Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Dose- and Time-Related Effects of Pilocarpine Mouthwash on Salivation

  • Song, Je-Il (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Park, Jo-Eun (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Hye-Kyoung (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Ki-Suk (Department of Oral Medicine, College of Dentistry, Dankook University)
  • Received : 2017.08.23
  • Accepted : 2017.09.18
  • Published : 2017.09.30
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Abstract

Purpose: Pilocarpine as a salivation stimulant in pill form has mostly been used to relieve oral dryness for xerostomic patients but its use may often be limited due to variable side effects from systemic absorption. Therefore, the purpose of this study was to investigate the effects of pilocarpine mouthwash on salivation according to the variable concentration and duration for healthy volunteers. Related adverse effects and subjective assessment on its effects on salivation were also examined. Methods: This study was performed as placebo-controlled, double-blind, randomized clinical trial. Thirty healthy volunteers (male=23, mean age=22.2 years) were randomly allocated to 6 groups with the different concentration of pilocarpine mouthwash (placebo, 0.1%, 0.5%, 1.0%, 1.5%, and 2.0%). The whole experiment consisted of 3 sessions according to the duration of mouthwash, i.e., 1, 3, and 5 minutes with the mean wash-out period ${\geq}2$ days between the sessions. Unstimulated whole saliva was collected before and after gargling with a mouthwash. Results: Salivation of the higher concentration groups ${\geq}1%$ significantly increased than those of lower concentration group. The application period of mouthwash did not cause any changes of salivary flow rate at the higher concentrations ${\geq}1.0%$. The lower concentrations of 0.5% and 0.1% had no effects on salivation even after 5-minute mouthwash. There was no significant difference between blood pressure and pulse rate before and after use of mouthwash. Conclusions: From the results of the current study, pilocarpine mouthwash with at least 1.0% concentration more than a minute might be clinically effective in salivation without any serious side effects. Dose of mouthwash rather than duration seems to be a critical factor to salivation.

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References

  1. Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc 1987;115:581-584. https://doi.org/10.1016/S0002-8177(87)54012-0
  2. Mandel ID. Sialochemistry in diseases and clinical situations affecting salivary glands. Crit Rev Clin Lab Sci 1980;12:321-366. https://doi.org/10.3109/10408368009108733
  3. Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J 2010;55:238-244. https://doi.org/10.1111/j.1834-7819.2010.01229.x
  4. Orellana MF, Lagravere MO, Boychuk DG, Major PW, Flores-Mir C. Prevalence of xerostomia in population-based samples: a systematic review. J Public Health Dent 2006;66:152-158. https://doi.org/10.1111/j.1752-7325.2006.tb02572.x
  5. Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:28-46. https://doi.org/10.1016/j.tripleo.2003.07.010
  6. Ishii M, Kurachi Y. Muscarinic acetylcholine receptors. Curr Pharm Des 2006;12:3573-3581. https://doi.org/10.2174/138161206778522056
  7. Frydrych AM, Davies GR, Slack-Smith LM, Heywood J. An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia. Aust Dent J 2002;47:249-253. https://doi.org/10.1111/j.1834-7819.2002.tb00337.x
  8. Hamlar DD, Schuller DE, Gahbauer RA, et al. Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma. Laryngoscope 1996;106:972-976. https://doi.org/10.1097/00005537-199608000-00011
  9. Lockhart PB, Fox PC, Gentry AC, Acharya R, Norton HJ. Pilot study of controlled-release pilocarpine in normal subjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:517-524. https://doi.org/10.1016/S1079-2104(96)80196-X
  10. Berk L. Systemic pilocarpine for treatment of xerostomia. Expert Opin Drug Metab Toxicol 2008;4:1333-1340. https://doi.org/10.1517/17425255.4.10.1333
  11. Bernardi R, Perin C, Becker FL, et al. Effect of pilocarpine mouthwash on salivary flow. Braz J Med Biol Res 2002;35:105-110. https://doi.org/10.1590/S0100-879X2002000100015
  12. Taweechaisupapong S, Pesee M, Aromdee C, Laopaiboon M, Khunkitti W. Efficacy of pilocarpine lozenge for post-radiation xerostomia in patients with head and neck cancer. Aust Dent J 2006;51:333-337. https://doi.org/10.1111/j.1834-7819.2006.tb00453.x
  13. Mikhail AR, inventor; Mikhail AR, assignee. Pilocarpine mouthwash for dry mouth relief. United States patent US 4209505 A. 1980 Jun 24.
  14. Park KH. Evaluations on salivary flow induction and dissolution patterns in saliva of pilocarpine chewing tablet in healthy human volunteers. J Korean Pharm Sci 1997;27:331-335.
  15. Park JE, Kim ME, Kim KS. Comparison of pilocarpine solution and tablet on salivary flow rate [thesis]. Seoul: Dankook University; 2012.
  16. Fox PC. Management of dry mouth. Dent Clin North Am 1997;41:863-875.
  17. Greenspan D, Daniels TE. Effectiveness of pilocarpine in postradiation xerostomia. Cancer 1987;59:1123-1125. https://doi.org/10.1002/1097-0142(19870315)59:6<1123::AID-CNCR2820590614>3.0.CO;2-X
  18. LeVeque FG, Montgomery M, Potter D, et al. A multicenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients. J Clin Oncol 1993;11:1124-1131. https://doi.org/10.1200/JCO.1993.11.6.1124
  19. Schuller DE, Stevens P, Clausen KP, Olsen J, Gahbauer R, Martin M. Treatment of radiation side effects with oral pilocarpine. J Surg Oncol 1989;42:272-276. https://doi.org/10.1002/jso.2930420414
  20. Johnson JT, Ferretti GA, Nethery WJ, et al. Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med 1993;329:390-395. https://doi.org/10.1056/NEJM199308053290603
  21. Fox PC, Atkinson JC, Macynski AA, et al. Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Arch Intern Med 1991;151:1149-1152. https://doi.org/10.1001/archinte.1991.00400060085014
  22. Wiseman LR, Faulds D. Oral pilocarpine: a review of its pharmacological properties and clinical potential in xerostomia. Drugs 1995;49:143-155. https://doi.org/10.2165/00003495-199549010-00010
  23. Weaver ML, Tanzer JM, Kramer PA. Salivary flow induction by buccal permucosal pilocarpine in anesthetized beagle dogs. J Dent Res 1992;71:1762-1767. https://doi.org/10.1177/00220345920710110101
  24. Collins LM, Dawes C. The surface area of the adult human mouth and thickness of the salivary film covering the teeth and oral mucosa. J Dent Res 1987;66:1300-1302. https://doi.org/10.1177/00220345870660080201
  25. Rosas J, Ramos-Casals M, Ena J, et al. Usefulness of basal and pilocarpine-stimulated salivary flow in primary Sjogren's syndrome. Correlation with clinical, immunological and histological features. Rheumatology (Oxford) 2002;41:670-675. https://doi.org/10.1093/rheumatology/41.6.670