Elsevier

Archives of Oral Biology

Volume 60, Issue 2, February 2015, Pages 242-255
Archives of Oral Biology

Review
Salivary hypofunction: An update on aetiology, diagnosis and therapeutics

https://doi.org/10.1016/j.archoralbio.2014.10.004Get rights and content

Highlights

  • Salivary dysfunctions have a negative impact on the quality of life of patients.

  • We investigated diagnosis methods and risk factors for salivary dysfunctions.

  • Therapeutic modalities to restore salivary function were also discussed.

  • New therapeutic modalities have been studied and involve stem cells transplantation.

Abstract

Saliva is of paramount importance for the maintenance of oral and general homeostasis. Salivary hypofunction predispose patients to disorders such as dysgeusia, pain and burning mouth, caries and other oral infectious diseases, dysphagia and dysphonia. The aim of this study was to provide an update on the aetiology, diagnostic methods and therapeutic strategies for the management of hyposalivation and xerostomia. The present paper describes subjective and objective methods for the diagnosis of salivary dysfunctions; moreover a number of drugs, and systemic disorders associated with decreased salivary flow rate are listed. We also focused on the underlying mechanisms to radiotherapy-induced salivary damage. Therapeutics for hyposalivation and xerostomia were discussed and classified as preventive, symptomatic, topical and systemic stimulants, disease-modifying agents, and regenerative. New therapeutic modalities have been studied and involve stem cells transplantation, with special attention to regeneration of damage caused by ionizing radiation to the salivary glands. More studies in this area are needed to provide new perspectives in the treatment of patients with salivary dysfunctions.

Introduction

Saliva is of paramount importance for the maintenance of oral and general homeostasis. It displays a crucial role in the digestive function, taste, cleaning, hydratation of the oral mucosa, and protection of the teeth, due to buffering and remineralization properties. Besides, saliva controls the composition of the oral microflora due to antibacterial, antifungal and antiviral properties, protecting the body from deleterious extrinsic influences. Saliva is composed of more than 99% water along with electrolytes; the protein components include immunoglobulins, digestive enzymes such as amylase and lipase, and antibacterial and antifungal enzymes, as well as mucins.1, 2, 3, 4 Salivary secretion is controlled by the autonomous nervous system, mainly by parasympathetic nerve signals. About 90% of saliva is produced by the major salivary glands and the daily volume varies from 0.5 to 1.0 L.4, 5, 6 When at rest, 65% of saliva is produced by the submandibular glands, which produce saliva rich in mucin, which supplies lubrification for the mucosa. Under stimulation, the parotids account for 50% of salivary volume.4, 5, 7

Nederfors8 suggests that salivary dysfunctions can be divided into three aspects: xerostomia, as subjective alteration; hyposalivation, as objective reduction of salivary flow and alterations in salivary composition. In early stages, hyposalivation is characterized by decreased salivary volume, besides saliva is thick and dispersed. The oral mucosa becomes dry and atrophic, and the patients can gradually show dysgeusia, dysphagia and dysarthria, as well as risk of developing ulcerations, caries, gingivitis, periodontitis, candidosis, and bacterial sialadenitis, among others.9, 10 Those changes cause important harm to the oral homeostasis and to the quality of life.

Considering the abovementioned, the present study is an updated approach of the main risk factors associated to salivary dysfunctions, such as drugs, systemic diseases, radiation and ageing. The diagnostic methods and therapeutic measures, including regenerative therapies and the use of stem cells to restore salivary function are also discussed. A Medline/PubMed/search was conducted using the terms xerostomia, hyposalivation, dry mouth and salivary hypofunction in combination with aetiology, drugs, systemic disorders, diagnosis, management, and treatment. Articles published in the English language were selected and reviewed. Suitable references from these articles were also reviewed.

Section snippets

Diagnosis of salivary dysfunctions

The diagnosis of salivary dysfunctions can be obtained by means of subjective and objective methods. These methods can be classified into questionnaires or interviews, secretion tests, mucosal surface tests, qualitative analyses, functional analyses and glandular morphology analyses11 (Table 1).

Subjective methods are used to determine the intensity and cause of xerostomia.12 A number of questionnaires have been utilized, and there is not a consensus on the best form of grading xerostomia,

Drugs

Several drugs are able of inducing hyposalivation and xerostomia, but they rarely cause irreversible damage to the salivary glands. In Table 2 were listed classes of drugs with potential to cause salivary dysfunction. Unfortunately few studies have examined salivary flow, much of the data, being based on a subjective complaint of dry mouth. Besides, little data about the effects of many supposed xerostomia-inducing drugs on salivation are available. Although the exact mechanisms whereby some

Therapeutic options

The therapeutic approach of salivary dysfunctions depends basically on residual glandular function and is aimed at the alleviation of symptoms and prevention and correction of eventual sequelae, as well as at the treatment of associated systemic diseases. The treatment of hyposalivation and xerostomia can be classified as (1) preventive, (2) symptomatic, (3) topical and systemic stimulants, (4) disease-modifying agents, and (5) regenerative.81, 150

Conclusions

Salivary dysfunctions are common, have a negative impact on the quality of life, and can be caused by a number of local and systemic conditions. In the present study we described subjective methods, as well as objective methods for determining alterations in salivary secretion. In addition to this, we addressed the possible etiologic factors and established treatments in the literature, as well as new therapeutic strategies still under investigation. Clinicians must be aware of the signs and

Funding

There is no funding source to state in this research.

Competing interest

There is no conflict of interest in this research.

Ethical approval

Not applicable.

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