Antihypertensive Drugs Induced Xerostomia: A Short Review

Karthikeyan Murthykumar¹, Dr.Dhanraj²

¹Final Year BDS^, Department of Prosthodontics, Saveetha Dental college, Chennai

²Senior Lecturer, Department of Prosthodontics, Saveetha Dental college, Chennai

*Corresponding Author E-mail: mayorbosspromo@gmail.com

Received on 15.02.2016 Modified on 25.02.2016

Accepted on 18.03.2016 © RJPT All right reserved

Research J. Pharm. and Tech. 2016; 9(5): 591-592.

DOI: 10.5958/0974-360X.2016.00111.6

ABSTRACT:

Xerostomia refers to a subjective sensation of a dry mouth , its frequently, but not always associated with salivary gland hypofunctions. Xerostomia is a common problem that has reported in 25% of older adults. In the past, complaints of dry mouth in older patient was ascribed to the predictable result of aging. However, it is now generally accepted that any reductions in salivary functions associated with age are modest and probably are not associated with any significant reductions in salivary functions. Instead, xerostomia in older asults is more likely to be the result of other factors, especially medications. More than 500 drugs have been reported to produce xerostomia as side effect. This review brief discuss about the antihypertensive drugs causing xerostomia.

KEYWORDS: Xerostomia, antihypertensive drugs, side effects.

INTRODUCTION:

Xerostomia also termed as drug mouth is the medical term for the subjective symptoms of dryness in the mouth, which may be associated with change in composition of saliva or reduced salivary flow or have no identifiable cause. Xerostomia is the subjective feeling of oral dryness, which is often associated with hypofunction of the salivary gland. It is more common in older people (1). It is know that more than 500 drugs may lead to hyposalivation the medications which most frequently cause hyposalivation are the one most commonly used, such as antihypertensive and psychotropic drugs. It is known that these groups of drugs cause dry mouth: antihypertensives, anticholinergics, antihistamines, benzodiazepines, cytostatics, diuretics, proton pump inhibitors and H2 antagonists, antipsychotics, antidepressants, hypnotics, opioids, muscarinic antagonists and alpha receptor agonists, appetite suppressors, bronchodilators, drugs for HIV treatment, decongestants, and skeletal muscle relaxants (2).

Drugs can cause parasympatholytic activity in several ways, including competitive inhibition of acetylcholine at the parasympathetic ganglia and at the effectors junction. Drugs may also influence parasympathetic response indirectly via interactions with the sympathetic and central nervous system (3).

Drug related xerostomia:

Common habits such as tobacco smoking, alcohol use and the consumption of beverages containing caffeine can cause some oral dryness. Drugs are the most common cause of reduced salivation (2). Dry mouth is a common complaint in patients treated for hypertensive, psychiatric, or urinary problems(4) and in elderly (5,6) mainly as consequence of the large number of drugs used (7,8) and polypharmacy (6,9,7). Age and medication seem to play a important role in individuals with objective evidence of hyposalivation, while female gender and psychological factors are important in individuals with subjective oral dryness (10).

Antihypertensives:

The ganglion blockers and particularly the beta-blockers may cause dry mouth (9) thought to be associated with activation of central nervous system and salivary gland alpha 2-adrenergic receptors. Such antihypertensive drugs, or sympatholytics, are now little used because of such prominent adverse drug reactions as dry mouth. Newer centrally acting antihypertensives, with selective agonist effects on the imidazoline I1 brainstem-receptors in the rostral ventromedulla, appear to modulate sympathetic activity and blood pressure without affecting salivary flow: Moxonidine and rilmenidine are example of this new class. Moxonidine can produce dry mouth, more frequently than placebo (11) but only in a minority, and significantly less than with the older antihypertensives (12). Rilmenidine produces little dry mouth (13). ACE inhibitors, which blocks the ACE enzyme in the renin-angiotensin-aldosterone system, produce dry mouth in 13% of patients (14).

Management:

The dental management of patients suffering from dry mouth should begin with thorough patient education and the identification of the underlying cause. Treatment should include local and systemic stimulation of salivary glands, palliative treatment for symptomatic relief, as well as preventing and treating oral complication (15). Patient with dry mouth may stop chewing and reactively modify their diet to a liquid or semi liquid diet rich in fermentable carbohydrates in order to compensate for oral dryness. Consequently, patient should be referred for nutritional counseling to educate them minimize any negative effects from reactionary diet alterations (16). A non-specific mechanical and gustatory stimulant increases salivation; therefore, the use of sugar free gums, hard candies, and mints are highly recommended for the relief of symptoms in patients with residual salivary capacity (17). In studies it has been found that xylitol sweetened gums prevent caries (18). The use of citric acid or candies is discouraged due to accelerating caries development (16). Lifestyle changes available to patients suffering from dry mouth to control and prevent dental caries include adhering to a rigorous oral hygiene regimen and non-cariogenic diet. The need for meticulous plaque control via assiduous oral hygiene is necessary for xerostomic patients. Brushing twice a day with a soft bristle toothbrush and the use of a low abrasive, highly fluorinated toothpaste is recommended, accompanied by a sodium fluoride rinse (19). Current interest involves the use of fluoride varnishes to prolong the exposure to fluoride an approach that may be beneficial to prevent xerostomia associated caries (15).

CONCLUSION :

There are few relevant randomized double-blinded controlled studies in this field, and the only data available are from case reports, small series, and non-peer- reviewed reports. The clinician should take a careful drug history.

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