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	<title>Dry Mouth Pump</title>
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		<title>Dry Mouth &#8211; Real Cases</title>
		<link>http://drymouthpump.com/blog/?p=30</link>
		<comments>http://drymouthpump.com/blog/?p=30#comments</comments>
		<pubDate>Sat, 24 Apr 2010 13:06:05 +0000</pubDate>
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I suffer from end stage lung disease (COPD) I am presently going  through a flare up and my oxygen drops into the 80&#8217;s with minimum  exertion.  I am on 20 mg of prednisone (tapering off) and was on  Factive. I take 20mg of Lexapro, Spiriva, Advair, Protonix, theophylline  and 20 [...]]]></description>
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<p>I suffer from end stage lung disease (COPD) I am presently going  through a flare up and my oxygen drops into the 80&#8217;s with minimum  exertion.  I am on 20 mg of prednisone (tapering off) and was on  Factive. I take 20mg of Lexapro, Spiriva, Advair, Protonix, theophylline  and 20 mg of Micardis. I put on weight (5&#8242;4, 236 lbs-female) but I had a  very thorough exam for my heart- no sugar, cholesterol or triglyceride  problem, no thyroid, stress test and echo perfect as well as blood  pressure (it goes up a bit when I exert but usually is runs about 130/80  or bad is 140/90. Sometime it drops to 117/78. So, in that regard I am  very lucky.  My mouth became dry and I became very thirsty with this  flare up (it has been going on now for about 3.5 weeks) I have a partial  bridge and caps.  I do not know what to make of it. I also noticed my skin getting very dry so I bought some Gatoraid and  drank that and it helped for about 3 days.  Seems like I&#8217;m dehydrated. I  am constantly drinking water &#8211; maybe 10 glasses or so.  Am constantly  going to the bathroon to urinate and do have a yeast infection that will  not go away. I also have been having headaches &#8211; mild and get dizzy-  which I think is from the drop in oxygen.  What do you suggest?  Which doctor should I see- my primary, pulmonist,  ENT, gynocologist or all? Sorry for the overload.  I am 55 yrs. old if that makes any difference. I  get hot flashes now and then but mostly in the extremities and do not  sweat just get hot on the top of my head. (don&#8217;t laugh-is true) Thanks&#8230; Maria   Published: July 23 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=3641" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=3641">Permalink</a>&#8211;></p>
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<p>I have had dry mouth for a long time due to several autoimmune  diseases.  The only thing that helps me is Biotene Oral Balance Dry  Mouth Moisturizing Gel.  They now make a spray that I can&#8217;t use because  it hurts my mouth.  I&#8217;ve tried everything and this gel is the best  because it soothes your mouth and doesn&#8217;t sting.  Most places stock the  spray, and I have to buy the gel online.  If I drink a lot of water at  night it helps, but then I&#8217;m up running to the bathroom.   Published: July 21 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=3556" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=3556">Permalink</a>&#8211;></p>
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<p>To treat my dry mouth, I have two glasses of water before bed. I try  to form saliva as much as possible. I don’t have coffee — even decaff.  Yes, sugar-free juices and mints help. Published: July 21 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=3467" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=3467">Permalink</a>&#8211;></p>
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<p>Sores in my mouth and tongue for about two years being treated with a  prednisone mouth wash and is not getting any better. It is not the  medications I am on because my doctor already had started eliminating  each med but nothing has helped. My age is 81.  Published: July 18 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=3419" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=3419">Permalink</a>&#8211;></p>
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<p>For 2 years now I have woken up every morning with a mouth so dry it  feels like I have spent a month lost in the desert without water. My  doctor tells me only that I must sleep with my mouth open as a result of  congestion. My nasal passages are clear upon waking so I think it has  some other cause. I take no meds, only vitamins, digestive enzymes and  protein powder.  Published: July 10 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=3011" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=3011">Permalink</a>&#8211;></p>
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<p>I have only had what I call a dry mouth for a week and a half, and  already I am quite tired of it.  I read that most people with this  condition complain of no saliva; however, I have saliva, and can swallow  it.  But my tongue is dry and split and sore.  I have sores in my mouth  from the cheeks sticking to my teeth when I shut my mouth for even a  few minutes.  It came on suddenly.  I have no idea what is causing it.   The doctor suggested rheumatoid arthritis; I&#8217;m still waiting for test  results. Published: July 07 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=2734" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=2734">Permalink</a>&#8211;></p>
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<p>I believe I get a dry mouth from my stomach; perhaps food is digested  or not digested, am I too acidic, is it the stress that I have been  going through.  I just know it&#8217;s very uncomfortable, I am constantly  drawing for saliva and this looks and sounds awful. I believe it started  when I was drinking a lot of coffee, perhaps I damaged something.  The  dryness comes and goes sometimes worse sometimes less. I am on a  sedative mainly for sleep but I find that this sometimes helps me by  calming stomach nerves.  Published: July 07 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=2714" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=2714">Permalink</a>&#8211;></p>
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<p>I have Sjogren’s syndrome because of fibromyalgia. Consequently, I  have dry eyes and dry mouth.  The eyes I can handle with drops, but the  mouth is a big problem. It’s constantly dry day and night. I suck on  sugar-free candy, drink lots of water, etc.  Often I can&#8217;t open my  mouth, and talking is a chore at times. Published: June 25 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=2125" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=2125">Permalink</a>&#8211;></p>
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<p>I have been experiencing dry mouth for the last six weeks now and it  affects me mostly at night when I go to sleep. I do not take medication  for anything and not inclined to take pain killers either. The only  thing I have done is changed my toothpaste and I am not sure if that has  anything to do with it or not.   Published: June 24 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1986" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1986">Permalink</a>&#8211;></p>
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<p>I have terrible dry mouth.  I wake up at night with my tongue stuck  to the roof of my mouth. It hurts to get it loose. During the day I have  spells of dry mouth that make it hard to talk. It is getting worse. I  have started keeping a water bottle with me.  I take many medicines I  take steroids for Addison’s-blood pressure meds, 3 of them, Neurontin  for arthritis and thyroid meds.  That is likely to be part of my  problem. I wish I could find a way to not have dry mouth. Published: June 24 ::</p>
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<p>I am taking Zopiclone at night 1 tablet 7.5mg, I have an awful dry  mouth but worst of all a great deal of my food tastes like poison &amp;  my wife is throwing out good food to the birds everyday. I have been on  these tablets for 8 weeks, I also take Amitriptyline 10mg at night.   Published: June 19 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1755" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1755">Permalink</a>&#8211;></p>
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<p>My mouth is dry at night and I keep a bottle of water nearby to  relieve the symptom. I take medication for hypertension and cholesterol.   Published: June 18 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1644" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1644">Permalink</a>&#8211;></p>
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<p>I am searching the Net for more information on this subject.  I am 61  and over the past year I have been waking several times each night with  a dry, parched mouth.  My tongue feels like it is three times larger  than it usually does and the inside of my mouth is like a desert.  I  keep a glass of water by my bed at all times and sip on it when I am  wakened by this, for surely it does awaken me.  My sleep is being  severely interrupted by this phenomenon. I have no other symptoms and do  not take any other medication except an occasional Robaxin for back  pain. Published: June 18 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1708" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1708">Permalink</a>&#8211;></p>
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<p>I am a Registered Nurse. I have worked in many hospital settings.  When a patent experiences a dry mouth for what ever reason, I also have  the dietary department bring sliced lemons for the patient to suck on.   This seems to activate the salivary glands to produce much needed  moisture. I have a lot of sinus and allergy problems. I also use lemons  for my own use. Hope this may help someone.   Published: June 12 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1171" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1171">Permalink</a>&#8211;></p>
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<p>My mouth gets so dry at night that it literally sticks shut and I  have a difficult time tearing my tongue away from the top of my mouth.  I  am on bladder medication (oxybutynin). Published: June 11 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1079" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1079">Permalink</a>&#8211;></p>
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<p>Sometimes I try to remember what it is like to have a normal mouth  with saliva.   That is not my present reality.  I have dry mouth due to Sjögren’s  Syndrome.  No matter how much I drink, my mouth always feels sticky and  dry.  When I wake up in the morning, I can barely swallow.  I can no  longer lick an envelope or spit (not that I was much of a spitter).  The  corners of my mouth often crack from dryness and my tongue hurts.  I  can&#8217;t eat anything spicy or use any minty oral care products as they  hurt my tongue.  I use special toothpastes and other products for dry  mouth but nothing really helps.  I have difficulty talking unless I chew  gum so I always carry it with me.   Can I remember what it was like before I developed this problem.    Published: June 11 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1092" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1092">Permalink</a>&#8211;></p>
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<p>I was told that I had sleep apnea and that it was border line, if I  didn&#8217;t sleep with a mask on at night it would get worse, and could even  cause death. Prior to this I did not have dry mouth. I followed Doctors  orders and began sleeping with a mask eight months, I developed dry  mouth. It got so bad I just quit, now at night between 3:00 am and 4:00  am my mouth get so dry that my tongue bleeds and blood gets on my lips. I  have to get up and rinse my mouth out because the blood dries on mt  lips and leaves a very uncomfortable feeling.  Published: June 10 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=1035" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=1035">Permalink</a>&#8211;></p>
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<p>Lately I&#8217;ve woke up with such a dry mouth that I can not swallow. I  keep water on the night stand for such occasions, but sipping water  throughout the night does not seem to help. Therefore I&#8217;m awake a large  portion of the night.  Published: June 09 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=840" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=840">Permalink</a>&#8211;></p>
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<p>My dry mouth only occurs at night and has been a symptom for about  three months.  I occasional use some form of decongestant and had for a  short time used Claritin nightly for about two weeks to stop a post  nasal drip that made me cough.  During the day there seems to be no  problem, perhaps because I drink more water regularly.   Published: June 09 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=852" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=852">Permalink</a>&#8211;></p>
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<p>I was diagnosed 9 months ago with Parkinsons Disease (&#8220;PD&#8221;).  One of  the medications I am taking (Azilect) lists, among others, a side effect  of dry mouth.  The PD itself I believe can cause dry mouth also.  My  mouth gets so dry at times that my tongue sticks to the roof of my  mouth.  My tongue is constantly sore &#8211; like it was scalded &#8211; and I am  forever getting a membrane type of coating over the roof of my mouth too  which is a dog of a thing to shift.  Dry lips, coated tongue, bad  breath etc all seem to be part of the package.  My teeth aren&#8217;t the  strongest, so I try to avoid chewing gum too much, and now use mint  sweets to suck on.  It only helps slightly.  Any ideas or advice out  there? Published: June 09 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=964" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=964">Permalink</a>&#8211;></p>
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<p>My throat is so dry at night that i must keep water or juice at my  bedside. also I keep chewing gum handy. This condition interferes with  my sleep so I stay tired.  I caugh constantly sometimes to the point of  becoming dizzy and losing my breath.  I must constantly take caugh  medicine.  I have to sleep with my head elevated.  Doctors have been no  help. Published: June 09 ::  <!--<a href="/script/main/art.asp?articlekey=43095&#038;questionid=180&#038;answerid=893" mce_href="/script/main/art.asp?articlekey=43095&amp;questionid=180&amp;answerid=893">Permalink</a>&#8211;></p>
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<p>I was getting dry mouth worse and worse as time went by, until it  finally got to the point that my mouth was literally sticking together  and was not easy to open. I was sent to a sleep center, and it turned  out that I had sleep apnea and was also sleeping with my mouth open most  of the night.</p>
<p>source: http://www.medicinenet.com/dry_mouth/discussion-180.htm</p>
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		<title>Helping Patients with Dry Mouth</title>
		<link>http://drymouthpump.com/blog/?p=28</link>
		<comments>http://drymouthpump.com/blog/?p=28#comments</comments>
		<pubDate>Sat, 24 Apr 2010 11:55:55 +0000</pubDate>
		<dc:creator>admin</dc:creator>
				<category><![CDATA[Uncategorized]]></category>

		<guid isPermaLink="false">http://drymouthpump.com/blog/?p=28</guid>
		<description><![CDATA[Helping patients with dry mouth
By Cathy L. Bartels, Pharm.D., assistant professor, pharmacy  practice,                  School of                  Pharmacy and Allied Health Sciences, [...]]]></description>
			<content:encoded><![CDATA[<h4>Helping patients with dry mouth</h4>
<p>By Cathy L. Bartels, Pharm.D., assistant professor, pharmacy  practice,                  School of                  Pharmacy and Allied Health Sciences,                           University of                  Montana</p>
<h4><strong>Introduction</strong></h4>
<p>Xerostomia is defined as dry mouth resulting from reduced or  absent saliva flow. Xerostomia is not a disease, but it may be a symptom  of various medical conditions, a side effect of a radiation to the head  and neck, or a side effect of a wide variety of medications. It may or  may not be associated with decreased salivary gland function.1,2  Xerostomia is a common complaint found often among older adults,  affecting approximately 20 percent of the elderly.1,3-5 However,  xerotomia does not appear to be related to age itself as much as to the  potential for elderly to be taking medications that cause xerostomia as a  side effect.</p>
<p>Normal salivary function is mediated by the muscarinic M3  receptor. Stimulation of this receptor results in increased watery flow  of salivary secretions. When the oral mucosal surface is stimulated,  afferent nerve signals travel to the salivatory nuclei in the medulla.  The medullary signal may also be affected by cortical inputs resulting  from stimuli such as taste, smell, anxiety or depression. Efferent nerve  signals, mediated by acetylcholine, also stimulate salivary glandular  epithelial cells and increase salivary secretions.7</p>
<h4><strong>Saliva components</strong></h4>
<p>Saliva is the viscous, clear, watery fluid secreted from the  parotid, submaxillary, sublingual and smaller mucous glands of the  mouth. Saliva contains two major types of protein secretions, a serous  secretion containing the digestive enzyme ptyalin and a mucous secretion  containing the lubricating aid mucin. The pH of saliva falls between 6  and 7.4. Saliva also contains large amounts of potassium and bicarbonate  ions, and to a lesser extent sodium and chloride ions. In addition,  saliva contains several antimicrobial constituents, including  thiocyanate, lysozyme, immunoglobulins, lactoferrin and transferrin.8</p>
<h4><strong>Functions of saliva</strong></h4>
<p>Saliva possesses many important functions including  antimicrobial activity, mechanical cleansing action, control of pH,  removal of food debris from the oral cavity, lubrication of the oral  cavity, remineralization and maintaining the integrity of the oral  mucosa.2,8-10</p>
<h4><strong>Complications associated with xerostomia </strong></h4>
<p>Xerostomia is often a contributing factor for both minor and  serious health problems. It can affect nutrition and dental, as well as  psychological, health. Some common problems associated with xerostomia  include a constant sore throat, burning sensation, difficulty speaking  and swallowing, hoarseness and/or dry nasal passages.1 Xerostomia is an  original hidden cause of gum disease and tooth loss in three out of  every 10 adults.11 If left untreated, xerostomia decreases the oral pH  and significantly increases the development of plaque and dental  caries.1,2 Oral candidiasis is one of the most common oral infections  seen in association with xerostomia.(2)</p>
<h4><strong>Signs and symptoms of xerostomia </strong></h4>
<p>Individuals with xerostomia often complain of problems with  eating, speaking, swallowing and wearing dentures. Dry, crumbly foods,  such as cereals and crackers, may be particularly difficult to chew and  swallow. Denture wearers may have problems with denture retention,  denture sores and the tongue sticking to the palate. Patients with  xerostomia often complain of taste disorders (dysgeusia), a painful  tongue (glossodynia) and an increased need to drink water, especially at  night. Xerostomia can lead to markedly increased dental caries, parotid  gland enlargement, inflammation and fissuring of the lips (cheilitis),  inflammation or ulcers of the tongue and buccal mucosa, oral  candidiasis, salivary gland infection (sialadenitis), halitosis and  cracking and fissuring of the oral mucosa.(2,6,9,13)</p>
<h4><strong>Diagnosis and evaluation of xerostomia</strong></h4>
<p>Diagnosis of xerostomia may be based on evidence obtained from  the patient&#8217;s history, an examination of the oral cavity and/or  sialometry, a simple office procedure that measures the flow rate of  saliva. Xerostomia should be considered if the patient complains of dry  mouth, particularly at night, or of difficulty eating dry foods such as  crackers.(2,5,7) When the mouth is examined, a tongue depressor may  stick to the buccal mucosa.9 In women, the &#8220;lipstick sign,&#8221; where  lipstick adheres to the front teeth, may be a useful indicator of  xerostomia.7</p>
<p>The oral mucosa may be dry and sticky, or it may appear  erythematous due to an overgrowth of Candida albicans. The red patches  often affect the hard or soft palate and dorsal surface of the tongue.  Occasionally, pseudomembranous candidiasis will be present, appearing as  removable white plaques on any mucosal surface. There may be little or  no pooled saliva in the floor of the mouth, and the tongue may appear  dry with decreased numbers of papillae. The saliva may appear stringy,  ropy or foamy. Dental caries may be found at the cervical margin or neck  of the teeth, the incisal margins or the tips of the teeth.2</p>
<p>Several office tests and techniques can be utilized to  ascertain the function of salivary glands. In sialometry, or salivary  flow measurement, collection devices are placed over the parotid gland  or the submandibular/</p>
<p>sublingual gland duct orifices, and saliva is stimulated with  citric acid. The normal salivary flow rate for unstimulated saliva from  the parotid gland is 0.4 to 1.5 mL/min/gland.2,3 The normal flow rate  for unstimulated, &#8220;resting&#8221; whole saliva is 0.3 to 0.5 mL/min; for  stimulated saliva, 1 to 2 mL/min. Values less than 0.1 mL/min are  typically considered xerostomic, although reduced flow may not always be  associated with complaints of dryness.2,5</p>
<p>Sialography is an imaging technique that may be useful in  identifying salivary gland stones and masses. It involves the injection  of radio-opaque media into the salivary glands.2,3 Salivary scintigraphy  can be useful in assessing salivary gland function. Technetium-99m  sodium pertechnate is intravenously injected to ascertain the rate and  density of uptake and the time of excretion in the mouth.2,3 Minor  salivary gland biopsy is often used in the diagnosis of Sjögren&#8217;s  syndrome (SS), human immunodeficiency virus-salivary gland disease,  sarcoidosis, amyloidosis and graft-vs.-host disease. Biopsy of major  salivary glands is an option when malignancy is suspected.2</p>
<h2><strong>Common causes of xerostomia</strong></h2>
<h4><strong>Medications </strong></h4>
<p>Perhaps the most prevalent cause of xerostomia is medication.  Xerogenic drugs can be found in 42 drug categories and 56  subcategories.14 More than 400 commonly used drugs can cause  xerostomia.10,14 The main culprits are antihistamines, antidepressants,  anticholinergics, anorexiants, antihypertensives, antipsychotics,  anti-Parkinson agents, diuretics and sedatives. Other drug classes that  commonly cause xerostomia include antiemetics, antianxiety agents,  decongestants, analgesics, antidiarrheals, bronchodilators and skeletal  muscle relaxants.2,6,10,14,15 It should be noted that, while there are  many drugs that affect the quantity and/or quality of saliva, these  effects are generally not permanent.</p>
<p>Patients complaining of xerostomia should be interviewed and  their medications should be reviewed. It may be possible to change  medications or dosages to provide increased salivary flow. Symptoms of  xerostomia are often worse between meals, at night and in the morning.  Therefore, consider modifying drug schedules to achieve maximum plasma  levels when the patient is awake.9 Consider easy-to-take formulations,  such as liquids, and avoid sublingual dosage forms if possible. Counsel  your patients regarding which medications can and cannot be crushed.  Also counsel them to first lubricate the mouth and throat with water  prior to taking capsules and tablets and to follow this with a full  glass of water. If possible, consider switching the patient from one  medication to another with comparable efficacy but with less  anticholinergic activity, for example, switching from the tricyclic  antidepressant amoxapine to desipramine.</p>
<h4><strong>Diseases and other conditions </strong></h4>
<p>The most common disease causing xerostomia is Sjögren&#8217;s  syndrome (SS), a chronic inflammatory autoimmune disease that occurs  predominantly in postmenopausal women. It is estimated that as many as 3  percent of Americans suffer from Sjögren&#8217;s syndrome, with 90 percent of  these patients being women with a mean age at diagnosis of 50 years. SS  is characterized by lymphocytic infiltration of salivary and lacrimal  glands, resulting in xerostomia and xerophthalmia. This combination is  called the sicca complex. Enlargement of major salivary glands occurs in  about one-third of patients with SS.9 There is no cure for the disease.  The goal of therapy is to manage symptoms. Common symptoms associated  with SS, in addition to xerostomia and xerophthalmia, include blurred  vision, recurrent eye and mouth infections, dysphagia or difficulty  swallowing, oral soreness, smell and taste alternations, fissures on the  tongue and lips, fatigue, dry nasal passages and throat, constipation  and vaginal dryness.(3)</p>
<p>Sarcoidosis and amyloidosis are other chronic inflammatory  diseases that cause xerostomia. In sarcoidosis, noncaseating epithelioid  granulomas in salivary glands result in reduced salivary flow. In  amyloidosis, amyloid deposits in the salivary glands result in  development of xerostomia.(2)</p>
<p>HIV-salivary gland disease occurs in some individuals infected  with HIV, mainly in children. This disease results in enlargement of the  parotid glands and, occasionally, the submandibular glands, resulting  in xerostomia. The T-lymphocyte infiltrate is mainly comprised of CD8+  cells, as compared with SS where CD4+ cells predominate.(2)</p>
<p>Other systemic diseases that can cause xerostomia include  rheumatoid arthritis, systemic lupus erythematosus, scleroderma,  diabetes mellitus, hypertension, cystic fibrosis, bone marrow  transplantation, endocrine disorders, nutritional deficiencies,  nephritis, thyroid dysfunction and neurological diseases such as Bell&#8217;s  palsy and cerebral palsy. Hyposecretory conditions, such as primary  biliary cirrhosis, atrophic gastritis and pancreatic insufficiency, may  also cause xerostomia. Dehydration resulting from impaired water intake,  emesis, diarrhea or polyuria can result in xerostomia. Psychogenic  causes, such as depression, anxiety, stress or fear, can also result in  xerostomia. Alzheimer&#8217;s disease or stroke may alter the ability to  perceive oral sensations. Dry mouth is often exacerbated by activities  such as hyperventilation, breathing through the mouth, smoking or  drinking alcohol. Trauma to the head and neck area can damage the nerves  supplying sensation to the mouth, impairing the normal function of the  salivary glands.2,6</p>
<h4><strong>Cancer therapy</strong></h4>
<p>Xerostomia is the most common toxicity associated with standard  fractionated radiation therapy to the head and neck. Acute xerostomia  from radiation is due to an inflammatory reaction, while late  xerostomia, which can occur up to one year after radiation therapy,  results from fibrosis of the salivary gland and is usually permanent.16  Radiation causes changes in the serous secretory cells, resulting in a  reduction in salivary output and increased viscosity of the saliva. A  common early complaint following radiation therapy is thick or sticky  saliva. The degree of permanent xerostomia depends on the volume of  salivary gland exposed to radiation and the radiation dose. When the  total radiation dose exceeds 5,200 cGy, salivary flow is reduced, and  little or no saliva is expressible from the salivary ducts. These  changes are typically permanent.2</p>
<p>Certain cancer chemotherapeutic drugs can also change the  composition and flow of saliva, resulting in xerostomia, but these  changes are usually temporary. Xerostomia may also occur during  graft-vs.-host disease. When donor lymphocytes proliferate and  infiltrate the recipient&#8217;s salivary glands and other tissues, changes  can occur in a clinical pattern resembling those seen in Sjögren&#8217;s  syndrome.2</p>
<p>Patients experiencing xerostomia from radiation therapy or  cancer chemotherapy are at particular risk of infections from normal  oral flora. Oral ulcerations can become the nidus of invasive  gram-positive and gram-negative infections, and opportunistic infections  with fungal organisms such as Candida can occur.9</p>
<h4><strong>Practice scenario/case study</strong></h4>
<p>A 54-year-old woman complaining of a two-month history of  fatigue and general trouble sleeping at night, stating that she wakes up  often with a dry mouth and throat. She also states her eyes have been  dry, tired and red lately, but she attributes this to her poor sleep  patterns. She states she is currently consuming up to seven pints a day  of liquids (coffee, tea, water, juice, milk, soda, etc.), and she is  very distressed by her severe dry mouth. She wakes several times during  the night and averages only four hours sleep. She drinks minimal alcohol  and smokes approximately 15 cigarettes per day. She has no other  complaints, and her past medical history is significant only for a  history of allergic rhinitis for which she takes OTC antihistamines and  decongestants.</p>
<p>The following are some examples of questions you might ask.</p>
<ul>
<li>Do you need to moisten your mouth frequently or sip liquids  often?</li>
<li>Does your mouth feel dry at mealtime?</li>
<li>Do you have less saliva than you used to?</li>
<li>Do you have trouble swallowing?</li>
<li>Is it difficult to eat dry foods such as crackers or toast?</li>
<li>Do you suffer from any chronic illness, such as diabetes or  hypertension?</li>
<li>When was the last time you had a complete physical  examination by your doctor?</li>
<li>What prescription and OTC medications are you currently  taking?</li>
<li>What dietary supplements are you currently taking?</li>
<li>How often do you brush your teeth?</li>
<li>Do you wear dentures? If so, how often do you clean your  dentures?</li>
<li>When was the last time you saw your dentist for a regular  checkup?</li>
<li>Do you have toothaches or other dental pain?</li>
<li>Have you noticed any sores in your mouth or on your lips?</li>
<li>How much water do you drink throughout the day?</li>
</ul>
<h4><strong>Management of xerostomia </strong></h4>
<p>Ideally, the management of xerostomia will include the  identification of the underlying cause. In the event that steps can be  taken to minimize the effect of the underlying cause, this should be  done. For many patients, however, little can be done to alter the  underlying cause. For those whose xerostomia is related to medication  use, effective symptomatic treatment may be important to maintain  compliance with their medication regime. Symptomatic treatment typically  includes four areas: increasing existing saliva flow, replacing lost  secretions, control of dental caries and specific measures such as  treatment of infections.17,18</p>
<h4><strong>Self-care</strong></h4>
<p>Patients suffering from xerostomia should be encouraged to take  an active role in management of their xerostomia with regard to both  identifying products and practices that are most useful to them and in  being vigilant to minimize the risks to dental health. Patients should  be encouraged to conduct a daily mouth examination, checking for red,  white or dark patches, ulcers or tooth decay. If anything unusual is  found, it should be reported to their physician or dentist. Patients  should be encouraged to practice regular preventive dentistry. Plaque  removal and treatment of gingival infections or inflammation and dental  caries are essential. Patients should also be counseled to brush and  floss regularly and to use fluoride daily. The teeth should be cleansed  at least twice daily using a soft bristled toothbrush and mildly  flavored low-abrasive fluoride toothpaste.</p>
<p>Products containing sodium lauryl sulfate should be avoided as  they may contribute to the formation of aphthous ulcers or canker sores.  Sodium fluoride rinses should be held in the mouth for at least one  minute before expectorating, while fluoride gels can be applied with a  toothbrush and left in place for two to three minutes before  expectorating. No food or beverage should be consumed for at least 30  minutes after fluoride application. Chlorhexidine rinses also may be  useful in preventing caries by reducing lactobacillus counts in the  mouth.</p>
<p>Dentures should not be worn during sleep and should be kept  clean by overnight soaking. Acrylic appliances should be soaked in a  sodium hypochlorite solution, and metal dentures should be soaked in  chlorhexidine.2,3,6,9,10,17,18 Patient may want to consider visiting  their dentist more frequently and should take advantage of the  opportunity to discuss their xerostomia with their dental hygienist.</p>
<p>Because of their susceptibility to dental caries, patients with  xerostomia should avoid sugary or acidic foods or beverages. These  patients should also avoid irritating foods that are dry, spicy,  astringent or excessively hot or cold. If possible, tobacco and alcohol  intake should be eliminated to control dental caries.1-3,6,9,10,15,17-19  Lubricants such as Orajel® or Vaseline® and glycerin swabs on the lips  and under dentures may relieve drying, cracking, soreness, and mucosal  trauma.9,18 A cold air humidifier may aid mouth breathers who typically  have their worst symptoms at night.2,3,6,9,10,17,18</p>
<p>Saliva stimulants or sialagogues, such as sugarless candies and  chewing gum, may be used to stimulate saliva flow when functional  salivary glands remain. Patients should be advised to take frequent sips  of water throughout the day and to suck on ice chips. Eating foods such  as carrots or celery may also help patients with residual salivary  gland function. Addition of flavor enhancers such as herbs, condiments  and fruit extracts may make food more palatable to patients complaining  of their food tasting bland, papery, salty or otherwise  unpleasant.1-3,6,9,10,15,17-19 Listed below are several additional  self-care steps that patients can take to minimize the effects of their  xerostomia.</p>
<h4><strong>Over-the-counter products </strong></h4>
<p>There are several over-the-counter products that are available  to provide assistance in the management of xerostomia. These products  range from saliva substitutes and stimulants to products designed to  minimize dental problems.</p>
<h4><strong>Saliva substitutes:</strong></h4>
<p>Artificial saliva or saliva substitutes can be used to replace  moisture and lubricate the mouth. These substitutes are available  commercially, but they can also be compounded. Artificial salivas are  formulated to mimic natural saliva, but they do not stimulate salivary  gland production. Therefore, they must be considered as replacement  therapy rather than a cure.1,13,15,17</p>
<p>Commercially available products come in a variety of  formulations including solutions, sprays, gels and lozenges. In general,  they contain an agent to increase viscosity, such as  carboxymethylcellulose or hydroxyethylcellulose, minerals such as  calcium and phosphate ions and fluoride, preservatives such as methyl-  or propylparaben, and flavoring and related agents.15,20</p>
<p>Some commercially available saliva substitutes  include:13,15,20,21</p>
<p>• Carboxymethyl, or hydroxyethylcellulose solutions:</p>
<p>• Entertainer&#8217;s Secret® (KLI Corp) , spray</p>
<p>• Glandosane® (Kenwood/Bradley) spray</p>
<p>• Moi-Stir® (Kingswood Labs) spray</p>
<p>• Moi-Stir® Oral Swabsticks (Kingswood Labs) swabs</p>
<p>• Optimoist® (Colgate-Palmolive) spray</p>
<p>• Saliva Substitute® (Roxane Labs) liquid</p>
<p>• Salivart® (Gebauer) preservative-free aerosol</p>
<p>• Salix® (Scandinavian Natural Health &amp; Beauty) tablets</p>
<p>• V. A. Oralube® (Oral Dis. Res. Lab) sodium-free; liquid</p>
<p>• Xero-Lube® Artificial Saliva (Scherer) sodium-free; spray</p>
<p>• Mucopolysaccharide Solutions:</p>
<p>• MouthKote® (Parnell) , spray</p>
<h4><strong>Saliva stimulants:</strong></h4>
<p>Natrol Dry Mouth Relief, which has recently been developed,  utilizes a patented pharmaceutical grade of anhydrous crystalline  maltose (ACM) to stimulate saliva production. As its effect is to  stimulate functional salivary glands, it would not be appropriate for  patients whose salivary gland function has been lost through  radiological treatment. However, in a clinical study of patients with  Sjorgren&#8217;s Syndrome, ACM was shown to increase secretions and  significantly improve patient&#8217;s subjective assessment of symptoms.34  Natrol Dry Mouth Relief is formulated as lozenges which are to be  dissolve in the mouth three times daily.</p>
<h4><strong>Dentifrices:</strong></h4>
<p>Biotene® and Oralbalance® products are available  over-the-counter from Laclede, Inc. (These are antixerostomia  dentifrices that contain three salivary enzymes, lactoperoxidase,  glucose oxidase and lysozyme, specifically formulated to activate  intra-oral bacterial systems.9</p>
<p>Currently available formulations include:</p>
<p>• Biotene® Dry Mouth Toothpaste</p>
<p>• Biotene® Gentle Mouthwash</p>
<p>• Biotene® Dry Mouth Gum</p>
<p>• Oralbalance® Long-lasting Moisturizing Gel</p>
<p>• Biotene® Dry Mouth Kit</p>
<h4><strong>Prescription Products </strong></h4>
<p>Pilocarpine: Pilocarpine is a cholinergic parasympathomimetic  agent with predominantly muscarinic M3 action that causes stimulation of  residual-functioning exocrine glands. The tablets are indicated for the  treatment of symptoms of dry mouth from salivary gland hypofunction  caused by Sjögren&#8217;s syndrome or by radiotherapy for cancer of the head  and neck. The time to reach peak concentrations following oral  administration is approximately 1.25 hours. The duration of sialogogic  effect is about two to three hours. In clinical studies, pilocarpine at  dosages of 5 mg to 30 mg, divided into one to four oral daily doses, was  shown to significantly decrease dryness of the mouth and eyes when  compared to artificial saliva or placebo in patients with Sjögren&#8217;s  syndrome and those who developed xerostomia following radiation  therapy.2,3,17,18,22,24</p>
<p>Pilocarpine is contraindicated in patients with uncontrolled  asthma, narrow-angle glaucoma or iritis. It is pregnancy category C. The  most common side effects are increased sweating and gastrointestinal  intolerance. Hypotension, rhinitis, diarrhea and visual disturbances can  also occur. The recommended initial dose is one 5 mg tablet taken TID  or QID; the usual dosage range is up to three to six tablets (15 to 30  mg) per day, not to exceed two tablets (10 mg) per dose. At least six to  12 weeks of uninterrupted therapy may be necessary before improvement  in symptoms is seen. Pilocarpine is available in an ophthalmic solution  and gel and also as an oral tablet (Salagen®). The tablet can also be  compounded into an oral solution of varying concentrations.3,17,22,23  The 2001 AWP for 30 days of treatment with Salagen® 5 mg QID is  $152.64.25</p>
<p>Cevimeline: Cevimeline is a cholinergic agonist with a high  affinity for the muscarinic M3 receptors located on lacrimal and  salivary gland epithelium, leading to an increase in exocrine gland  secretions including saliva and sweat.7,26-28 It is indicated for the  treatment of symptoms of dry mouth in patient&#8217;s with Sjögren&#8217;s  syndrome.26 It is rapidly absorbed from the gastrointestinal tract,  reaching peak concentrations in approximately 90 minutes without food.  Its duration of sialogogic effect is unclear. Clinical trials have shown  it to be more effective than placebo in relieving symptoms of dry  mouth. No clinical trials are available comparing it to pilocarpine.</p>
<p>It is contraindicated in patients with uncontrolled asthma,  narrow-angle glaucoma, or iritis. It is pregnancy category C. Excessive  sweating and nausea are the most frequently reported adverse effects  with cevimeline. Rhinitis, diarrhea and visual disturbances, especially  at night, can also occur.26-28 The recommended oral dosage is 30 mg TID.  The 2001 AWP for 30 days of treatment is $118. (13.29)</p>
<p>Other medications and preparations: Anethole trithione is a  bile secretion-stimulating drug, or cholagogue. It stimulates the  parasympathetic nervous system and increases the secretion of  acetylcholine, resulting in the stimulation of salivation from serous  acinic cells. Anethole trithione has been used for many years in the  treatment of chronic xerostomia, but reports differ regarding its  efficacy. While some studies report improvements in salivary flow rates  in drug-induced xerostomia, trials in patients with Sjögren&#8217;s syndrome  show conflicting results. Side effects reported include abdominal  discomfort and flatulence. Dosages of 75 mg three times daily may be  effective in treating patients with mild-to-moderate symptoms of  xerostomia, but further research is needed to establish its safety and  efficacy in this setting.2,3,8</p>
<p>Yohimbine is an alpha-2 adrenergic antagonist which indirectly  results in an increase of cholinergic activity peripherally.3,30 In one  small, randomized, double-blind, crossover study, the effect of  yohimbine was compared to that of anethole trithione in 10 patients  treated with psychotropic medications. Patients given yohimbine 6 mg  three times daily for five days showed significantly increased saliva  flow (p&lt;0.01) when compared with anethole trithione 25 mg TID.31</p>
<p>Human interferon alfa (IFN-a) is currently undergoing clinical  trials to determine the safety and efficacy of low-dose lozenges in the  treatment of salivary gland dysfunction and xerostomia in patients with  Sjögren&#8217;s syndrome. In one study, IFN-a lozenges at dosages of 150 IU  given TID for 12 weeks resulted in a significant increase in stimulated  whole saliva (p=0.04) when compared with placebo.3</p>
<p>Development of saliva substitutes based on novel thickening  agents in hopes of providing longer retention on the mucosal surface is  another area of current research. Substitutes based on linseed  polysaccharide (Salinum®,                  Miwana                  AB,                  Gallivare,         Sweden         ) or xanthan gum polysaccharide (Xialine®,                           Lommerse Pharma BV,                  Oss, the                               Netherlands         ) have been shown to be effective in patients with Sjögren&#8217;s  syndrome.12</p>
<p>Another area of research includes the production of  antimicrobial peptides originally derived by histatins, antifungal  proteins naturally occurring in serous salivary glands.12 Prednisolone  irrigation of parotid glands is being investigated as a potential  treatment of xerostomia in patients with Sjögren&#8217;s syndrome.32  Slow-release delivery systems for pilocarpine are also being  investigated.12 Vaccination with autoreactive T cells or with T cell  receptor peptides is another area of research, as is the possibility of  inserting water transporting proteins or aquaporins, in the cell  membrane of the ductal cells.12</p>
<h4><strong>Practice scenario/case study</strong></h4>
<p>Now let&#8217;s return to our previous case: A 54-year-old woman  complaining of a two-month history of fatigue and general trouble  sleeping at night, stating that she wakes up often with a dry mouth and  throat. After discussing her problem with you earlier, she made an  appointment with her physician and has subsequently been diagnosed with  Sjögren&#8217;s syndrome. She now returns to discuss management options for  her xerostomia.</p>
<p>What specific treatment options and counseling tips should you  offer her at this time?</p>
<p>• For her allergic rhinitis, suggest nonsedating antihistamines  and avoidance of products containing decongestants.</p>
<p>• Go over the self-care measures covered earlier in this  discussion (with emphasis on minimizing caffeine consumption and  smoking).</p>
<p>• Give advice about good oral hygiene.</p>
<p>• Encourage adequate fluid intake, avoiding caffeine and  sugar-containing products and alcohol.</p>
<p>• Encourage her to quit smoking.</p>
<p>• Consider the use of an artificial saliva and/or OTC saliva  stimulant.</p>
<h4><strong>SUMMARY/CONCLUSIONS</strong></h4>
<p>Xerostomia is a common problem and if not recognized and  treated, can have a significant effect on a patient&#8217;s quality of life.  Through proper education, assessment, prevention, referral and  appropriate treatment, patients with dentists help, can minimize  xerostomia and its effect on dental health and quality of life.</p>
<h4><strong>REFERENCES:</strong></h4>
<p>1. American Dental Association. The public: Oral health topics:  Dry mouth. [www document] (September 12, 2000). Available from URL:  www.ada.org/public/topics/drymouth.html.</p>
<p>2. Greenspan D. Xerostomia: Diagnosis and management. Oncology  1996;10(Suppl):7-11.</p>
<p>3. Dyke S. Clinical management and review of Sjögren&#8217;s  syndrome. Int J Pharm Compound 2000;4:338-341.</p>
<p>4. Pray WS. Consult your pharmacist. Help for patients with dry  mouth. US Pharmacist 2000;25:16-22.</p>
<p>5. Sreebny LM, Valdini A. Xerostomia: A neglected symptom. Arch  Intern Med 1987;147:1333-1337.</p>
<p>6. Astor FC, Hanft KL, Ciocon JO. Xerostomia: A prevalent  condition in the elderly. Ear Nose Throat J 1999;78:476-479.</p>
<p>7. Fox RI. Sjögren syndrome: New approaches to treatment. [www  document] (n.d. 2/1/01). Available from URL:  www.medscape.com/Medscape/rheumatology/TreatmentUpdate/2000/tu01/pnt-tu01.html</p>
<p>8. Hamada T, Nakane T, Kimura T, Arisawa K, Yoneda K, Yamamoto  T, Osaki T. Treatment of xerostomia with the bile secretion-stimulant  drug anethole trithione: A clinical trial. Am J Med Sci  1999;318:146-151.</p>
<p>9. McDonald E, Marino C. Dry mouth: Diagnosing and treating its  multiple causes. Geriatrics 1991;46:61-63.</p>
<p>10. National Institute of Dental and Craniofacial Research  (NIDCR), National Institutes of Health (NIH). Dry mouth.                           Bethesda,                  MD: National Oral Health Information Clearinghouse (NOHIC).  1999.</p>
<p>11.                           California Dental Hygienists&#8217; Association. Xerostomia: Dry  mouth. [www document] (October 25, 2000). Available from URL:  www.cdha.org/articles/drymouth.htm.</p>
<p>12.    Van Der Reijden WA, Vissink A, Veerman ECI, Amerongen  AVN. Treatment of oral dryness related complaints (xerostomia) in  Sjögren&#8217;s syndrome. Ann Rheum Dis 1999;58:465-473.</p>
<p>13.    Flynn AA. Counseling special populations on oral health  care needs: Patients who are at increased risk for oral disease need to  take special care of their teeth. Am Pharm 1993;33:33-39.</p>
<p>14.    Sreebny LM, Schwartz SS. A reference guide to drugs and  dry mouth – 2nd edition. Gerodontology 1997;14:33-47.</p>
<p>15.    Anon. Treatment of xerostomia. Med Lett Drugs Ther  1988;30(771):74-76.</p>
<p>16.    Hensley ML, Schuchter LM, Lindley C,                           Meropol                  NJ, Cohen GI, Broder G, et al. American society of clinical  oncology clinical practice guidelines for the use of chemotherapy and  radiotherapy protectants. J Clin Oncol 1999;17:3333-3355.</p>
<p>17.    Kuntz R, Allen M, Osburn J. Xerostomia. Int J Pharm  Compound 2000;4:1176-177.</p>
<p>18.    Anon. Management of dry mouth and halitosis.  Practitioner 1990;234:618-619.</p>
<p>19.    Davies A. Clinically proved treatments for xerostomia  were ignored. BMJ 1998;316:1247.</p>
<p>20.    Burham TH, editor. Drug facts and comparisons.                           St. Louis (MO): Facts and ComparisonsÒ ;2000.</p>
<p>21.    Evens RP, Ingalls K. Artificial saliva – availability  (Drug Consult). In: Hutchison TA,                           Shahan DR,                  Anderson ML (Eds). DRUGDEXÒ System. MICROMEDEX, Inc., Englewood  (CO), (edition expires 3/31/01.</p>
<p>22.    Anon. Salagen. Med Lett Drugs Ther 1994;36:76.</p>
<p>23.    MGI Pharma Inc. SalagenÒ Tablets prescription  information.                           Minnetonka,                  MN:1998 April.</p>
<p>24.    Vivino FB, Al-Hashimi I, Khan Z, LeVeque FG, Salisburn  PL, Tran-Johnson TK, et al. Pilocarpine tablets for the treatment of dry  mouth and dry eye symptoms in patients with Sjögren syndrome. A  randomized, placebo-controlled, fixed-dose, multicenter trial. Arch  Intern Med 1999;159:174-181.</p>
<p>25.    Cardinale V, editor. 2000 Drug TopicsÒ Red BookÒ .  Pharmacy&#8217;s Fundamental ReferenceTM<span style="text-decoration: underline;">. Montvale (NJ): Medical Economics  Co.;2000.</span></p>
<p>26.    SnowBrand Pharmaceuticals Inc. EvoxacÒ Capsules package  insert.                           Rockville,                  MD: 2000 Feb.</p>
<p>27.    Anon. Cevimeline (Evoxac) for dry mouth. Med Lett Drugs  Ther 2000;42:70.</p>
<p>28.    Kehoe WA. New drug: Evoxac (cevimeline). Pharmacist&#8217;s  Letter 2000 May. Detail No.:160511.</p>
<p>29.    Cardinale V, editor. 2000 Drug TopicsÒ Red BookÒ .  Pharmacy&#8217;s Fundamental ReferenceTM<span style="text-decoration: underline;">. February 2001 Update. Montvale  (NJ): Medical Economics Co.;2000.</span></p>
<p>30.    DRUGDEXÒ Editorial Staff. Yohimbine therapy of  xerostomia (Drug Consult). In: Hutchison TA,                           Shahan DR,                  Anderson ML (Eds). DRUGDEXÒ System. MICROMEDEX, Inc., Englewood  (CO), edition expires 3/31/01.</p>
<p>31.    Bagheri H, Schmitt L, Berlan M, Montastruc JL. A  comparative study of the effects of yohimbine and anetholtrithione on  salivary secretion in depressed patients treated with psychotropic  drugs. Eur J Clin Pharmacol 1997;52:339-342.</p>
<p>32.    Izumi M, Eguchi K, Nakamura H, Takagi Y, Kawabe Y,  Nakamura T. Corticosteroid irrigation of parotid gland for treatment of  xerostomia in patients with Sjögren&#8217;s syndrome. Ann Rheum Dis  1998;57:464-469.</p>
<p>33.    Jessin JM, Batz F, Hitchens K. Pharmacist&#8217;s  Letter/Prescriber&#8217;s Letter Natural Medicines Comprehensive Database.  Stockton, CA: Therapeutic Research Faculty; 1999.</p>
<p>34.    Fox PC, Cummins MJ, Cummins JM. Use of orally  administered anhydrous crystalline maltose for relief of dry mouth.  Journal of Alternative and Complementary Medicine 2001; 7: 33-43.</p>
<p>source: http://www.oralcancerfoundation.org/dental/xerostomia.htm</p>
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		<title>Dry Mouth Caused by Radiation Therapy</title>
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		<pubDate>Sat, 24 Apr 2010 11:52:55 +0000</pubDate>
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		<description><![CDATA[Dry mouth (xerostomia), is most commonly caused by radiation therapy  directed at the head and neck region of the body. Radiation may  irreversibly affect the production and quality of saliva in the salivary  glands. A number of medications can also induce xerostomia. Dry mouth  may affect the patients speech, taste sensation [...]]]></description>
			<content:encoded><![CDATA[<p>Dry mouth (xerostomia), is most commonly caused by radiation therapy  directed at the head and neck region of the body. Radiation may  irreversibly affect the production and quality of saliva in the salivary  glands. A number of medications can also induce xerostomia. Dry mouth  may affect the patients speech, taste sensation and ability to swallow.</p>
<p>Many patients complain of a sore or burning sensation, cracked lips,  and fissures in the corners of the mouth. There is also an increased  risk of cavities and mouth disease due to less saliva to cleanse the  teeth and gums.</p>
<p>There are now some means of preventing xerostomia that were not  available a few years ago. <a href="http://www.drugs.com/cons/Amifostine.html">Amifostine</a>, a  radiation protector of normal tissues, has been shown to protect the  salivary glands when given daily with radiation therapy. Also, a  treatment known as <a href="http://www.proton-therapy.org/">Proton  therapy</a> may allow the radiation oncologist to spare the salivary  glands from getting significant radiation doses. This may prevent dry  mouth in the future. If you are getting radiation therapy to the head  and neck region, you should discuss these options with your radiation  oncologist. If you have developed xerostomia, there are management  strategies that can effectively deal with your dry mouth and prevent  cavities and periodontal disease.</p>
<p>Try to follow these simple guidelines:</p>
<ul>
<li>Perform oral hygiene at least four times a day. (After each meal  and before bedtime)</li>
<li>The oral cavity should be rinsed and wiped immediately after  meals</li>
<li>Dentures need to be brushed and rinsed after meals</li>
<li>Only use toothpaste with fluoride when brushing</li>
<li>Keep water handy to keep the mouth moist at all times</li>
<li>Apply prescription strength fluoride gel at bedtime</li>
<li>Rinse with salt and baking soda solution 4-6 times a day</li>
<li>Avoid liquids and foods with high sugar content</li>
<li>Avoid rinses containing alcohol</li>
<li>Use moisturizer regularly on lips</li>
<li><a href="http://www.medicinenet.com/pilocarpine-oral/article.htm">Oral  pilocarpine (Salagen)</a> is the only drug approved by the FDA to  stimulate saliva secretion from the remaining salivary glands.</li>
</ul>
<p>source: http://www.thecancerblog.com/2007/02/13/radiation-tips-for-dealing-with-dry-mouth/</p>
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		<title>Xerostomia (Dry Mouth)</title>
		<link>http://drymouthpump.com/blog/?p=24</link>
		<comments>http://drymouthpump.com/blog/?p=24#comments</comments>
		<pubDate>Fri, 23 Apr 2010 14:06:02 +0000</pubDate>
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		<description><![CDATA[Xerostomia  (Dry Mouth)
Xerostomia is  not a disease but can be a symptom of certain diseases.  It can produce serious negative effects on  the patients quality of life, affecting dietary habits, nutritional status,  speech, taste, tolerance to dental prosthesis and increases susceptibility to  dental caries.   The increase in dental caries can [...]]]></description>
			<content:encoded><![CDATA[<p><strong>Xerostomia  (Dry Mouth)</strong></p>
<p><strong>Xerostomia is  not a disease but can be a symptom of certain diseases.  It can produce serious negative effects on  the patients quality of life, affecting dietary habits, nutritional status,  speech, taste, tolerance to dental prosthesis and increases susceptibility to  dental caries.   The increase in dental caries can be devastating in many patients and therefore special care must be made to control this  condition.</strong></p>
<p><strong>Causes for Xerostomia include:</strong></p>
<ul>
<dl>
<dd><strong>-Medications       &#8211; Several hundred current medications can cause xerostomia. These       include  antihypertensives, antidepressants, analgesics,       tranquilizers, diuretics and antihistamines c.</strong></dd>
<dd><strong>-Cancer        Therapy &#8211; Chemotherapeutic drugs  can       change the flow and composition of the saliva. Radiation treatment  that is       focused on or near the salivary gland can temporarily or  permanently       damage the salivary glands.</strong></dd>
<dd><strong>-Sjogren&#8217;s       syndrome &#8211; An autoimmune  disease, causes       xerostomia and dry eyes.</strong></dd>
<dd><strong>-Other        conditions -such as bone marrow       transplants, endocrine disorders, stress, anxiety, depression, and       nutritional deficiencies may cause xerostomia.</strong></dd>
<dd><strong>-Nerve        Damage &#8211; Trauma to the head and  neck area       from surgery or wounds can damage the nerves that supply sensation  to the       mouth. While the salivary glands may be left intact, they cannot  function       normally without the nerves that signal them to produce saliva.</strong></dd>
</dl>
</ul>
<p><strong>Treatment:</strong></p>
<p><strong> 1.  Identify the xerostomic condition and the cause.  Some of the causes may be ameliorated and this will aid therapy.  But in many situations, it will be difficult to eliminate the causes.  Thus, it will be necessary for the Dentist to control the results of  xerostomia.  This is especially true about the increase in dental caries.</strong></p>
<p><strong> 2.  Palliative treatment can be used but does not cure the condition: </strong></p>
<dl>
<dd><strong>-pilocarpine (Salagen) 5mg, qid,       prescription required.</strong></dd>
<dd><strong>-special food preparation &#8211;  blended and       moist foods are easier to swallow</strong></dd>
<dd><strong>artificial saliva (available       over-the-counter).</strong></dd>
<dd><strong>-sipping plain water is usually  preferred       over artificial saliva by most patients.</strong></dd>
<dd><strong>-Biotene brand, over-the-counter,  dry       mouth products (toothpaste, alcohol- free mouth rinse and  Oralbalance       lubricating gel).</strong></dd>
<dd><strong>-avoidance of alcohol-based mouth  rinses</strong></dd>
<dd><strong>-use of water and glycerin  mixed  in       a small aerosol spray bottle.</strong></dd>
<dt> </dt>
<dt><strong>3.  Since a marked increase in       dental caries is a common occurrence, it is important that this  side effect is       controlled.  This will involve using the risk assessment and       treatment strategies  outlined in the cariology course.</strong></dt>
<dd> </dd>
<dd><strong>-Establish if the patient is  Xerostomic       from symptoms and determine <a href="http://www.uic.edu/classes/peri/peri343/xerost/saliva2.htm">salivary        flow rate</a>.<br />
-The xerostomic patient is classified into a <a href="http://www.uic.edu/classes/peri/peri343/carilec3/lowrisk.htm"> risk assessment </a>as outlined in the course material.  However,       this patient should be classified at high risk even if there are  only       several  incipient lesions.  This is done only in this type of       patient because of the high caries risk.<br />
-Determine if this patient is <a href="http://www.uic.edu/classes/peri/peri343/xerost/caract.htm"> caries  active or not       active</a> and follow the high risk protocol in the main<a href="http://www.uic.edu/classes/peri/peri343/carilec3/trovervw.htm"> outline       in this course</a>.  When the <em>ms</em> infection is under control       use a <a href="http://www.uic.edu/classes/peri/peri343/xerost/remin.htm"> remineralization protocol</a> along with the monitoring. </strong></dd>
<dd><strong>-Additional suggestions:<br />
</strong><strong> </strong> <strong>-Both an <em>ms</em> and<em> lactobacillus</em> tests are indicated.<br />
-Carefully observe color, texture and location of       lesions. </strong> </dd>
<dd><strong> -Seal       pit and fissures and rough restorative margins with fluoride       containing  sealents.<br />
-CHX treatment may have to be prolonged along with use       of fluoride.<br />
-Prolonged use of Xylitol gum is importance       since its use enhances salivary flow and  helps control <em>mutans       strep.</em><br />
-Enhance use of hard cheese in diet.<br />
</strong> <strong>-Use        sucralose in cooking.</strong></dd>
<dd> </dd>
<dd><strong>source: </strong>http://www.uic.edu/classes/peri/peri343/xerost/xerost1.htm</dd>
</dl>
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		<title>Study May Help Head and Neck Cancer Patients Find Relief From Dry Mouth</title>
		<link>http://drymouthpump.com/blog/?p=22</link>
		<comments>http://drymouthpump.com/blog/?p=22#comments</comments>
		<pubDate>Wed, 31 Mar 2010 00:52:03 +0000</pubDate>
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		<description><![CDATA[March 2007
By the late 1980s, NIDCR scientist Dr. Bruce  Baum was frustrated. He had been searching for new drugs and other  treatments that might help restore adequate salivary flow in people  whose salivary glands had been damaged by radiation treatment for  cancer. Yet, despite all of his hard work, Baum said [...]]]></description>
			<content:encoded><![CDATA[<p><strong>March 2007</strong></p>
<p><img src="http://www.nidcr.nih.gov/NR/rdonlyres/36E15DA2-5A59-41D2-A951-F3FB87A8805D/3172/BJBaum.jpg" border="0" alt="Picture of Bruce Baum" align="right" />By the late 1980s, NIDCR scientist Dr. Bruce  Baum was frustrated. He had been searching for new drugs and other  treatments that might help restore adequate salivary flow in people  whose salivary glands had been damaged by radiation treatment for  cancer. Yet, despite all of his hard work, Baum said he had not come  close to solving the problem.  That&#8217;s when he decided to turn to gene  transfer, sometimes called gene therapy.  If a fluid-transporting gene  could be transferred into the damaged glands, he could potentially  restore some degree of salivary flow and secretion into the mouth.   According to Baum, the big question was:  How would he deliver a gene  into a salivary gland?  The answer came to him several weeks later when  he realized it might be possible to put a gene and its viral vector into  a syringe and infuse them directly into the gland through its opening  in the mouth.  After more than a decade of systematically working out  the science of gene transfer to the salivary glands, Baum and colleagues  are ready to move the science into the clinic.  The Inside Scoop  recently met with Dr. Baum and talked to him about dry mouth in  recovering cancer patients and the design of his upcoming clinical  trial. <strong><strong><strong> </strong></strong></strong></p>
<h4><strong><strong><strong><span style="color: #408080;">Nearly all patients  with head and neck cancer have their tumors irradiated for several  weeks.  As I understand it, the problem is radiation doesn&#8217;t  discriminate between tumor cells and healthy salivary glands.  Is that  correct?</span> </strong></strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>That’s essentially right.  The radiation kills the tumor cells but  unfortunately also affects the nearby salivary glands.  The damaged  glands become less permeable to the water that naturally flows through  them and either will yield less saliva or stop working altogether.  If  the damage is extensive, cancer patients will notice a persistent and  irritating dryness in their mouths called radiation-induced xerostomia,  or, more colloquially, dry mouth.  It’s a very common problem.  A survey  of head and neck cancer patients comes to mind that was published a few  years ago.  It found that 65 percent of long-term survivors &#8211; defined  as living three years post radiation therapy &#8211; had moderate to severe  xerostomia. 1</p>
<h4><span style="color: #408080;">Why is this parched sensation so irritating?</span></h4>
<p>There’s an old Blues song titled, “You don’t miss your water til the  well runs dry.”  That’s certainly true with saliva.  Most people don’t  think of it until the moisture in their mouths runs dry, and that’s what  makes xerostomia so irritating.  Recovering cancer patients wonder,  “Why is my mouth so dry?”  But the dryness is more than an irritation.   It can be a significant problem that impairs a person’s ability to chew,  swallow, and even speak.  In addition, dry mouth can lead to oral  infections, such as tooth decay and Candidiasis.  <strong><strong> </strong></strong></p>
<p><strong><strong><strong><span style="color: #408080;"> </span></strong></strong></strong></p>
<h4><strong><strong><strong><span style="color: #408080;"><span style="color: #408080;">Can anything be done to increase  salivary flow?</span> </span></strong></strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>For some people, yes.  If tissue remains that is water permeable and  capable of secretion, compounds such as pilocarpine can stimulate the  glands to produce more saliva.  The problem is most patients have  salivary glands that have stopped working.<strong><strong><strong> </strong></strong></strong></p>
<h3><strong><strong><strong><span style="color: #408080;"></p>
<h4><strong><span style="color: #408080;">How so?</span> </strong></h4>
<p></span></strong></strong></strong></h3>
<p><strong><strong> </strong></strong></p>
<p>The radiation leaves the glands water impermeable.  Let me explain.   Salivary glands kind of look like a bunch of grapes attached to a stem.   The grapes are called acinar cells.  In people with working salivary  glands, water enters the acinar cells, where myriad proteins are added,  and the mixture then flows through the stems for further processing and  ultimately exit into the mouth as saliva.  In most head and neck cancer  patients, the radiation has wiped out the acinar cells.  They’re left  with a network of water-impermeable stems that have no salivary flow.   There is nothing left to stimulate.</p>
<p><strong><strong><strong> </strong></p>
<h4><strong><span style="color: #408080;">And that&#8217;s where salivary  gene transfer is different than pilocarpine.  It will for the first  time help those with impermeable salivary glands. </span></strong></h4>
<p></strong></strong></p>
<p>That’s our hope.  The gene transfer that we have developed builds on  the fundamental fact that the stems, or ducts, are water impermeable in  the irradiated glands.  We think that with gene transfer, the ducts will  have the potential to move fluid and secrete it into the mouth. <strong><strong><strong> </strong></strong></strong></p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h4><span style="color: #408080;">The answer, as I&#8217;ve heard you say, is osmosis.</span> <strong><strong> </strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>Correct, it’s that concept everybody learns in junior high school.   Water naturally follows an osmotic energy gradient, flowing from areas  of low to high salt concentration.  We believe the irradiated duct cells  can generate such an osmotic gradient.  Over the last decade or so,  I’ve worked with scientists in our laboratory to determine whether  transferring a gene into the cells that line the ducts can take  advantage of the ability of these cells to generate an osmotic gradient  and secrete saliva into the mouth.  In August 2006, we received approval  from the Food and Drug Administration to conduct the first  gene-transfer study in people with radiation-induced xerostomia.  <strong><strong><strong> </strong></strong></strong></p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h4><span style="color: #408080;">Which gene will be transferred?</span> <strong><strong> </strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>The gene is Aquaporin-1.  It encodes a large protein that transports  fluid by forming pores, or water channels, in the cell membrane.  Our  hope is the transferred gene will produce reasonable levels of the  aquaporin-1 protein in duct cells, setting in motion a therapeutic  domino effect.  That is, the aquaporin-1 protein will open up water  channels in the duct cells.  That will allow the very rapid movement of  water through the duct in response to the osmotic gradient that we  believe can be generated.</p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h3><strong><strong><strong><span style="color: #408080;"> </span></strong></strong></strong></h3>
<h4><strong><strong><strong><span style="color: #408080;"><span style="color: #408080;">The gene is contained in a  vector, which serves almost like a trojan horse to deliver aquaporin-1  to its target.  Which vector will you use?</span> </span></strong></strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>An adenovirus.  It’s a common respiratory virus that has been used in  gene transfer studies for many years.  The virus has been modified and  won’t make a person sick. <strong><strong><strong> </strong></strong></strong></p>
<p><strong><strong><strong><span style="color: #408080;"> </span></strong></strong></strong></p>
<h4><strong><strong><strong><span style="color: #408080;"><span style="color: #408080;">Will the first study be a Phase I  investigation, meaning it will evaluate the safety and tolerability of  the gene transfer in the participants?</span> </span></strong></strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>It will be simultaneously a Phase I and II study, which is quite  commonly done today.  As part of the Phase II component, we will collect  some efficacy data.  By that, I mean we will measure whether salivary  fluid output improves in the patients and, in turn, if they notice that  their mouths feel moister and less dry.</p>
<h4><span style="color: #408080;">How large will the study be?</span></h4>
<p>The study will enroll 15 to 21 patients.</p>
<p><strong><strong></p>
<h3><strong><span style="color: #408080;"></p>
<h4><strong><span style="color: #408080;">All local participants?</span> </strong></h4>
<p></span></strong></h3>
<p></strong></strong></p>
<p>Well, in theory, they could live anywhere.  But the patients will  stay in the hospital here in Bethesda at least for the first three  days.  They must be back here on Day 7 and 14.  If people were to come  from the West Coast, they would probably have to stay in the area for an  extended period.  That could be a logistical problem.  We will track  the patients on Day 28, Day 42, and so on for a full year.  If the FDA  decides that they should be followed longer, we’ll do so.</p>
<h4><span style="color: #408080;">Are there conceptual advantages to performing  gene transfer in salivary glands as opposed to an internal organ?</span> <strong><strong> </strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>Absolutely.  First, unlike most internal organs, a salivary gland is  not critical for life.  Should a problem arise, people will continue to  survive with low levels of saliva.  Second, we have direct access to the  gland.  Its opening  is right there in the mouth, and we can infuse the  Aquaporin-1 gene directly into a major salivary gland.   There is no  need for anaesthesia or surgery.<strong><strong><strong> </strong></strong></strong></p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h4><span style="color: #408080;">Into which salivary gland will you deliver the  vector?</span> <strong><strong> </strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>We’ll use a single parotid gland.  The parotid gland is the largest  of the three major salivary glands.  If you touch the side of your face,  the parotid gland is located under the skin between the jawbone and the  lobe of the ear.</p>
<p><strong><strong><strong> </strong></p>
<h4><strong><span style="color: #408080;">A concern with gene transfer  studies is the vector might accidently integrate into the DNA of cells  elsewhere in the body and cause tumors and other problems.  Is that a  concern? </span></strong></h4>
<p></strong></strong></p>
<p>In theory, yes.  Practically speaking, no.  Adenoviruses are  non-integrating viruses.  Secondly, because a fibrous capsule surrounds  the salivary gland, the vector is essentially walled off from the rest  of the body.  One of the things we did in our animal studies is look for  the vector throughout the body.  In rats, the glands aren’t as well  encapsulated as they are in humans or primates.  The animals eat hard  chow, so you tend to see the virus in their mouth but it doesn’t spread  throughout their body.</p>
<h4><span style="color: #408080;">The rats had no tumors?  Even salivary tumors?</span> <strong><strong> </strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>That is correct.  They had no tumors anywhere. <strong><strong> </strong></strong></p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h4><strong><strong><strong><span style="color: #408080;">With the gene transfer, how much saliva might a patient  produce? </span></strong></strong></strong></h4>
<p><strong><strong> </strong></strong></p>
<p>We hope to restore 70 to 80 percent of normal salivary flow.  Based  on our earlier studies with miniature pigs, we saw significant increases  in salivary flow on days 3 and 7.  By day 14, it was, on average, a  little above background.   We had expected it to decrease by days 14 to  21.  Then comes the obvious question:  What next?  You can’t give the  virus again because the patients will have raised antibodies against  it.  <strong><strong><strong> </strong></strong></strong></p>
<p><strong><strong><strong> </strong></strong></strong></p>
<h4><span style="color: #408080;">So, what next?</span> <strong><strong> </strong></strong></h4>
<p><strong><strong></strong></strong></p>
<p>We have another vector called an adeno-associated virus, or AAV.  In  contrast to adenovirus,  AAV lasts a very long time and provides quite  stable gene transfer.  In mice, it can last essentially as long as the  animals are alive, which was up to two years.</p>
<p><strong><strong></p>
<h3><strong><span style="color: #408080;"></p>
<h4><strong><span style="color: #408080;">Why not launch the study with the  longer lasting vector?</span> </strong></h4>
<p></span> </strong></h3>
<p></strong></strong></p>
<p>To err on the side of caution. This study marks the first time that a  viral vector will be delivered into a human salivary gland.  Secondly,  because our research to date has been conducted in animals, we have not  yet demonstrated that radiation-damaged salivary duct cells in people  can generate an osmotic gradient and support fluid flow.  The adenovirus  is essentially self limiting and will be removed from each patient by  their immune system.  If, by chance, the strategy doesn’t work, I didn’t  want to have patients with a useless gene-transfer vector in their  bodies indefinitely.<strong><strong> </strong></strong></p>
<p><strong><strong></strong></strong></p>
<h4><span style="color: #408080;">So, the goal would be to build on this study  and move to Phase III.  Is that right?</span> <strong><strong></strong></strong></h4>
<p><strong><strong></strong></strong></p>
<p>Well, no.  It’s actually an interesting point.  If this works, we  could say that the Aquaporin-1 strategy works in humans.  That is, the  physiology of duct cells is such that they could generate an osmotic  gradient.  The strategy would be to go to an adeno-associated virus  vector for long term expression as a Phase I/II study.  If that works,  the goal would be to advance to a Phase III clinical trial.  <strong><strong><strong></strong></strong></strong></p>
<p><strong><strong><strong></strong></strong></strong></p>
<h4><span style="color: #408080;">Good luck with the study.</span> <strong><strong></strong></strong></h4>
<p><strong><strong></strong></strong></p>
<p>Thanks.  Let me just say, this study represents a start.  It’s a very  good start, though, based on solid science.  I hope other research  groups will take note of salivary gene transfer and continue to develop  it even further.  The salivary glands offer unique therapeutic  possibilities that should be more intensively explored, not only by  dental scientists but throughout medical research.  More importantly,  for all of the reasons that I’ve mentioned, it would be a big win for  recovering cancer patients who are forced to battle radiation-induced  xerostomia.  <strong><strong> </strong></strong></p>
<p><em>source: http://www.nidcr.nih.gov/Research/ResearchResults/InterviewsOHR/TIS032007.htm</em></p>
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		<title>What You Should Know About Dry Mouth</title>
		<link>http://drymouthpump.com/blog/?p=20</link>
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		<pubDate>Wed, 31 Mar 2010 00:50:22 +0000</pubDate>
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		<description><![CDATA[Symptoms of Dry Mouth

a sticky, dry feeling in the mouth
trouble chewing, swallowing, tasting, or speaking
a burning feeling in the mouth
a dry feeling in the throat
cracked lips
a dry, rough tongue
mouth sores
an infection in the mouth

Why is saliva so important?
Saliva does more than keep the mouth wet.

It helps digest food
It protects teeth from decay
It prevents infection by [...]]]></description>
			<content:encoded><![CDATA[<h2>Symptoms of Dry Mouth</h2>
<ul>
<li>a sticky, dry feeling in the mouth</li>
<li>trouble chewing, swallowing, tasting, or speaking</li>
<li>a burning feeling in the mouth</li>
<li>a dry feeling in the throat</li>
<li>cracked lips</li>
<li>a dry, rough tongue</li>
<li>mouth sores</li>
<li>an infection in the mouth</li>
</ul>
<h2><a name="5">Why is saliva so important?</a></h2>
<p>Saliva does more than keep the mouth wet.</p>
<ul>
<li>It helps digest food</li>
<li>It protects teeth from decay</li>
<li>It prevents infection by controlling bacteria and fungi in the  mouth</li>
<li>It makes it possible for you to chew and swallow</li>
</ul>
<p>Without enough saliva you can develop tooth decay or other infections  in the mouth. You also might not get the nutrients you need if you  cannot chew and swallow certain foods.</p>
<h2><a name="6">What causes dry mouth?</a></h2>
<p>People get dry mouth when the glands in the mouth that make saliva  are not working properly. Because of this, there might not be enough  saliva to keep your mouth wet. There are several reasons why these  glands (called salivary glands) might not work right.</p>
<ul>
<li><strong>Side effects of some medicines.</strong> More than 400  medicines can cause the salivary glands to make less saliva. For  example, medicines for high blood pressure and depression often cause  dry mouth.</li>
<li><strong>Disease.</strong> Some diseases affect the salivary  glands. Sjögren&#8217;s syndrome, HIV/AIDS, and diabetes can all cause dry  mouth.</li>
<li><strong>Radiation therapy.</strong> The salivary glands can be  damaged if they are exposed to radiation during cancer treatment.</li>
<li><strong>Chemotherapy.</strong> Drugs used to treat cancer can  make saliva thicker, causing the mouth to feel dry.</li>
<li><strong>Nerve damage.</strong> Injury to the head or neck can  damage the nerves that tell salivary glands to make saliva.</li>
</ul>
<h2><a name="7">What can be done about dry mouth?</a></h2>
<p>Dry mouth treatment will depend on what is causing the problem. If  you think you have dry mouth, see your dentist or physician. He or she  can try to determine what is causing your dry mouth.</p>
<ul>
<li>If your dry mouth is caused by medicine, your physician might change  your medicine or adjust the dosage.</li>
<li>If your salivary glands are not working right but can still  produce some saliva, your physician or dentist might give you a medicine  that helps the glands work better.</li>
<li>Your physician or dentist might suggest that you use artificial  saliva to keep your mouth wet.</li>
</ul>
<h2><a name="8">What can I do?</a></h2>
<ul>
<li>Sip water or sugarless drinks often.</li>
<li>Avoid drinks with caffeine, such as coffee, tea, and some  sodas. Caffeine can dry out the mouth.</li>
<li>Sip water or a sugarless drink during meals. This will make  chewing and swallowing easier. It may also improve the taste of food.</li>
<li>Chew sugarless gum or suck on sugarless hard candy to stimulate  saliva flow; citrus, cinnamon or mint-flavored candies are good  choices.</li>
<li>Don&#8217;t use tobacco or alcohol. They dry out the mouth.</li>
<li>Be aware that spicy or salty foods may cause pain in a dry  mouth.</li>
<li>Use a humidifier at night.</li>
</ul>
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		<title>What is xerostomia?</title>
		<link>http://drymouthpump.com/blog/?p=18</link>
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		<pubDate>Wed, 31 Mar 2010 00:45:07 +0000</pubDate>
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		<description><![CDATA[What is xerostomia?
Xerostomia (ZEER-oh-STOH-mee-ah) is known as dry mouth.  It is the  condition of not having enough saliva, or spit, to keep the mouth wet.   Dry mouth can happen to anyone occasionally  when nervous or  stressed.  However, when dry mouth persists, it can make chewing,  eating, swallowing and even talking difficult.  [...]]]></description>
			<content:encoded><![CDATA[<h1>What is xerostomia?</h1>
<p>Xerostomia (ZEER-oh-STOH-mee-ah) is known as dry mouth.  It is the  condition of not having enough saliva, or spit, to keep the mouth wet.   Dry mouth can happen to anyone occasionally  when nervous or  stressed.  However, when dry mouth persists, it can make chewing,  eating, swallowing and even talking difficult.  Dry mouth also increases  the risk for tooth decay because saliva helps keep harmful germs that  cause cavities and other oral infections in check.</p>
<p><strong>Causes<br />
</strong><br />
Dry mouth occurs when the salivary glands that  make saliva don&#8217;t work properly.  Many over-the-counter and prescription  medicines, as well as diseases such as diabetes, Parkinson&#8217;s disease  and Sjogren&#8217;s syndrome, can affect the salivary glands.  Other causes of  dry mouth include certain cancer treatments and damage to the glands&#8217;  nerve system.  It&#8217;s important to see your dentist or physician to find  out why your mouth is dry.</p>
<p><strong>Treatment</strong></p>
<p><strong></strong>Depending on the cause of your dry mouth,  your health care provider can recommend appropriate treatment. There are  also self-care steps you can take to help ease dry mouth, such as  drinking plenty of water, chewing sugarless gum, and avoiding tobacco  and alcohol.  Good oral care at home and regular dental check-ups will  help keep your mouth healthy.</p>
<h2>How Common is Xerostomia?</h2>
<p>Chronic dry mouth, or xerostomia, has long  been considered a problem of aging.  But how common is it?  The medical  literature contains just one study on the subject, and myriad questions  remain about the risk factors, incidence, and natural history of the  condition.  Now, in the December issue of the journal <em>Gerodontology</em>,  NIDCR grantees and colleagues have published a second longitudinal  study.  It tracked 1,205 dentate adults age 60 and older over several  years, with 246 participants being followed for 11 years.  The  researchers found that the prevalence of xerostomia increased from 21.4  percent to 24.8 percent between the fifth and eleventh year of follow  up.  However, one quarter of those with xerostomia fluctuated over time  in the severity, or status, of their condition.  The researchers also  carefully tracked the use of medications, a recognized but still  nonspecific risk factor for xerostomia.  Their use increased throughout  the study, with nearly 95 percent taking at least one medication at the  study’s 11-year mark.  According to the authors, “While only two  categories of medication being taken at 11 years were associated with  the incidence of xerostomia between 5 and 11 years (antidepressants and  daily aspirin), there were stronger associations when only those  medications taken since the 5-year assessment were included in the  analysis.  In this exposure category, xerostomia incidence was greater  among those taking diuretics, NSAIDs, antidepressants or daily aspirin.”</p>
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		<title>Should I follow a special diet while I am getting radiation therapy?</title>
		<link>http://drymouthpump.com/blog/?p=12</link>
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		<pubDate>Fri, 13 Nov 2009 20:26:54 +0000</pubDate>
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		<description><![CDATA[Your body uses a lot of energy to heal during radiation therapy. It is important that you eat enough calories and protein to keep your weight the same during this time. Ask your doctor or nurse if you need a special diet while you are getting radiation therapy. You might also find it helpful to [...]]]></description>
			<content:encoded><![CDATA[<p>Your body uses a lot of energy to heal during radiation therapy. It is important that you eat enough calories and protein to keep your weight the same during this time. Ask your doctor or nurse if you need a special diet while you are getting radiation therapy. You might also find it helpful to speak with a dietitian.</p>
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		<title>Who is on my radiation therapy team?</title>
		<link>http://drymouthpump.com/blog/?p=11</link>
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		<pubDate>Fri, 13 Nov 2009 20:25:30 +0000</pubDate>
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		<description><![CDATA[Many people help with your radiation treatment and care. This group of health care providers is often called the &#8220;radiation therapy team.&#8221; They work together to provide care that is just right for you. Your radiation therapy team can include:
Radiation oncologist. This is a doctor who specializes in using radiation therapy to treat cancer. He [...]]]></description>
			<content:encoded><![CDATA[<p>Many people help with your radiation treatment and care. This group of health care providers is often called the &#8220;radiation therapy team.&#8221; They work together to provide care that is just right for you. Your radiation therapy team can include:</p>
<p>Radiation oncologist. This is a doctor who specializes in using radiation therapy to treat cancer. He or she prescribes how much radiation you will receive, plans how your treatment will be given, closely follows you during your course of treatment, and prescribes care you may need to help with side effects. He or she works closely with the other doctors, nurses, and health care providers on your team. After you are finished with radiation therapy, your radiation oncologist will see you for follow-up visits. During these visits, this doctor will check for late side effects and assess how well the radiation has worked.</p>
<p>Nurse practitioner. This is a nurse with advanced training. He or she can take your medical history, do physical exams, order tests, manage side effects, and closely watch your response to treatment. After you are finished with radiation therapy, your nurse practitioner may see you for follow-up visits to check for late side effects and assess how well the radiation has worked.</p>
<p>Radiation nurse. This person provides nursing care during radiation therapy, working with all the members of your radiation therapy team. He or she will talk with you about your radiation treatment and help you manage side effects.</p>
<p>Radiation therapist. This person works with you during each radiation therapy session. He or she positions you for treatment and runs the machines to make sure you get the dose of radiation prescribed by your radiation oncologist.</p>
<p>Other health care providers. Your team may also include a dietitian, physical therapist, social worker, and others.</p>
<p>You. You are also part of the radiation therapy team. Your role is to:</p>
<p>Arrive on time for all radiation therapy sessions</p>
<p>Ask questions and talk about your concerns</p>
<p>Let someone on your radiation therapy team know when you have side effects</p>
<p>Tell your doctor or nurse if you are in pain</p>
<p>Follow the advice of your doctors and nurses about how to care for yourself at home, such as:</p>
<p>Taking care of your skin</p>
<p>Drinking liquids</p>
<p>Eating foods that they suggest</p>
<p>Keeping your weight the same</p>
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		<title>Is radiation therapy used with other types of cancer treatment?</title>
		<link>http://drymouthpump.com/blog/?p=10</link>
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		<pubDate>Fri, 13 Nov 2009 20:24:09 +0000</pubDate>
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		<description><![CDATA[Yes, radiation therapy is often used with other cancer treatments. Here are some examples:
Radiation therapy and surgery. Radiation may be given before, during, or after surgery. Doctors may use radiation to shrink the size of the cancer before surgery, or they may use radiation after surgery to kill any cancer cells that remain. Sometimes, radiation [...]]]></description>
			<content:encoded><![CDATA[<p>Yes, radiation therapy is often used with other cancer treatments. Here are some examples:</p>
<p>Radiation therapy and surgery. Radiation may be given before, during, or after surgery. Doctors may use radiation to shrink the size of the cancer before surgery, or they may use radiation after surgery to kill any cancer cells that remain. Sometimes, radiation therapy is given during surgery so that it goes straight to the cancer without passing through the skin. This is called intraoperative radiation.</p>
<p>Radiation therapy and chemotherapy. Radiation may be given before, during, or after chemotherapy. Before or during chemotherapy, radiation therapy can shrink the cancer so that chemotherapy works better. Sometimes, chemotherapy is given to help radiation therapy work better. After chemotherapy, radiation therapy can be used to kill any cancer cells that remain.</p>
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