Salivary Replacement Therapy/Salivary Stimulation- 3
The FDA has approved pilocarpine (Salagen®) for treatment of xerostomia caused by head and neck irradiation and from Sjogren's syndrome.26, 27, 28 Pilocarpine is a cholinergic agonist that stimulates muscarinic acetylcholine receptors in the salivary glands to increase serous salivary flow. This effect is dependent upon the presence of intact salivary gland tissue and nerve supply.24 Pilocarpine is dispensed in 5 mg tablets, at 2 tablets 3-4 times/day, with a total daily dose not to exceed 30 mg. Clients may need to take the drug for a minimum of 90 days to see optimum effects. Pilocarpine is contraindicated for clients with a known hypersensitivity to the drug, uncontrolled asthma or narrow-angle glaucoma. Drug interactions associated with pilocarpine include anticholinergic medications (e.g. antiparkinsonion drugs, carbamazepine, digoxin, sedative antihistamines, tricyclic antidepressants), cholinergic medications (e.g. antiglaucoma drugs) and beta-adrenergic blocking drugs.29,30
Mechanical stimuli can be used to increase salivary flow rates for clients who are unable to take pilocarpine. The act of mastication produces a large mechanical stimulus for increased salivary secretions, which may be mimicked by chewing sugarless gum. Sugarless gums contain alcohol sugars: mannitol, sorbitol and xylitol. Gum chewing provides two benefits: stimulation of salivary flow and decreased risk for tooth decay.14 Streptococcus mutans are inhibited by xylitol, and are fermented by Sorbitol and mannitol.31Studies have shown that chewing sugarless gum after eating significantly increases plaque pH.32, 33, 34, 35
