SALIVA SUBSTITUTES IN THE MANAGEMENT OF SALIVARY-GLAND DYSFUNCTION

Salivary gland dysfunction is a relatively common problem which results in the symptoms of a dry or scalded mouth, difficulties with speech, problems with eating,mucosal infections, denture intolerance, sialadenitis, increased dental caries and periodontal disease. The aetiology may be a functional disturbance or a morphological disorder. A broad-based programme is indicated in its management and this includes either stimulating residual gland function with sialogogues or, in severe cases, replacing the saliva with a substitute. Currently, most saliva substitutes are based on an aqueous solution containing carboxymethylcellulose or animal mucin. Delivery of these solutions remains a major factor in the successful clinical management of severe salivary gland dysfunction. Rinses and sprays are the most commonly employed delivery systems, being more acceptable than pastilles or lozenges which require a reasonable amount of saliva already present in the mouth in order to dissolve. A number of designs for reservoirs in dentures have been constructed. These are intended to deliver a steady supply of the saliva substitute over an extended time, although these have not as yet been widely adopted.