title: Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy.
abstract: OBJECTIVE
  Polypharmacy is a common cause of xerostomia. This study aimed to investigate whether xerostomia could be an adverse drug event of mouthwashes, when they are used for longer than 2 weeks by patients taking polypharmacy.
  
  
  METHODS
  This cross-sectional observational study included 120 hospitalized patients (60 middle-aged and 60 elderly patients), taking polypharmacy (≥4 drugs daily) and at risk of drug-induced xerostomia. Xerostomia was assessed by questioning participants.
  
  
  RESULTS
  A total of 62.5% of patients complained of xerostomia. In the middle-aged group (mean age=44.0 (8.7) years; 35.0% women) xerostomia seemed independently associated to mouthwashes, at the limit of significance (OR=5.00, 95% CI=0.99-25.3, p=0.052). Active principles in mouthwashes were mainly quaternary ammonium compounds (91.9%). Mouthwashes may disturb the healthy balance of the biofilm moisturizing the oral mucosa. The biofilm contains mucins, salivary glycoproteins with oligosaccharides side chains able to sequester water and endogenous bacteria surrounded by a glycocalyx. Oral bacteria are fully susceptible to quaternary ammonium (chlorhexidine, hexetidine, cetylpyridinium chloride) and to other antiseptics used in mouthwashes, such as betain, resorcin, triclosan, essential oils and alcohol. However, caregivers currently recommend such dental plaque control products to patients suffering from xerostomia in order to reduce the risk of caries and periodontitis.
  
  
  CONCLUSIONS
  This study is the first report that use of antiseptic mouthwashes for more than 2 weeks could worsen xerostomia in patients taking polypharmacy. Oral care protocols should avoid this iatrogenic practice, particularly when xerostomia alters the quality-of-life and worsens malnutrition.
authors.affiliation: Laboratory of Oral Health and Aging, Faculty of Dentistry, University Nice Sophia Antipolis , Nice , France.
authors.forename: Marlene
authors.initials: M
authors.lastname: Chevalier
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sakarovitch
authors.forename: Isabelle
authors.initials: I
authors.lastname: Precheur
authors.forename: Julie
authors.initials: J
authors.lastname: Lamure
authors.forename: Valerie
authors.initials: V
authors.lastname: Pouyssegur-Rougier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001622:Betaine / Q000009:adverse effects; D018441:Biofilms / Q000187:drug effects; D002594:Cetylpyridinium / Q000009:adverse effects; D002710:Chlorhexidine / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000517:prevention & control; D004347:Drug Interactions; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006590:Hexetidine / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes / Q000009:adverse effects*; D009822:Oils, Volatile / Q000009:adverse effects; D010518:Periodontitis / Q000517:prevention & control; D019338:Polypharmacy; D012118:Resorcinols / Q000009:adverse effects; D014260:Triclosan / Q000009:adverse effects; D014987:Xerostomia / Q000139:chemically induced*
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D009822:Oils, Volatile; D012118:Resorcinols; D000431:Ethanol; D001622:Betaine; D014260:Triclosan; D006590:Hexetidine; D002594:Cetylpyridinium; D002710:Chlorhexidine; C031389:resorcinol
keywords: adverse drug event; biofilm; iatrogenic disease; xerostomia