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22 Xerostomie: droge-mondsyndroom

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Speeksel, speekselklieren en mondgezondheid

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Samenvatting

Op grond van de experimentele gegevens kunnen de volgende conclusies worden getrokken:

  • Het is van cruciaal belang de oorzaak van de droge-mondklacht te diagnosticeren.

  • Indien de speekselklieren nog te stimuleren zijn, kan de droge-mondklacht bestreden worden met een smaak- of kauwstimulus of eventueel met een farmacon: supportive care.

  • Indien de speekselklieren niet meer te stimuleren zijn is de droge-mondklacht te bestrijden met een speekselsubstituut: palliative care.

  • Een speekselsubstituut op basis van mucinen voldoet beter in reologisch en bevochtigend opzicht dan de ontwikkelde speekselsubstituten op basis van CMC. Varkensmaagmucine lijkt geschikter dan runderspeekselmucine, maar een combinatie van beide mucinen is nog beter, eventueel gecombineerd met serumeiwitten.

  • Polymeren met zowel viskeuze als elastische eigenschappen, zoals de natuurlijke gommen (bijv. xanthaangom), worden door een aantal patiënten met xerostomie goed geaccepteerd. Speekselsubstituten op basis van xanthaangom lijken even effectief als speekselsubstituten op basis van dierlijke mucinen.

  • Het beste resultaat wordt veelal bereikt bij gebruik van de applicatie van een speekselsubstituut door middel van een spray en kauwtabletten. Voor een beperkte patiëntengroep is een applicatievorm (reservoir in een prothese) te maken die een continue bevochtiging van de mondholte gedurende gemiddeld vier uur mogelijk maakt.

  • Toevoeging van runderserumalbumine aan mucinebevattend speekselsubstituut kan leiden tot verlaging van het mucinegehalte en geeft verbetering van de reologische eigenschappen.

  • Nader onderzoek is gewenst naar een speekselsubstituut dat de mucosa verzacht, de orale microflora remt, de gebitselementen afdoende beschermt tegen demineralisatie en de orale functies bevordert.

  • Spoeldranken, mondsprays, mondgels en milde tandpasta’s met daarin verzachtende ingrediënten zoals olijfolie, betaïne of xylitol geven verlichting van xerostomie, die veroorzaakt wordt door het gebruik van meerdere geneesmiddelen (polyfarmacie; Ship e.a., 2007).

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van Nieuw Amerongen, A. (2008). 22 Xerostomie: droge-mondsyndroom. In: Speeksel, speekselklieren en mondgezondheid. Bohn Stafleu van Loghum, Houten. https://doi.org/10.1007/978-90-313-6317-9_22

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