Salivary Glands and Periodontal Changes in a Population of Sjögren's and Sicca Syndrome Treated by Pilocarpine: A Pilot Study

Thibaud Depinoy, Alain Saraux, Jacques-Olivier Pers, Sylvie Boisramé, Divi Cornec, Thierry Marhadour, Dewi Guellec, Valérie Devauchelle-Pensec, Luc Bressollette, Sandrine Jousse-Joulin, Thibaud Depinoy, Alain Saraux, Jacques-Olivier Pers, Sylvie Boisramé, Divi Cornec, Thierry Marhadour, Dewi Guellec, Valérie Devauchelle-Pensec, Luc Bressollette, Sandrine Jousse-Joulin

Abstract

Introduction: Oral administration of pilocarpine enhances salivary flow in sicca patients but its effect upstream on ultrasound (US) of salivary glands (SG) and downstream on periodontium remain unknown.

Methods: Sicca patients were prospectively included. Echostructural and vascularization of SG were assessed using B mode and pulsed Doppler (USPD). Vascularization of SG was measured using resistive index (RI) before and after stimulation by lemon juice. Echostructure (measure of glandular length in cm2, evaluation of parotid and submandibular glands parenchymal abnormalities) was assessed at baseline (M0) and after 3 months (M3) of treatment with pilocarpine. A dental consultation was performed at M0 and M3 to evaluate changes in unstimulated salivary flow (USSF), stimulated salivary flow (SSF), and periodontal parameters such as modified gingival index (Lobene), plaque index (Silness), bleeding index, pocket depth, and pH.

Results: Nineteen patients were included but only 11 received pilocarpine treatment for 3 months, as six stopped pilocarpine due to side effects and two were excluded for other causes. Among the 11 patients who completed the 3-month follow-up, five had primary Sjögren's syndrome according to the American-European's classification criteria. As expected, statistical differences were found concerning SSF (p = 0.018) and USSF (p = 0.027) between M0 and M3 while no statistical change in both SG echostructure and vascularization or periodontal evaluation was shown.

Conclusions: Pilocarpine improved SSF and USSF measurements in sicca syndrome but no ultrasonography of major salivary glands (SGUS) structural and vascular changes were detected as well as periodontal evaluation.

Keywords: Pilocarpine; Salivary glands; Sjögren’s syndrome; Ultrasonography.

Figures

Fig. 1
Fig. 1
Doppler waveform analysis of arterial supply in parotid gland (Pathologic Resistive Index: 0.58). The Doppler waveform analysis shows a decrease of the systolic peak, which explains the low resistive index (IR: 0.57) result in pSS patients
Fig. 2
Fig. 2
Flowchart of the screening patients from October 2012 and November 2014

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Source: PubMed

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