SUMMARY1. Unstimulated whole saliva and parotid saliva stimulated at a constant flow rate of 1-0 ml./min were collected from eight subjects at about 07.00, 11.00, 14.00, 17.00 and 22.00 hr and oral temperature was recorded several times daily for time spans of between 4 and 26 days. A leastsquares cosine wave was fitted to the data to test for the presence and characteristics of circadian rhythms. 2. Estimates of mean level, amplitude, acrophase and period were obtained for different components and the results were subjected to cosinor analysis.3. Unstimulated whole saliva showed significant circadian rhythms in flow rate and in the concentrations of sodium and chloride but not in protein, potassium, calcium, phosphate or urea.4. Stimulated parotid saliva showed significant circadian rhythms in the concentrations of protein, sodium, potassium, calcium and chloride but not in phosphate or urea 5. Oral temperature showed a circadian rhythm which, like the salivary rhythms, was of a 24.0 hr periodicity.

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BackgroundMedication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist.ObjectiveOur objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea.Data SourcesElectronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices.LimitationsWhile xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search.ConclusionsWe compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.

This paper discusses methods for collection of both whole saliva and individual gland secretions, the normal ranges of salivary flow rate, the effects of physiological variables which influence flow rate, and the role of saliva in oral sugar clearance. The physiological basis for the sensation of dry mouth is discussed, and a new concept is advanced which states that the sensation of dry mouth will occur when the salivary flow rate is less than the sum of the rates of water absorption and evaporation from the mouth. In a study of the effects of anticholinergic agents on salivary flow, the subjects experienced the sensation of dry mouth when the normal flow rate of unstimulated saliva was reduced by from 40 to 50%.

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