Modulation of Salivary Gland Function

Question 1

Acute or chronic reduced salivary flow may be due to:

Answer 1

Mechanical blockage, dehydration, emotional stress, infection of the salivary glands, local surgery, avitaminosis, diabetes, anemia, connective tissue disease, congenital factors, radiation therapy, Sjogren’s syndrome, medications.

Question 2

Drug induced xerostomia is a concern because:

Answer 2

1. older adults take more prescription and non-prescription drugs
2. Over 400 medications are implicated in causing xerostomia
3. oral health impact of xerostomia is consequential

Question 3

Drug categories implicated in causing xerostomia include:

Answer 3

sympathomimetics, diuretics, cardiovascular meds, anticholinergics, tricyclic antidepressants, antihistamines, psychotropic agents, antiparkinson agents, antineoplastic drugs, muscle relaxants.

Question 4

Herbal preparations that can induce xerostomia:

Answer 4

St. John’s wort, Gingko Biloba

Question 5

Factors contributing to increased caries susceptibility:

Answer 5

-decreased titers of antimicrobial substances and loss of mineralizing components and shift to more cariogenic bacteria.

Question 6

Caries in xerostomic pts most likely to occur near:

Answer 6

gingival margins and on exposed root surfaces.

Question 7

Xerostomia presents clinically with:

Answer 7

Periodontal problems, altered taste sensation, mouth soreness

Question 8

Xerostomia is associated with:

Answer 8

oral pain, increased oral infections, difficulty speaking, chewing and swallowing.

Question 9

Xerostomia tx is important to:

Answer 9

keep mouth moist, prevent caries, candida infections, and provide palliative relief.

Question 10

Palliative measures for xerostomia include:

Answer 10

• sipping water
• avoiding mouth rinses with alcohol
• ice melting
• limit caffeine
• humidifying sleeping area
• vaseline on lips

Question 11

Rx Saliva Substitute:

Answer 11

Sodium Carboxymethylcellulose 0.5%

• 8 fl oz
• rinse prn

Question 12

Commercial saliva substitutes:

Answer 12

Xero-lub, Salivart, Moi-Stir, Orex

Question 13

Rx fluoride therapy:

Answer 13

Stannous fluoride gel 0.4%

• 24 ml
• 5-10 mins/day in carrier (5-10 drops)

Question 14

What should be considered if poorly tolerated taste or ceramic restorations present?

Answer 14

Use of neutral pH sodium fluoride gel 1%

Question 15

Rx neutral sodium fluoride gel:

Answer 15

• 1%
• 24 ml
• 1 drop/tooth in tray, 5 mins daily
• Avoid rinsing/eating 30 mins.

Question 16

No more than ____ NaF should be dispensed in one container.

Answer 16

264 mg

Question 17

24 ml is approx:

Answer 17

2 week supply of gel

Question 18

Antifungal Rx

Answer 18

Nystatin (topical) or Fluconazole (systemic)

Question 19

Saliva stimulants like _____ may temporarily stimulate salivary flow.

Answer 19

sugarless gum or dissolving mints

Question 20

Parasympatholytics

Answer 20

decrease saliva secretion

Question 21

Parasympathomimetics

Answer 21

increase saliva secretion

Question 22

meds that decrease saliva

Answer 22

• Propantheline
• Methantheline
• Glycopyrolate
• Atropine

Question 23

meds that increase saliva secretion

Answer 23

• Pilocarpine
• Bethanechol
• Cevimelin

Question 24

A muscarinic receptor agonist that is FDA approved

Answer 24

Pilocarpine

Question 25

Pilocarpine, Bethanechol, and Cevimeline are

Answer 25

Parasympathomimetic drugs

Question 26

Doses of pilocarpine

Answer 26

Initial divided doses of 15 mg/day in 5 mg doses, can be up to 30 mg/day

Question 27

Pilocarpine side effects on glands

Answer 27

significant increase in parotid, submandibular, and sublingual secretions

Question 28

Pilocarpine effect depends on

Answer 28

residual salivary gland function

Question 29

T or F: Pilocarpine has no significant effect on blood pressure/heart rate

Answer 29

T

Question 30

Pilocarpine contraindications:

Answer 30

asthma and complete loss of salivary gland function

Question 31

Side effects of Pilocarpine:

Answer 31

sweating, chills, nausea, and dizziness

Question 32

Does prophylactic use of pilocarpine decrease reduction in severity of xerostomia...

Answer 32

Maybe?

Question 33

Used in divided doses of 75-200 mg/day without complaints of GI upset and a reduced tendency for sweating:

Answer 33

Bethanechol

Question 34

Treatment of Sjogren's syndrome: 30 mg tid

Answer 34

Cevimeline

Question 35

Pilocarpine activates the _____________ receptor in the _______ membrane of the _________ cell to form saliva

Answer 35

muscarinic, basal, acinar

Question 36

Parasympatholytic drugs should be used for

Answer 36

transient modulation

Question 37

Parasympatholytic drugs are

Answer 37

antisialogoges

Question 38

Competitive antagonists for the muscarinic receptors therefore will reduce salivary gland secretion

Answer 38

Parasympatholytic

Question 39

Contraindications of parasympatholytic drugs:

Answer 39

glaucoma, cardiovascular disease, and prostate hypertrophy

Question 40

Side effects of parasympatholytic drugs

Answer 40

Blurred vision, drowsiness, tachycardia, decreased intestinal or bladder smooth muscle action.

Question 41

T or F: Side effects of parasympatholytics can occur after single dose used in dental practice.

Answer 41

T

Question 42

Propatheline, methantheline, and glycopyrolate are examples of

Answer 42

Parasympatholytic drugs

Question 43

Atropine like drug that may be useful in inhibition of salivation before a dental procedure

Answer 43

Propantheline

Question 44

Dose of propantheline

Answer 44

Adults: 15 mg 30-40 mins before appt. Second tab can be given if needed. -Children should be half dose

Question 45

Alternative drug that has same effects as propantheline but thought to have more intense side effects:

Answer 45

Methantheline

Question 46

Dosage of Methantheline

Answer 46

50 mg or 100 mg before appt

Question 47

A quaternary amine of the anticholinergic class similar to propantheline but greater per mg potency and a longer duration of action:

Answer 47

Glycopyrolate

Question 48

Has less sedative effect and CNS effect than scopolamine and has a better therapeutic index than atropine as a antisialogog:

Answer 48

glycopyrolate

Question 49

Cardiac side effects are considered less frequents than for atropine

Answer 49

Glycopyrolate

Question 50

T or F: I added this card so there would be exactly 50 cards in this set.

Answer 50

T