title: Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.
abstract: 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.
authors: Department of Oral Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. inger.von.bultzingslowen@liv.se <inger.von.bultzingslowen@liv.se>
authors: Inger
authors: I
authors: von Bültzingslöwen
authors: Thomas P
authors: TP
authors: Sollecito
authors: Philip C
authors: PC
authors: Fox
authors: Troy
authors: T
authors: Daniels
authors: Roland
authors: R
authors: Jonsson
authors: Peter B
authors: PB
authors: Lockhart
authors: David
authors: D
authors: Wray
authors: Michael T
authors: MT
authors: Brennan
authors: Marco
authors: M
authors: Carrozzo
authors: Beatrice
authors: B
authors: Gandera
authors: Takashi
authors: T
authors: Fujibayashi
authors: Mahvash
authors: M
authors: Navazesh
authors: Nelson L
authors: NL
authors: Rhodus
authors: Morten
authors: M
authors: Schiødt
mesh_terms: 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
chemical_list: 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