - Sjögren–Syndrom - Speichelersatzmittel

Keywords

Xerostomia - Sjoegren's Syndrome - Saliva Substitute

Full Text

References

Literatur

1 Al–Hashimi I.. The management of Sjögren's syndrome in dental practice. J Am Dent Assoc. 2001; 132 1409-1417
2 Atkinson JC, Wu AJ.. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc. 1994; 125 409-416
3 Brown LR, Dreizen SA, Daly TE.. Interrelations of oral microorganisms, immunoglobulins, and dental caries following radiotherapy. J Dent Res. 1978; 57 882-893
4 Cassolato SF, Turnbull RS.. Xerostomia: clinical aspects and treatment. Gerodontology. 2003; 20 64-77
5 Christersson CE, Lindh L, Arnebrant T.. Film–forming properties and viscosities of saliva substitutes and human whole saliva. Eur J Oral Sci. 2000; 108 418-425
6 Dawes C.. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res. 1987; 66 648-653
7 Dreizen S, Brown LR, Handler S, Levy BM.. Radiation–induced xerostomia in cancer patients. Effect on salivary and serum electrolytes. Cancer. 1976; 38 273-278
8 Epstein JB, Loh R, Stevenson–Moore P. et al. . Chlorhexidine rinse in prevention of dental caries in patients following radiation therapy. Oral Surg Oral Med Oral Pathol. 1989; 68 401-405
9 Felst E, Dörner T, Hansen A.. Indikation und Option neuer immunmodulatorischer Therapien beim Sjögren–Syndrom. Z Rheumatol. 2007; 66 679-685
10 Fox PC.. Management of dry mouth. Dent Clin North Am. 1997; 41 863-876
11 Garg AK, Malo M.. Manifestations and treatment of xerostomia and associated oral effects secondary to head and neck radiation therapy. J Am Dent Assoc. 1997; 128 1128-1133
12 Gelhard TB, Fidler V, s'Gravenmade EJ, Vissink A.. Remineralization of softened human enamel in mucin– or CMC–containing artificial salivas. J Oral Pathol. 1983; 12 336-341
13 Ghezzi EM, Lange LA, Ship JA.. Determination of variation of stimulated salivary flow rates. J Dent Res. 2000; 79 1874-1878
14 Greenspan D, Daniels TE.. Effectiveness of pilocarpine in postradiation xerostomia. Cancer. 1987; 59 1123-1125
15 Guchelaar HJ, Vermes A, Meerwaldt JH.. Radiation–induced xerostomia: pathophysiology, clinical course and supportive treatment. Support Care Cancer. 1997; 5 281-288
16 Guggenheimer J, Moore PA.. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc. 2003; 134 61-69
17 Guijarro Guijarro B, López AF Sánchez, Hernández G. Vallejo. Treatment of Xerostomia. A review. Med Oral. 2001; 6 7-18
18 Gupta A, Epstein JB, Sroussi H.. Hyposalivation in elderly patients. J Can Dent Assoc. 2006; 72 841-846
19 Hatton MN, Levine MJ, Margarone JE. et al. . Lubrication and viscosity features of human saliva and commercially available saliva substitutes. J Oral Maxillofac Surg. 1987; 45 496-499
20 Imfeld T.. Oligosialia and xerostomia. II. Diagnosis, prevention and treatment. Schweiz Monatsschr Zahnmed. 1984; 94 1083-1096
21 Imfeld T.. Reduzierter Speichelfluß: Ursachen, Folgen und Diagnose. in: Reduzierter Speichelfluß und Mundtrockenheit: Herausforderung zur Zusammenarbeit in der Kariesprophylaxe. München: MSC Medizinischer Creativ Service GmbH 1995
22 Johnson JT, Ferretti GA, Nethery WJ. et al. . Oral pilocarpine for post–irradiation xerostomia in patients with head and neck cancer. N Engl J Med. 1993; 329 390-395
23 Joyston–Bechal S, Kidd EA.. The effect of three commercially available saliva substitutes on enamel in vitro. Br Dent J. 1987; 163 187-190
24 Kassan SS, Moutsopoulos HM.. Clinical ma– nifestations and early diagnosis of Sjogren syn– drome. Arch Intern Med. 2004; 164 1275-1284
25 Keene HJ, Fleming TJ.. Prevalence of caries–associated microflora after radiotherapy in patients with cancer of the head and neck. Oral Surg Oral Med Oral Pathol. 1987; 64 421-426
26 Kielbassa AM, Shohadai SP.. Die Auswirkungen von Speichelersatzmitteln auf die Läsionstiefe von demineralisiertem Schmelz. Dtsch Zahnarztl Z. 1999; 54 757-763
27 Kielbassa AM, Meyer–Lückel H.. Die Auswirkungen von Speichelersatzmitteln und Mundspüllösungen auf Dentin. Schweiz Monatsschr Zahnmed. 2001; 111 1060-1066
28 Kielbassa AM, Shohadai SP, Schulte–Mönting J.. Effect of saliva substitutes on mineral content of demineralized and sound dental enamel. Support Care Cancer. 2001; 9 40-47
29 Le Veque FG, Montgomery M, Potter D. et al. . A multicenter, randomized, double–blind, placebo–controlled, dose–titration study of oral pilocarpine for treatment of radiation–induced xerostomia in head and neck cancer patients. J Clin Oncol. 1993; 11 1124-1131
30 Levine MJ.. Artificial salivas: present and future. J Dent Res. 1987; 66 693-698
31 Meyer–Lückel H, Kielbassa AM.. Die Verwendung von Speichelersatzmitteln bei Patienten mit Xerostomie. Dtsch Zahnarztl Z. 2002; 57 335-344
32 Meyer–Lückel H, Schulte–Mönting J, Kielbassa AM.. The effect of commercially available saliva substitutes on predemineralized bovine dentin in vitro. Oral Dis. 2002; 8 192-198
33 Meyer–Lückel H, Tschoppe P, Kielbassa AM.. Linseed based saliva substitutes and their effect on mineral dissolution of predemineralized bovine dentin in vitro. J Dent. 2006; 34 751-756
34 Meyer–Lückel H, Kielbassa AM.. Influence of calcium phosphates added to mucin–based saliva substitutes on bovine dentin. Quintessence Int. 2006; 37 537-544
35 Meyer–Lückel H, Chatzidakis AJ, Kielbassa AM.. Effect of various calcium/phosphates ratios of carboxymethylcellulose–based saliva substitutes on mineral loss of bovine enamel in vitro. J Dent. 2007; 35 851-857
36 Momm F, Volegove–Neher NJ, Schulte–Mönting J. et al. . Different saliva substitutes for treatment of xerostomia following radiotherapy. Strahlenther Onkol. 2005; 181 231-236
37 Mühlemann HR.. Das Verhalten von Kiefer und Zähnen bei der Radiotherapie von malignen Tumoren der Mundhöhle und des Pharynx. Schweiz Monatsschr Zahnmed. 1945; 55 641-688
38 Nagy K, Urban E, Fazekas O. et al. . Controlled study of lactoperoxidase gel on oral flora and saliva in irradiated patients with oral cancer. J Craniofac Surg. 2007; 18 1157-1164
39 Nederfors T, Isaksson R, Mörnstad H. et al. . Prevalence of perceived symptoms of dry mouth in an adult Swedish population: relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol. 1997; 25 211-216
40 Scully C.. Drug effects on salivary glands: dry mouth. Oral Dis. 2003; 9 165-176
41 Scully C, Felix DH.. Oral medicine – update for the dental practitioner. Dry mouth and disorders of salivation. Br Dent J. 2005; 199 423-427
42 Ship JA, Pillemer SR, Baum BJ.. Xerostomia and the geriatric patient. J Am Geriatr Soc. 2003; 50 535-543
43 Smith RG, Burtner AP.. Oral side–effects of the most frequently prescribed drugs. Spec Care Dentist. 1994; 14 96-102
44 Sreebny LM, Schwarts SS.. A reference guide to drugs and dry mouth. Gerodontology. 1986; 5 75-99
45 Stratmann U, Mokrys K.. Mundtrockenheit – Ursachen und Symptomatik. Zahnarztl Mitt. 2000; 90 62-64
46 Tenovuo J, Lumikari M, Soukka T.. Salivary lysozyme, lactoferrin and peroxidases: antibacterial effects on cariogenic bacteria and clinical applications in preventive dentistry. Proc Finn Dent Soc. 1991; 87 197-208
47 Tschoppe P, Meyer–Lueckel H, Toll R. et al. . In vitro analysis of a new saliva substitute (Saliva natura) on enamel and dentin. Laryngorhinootologie. 2007; 86 723-727
48 Turner MD, Ship JA.. Dry mouth and its effect on the oral health of elderly people. J Am Dent Assoc. 2007; 138 15-20
49 van der Reijden WA, van der Kwaak H, Vissink A. et al. . Treatment of xerostomia with polymer–based saliva substitutes in patients with Sjögren`s syndrome. Arthritis Rheum. 1996; 39 57-63
50 van der Reijden WA, Vissink A, Veerman EC. et al. . Treatment of oral dryness related complaints (xerostomia) in Sjögren`s syndrome. Ann Rheum Dis. 1999; 58 465-474
51 Ventafridda V, De F Conno, Ripamonti C. et al. . Quality–of–life assessment during a palliative care programme. Ann Oncol. 1990; 1 415-420
52 Wiseman LR, Faulds D.. Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs. 1995; 49 143-155
53 Wolpert E, Jung F, Middelhoff HD. et al. . Treatment of drug–induced dryness of mouth in psychiatric patients – a controlled comparative study. Fortschr Neurol Psychiatr Grenzgeb. 1980; 48 224-233
54 Wynn RL, Meiller TF.. Artificial saliva products and drugs to treat xerostomia. Gen Dent. 2000; 48 630-636

Korrespondenzadresse

Dr. Sebastian Hahnel

Poliklinik für Zahnärztliche Prothetik Universitätsklinikum Regensburg

93042 Regensburg

Email: Sebastian.Hahnel@klinik.uni-regensburg.de