Saliva production

Bacterial catabolism of oral food residue is probably responsible for a higher [NHj] in the oral cavity than in the rest of the respiratory tract.Ammonia, the by-product of oral bacterial protein catabolism and subsequent ureolysis, desorbs from the fluid lining the oral cavity to the airstream.. Saliva, gingival crevicular fluids, and dental plaque supply urea to oral bacteria and may themselves be sites of bacterial NH3 production, based on the presence of urease in each of these materials.Consequently, oral cavity fNTi3)4 is controlled by factors that influence bacterial protein catabolism and ureolysis. Such factors may include the pH of the surface lining fluid, bacterial nutrient sources (food residue on teeth or on buccal surfaces), saliva production, saliva pH, and the effects of oral surface temperature on bacterial metabolism and wall blood flow. The role of teeth, as structures that facilitate bacterial colonization and food entrapment, in augmenting [NH3J4 is unknown. 

Older individuals have decreased host defense mechanisms such as slowed gastric emptying and decreased saliva production. They may present with atypical symptoms such as chest pain, asthma, hoarseness, coughing, wheezing, or poor dentition. These patients often do not seek medical attention because they believe their symptoms are part of the normal aging process. 

When there is no saliva production left, replacement for saliva can be used to moisturise the dry membranes of the mouth and is often given in combination with sodium fluoride to protect the teeth. 

Stimulation of saliva production is under sympathetic and parasympathetic control. Parasympathetic stimulation produces a serous watery secretion, whereas sympathetic stimulation produces much thicker saliva. Drug delivery systems, therefore, should not be placed over a duct or adjacent to a salivary duct, as this may dislodge the retentive system or may result in excessive wash-out of the drug or rapid dissolution/erosion of the delivery system making it difficult to achieve high local drug concentrations. If a retentive system is placed over salivary ducts, the reduced salivary flow rate may produce less or no mucus which is required for the proper attachment of a mucoadhesive delivery device. 

Nasopharyngeal intubation may increase saliva production and swallowing, hence diluting retrieved refluxate. No unconjugated bile detected here. 

Since the main clinical use for antisympathotonics is in the treatment of essential hypertension, such drugs will be discussed in Chapter 20 in more detail. The alkaloid reserpine from Rauwolfia serpentina was the first drug used clinically to reduce sympathetic tone. Reserpine reduce the ability of storage and release of various transmitters (adrenaline, noradrenaline, serotonine and dopamine) by an irreversible destruction of the axonal vesicle membranes. The duration of the reserpine effect is actually determined by the de novo synthesis of these structure. Beside various central side effects like sedation, depression, lassitude and nightmares the pattern of unwanted effects of reserpine is determined by the shift of the autonomic balance towards the parasympathetic branch myosis, congested nostrils, an altered saliva production, increased gastric acid production, bardycardia and diarrhea. As a consequence of the inhibition of central dopamine release, reserpine infrequently shows Parkinson-like disturbances of the extrapyramidal system. 

May cause dry mouth use hard candy, saliva product, or frequent rinsing of mouth... 

The sublingual surface area is relatively small but has a rich blood supply. The major advantage of this route is avoidance of intestinal destruction and hepatic first pass metabolism. However, absorption can be highly variable critical factors are the residence time of the drug in the mouth and saliva flow. Premature swallowing or excessive saliva production preclude efficient absorption. Nitroglycerin, nifedipine, propranolol, and buprenorphine are all available as sublingual preparations. Rectal... 

TCAs NITRATES 1. t risk of antimuscarinic side-effects when isosorbide dinitrate is co-administered with TCAs 2. i efficacy of sublingual nitrate tablets with TCAs 1. Additive effect both of these drugs cause antimuscarinic side-effects 2. Antimuscarinic effects i saliva production, which i dissolution of the tablet 1. Warn patients of this additive effect 2. Consider changing the formulation to a sublingual nitrate spray... 

Additive effect both drugs cause antimuscarinic side-effects. Antimuscarinic effects l saliva production, which l dissolution of the tablet... 

The widely held belief that saliva production significantly decreases with age is not well supported in the literature dealing with this subject. Aging does not appear to play a major role as a single contributing factor in causing xerostomia. However, senior citizens may receive medication that produces the side effect of xerostomia. The aged also develop medical problems that can diminish salivary production. 

Tyramine-containing foods lead to excessive sympathetic stimulation Medications inhibit breakdown of food because of decreased saliva production food in general may cause xerostomia... 

There have been several comparisons of tolterodine and oxybutynin. All agree that oxybutynin, in its standard formulation at a dose of 5 mg bd, while of similar efficacy, produces significantly more adverse effects (5). The incidence of dry mouth reached 60%, and over 75% in patients taking the highest dose of 5 mg tds. Direct measurements of saliva production confirmed that oxybutynin 5 mg/day reduces saliva output significantly more than tolterodine 2 mg or a modified-release formulation of oxybutynin 10 mg, all given as single doses (6). In over 300 patients modified-release oxybutynin once-daily produced less dry mouth (28 versus 33%) than immediate-release tolterodine 2 mg bd (7). 

In 1983, the species immediately attracted the attention of biochemists and clinicians, after G. Drewitz described mysterious psychotropic intoxications caused by these mushrooms in the city and district of Potsdam, Germany, during June and July, 1980. The observed range of effects was sensational for mushrooms of the Inocybe genus, because many of its species induce t5q)ical muscarine poisoning symptoms. Muscarine causes parasympathetico-mimetic symptoms, such as pupil contraction (miosis), increased salivation and saliva production. Muscarine has been identified in at least 40 species of the Inocybe genus. The first reports... 

Mucosa degeneration Reduced saliva production Capsules... 

Symptoms of nerve agent poisoning resulting from a low dose include increased saliva production, runny nose, and a feeling of pressure on the chest. Pupils of the eyes exhibit pinpoint constriction (miosis), short-range vision is impaired, and the victim feels pain when trying to focus on a nearby object. Headache may follow with tiredness, slurred speech, and hallucinations. Exposures to higher doses present more dramatic symptoms. Bronchioconstriction and secretion of mucous in the... 

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