Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.
OBJECTIVE
The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia.


METHODS
Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005.


RESULTS
Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient.


CONCLUSIONS
These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.
von Bültzingslöwen
Inger
I
Department of Oral Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. inger.von.bultzingslowen@liv.se <inger.von.bultzingslowen@liv.se>
Sollecito
Thomas P
TP
Fox
Philip C
PC
Daniels
Troy
T
Jonsson
Roland
R
Lockhart
Peter B
PB
Wray
David
D
Brennan
Michael T
MT
Carrozzo
Marco
M
Gandera
Beatrice
B
Fujibayashi
Takashi
T
Navazesh
Mahvash
M
Rhodus
Nelson L
NL
Schiødt
Morten
M
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D018721:Muscarinic Agonists / Q000627:therapeutic use*; D010862:Pilocarpine / Q000627:therapeutic use*; D011812:Quinuclidines / Q000627:therapeutic use*; D000069283:Rituximab; D012472:Salivation; D012859:Sjogren's Syndrome / Q000188:drug therapy; D013876:Thiophenes / Q000627:therapeutic use*; D014987:Xerostomia / Q000188:drug therapy* / Q000821:virology
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D016898:Interferon-alpha; D018721:Muscarinic Agonists; D011812:Quinuclidines; D013876:Thiophenes; D010862:Pilocarpine; D000069283:Rituximab; C059240:cevimeline