Mutans streptococci in xerostomic cancer patients after pilocarpine therapy: a pilot study.
OBJECTIVE
Opiod- and/or radiation-induced xerostomia in cancer patients is frequently associated with elevated levels of cariogenic mutans streptococci (MS).


METHODS
In a single-center, single blind 8-week clinical trial at The University of Texas M. D. Anderson Cancer Center, and from an initial sample of 32 patients, we evaluated MS counts in 28 cancer patients receiving chronic analgesic treatment for cancer pain. All patients received escalating doses of pilocarpine (Salagen) tablets, either 2.5 mg to 5 mg or 5 mg to 7.5 mg qid for 6 weeks, followed by placebo qid for a 2-week washout period. Whole resting saliva flow rates (g/5 min) and MS counts were evaluated at pretreatment, 3 weeks, 6 weeks, and 8 weeks. MS samples were obtained by 5-mL saline rinse (15 sec) at each visit prior to sialometry.


RESULTS
In 19 patients (59%), MS counts exceeded 10(5) CFU/mL. At the end of the 6-week trial, 96% of patients showed a positive response to pilocarpine following a 30-minute postdosing evaluation (P=.001). MS counts were lower in 17 patients, higher in 6 patients, and nondetectable before and after pilocarpine in 5 patients (P=.03).


CONCLUSIONS
The reduced MS counts associated with improved saliva flow rates following pilocarpine therapy in this short-term pilot study are encouraging, but further investigation in a larger group of patients over a longer study period is indicated.
Chambers
Mark S
MS
The University of Texas, M. D. Anderson Cancer Center, (MDACC), Department of Head and Neck Surgery, Houston, Texas 77030-4009, USA. mchamber@mdanderson.org
Keene
Harris J
HJ
Toth
Béla B
BB
Lemon
James C
JC
Gallagher
Susan C
SC
Martin
Charles G
CG
Martin
Jack W
JW
D000701:Analgesics, Opioid / Q000627:therapeutic use; D015169:Colony Count, Microbial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000382:microbiology; D018721:Muscarinic Agonists / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000517:prevention & control; D010862:Pilocarpine / Q000627:therapeutic use*; D010865:Pilot Projects; D010919:Placebos; D012463:Saliva / Q000187:drug effects / Q000378:metabolism; D012636:Secretory Rate / Q000187:drug effects; D016037:Single-Blind Method; D013295:Streptococcus mutans / Q000254:growth & development* / Q000302:isolation & purification; D014070:Tooth / Q000382:microbiology; D014987:Xerostomia / Q000209:etiology / Q000382:microbiology*
D000701:Analgesics, Opioid; D018721:Muscarinic Agonists; D010919:Placebos; D010862:Pilocarpine