ascorbic-acid and Xerostomia

Patients complaining of a dry mouth can present themselves to various clinicians such as the primary care physician, dentists, otolaryngologists and/or oral surgeons. The aim of our review is to provide a systematic method of assessing and managing these patients based on current best evidence published in the literature.. A literature search was performed on 20th April 2009 using MEDLINE and EMBASE using the terms dry mouth and xerostomia in combination with diagnosis, management, investigations and treatment.. There appears to be little correlation between patient symptoms and objectives tests of salivary flow. Therefore clinical management should be based on patient symptoms. There is good evidence to support that xerostomia is commonly associated with anticholinergic drugs, and altering such agents plays an important role in the management of these patients. In patients with residual salivary gland function, the use of salivary stimulants appears to be more beneficial than salivary substitutes.. Xerostomia can be debilitating and primarily affects the middle aged and elderly population. The most common causes of xerostomia include medications with anticholinergic properties, dehydration, diabetes and radiotherapy for head and neck cancer. Treatment of xerostomia essentially involves addressing the cause followed by salivary substitutes and/or salivary stimulants.

Topics: Acupuncture Therapy; Ascorbic Acid; Chewing Gum; Humans; Malates; Medical History Taking; Muscarinic Agonists; Parasympathomimetics; Physical Examination; Pilocarpine; Radiation-Protective Agents; Referral and Consultation; Saliva, Artificial; Xerostomia

The present study was conducted to determine the preventive efficacy of vitamin C/E complex supplementation for radiotherapy (RT)-induced xerostomia in patients with head and neck cancer.. Prospective, double-blinded, randomized, placebo-controlled study.. A single tertiary referral institution.. The trial group (n = 25) received antioxidant supplements (100 IU of vitamin E + 500 mg of vitamin C) twice per day during RT, while the control group (n = 20) received an identical placebo. Pre-RT and 1 and 6 months post-RT, patient-reported xerostomia questionnaires, observer-rated xerostomia score, and salivary scintigraphy were serially obtained to compare xerostomia severity between the 2 groups.. The trial group showed greater improvements in xerostomia questionnaire and score at 6 months post-RT when compared with those at 1 month post-RT (P = .007 and .008, respectively). In contrast, the control group showed no changes between 1 and 6 months post-RT. By salivary scintigraphy, there was no difference in maximal accumulation or ejection fraction between the 2 groups. However, the trial group maintained significantly better oral indices at the prestimulatory (P = .01) and poststimulatory (P = .009) stages at 1 month post-RT, compared with the control group. At the final follow-up, there was no difference in overall survival and disease-free survival between the 2 groups.. Our data suggest that short-term supplementation with an antioxidant vitamin E/C complex exerts a protective effect against RT-induced xerostomia.

Topics: Ascorbic Acid; Double-Blind Method; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Prospective Studies; Radiation Injuries; Surveys and Questionnaires; Treatment Outcome; Vitamin E; Xerostomia

Five saliva stimulants (Salivin, V6, Mucidan, Ascoxal-T and Nicotinamide) and three saliva substitutes (Saliment, Salisynt and an ex témpore solution) were evaluated in 106 patients with a low salivay flow rate and a long history of dry mouth. The study was carried out as a multi-centre study in collaboration with ten different hospital dental clinics. The participants were interviewed about their complaints related to dry mouth. Each patient was then asked to use the eight saliva stimulants and substitutes for 14 days in a randomized order with one week intervals. After the 14-day-periods, the patients were interviewed about the effect of the various products by a dentist using a standardized questionnaire. Paraffin-stimulated whole saliva samples were collected after each test period. The most serious complaints among the patients were, besides dryness of the mouth, difficulty to talk and difficulty to swallow. The results showed that all eight tested saliva stimulants and substitutes relieved the symptoms of dry mouth to some extent. However, V6 chewing gum and Salivin lozenge were ranked as the two best products by the patients. No long-term effect was found with any of the eight products on the flow rate of paraffin-stimulated whole saliva.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Carboxymethylcellulose Sodium; Drug Combinations; Female; Glycerol; Humans; Lactates; Lactic Acid; Middle Aged; Niacinamide; Saliva; Saliva, Artificial; Secretory Rate; Sorbitol; Xerostomia

Xerostomia is the most prominent complication in patients with head and neck carcinoma after radiotherapy (RT). Diffusion-weighted magnetic resonance imaging (DWI) with gustatory stimulation may contribute to the evaluation of salivary gland function.. To investigate the value of DWI for quantifying physiological changes of the parotid gland during gustatory stimulation in patients before and after RT.. Magnetic resonance imaging (MRI) was performed in 28 consecutive patients with nasopharyngeal carcinoma before and after RT and clinical xerostomia was also assessed. A DWI sequence was performed once at rest and continually repeated seven times during stimulation with ascorbic acid. Apparent diffusion coefficient (ADC) maps for parotid glands at different time points and the range of increase with stimulation were calculated. Paired two-tailed Student t tests were used to compare the ADC values before and after stimulation, and before and after RT.. Before RT, the ADC showed an initial increase (P < 0.001) and then fluctuated during stimulation. After RT, as the clinical xerostomia changed from Grade 0 to Grade 2, the mean ADC at rest increased compared with the pre-RT value (P < 0.001). A similar response to stimulation was observed, but the range of increase between the maximum ADC during stimulation and the baseline value at rest was higher post-RT than pre-RT (P = 0.022). The minimum ADC during stimulation was higher than the baseline value post-RT (P = 0.028), but there was no difference pre-RT (P = 0.603).. DWI combined with gustatory stimulation seems to display the physiological changes of the parotid gland following RT and may be a potential tool for non-invasively assessing salivary gland function.

Topics: Adult; Aged; Ascorbic Acid; Diffusion Magnetic Resonance Imaging; Echo-Planar Imaging; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Nasopharyngeal Neoplasms; Parotid Gland; Prospective Studies; Taste; Xerostomia; Young Adult

Topics: Ascorbic Acid; Blood Glucose; Diabetes Mellitus, Type 2; Female; Glycated Hemoglobin; Humans; Male; Middle Aged; Radionuclide Imaging; Reference Values; Saliva; Salivary Glands; Xerostomia

Xerostomia, the subjective feeling of dry mouth, affects millions of people particularly the elderly. It is invariably associated with hypofunction of the salivary glands. The amount, rate of secretion, and composition of saliva are regulated by both sympathetic and parasympathetic receptor systems whose stimulation transmits signals through intracellular messengers (cations, nucleotides, phospholipid derivatives) to structures and enzymes within the cell. Salivary glands express a variety of cell-surface receptors including adrenergic (alpha and beta), muscarinic-cholinergic, substance P, vasoactive intestinal peptide hormone, and ATP receptors. Ascorbate which is present in salivary acinar cells in relatively high concentrations, is closely involved in many cellular functions including the metabolism of pyrimidines, intracellular calcium, the catecholamines and other neurotransmitters which regulate salivary gland exocytosis. Ascorbate-dependent carboxyl-terminal peptide alpha-amidation enzyme similar to the pituitary peptidyl-glycine alpha-amidating monooxygase, is also present in salivary glands. It is therefore not fortuitous that the seemingly unrelated numerous factors like aging, drug ingestion, pregnancy, smoking, ionizing radiation, stress, and various pathological states such as cancer, autoimmune disorders, diabetes mellitus, and hypertension often implicated in the causation of xerostomia, all promote increased tissue requirement for and/or depletion of ascorbate.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Humans; Salivary Glands; Xerostomia

Two saliva stimulating drugs, solutions of Hybrin and malic acid were in an in vitro study found to have a heavy demineralizing effect on the root surface of the dental hard tissue. Consequently the drugs cannot be recommended to patients suffering from dry mouth reaction.

Topics: Ascorbic Acid; Dental Caries; Dental Cementum; Dentin; Humans; Malates; Saliva; Salivation; Tablets; Tooth Root; Xerostomia

Eight patients undergoing antidepressant therapy with nortriptyline for 1--4 years were investigated. The period of the investigation was 7 weeks and included a 2-week placebo period, blind for the patients. Total saliva secretion measurement, the nortriptyline plasma level, and signs and symptoms of depression and side effects were obtained once a week during the study. The results of the investigation were: (1) long-term treatment with nortriptyline is followed by hyposecretion or xerostomia, (2) the reduction of the secretion is reversible, (3) re-establishment of treatment with dosage leading to the same serum level of nortriptyline is immediately followed by a drop in saliva secretion, and (4) the changes in salivary secretion are useful as an indicator of side effects. The practical importance of the investigation is discussed.

Topics: Aged; Ascorbic Acid; Bipolar Disorder; Carbonates; Female; Humans; Male; Middle Aged; Nortriptyline; Placebos; Saliva; Salivation; Sleep; Sodium; Time Factors; Xerostomia

Topics: Adult; Aged; Ascorbic Acid; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Salivation; Sialography; Xerostomia

Topics: Adult; Ascorbic Acid; Ascorbic Acid Deficiency; Dental Caries; Diet; Humans; Keratoconjunctivitis; Lacrimal Apparatus; Male; Middle Aged; Oral Manifestations; Salivary Gland Diseases; Scurvy; Sjogren's Syndrome; Skin Manifestations; Xerostomia