SIALOGOGUE AND ANTI-SIALOGOGUE AND ANTI-SIALOGOGUESIALOGOGUE

DR.FOYSAL SIRAZEEDR.FOYSAL SIRAZEEBDS(DU),MS(FINAL PART),BDS(DU),MS(FINAL PART),

BSMMU,DHAKA.BSMMU,DHAKA.

SIALOGOGUESIALOGOGUE#Definition…………#Definition…………

....Sialogogue are the Sialogogue are the

agents or drugs agents or drugs which are used which are used to increased to increased salivation due to salivation due to dryness of mouth dryness of mouth or any other or any other reasons.reasons.

Classification of Classification of sialogoguesialogogue

####sialogogue

Agent which increasesalivary reflex…

*Bitter food*Hot food

*Spicy food*Alcohol

Saliva substitute*Anti-bacterial agent

*Complex mixture of salt*Sorbitol or sweetener

*Cellulose and* Flavoring agent

Cholino-mimetic drugs*Pilocarpin

*Neostigmine*Physostigmine

HOT AND SPICY FOODHOT AND SPICY FOOD

SOUR FOODSSOUR FOODS

BITTER FOODSBITTER FOODS

Sialogogues agentsSialogogues agents

XEROSTOMIAXEROSTOMIA#Definition…..#Definition…..The term xerostomia or The term xerostomia or

“dry mouth” refers to “dry mouth” refers to a subjective complaint a subjective complaint of dryness involving of dryness involving the oral mucosa and the oral mucosa and oro-pharynx that may oro-pharynx that may or may not be or may not be accompanied by accompanied by salivary gland hypo salivary gland hypo function, an objective function, an objective decrease in salivary decrease in salivary flow.flow.

Etiologic factors/Causes of Etiologic factors/Causes of xerostomiaxerostomia

Potential etiologic factors for Potential etiologic factors for Xerostomia and/or Salivary Xerostomia and/or Salivary

gland Hypo function…….gland Hypo function…….#Mediations------#Mediations------ *Antihistamines*Antihistamines *Decongestants*Decongestants *Antidepressants*Antidepressants *Sedatives/ anxiolytic*Sedatives/ anxiolytic agentagent *Anti-hypertensive *Anti-hypertensive

agent agent *Anti-cholinergic agent*Anti-cholinergic agent *Anti- neoplastic agent*Anti- neoplastic agent *Anti-psychotic agent*Anti-psychotic agent#Radiation therapy#Radiation therapy

Etiologic factors/Causes of Etiologic factors/Causes of xerostomiaxerostomia…..continue…..continue

#Systemic diseases-----#Systemic diseases----- *Sjögren’s syndrome*Sjögren’s syndrome *Diabetes mellitus*Diabetes mellitus *Diabetes insipidus*Diabetes insipidus *Sarcoidosis*Sarcoidosis *Human Immunodeficiency *Human Immunodeficiency

Virus Virus *(HIV) infection*(HIV) infection *Hepatitis C infection*Hepatitis C infection *Graft versus host disease *Graft versus host disease *Parkinson’s disease*Parkinson’s disease

Etiologic factors/Causes of Etiologic factors/Causes of xerostomiaxerostomia…..continue…..continue

#Electrolyte loss-------#Electrolyte loss------- *Decreased fluid intake*Decreased fluid intake *Hemorrhage*Hemorrhage *Vomiting*Vomiting *Diarrhea*Diarrhea

#Local factors------#Local factors------ *Smoking*Smoking *Excessive caffeine *Excessive caffeine

intakeintake *Mouth breathing*Mouth breathing *Alcohol abuse*Alcohol abuse

Examples of Common medications associated Examples of Common medications associated With Xerostomia and/or Salivary gland Hypo With Xerostomia and/or Salivary gland Hypo

function ………function ………#Anti-Histamines…..#Anti-Histamines….. *Diphenhydramine*Diphenhydramine *Chlorpheniramine*Chlorpheniramine#Decongestants …..#Decongestants ….. *Pseudo ephedrine*Pseudo ephedrine#Anti-Depressant …..#Anti-Depressant ….. *Amitriptyline*Amitriptyline *Fluoxetine*Fluoxetine *Paroxetine*Paroxetine *Citalopram*Citalopram#Sedatives/anxiolytic …..#Sedatives/anxiolytic ….. *Diazepam*Diazepam *Lorazepam*Lorazepam *Alprazolam*Alprazolam

Examples of Common medications Examples of Common medications associated With Xerostomia and/or associated With Xerostomia and/or Salivary gland Hypo function ………Salivary gland Hypo function ………

#Anti-Hypertensive agent …..#Anti-Hypertensive agent ….. *Methyldopa*Methyldopa *Chlorothiazide*Chlorothiazide *Furosemide*Furosemide *Metoprolol*Metoprolol *Calcium channel *Calcium channel

blockersblockers#Anti-Cholinergic agent …..#Anti-Cholinergic agent ….. *Atropine*Atropine *Scopolamine*Scopolamine#Anti-Psychotic agent …..#Anti-Psychotic agent ….. *Haloperidol*Haloperidol * Phenothiazine * Phenothiazine

derivativesderivatives

Management of Management of XerostomiaXerostomia

Management of xerostomia involves……Management of xerostomia involves……1.Patient education, diet, and lifestyle 1.Patient education, diet, and lifestyle

modifications; modifications; 2. Management of systemic diseases and 2. Management of systemic diseases and

medication use;medication use;3.Prevention of dental and oral mucosal 3.Prevention of dental and oral mucosal

diseases; diseases; 4. Palliative management of symptoms; and4. Palliative management of symptoms; and5. Sialogogues or salivary gland stimulants.5. Sialogogues or salivary gland stimulants.

ANTI-SIALOGOGUEANTI-SIALOGOGUE#Definition …..#Definition ….. AntiAnti--Sialogogues are the agents Sialogogues are the agents

or drugs which are used to or drugs which are used to decreased salivation due to decreased salivation due to excessive salivation in mouth or excessive salivation in mouth or any other reasons.any other reasons.

Classification of anti-Classification of anti-SialogoguesSialogogues

ANTI-SAIALOGOGUE

LOCALLY ACTING SYSTEMICALLY ACTING

e.g. ASTRINGENTS CHOLINERGIC ANTAGONISTCNS DEPRESSANTS

e.g. Morphine,Opium.

ANTI-MUSCARINICe.g.. Atropine,Scopolamine

ANTI-NICOTINIC

AUTONOMIC GANGLIONIC BLOCKERe.g. Hexamittonium

PTYALISMPTYALISM#Definition ……#Definition …… It is a clinical It is a clinical

condition condition characterized by characterized by excessive secretion excessive secretion of saliva from of saliva from major or minor major or minor salivary glands of salivary glands of oral region.oral region.

CAUSES OF PTYALISMSCAUSES OF PTYALISMSA. Pathos-physiological causes….A. Pathos-physiological causes…. a) Physiological causes….a) Physiological causes…. *Pregnancy,*Pregnancy, *Malnutrition,*Malnutrition, *Menstruation,*Menstruation, b) Pathological causes….b) Pathological causes…. 1) CNS causes….1) CNS causes…. *Bell’s palsy,*Bell’s palsy, *Hysteria,*Hysteria, *Rabies,*Rabies, *Stroke,*Stroke, *Parkinson’s disease.*Parkinson’s disease.

CAUSES OF PTYALISMSCAUSES OF PTYALISMS……(continue)(continue)

2) Endocrine causes….2) Endocrine causes…. *Exophthalmia goiter.*Exophthalmia goiter. 3) GIT causes….3) GIT causes…. *Nausea and vomiting,*Nausea and vomiting, *Gastro esophageal reflex.*Gastro esophageal reflex. 4) Oral causes….4) Oral causes…. *Stomatitis,*Stomatitis, *ANUG.*ANUG.B. Drug induced…..B. Drug induced….. a)Cholinomimetic agent…..a)Cholinomimetic agent….. *Pilocarpine,*Pilocarpine, *Neostigmine,*Neostigmine, *Physostigmine.*Physostigmine. b)Others agent….b)Others agent…. *Mercury,*Mercury, *Iodine.*Iodine.

MANAGEMENT OF MANAGEMENT OF PTYALISMSPTYALISMS

Management of ptyalism depends Management of ptyalism depends upon the causes….upon the causes….

Speech therapySpeech therapy Behavioral therapyBehavioral therapy Radiation therapyRadiation therapy MedicationsMedications SurgerySurgery