Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies
Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies
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DOI：
10.1007/s00520-002-0409-5
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发表时间：
2003-04-01
影响因子：
3.1
通讯作者：
Veerman, ECI
中科院分区：
文献类型：
--
作者：
Amerongen, AVN;Veerman, ECI
在癌症患者中，与一般人群一样，药物是口干症最常见的原因。一般来说，这些患者的唾液流可以通过唾液腺的机械或药理刺激来刺激。口腔粘膜受损疼痛可以通过软化、润滑漱口水或凝胶来治疗。一个特殊的病人群体是那些因头颈部恶性肿瘤而接受放射治疗的病人。这种治疗不可避免地与对口腔组织（包括唾液腺）的损伤有关，导致唾液腺功能减退。当存在残余分泌能力时，建议通过机械或味觉刺激定期刺激唾液腺，作为支持性口腔护理。或者，可以通过使用胆碱能药物制剂如毛果芸香碱或西维美林来刺激唾液流。放射治疗结束后，应每3个月进行一次牙齿检查，以控制任何初期的口腔炎症和蛀牙。对于日常使用，建议使用特殊的牙膏（例如儿童牙膏），因为普通牙膏的味道对这些患者来说可能太强烈了。夜间口腔干燥可以通过用水喷洒口腔表面或在牙齿光滑表面上涂抹少量牙膏来缓解。当刺激唾液分泌失败时，可以通过应用漱口水和唾液替代物的形式给予患者姑息性口腔护理。需要每天使用漱口水，例如Biotene、Oral Balance或Zendium，或其中一种唾液替代品。不同类型的唾液替代品现在可商购获得，含有不同的聚合物作为增稠剂，例如羧甲基纤维素（Oralube和Glandosane）、聚丙烯酸和黄原胶（Xialine）。然而，仍处于实验阶段的最新发展是含有抗微生物肽的生物活性唾液替代物和漱口水，以保护口腔组织免受微生物定植并抑制和治愈粘膜和牙龈炎症。
In cancer patients, as in the general population, medication is the most common cause of xerostomia. In general, saliva flow in these patients can be stimulated by mechanical or pharmacological stimulation of the salivary glands. Painful damaged oral mucosa can be treated by softening, lubricating mouthwashes or gels. A specific group of patients are those receiving radiotherapy for malignant tumours in the head and neck region. This treatment is inevitably associated with damages to the oral tissues, including the salivary glands, resulting in salivary gland hypofunction. When residual secretory capacity is present, it is advisable to stimulate the salivary glands by mechanical or gustatory stimuli regularly in these patients as supportive oral care. Alternatively, salivary flow can be stimulated by the use of cholinergic pharmaceutical preparations, such as pilocarpine or cevimeline. After the radiation therapy is ended, a dental check-up should be done every 3 months to allow control of any incipient oral inflammation and dental decay. For daily use, a special dentifrice (e.g. children's toothpaste) is recommended, since the taste of a regular dentifrice may be too strong for these patients. Nocturnal oral dryness can be alleviated by spraying the oral surfaces with water, or by applying a small amount of dentifrice on the dental smooth surfaces. When stimulation of salivary secretion fails, patients can be given palliative oral care in the form of application of mouthwashes and saliva substitutes. The daily use of a mouthwash, e.g. Biotene, Oral Balance or Zendium, or one of the saliva substitutes is indicated. Different types of saliva substitutes are now commercially available, containing different polymers as thickening agents, e.g. carboxymethylcellulose (Oralube and Glandosane), polyacrylic acid, and xanthan gum (Xialine). Recent developments, which are, however, still in the experimental stage, are bio-active saliva substitutes and mouthwashes containing antimicrobial peptides to protect the oral tissues against microbial colonization and to suppress and to cure mucosal and gingival inflammation.