An update of the etiology and management of xerostomia

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics

Volumn 97, Issue 1, 2004, Pages 28-46

  Porter, S R ^a,b,c   Scully, C ^a,b   Hegarty, A M ^a,c  

^a UNIVERSITY COLLEGE LONDON   (United Kingdom)

^b UNIVERSITY OF LONDON   (United Kingdom)

^c UNIVERSITY COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CEVIMELINE; CHOLINERGIC RECEPTOR STIMULATING AGENT; PILOCARPINE; SALIVA SUBSTITUTE;

CLINICAL FEATURE; CLINICAL TRIAL; DRUG EFFECT; HUMAN; RADIOTHERAPY; REVIEW; SALIVARY GLAND DISEASE; SJOEGREN SYNDROME; XEROSTOMIA;

EID: 0347949726     PISSN: 10792104     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.tripleo.2003.07.010     Document Type: Article

References (229)

1. Bergdahl M., Bergdahl J. Low unstimulated salivary flow and subjective oral dryness association with medication, anxiety, depression and stress . J Dent Res. 79:2000;1652-1658.
2. Berne RM. Physiology. 4th ed. St Louis (MO): Mosby, 1998. p. 619-621.
3. Carlson G.W. The salivary glands. Embryology, anatomy, and surgical applications. Surg Clin North Am. 80:2000;261-273.
4. Scully C., Flint S., Porter S.R. Oral diseases: an illustrated guide to diagnosis and management of diseases of the oral mucosa, gingivae, teeth, salivary glands, bones and joints. 2nd ed :1996;Martin Dunitz, London.
5. Porter S.R., Scully C. Adverse drug reactions in the mouth. Clin Dermatol. 18:2000;525-532.
6. Pajukoski H., Meurman J.H., Halonen P., Sulkava R. Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 92:2001;641-649.
7. Trindade E., Menon D., Topfer L.A., Coloma C. Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants a meta-analysis . CMAJ. 159:1998;1245-1252.
8. Hunter K.D., Wilson W.S. The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Arch Oral Biol. 40:1995;983-989.
9. Ravindran A.V., Judge R., Hunter B.N., Bray J., Morton N.H. A double-blind, multicenter study in primary care comparing paroxetine and clomipramine in patients with depression and associated anxiety. Paroxetine Study Group. J Clin Psychiatry. 58:1997;112-118.
10. Teare J.P., Spedding C., Whitehead M.W., Greenfield S.M., Challacombe S.J., Thompson R.P. Omeprazole and dry mouth. Scand J Gastroenterol. 30:1995;216-218.
11. Bruera E., Belzile M., Neumann C.M., Ford I., Harsanyi Z., Darke A. Twice-daily versus once-daily morphine sulphate controlled-release suppositories for the treatment of cancer pain. A randomized controlled trial. Support Care Cancer. 7:1999;280-283.
12. Hill J.L., Zacny J.P. Comparing the subjective, psychomotor, and physiological effects of intravenous hydromorphone and morphine in healthy volunteers. Psychopharmacology (Berl). 152:2000;31-39.
13. Chilla R., Arglebe C. Pharmacotherapy of hypertension and its significance for the function of the salivary glands. (author's translation) MMW Munch Med Wochenschr. 117:1975;1425-1428.
14. Schoenberger J.A., Croog S.H., Sudilovsky A., Levine S., Baume R.M. Self-reported side effects from antihypertensive drugs. A clinical trial. Quality of Life Research Group. Am J Hypertens. 3:1990;123-132.
15. Croog S.H., Elias M.F., Colton T., Baume R.M., Leiblum S.R., Jenkins C.D., et al. Effects of antihypertensive medications on quality of life in elderly hypertensive women. Am J Hypertens. 7:1994;329-339.
16. Nederfors T. Xerostomia prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists . Swed Dent J Suppl. 116:1996;1-70.
17. Darwaza A., Lamey P.J., Connell J.M. Hydrallazine-induced Sjögren's syndrome. Int J Oral Maxillofac Surg. 17:1988;92-93.
18. Scully C., Epstein J.B. Oral health care for the cancer patient. Eur J Cancer B Oral Oncol. 32B:1996;281-292.
19. Epstein JB, Stevenson-Moore P, Scully C. Management of xerostomia. J Can Dent Assoc 192;58:140-143.
20. Epstein J.B., van der Meij E.H., Lunn R., Stevenson-Moore P. Effects of compliance with fluoride gel application on caries and caries risk in patients after radiation therapy for head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 82:1996;268-275.
21. Singh N., Scully C., Joyston-Bechal S. Oral complications of cancer therapies prevention and management . Clin Oncol (R Coll Radiol). 8:1996;. 15-24.A.
22. Pow EH, McMillan AS, Leung WK, Wong MC, Kwong DL. Salivary gland function and xerostomia in southern Chinese following radiotherapy for nasopharyngeal carcinoma. Clin Oral Investig 2003;7(4):230-4.
23. Davies A.N., Broadley K., Beighton D. Xerostomia in patients with advanced cancer. J Pain Symptom Manage. 22:2001;820-850.
24. Hainsworth J.D., Meluch A.A., McClurkan S., Gray J.R., Stroup S.L., Burris H.A. III, et al. Induction paclitaxel, carboplatin, and infusional 5-FU followed by concurrent radiation therapy and weekly paclitaxel/carboplatin in the treatment of locally advanced head and neck cancer a phase II trial of the Minnie Pearl Cancer Research Network . Cancer J. 8:2002;311-321.
25. Ackerstaff A.H., Tan I.B., Rasch C.R., Balm A.J., Keus R.B., Schornagel J.H., et al. Quality-of-life assessment after supradose selective intra-arterial cisplatin and concomitant radiation (RADPLAT) for inoperable stage IV head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 128:2002;1185-1190.
26. Nagler R.M. Effects of radiotherapy and chemotherapeutic cytokines on a human salivary cell line. Anticancer Res. 18:1998;309-314.
27. Nagler R.M., Sherman Y., Nagler A. Histopathological study of the human submandibular gland in graft versus host disease. J Clin Pathol. 52:1999;395-397.
28. Levy S., Nagler A., Okon S., Marmary Y. Parotid salivary gland dysfunction in chronic graft-versus-host disease (cGVHD) a longitudinal study in a mouse model . Bone Marrow Transplant. 25:2000;1073-1078.
29. Demarosi F., Bez C., Sardella A., Lodi G., Carrassi A. Oral involvement in chronic graft-vs-host disease following allogenic bone marrow transplantation. Arch Dermatol. 138:2002;842-843.
30. Schubert M.M., Sullivan K.M., Morton T.H., Izutsu K.T., Peterson D.E., Flournoy N., et al. Oral manifestations of chronic graft-v-host disease. Arch Intern Med. 144:1984;1591-1595.
31. Janin-Mercier A., Saurat J.H., Bourges M., Sohier J., Jean L.D., Gluckman E. The lichen planus like and sclerotic phases of the graft versus host disease in man an ultrastructural study of six cases . Acta Derm Venereol. 61:1981;187-193.
32. Nicolatou-Galitis O., Kitra V., Van Vliet-Constantinidou C., Peristeri J., Goussetis E., Petropoulos D., et al. The oral manifestations of chronic graft-versus-host disease (cGVHD) in paediatric allogeneic bone marrow transplant recipients. J Oral Pathol Med. 30:2001;148-153.
33. Fox R.I., Stern M., Michelson P. Update in Sjögren syndrome. Curr Opin Rheumatol. 12:2000;391-398.
34. Bowman S.J. Collaborative research into outcome measures in Sjögren's syndrome. Update on disease assessment. Scand J Rheumatol Suppl. 116:2002;23-27.
35. Vitali C. Classification criteria for Sjögren's syndrome. Ann Rheum Dis. 62:2003;94-95.
36. Jonsson R., Moen K., Vestrheim D., Szodoray P. Current issues in Sjögren's syndrome. Oral Dis. 8:2002;130-140.
37. Fye K.H., Terasaki P.I., Moutsopoulos H., Daniels T.E., Michalski J.P., Talal N. Association of Sjögren's syndrome with HLA-B8. Arthritis Rheum. 19:1976;883-886.
38. Fox R.I., Stern M. Sjögren's syndrome mechanisms of pathogenesis involve interaction of immune and neurosecretory systems . Scand J Rheumatol Suppl. 116:2002;3-13.
39. Ogawa N., Ping L., Zhenjun L., Takada Y., Sugai S. Involvement of the interferon-gamma-induced T cell-attracting chemokines, interferon-gamma- inducible 10-kd protein (CXCL10) and monokine induced by interferon-gamma (CXCL9), in the salivary gland lesions of patients with Sjögren's syndrome. Arthritis Rheum. 46:2002;2730-2741.
40. Drosos A.A., Voulgari P.V., Psychos D.N., Tsifetaki N., Bai M. Sicca syndrome in patients with sarcoidosis. Rheumatol Int. 18:1999;177-180.
41. Ohtsuka S., Yanadori A., Tabata H., Yamakage A., Yamazaki S. Sarcoidosis with giant parotomegaly. Cutis. 68:2001;199-200.
42. Porter S.R., Scully C. HIV the surgeon's perspective. Part 3. Diagnosis and management of malignant neoplasms . Brit J Oral Maxillofac Surg. 32:1994;241-247.
43. Schiodt M. HIV-associated salivary gland disease a review . Oral Surg Oral Med Oral Pathol. 73:1992;164-167.
44. Mbopi-Keou F.X., Belec L., Teo C.G., Scully C., Porter S.R. Synergism between HIV and other viruses in the mouth. Lancet Infect Dis. 2:2002;416-424.
45. Franco-Paredas C., Rebolledo P., Folch E., Hernandez I., del Rio C. Diagnosis of diffuse CD8+ lymphocytosis syndrome in HIV-infected patients. AIDS Read. 12:2002;408-413.
46. Porter S.R., Scully C. HIV topic update protease inhibitor therapy and oral health care . Oral Dis. 4:1998;159-163.
47. Scully C., Diz Dios P. Orofacial effects of antiretroviral therapies. Oral Dis. 7:2001;205-210.
48. Dodd C.L., Greenspan D., Westenhouse J.L., Katz M.H. Xerostomia associated with didanosine. Lancet. 340:1992;790.
49. Allan J.D., Connolly K.J., Fitch H., Jackson-Pope L., McLaren C., Canetta R., et al. Long-term follow-up of didanosine administered orally twice daily to patients with advanced human immunodeficiency virus infection and hematologic intolerance of zidovudine. Clin Infect Dis. 16:1993;46-51.
50. Danner S.A., Carr A., Leonard J.M., Lehman L.M., Gudiol F., Gonzales J., et al. A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of HIV-1 protease. European-Australian Collaborative Ritonavir Study Group. N Engl J Med. 333:1995;1528-1533.
51. Lodi G., Porter S.R. Hepatitis C virus infection. Review and implications for the dentist. Oral Surg Oral Med Oral Path Oral Radiol Endod. 86:1998;8-22.
52. Arase Y., Ikeda K., Tsubota A., Suzuki Y., Saitoh S., Kobayashi M., et al. Serum levels of gamma-globulin and total bilirubin influence the prevalence of multiple extrahepatic complication in patients with hepatitis C virus infection. Hepatol Res. 25:2003;14-21.
53. Mariette X., Loiseau P., Morinet F. Hepatitis C virus in saliva. Ann Intern Med. 122:1995;556.
54. Loustaud-Ratti V., Riche A., Liozon E., Labrousse F., Soria P., Rogez S., et al. Prevalence and characteristics of Sjögren's syndrome or Sicca syndrome in chronic hepatitis C virus infection a prospective study . J Rheumatol. 28:2001;2245-2251.
55. Ferreiro M.C., Prieto M.H., Rodriguez S.B., Vazquez R.L., Iglesias A.C., Dios P.D. Whole stimulated salivary flow in patients with chronic hepatitis C virus infection. J Oral Pathol Med. 31:2002;117-120.
56. Henderson L., Muir M., Mills P.R., Spence E., Fox R., McCruden E.A., et al. Oral health of patients with hepatitis C virus infection a pilot study . Oral Dis. 7:2001;271-275.
57. Scott C.A., Avellini C., Desinan L., Pirisi M., Ferraccioli G.F., Bardus P., et al. Chronic lymphocytic sialoadenitis in HCV-related chronic liver disease comparison of Sjögren's syndrome . Histopathology. 30:1997;41-48.
58. Coll J., Gambus G., Corominas J., Tomas S., Esteban J.I., Guardia J. Immunohistochemistry of minor salivary gland biopsy specimens from patients with Sjögren's syndrome with and without hepatitis C virus infection. Ann Rheum Dis. 56:1997;390-392.
59. Porter S.R., Scully C., Lodi G., Teo C.G. Lack of association between hepatitis C virus and Sjögren's syndrome. Oral Dis. 2:1996;183-184.
60. Gaston J.S., Rowe M., Bacon P. Sjögren's syndrome after infection by Epstein-Barr virus. J Rheumatol. 17:1990;558-561.
61. Pflugfelder S.C., Roussel T.J., Culbertson W.W. Primary Sjögren's syndrome after infectious mononucleosis. JAMA. 257:1987;1049-1050.
62. Whittingham S., McNeilage L.J., Mackay I.R. Epstein-Barr virus as an etiological agent in primary Sjögren's syndrome. Med Hypotheses. 22:1987;373-386.
63. Hajjar C., Sainte-Foie S., Savin J., Lacave J., Berlet F., Teron-Aboud B., Batelier L., Guillemin B. HTLV 1 infection and sicca syndrome. J Fr Ophthalmol. 18:1995;597-602.
64. Nakamura H., Eguchi K., Nakamura T., Mizokami A., Shirabe S., Kawakami A., et al. High prevalence of Sjögren's syndrome in patients with HTLV-1 associated myelopathy. Ann Rheum Dis. 56:1997;167-172.
65. Yakimchuk K.S. Chronic infection with hepatitis and herpes viruses in patients with Sjogren's disease. Bull Exp Biol Med. 133:2002;54-57.
66. Ikuno N., Mackay I.R., Jois J., Omagari K., Rowley M.J. Antimitochondrial autoantibodies in saliva and sera from patients with primary biliary cirrhosis. J Gastroenterol Hepatol. 16:2001;1390-1394.
67. Ferguson D.B. The flow rate and composition of human labial gland saliva. Arch Oral Biol. 44:1999;S11-14.
68. Manfredini M, McCullough MJ, Vescouri P, Al-Karaoui ZM, Porter SR. Update on diabetes mellitus and related cell diseases. Oral Dis (in press).
69. Sheppard I.M. Oral manifestations of diabetes mellitus a study of one hundred cases . J Am Dent Assoc. 29:1942;1188-1192.
70. Newrick P.G., Bowman C., Green D., O'Brien I.A., Porter S.R., Scully C., et al. Parotid salivary secretion in diabetic autonomic neuropathy. J Diabet Complications. 5:1991;35-37.
71. Sharon A., Ben-Aryeh H., Itzhak B., Yoram K., Szargel R., Gutman D. Salivary composition in diabetic patients. J Oral Med. 40:1985;23-26.
72. Albrecht M., Banoczy J., Baranyi E., Tamas G. Jr, Szalay J., Egyed J., et al. Studies of dental and oral changes of pregnant diabetic women. Acta Diabetol Lat. 24:1987;1-7.
73. Harrison R., Bowen W.H. Periodontal health, dental caries, and metabolic control in insulin-dependent diabetic children and adolescents. Pediatr Dent. 9:1987;283-286.
74. Rees T.D. The diabetic dental patient. Dent Clin North Am. 38:1994;447-463.
75. Finney L.S., Finney M.O., Gonzalez-Campoy J.M. What the mouth has to say about diabetes. Careful examinations can avert serious complications. Postgrad Med. 102:1997;117-126.
76. Conner S., Iranpour B., Mills J. Alteration in parotid salivary flow in diabetes mellitus. Oral Surg Oral Med Oral Pathol. 30:1970;55-59.
77. Sreebny L.M., Yu A., Green A., Valdini A. Xerostomia in diabetes mellitus. Diabetes Care. 15:1992;900-904.
78. Meurman J.H., Collin H.L., Niskanen L., Toyry J., Alakuijala P., Keinanen S., et al. Saliva in non-insulin-dependent diabetic patients and control subjects the role of the autonomic nervous system . Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 86:1998;69-76.
79. Lin C.C., Sun S.S., Kao A., Lee C.C. Impaired salivary function in patients with noninsulin-dependent diabetes mellitus with xerostomia. J Diabetes Complications. 16:2002;176-179.
80. Hodgson T.A., Shah R., Porter S.R. The investigation of major salivary gland agenesis a case report . Pediatr Dent. 23:2001;131-134.
81. Nordgarden H., Johannessen S., Storhaug K., Jensen J.L. Salivary gland involvement in hypohidrotic ectodermal dysplasia. Oral Dis. 4:1998;152-154.
82. Dumic M., Mravak-Stipetic M., Kaic Z., Ille J., Plavsic V., Batinica S., et al. Xerostomia in patients with triple A syndrome - a newly recognised finding. Eur J Pediatr. 159:2000;885-888.
83. Zhou Z., Lu Y., Wu L. Clinicopathological and diagnostic study of amyloidosis of oral maxillofacial area. Zhonghua Kou Qiang Yi Xue Za Zhi. 33:1998;282-284.
84. Hachulla E., Janin A., Flipo R.M., Saile R., Facon T., Bataille D., et al. Labial salivary gland biopsy is a reliable test for the diagnosis of primary and secondary amyloidosis. A prospective clinical and immunohistologic study in 59 patients. Arthritis Rheum. 36:1993;691-697.
85. Vrielinck L.J., van Parys G., van Damme B., Bossuyt M. Sicca syndrome with iron deposition in the salivary glands. Int J Oral Maxillofac Surg. 17:1988;11-13.
86. Takeda Y., Ohya T. Sicca symptom in a patient with hemochromatosis minor salivary gland biopsy for differential diagnosis . Int J Oral Maxillofac Surg. 16:1987;745-748.
87. Sadler G.R., Stoudt A., Fullerton J.T., Oberle-Edwards L.K., Nguyen Q., Epstein J.B. Managing the oral sequelae of cancer therapy. Medsurg Nurs. 12:2003;28-36.
88. Hamburger J. Sjögren's syndrome as seen by an oral physician. Scand J Rheumatol Suppl. 115:2001;34-39.
89. Pedersen A.M., Nauntofte B. Primary Sjögren's syndrome oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy . Expert Opin Pharmacother. 2:2001;1415-1436.
90. Soto-Rojas A.E., Kraus A. The oral side of Sjögren syndrome. Diagnosis and treatment. A review. Arch Med Res. 33:2002;95-106.
91. Strombeck B., Ekdahl C., Manthorpe R., Wikstrom I., Jacobsson L. Health-related quality of life in primary Sjögren's syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol. 29:2000;20-28.
92. Hay K.D., Morton R.P., Wall C.R. Quality of life and nutritional studies in Sjögren's syndrome patients with xerostomia. N Z Dent J. 97:2001;128-131.
93. Rostron J., Rogers S., Longman L., Kaney S., Field E.A. Health-related quality of life in patients with primary Sjogren's syndrome and xerostomia a comparative study . Gerodontology. 19:2002;53-59.
94. Jonsson R., Haga H.J., Gordon T.P. Current concepts on diagnosis, autoantibodies and therapy in Sjögren's syndrome. Scand J Rheumatol. 29:2000;341-348.
95. al-Hashimi I., Taylor S.E. A new medication for treatment of dry mouth in Sjögren's syndrome. Tex Dent J. 118:2001;262-266.
96. Vlachoyiannopoulos P.G. Therapy of Sjögren's syndrome. New aspects and future directions. Ann Med Interne (Paris). 149:1998;49-53.
97. Meyer-Lueckel H., Kielbassa A.M. Use of saliva substitutes in patients with xerostomia. Schweiz Monatsschr Zahnmed. 112:2002;1037-1058.
98. Senahayake F., Piggott K., Hamilton-Miller J.M. A pilot study of Salix SST (saliva-stimulating lozenges) in post-irradiation xerostomia. Curr Med Res Opin. 14:1998;155-159.
99. Warde P., Kroll B., O'Sullivan B., Aslanidis J., Tew-George E., Waldron J., et al. A phase II study of Biotene in the treatment of postradiation xerostomia in patients with head and neck cancer. Support Care Cancer. 8:2000;203-208.
100. Epstein J.B., Emerton S., Le N.D., Stevenson-Moore P. A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol. 35:1999;132-137.
101. Epstein J.B., Stevenson-Moore P. A clinical comparative trial of saliva substitutes and radiation-induced salivary gland hypofunction. Spec Care Dentist. 12:1992;21-23.
102. Samarawickrama D.Y. Saliva substitutes how effective and safe are they? Oral Dis. 8:2002;177-179.
103. Hooper P., Tincello D.G., Richmond D.H. The use of salivary stimulant pastilles to improve compliance in women taking oxybutynin hydrochloride for detrusor instability a pilot study . Br J Urol. 80:1997;414-416.
104. Momm F., Guttenberger R. Treatment of xerostomia following radiotherapy does age matter? Support Care Cancer. 10:2002;505-508.
105. Rhodus N.L., Bereuter J. Clinical evaluation of a commercially available oral moisturizer in relieving signs and symptoms of xerostomia in postirradiation head and neck cancer patients and patients with Sjögren's syndrome. J Otolaryngol. 29:2000;28-34.
106. Criswell M.A., Sinha C.K. Hyperthermic, supersaturated humidification in the treatment of xerostomia. Laryngoscope. 111:2001;992-996.
107. Frost P.M., Shirlaw P.J., Walter J.D., Challacombe S.J. Patient preferences in a preliminary study comparing an intra-oral lubricating device with the usual dry mouth lubricating methods. Br Dent J. 193:2002;403-408.
108. Fox R.I., Michelson P. Approaches to the treatment of Sjogren's syndrome. J Rheumatol Suppl. 61:2000;15-21.
109. Vivino F.B. The treatment of Sjögren's syndrome patients with pilocarpine-tablets. Scan J Rheumatol Suppl. 115:2001;1-9.
110. Ferguson M.M. Pilocarpine and other cholinergic drugs in the management of salivary gland dysfunction. Oral Surg Oral Med Oral Pathol. 75:1993;186-191.
111. Wiseman L.R., Faulds D. Oral pilocarpine a review of its pharmacological properties and clinical potential in xerostomia . Drugs. 49:1995;143-155.
112. Gunn J.A., Cooke A.M. Pilocarpine as an antagonist to the undesired effects of ganglion-blocking agents in the treatment of hypertension. Br Med J. 4877:1954;1473.
113. Prutting J. Pilocarpine with psychostimulants. JAMA. 191:1965;603.
114. Prutting J. Pilocarpine nitrate and psychostimulants. Antagonistic agent to anticholinergic effects. JAMA. 193:1965;236-237.
115. Ferguson MM. Pilocarpine and other cholinergic drugs in the management of salivary gland dysfunction. Oral Surg Oral Med Oral Pathol 1993;75:186-91.
116. Aromdee C., Ferguson M.M., Ledger R., Wall J. A pilot study of the disposition of pilocarpine in plasma, saliva and urine after a single oral dose. Eur J Pharm Sci. 8:1999;81-83.
117. Vivino F.B., Al-Hashimi I., Khan Z., LeVeque F.G., Salisbury P.L. III, Tran-Johnson T.K., et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren's syndrome a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group . Arch Intern Med. 159:1999;174-181.
118. Bell M., Askari A., Bookman A., Frydrych S., Lamont J., McComb J., et al. Sjögren's syndrome a critical review of clinical management . J Rheumatol. 26:1999;2051-2061.
119. Taylor S.E., Miller E.G. Preemptive pharmacologic intervention in radiation-induced salivary dysfunction. Proc Soc Exp Biol Med. 221:1999;14-26.
120. Brizel D.M., Wasserman T.H., Henke M., Strnad V., Rudat V., Monnier A., et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol. 18:2000;3339-3345.
121. Buntzel J., Glatzel M., Kuttner K., Weinaug R., Frohlich D. Amifostine in simultaneous radiochemotherapy of advanced head and neck cancer. Semin Radiat Oncol. 12:2002;4-13.
122. Koukourakis M.I. Amifostine in clinical oncology current use and future applications . Anticancer Drugs. 13:2002;181-209.
123. Johnson J.T., Ferretti G.A., Nethery W.J., Valdez I.H., Fox P.C., Ng D., et al. Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. N Engl J Med. 329:1993;390-395.
124. Valdez I.H., Wolff A., Atkinson J.C., Macynski A.A., Fox P.C. Use of pilocarpine during head and neck radiation therapy to reduce xerostomia and salivary dysfunction. Cancer. 71:1993;1848-1851.
125. Joensuu H., Bostrom P., Makkonen T. Pilocarpine and carbacholine in treatment of radiation-induced xerostomia. Radiother Oncol. 26:1993;33-37.
126. Hamlar D.D., Schuller D.E., Gahbauer R.A., Buerki R.A., Staubus A.E., Hall J., et al. Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma. Laryngoscope. 106:1996;972-976.
127. Jacobs C.D., van der Pas M. A multicenter maintenance study of oral pilocarpine tablets for radiation-induced xerostomia. Oncology (Huntingt). 10:1996;16-20.
128. Greenspan D., Daniels T.E. Effectiveness of pilocarpine in postradiation xerostomia. Cancer. 59:1987;1123-1125.
129. Fox P.C., Atkinson J.C., Macynski A.A., Wolff A., Kung D.S., Valdez I.H., et al. Pilocarpine treatment of salivary gland hypofunction and dry mouth (xerostomia). Arch Intern Med. 151:1991;1149-1152.
130. Vissink A, Burlage FR, Spijkervet FK, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med 2003:14:213-25.
131. LeVeque F.G., Montgomery M., Potter D., Zimmer M.B., Rieke J.W., Steiger B.W., et al. A mulitcenter, randomized, double-blind, placebo-controlled, dose-titration study of oral pilocarpine for treatment of radiation-induced xerostomia in head and neck cancer patients. J Clin Oncol. 11:1993;1124-1131.
132. Hawthorne M., Sullivan K. Pilocarpine for radiation-induced xerostomia in head and neck cancer. Int J Palliat Nurs. 6:2000;228-232.
133. Cooper R.A., Cowan R.A., Owens S.E., Jeans S.P., Roberts J.K., Hillel P.G., et al. Does salivary gland scintigraphy predict response to pilocarpine in patients with post-radiotherapy xerostomia? Eur J Nucl Med. 26:1999;220-225.
134. Horiot J.C., Lipinski F., Schraub S., Maulard-Durdux C., Bensadoun R.J., Ardiet J.M., et al. Post-radiation severe xerostomia relieved by pilocarpine a prospective French cooperative study . Radiother Oncol. 55:2000;233-239.
135. Niedermeier W., Matthaeus C., Meyer C., Staar S., Muller R.P., Schulze H.J. Radiation-induced hyposalivation and its treatment with oral pilocarpine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 86:1998;541-549.
136. Lajtman Z., Krajina Z., Krpan D., Vincelj J., Borcic V., Popovic-Kovacic J. Pilocarpine in the prevention of postirradiation xerostomia. Acta Med Croatica. 54:2000;65-67.
137. Frydrych A.M., Davies G.R., Slack-Smith L.M., Heywood J. An investigation into the use of pilocarpine as a sialogogue in patients with radiation induced xerostomia. Aust Dent J. 47:2002;249-253.
138. Anonymous. Oral pilocarpine: new preparation. Xerostomia after radiation therapy: moderately effective but costly. Prescrire Int 2002;11:99-101.
139. Warde P., O'Sullivan B., Aslanidis J., Kroll B., Lockwood G., Waldron J., et al. A Phase III placebo-controlled trial of oral pilocarpine in patients undergoing radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 54:2002;9-13.
140. Nelson J.D., Friedlaender M., Yeatts R.P., Yee R., McDermott M., Orlin S., et al. Oral pilocarpine for symptomatic relief of keratoconjunctivitis sicca in patients with Sjogren's syndrome. The MGI PHARMA Sjögren's Syndrome Study Group. Adv Exp Med Biol. 438:1998;979-983.
141. Papas A.S., Fernandez M.M., Castano R.A., Gallagher S.C., Trivedi M., Shrotriya R.C. Oral pilocarpine for symptomatic relief of dry mouth and dry eyes in patients with Sjögren's syndrome. Adv Exp Med Biol. 438:1998;973-978.
142. Nusair S., Rubinow A. The use of oral pilocarpine in xerostomia and Sjögren's syndrome. Semin Arthritis Rheum. 28:1999;360-367.
143. Rhodus N.L. Oral pilocarpine HCl stimulates labial (minor) salivary gland flow in patients with Sjögren's syndrome. Oral Dis. 3:1997;93-98.
144. Rhodus N.L., Liljemark W., Bloomquist C., Bereuter J. Candida albicans levels in patients with Sjögren's syndrome before and after long-term use of pilocarpine hydrochloride a pilot study . Quintessence Int. 29:1998;705-710.
145. Rhodus N., Dahmer L., Lindemann K., Rudney J., Mathur A., Bereuter J. s-IgA and cytokine levels in whole saliva of Sjögren's syndrome patients before and after oral pilocarpinehydrochloride administration a pilot study . Clin Oral Investig. 2:1998;191-196.
146. Singhal S., Mehta J., Rattenbury H., Treleaven J., Powles R. Oral pilocarpine hydrochloride for the treatment of refractory xerostomia associated with chronic graft-versus-host disease. Blood. 85:1995;1147-1148.
147. Singhal S., Powles R., Treleaven J., Rattenbury H., Mehta J. Pilocarpine hydrochloride for symptomatic relief of xerostomia due to chronic graft-versus-host disease or total-body irradiation after bone-marrow transplantation for hematologic malignancies. Leuk Lymphoma. 24:1997;539-543.
148. Nagler R.M., Nagler A. Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease a sialometrical study . Bone Marrow Transplant. 23:1999;1007-1011.
149. Nagler RM, Nagler A The effect of pilocarpine on salivary constituents in patients with chronic graft-versus-host disease. Arch Oral Biol. 46:2001;689-695.
150. Salah R.S., Cameron O.G. Pilocarpine for anticholinergic adverse effects associated with desipramine treatment. [letter] Am J Psychiatry. 153:1996;579.
151. Martinez-Gomis J., Planas M.E., Planelles X., Bartrons R., Sanchez S. Fluoride and pilocarpine reduce the risk of caries produced by chronic clomipramine treatment in rats. Caries Res. 31:1997;155-160.
152. Bagheri H., Schmitt L., Berlan M., Montastruc J.L. A comparative study of the effects of yohimbine and anetholtrithione on salivary secretion in depressed patients treated with psychotropic drugs. Eur J Clin Pharmacol. 52:1997;339-342.
153. Everett H.C. The use of bethanechol chloride with tricyclic antidepressants. Am J Psychiatry. 132:1975;1202-1204.
154. Schubert D.S. Use of bethanechol chloride with phenothiazines a case report . Am J Psychiatry. 136:1979;110-111.
155. Epstein J.B., Burchell J.L., Emerton S., Le N.D., Silverman S. Jr. A clinical trial of bethanechol in patients with xerostomia after radiation therapy. A pilot study. Oral Surg Oral Med Oral Pathol. 77:1994;610-614.
156. Iwabuchi Y., Masuhara T. Sialogogic activities of SNI-2011 compared with those of pilocarpine and McN-A-343 in rat salivary glands identification of a potential therapeutic agent for treatment of Sjögren's syndrome . Gen Pharmacol. 25:1994;123-129.
157. Iga Y., Arisawa H., Ogane N., Saito Y., Tomizuka T., Nakagawa-Yagi Y., et al. (+/-)-cis-2-methylspiro [1,3-oxathiolane-5,3′-quinuclidine] hydrochloride, hemihydrate (SNI-2011, cevimeline hydrochloride) induces saliva and tear secretions in rats and mice the role of muscarinic acetylcholine receptors . Jpn J Pharmacol. 78:1998;373-380.
158. Anon. Cevimeline (Evoxac) for dry mouth. [letter] Med Lett Drugs Ther. 42:2000;70.
159. Fife R.S., Chase R.K., Dore M.D., Wiesenhutter C.W., Lockhart P.B., Tindall E., et al. Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome a randomized trial . Arch Intern Med. 162:2002;1293-1300.
160. Shiozawa A. Cevimeline hydrochloride hydrate (Saligren capsule 30 mg) a review of its pharmacological profiles and clinical potential in xerostomia . Nippon Yakurigaku Zasshi. 120:2002;253-258.
161. Petrone D., Condemi J.J., Fife R., Gluck O., Cohen S., Dalgin P. A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren's syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum. 46:2002;748-754.
162. Wall G.C., Magarity M.L., Jundt J.W. Pharmacotherapy of xerostomia in primary Sjögren's syndrome. Pharmacotherapy. 22:2002;621-629.
163. Ukai Y., Taniguchi N., Takeshita K., Kimura K., Enomoto H. Chronic anethole trithione treatment enhances the salivary secretion and increases the muscarinic acetylcholine receptors in the rat submaxillary gland. Arch Int Pharmacodyn Ther. 271:1984;206-212.
164. Ukai Y., Taniguchi N., Takeshita K., Ogasawara T., Kimura K. Enhancement of salivary secretion by chronic anethole trithione treatment. Arch Int Pharmacodyn Ther. 294:1988;248-258.
165. Ukai Y., Taniguchi N., Yamazaki A., Kimura K. Enhancement of phosphatidylinositol turnover and cyclic nucleotide accumulation by chronic anethole trithione treatment in rat submaxillary glands. J Pharm Pharmacol. 41:1989;247-252.
166. Hamada T., Nakane T., Kimura T., Arisawa K., Yoneda K., Yamamoto T., et al. Treatment of xerostomia with the bile secretion-stimulating drug anethole trithione a clinical trial . Am J Med Sci. 318:1999;146-151.
167. Nagano T., Takeyama M. Enhancement of salivary secretion and neuropeptide (substance P, alpha-calcitonin gene-related peptide) levels in saliva by chronic anethole trithione treatment. J Pharm Pharmacol. 53:2001;1697-1702.
168. Epstein J.B., Schubert M.M. Synergistic effect of sialagogues in management of xerostomia after radiation therapy. Oral Surg Oral Med Oral Pathol. 64:1987;179-182.
169. Schiodt M., Oxholm P., Jacobsen A. Treatment of xerostomia in patients with primary Sjögren's syndrome with sulfarlem. Scand J Rheumatol Suppl. 61:1986;250-252.
170. Avisar R., Savir H., Machtey I., Ovaknin L., Shaked P., Menache R., et al. Clinical trial of bromhexine in Sjögren's syndrome. Ann Ophthalmol. 13:1981;971-973.
171. Prause J.U., Frost-Larsen K., Hoj L., Isager H., Manthorpe R. Lacrimal and salivary secretion in Sjögren's syndrome the effect of systemic treatment with bromhexine . Acta Ophthalmol (Copenh). 62:1984;489-497.
172. Nanni J.M., Nguyen K.H., Alford C.E., Robinson C.P., Stewart C.M., Maeda N., et al. Assessment of bromhexine as a treatment regime in Sjögren's syndrome-like disease in the NOD (non-obese diabetic) mouse. Clin Exp Rheumatol. 15:1997;515-521.
173. Itthagarun A., Wei S.H. Chewing gum and saliva in oral health. J Clin Dent. 8:1997;159-162.
174. Warde P., Kroll B., O'Sullivan B., Aslanidis J., Tew-George E., Waldron J., et al. A phase II study of Biotene in the treatment of postradiation xerostomia in patients with head and neck cancer. Support Care Cancer. 8:2000;203-208.
175. Davies A.N. A comparison of artificial saliva and chewing gum in the management of xerostomia in patients with advanced cancer. Palliat Med. 14:2000;197-203.
176. Erlichman M. Patient selection criteria for electrostimulation of salivary production in the treatment of xerostomia secondary to Sjogren's syndrome. Health Technol Assess Rep. 8:1990;1-7.
177. Talal N., Quinn J.H., Daniels T.E. The clinical effects of electrostimulation on salivary function of Sjögren's syndrome patients. A placebo controlled study. Rheumatol Int. 12:1992;43-45.
178. Blom M., Dawidson I., Angmar-Mansson B. The effect of acupuncture on salivary flow rates in patients with xerostomia. Oral Surg Oral Med Oral Pathol. 73:1992;293-298.
179. Blom M., Dawidson I., Fernberg J.O., Johnson G., Angmar-Mansson B. Acupuncture treatment of patients with radiation-induced xerostomia. Eur J
180. Blom M., Lundeberg T. Long-term follow-up of patients treated with acupuncture for xerostomia and the influence of additional treatment. Oral Dis. 6:2000;15-24.
181. Johnstone P.A., Peng Y.P., May B.C., Inouye W.S., Niemtzow R.C. Acupuncture for pilocarpine-resistant xerostomia following radiotherapy for head and neck malignancies. Int J Radiat Oncol Biol Phys. 50:2001;353-357.
182. List T., Lundeberg T., Lundstrom I., Lindstrom F., Ravald N. The effect of acupuncture in the treatment of patients with primary Sjögren's syndrome. A controlled study. Acta Odontol Scand. 56:1998;95-99.
183. Rydholm M., Strang P. Acupuncture for patients in hospital-based home care suffering from xerostomia. J Palliat Care. 15:1999;20-23.
184. Johnstone P.A., Niemtzow R.C., Riffenburgh R.H. Acupuncture for xerostomia clinical update . Cancer. 94:2002;1151-1156.
185. Pedersen A., Gerner N., Palmvang I., Hoier-Madsen M. LongoVital in the treatment of Sjögren's syndrome. Clin Exp Rheumatol. 17:1999;533-538.
186. Horrobin D.F. Essential fatty acid and prostaglandin metabolism in Sjögren's syndrome, systemic sclerosis and rheumatoid arthritis. Scand J Rheumatol Suppl. 61:1986;242-245.
187. Oxholm P., Manthorpe R., Prause J.U., Horrobin D. Patients with primary Sjogren's syndrome treated for two months with evening primrose oil. Scand J Rheumatol. 15:1986;103-108.
188. Belch J.J., Hill A. Evening primrose oil and borage oil in rheumatologic conditions. Am J Clin Nutr. 71:2000;352S-356S.
189. Chodorowski Z. Cappuccino coffee treatment of xerostomia in patients taking tricyclic antidepressants preliminary report . Przegl Lek. 59:2002;392-393.
190. Johansson G., Andersson G., Edwardsson S., Bjorn A.L., Manthorpe R., Attstrom R. Effects of mouthrinses with linseed extract Salinum without/with chlorhexidine on oral conditions in patients with Sjögren's syndrome. A double-blind crossover investigation. Gerodontology. 18:2001;87-94.
191. Shiozawa S, Kuroki Y, Yoshihara R, Chihara K, Hirata M, Tanaka T, et al. Increasing effect of oral interferon alpha in saliva secretion of Sjögren's syndrome patients [abstract]. Ann Jpn Rheum Assoc 1993;
192. Ferraccioli G.F., Salaffi F., De Vita S., Casatta L., Avellini C., Carotti M., et al. Interferon alpha-2 (IFN α2) increases lacrimal and salivary function in Sjögren's syndrome patients. Preliminary results of an open pilot trial versus OH-chloroquine. Clin Exp Rheumatol. 14:1996;367-371.
193. Cotler S.J., Wartelle C.F., Larson A.M., Gretch D.R., Jensen D.M., Carithers R.L. Jr. Pretreatment symptoms and dosing regimen predict side-effects of interferon therapy for hepatitis C. J Viral Hepat. 7:2000;211-217.
194. Unoki H., Moriyama A., Tabaru A., Masumoto A., Otsuki M. Development of Sjögren's syndrome during treatment with recombinant human interferon-alpha-2b for chronic hepatitis C. J Gastroenterol. 31:1996;723-727.
195. Shiozawa S., Morimoto I., Tanaka Y., Shiozawa K. A preliminary study on the interferon-alpha treatment for xerostomia of Sjögren's syndrome. Br J Rheumatol. 32:1993;52-54.
196. Shiozawa K, Tanaka Y, Yoshihara R, Hirata M, Kabebuma S, Shiozawa S. Effect of orally administered interferon alpha on saliva production in Sjögren's syndrome [abstract]. Ann Jpn Rheum Assoc 1993;
197. Shiozawa S., Tanaka Y., Shiozawa K. Single-blinded controlled trial of low-dose oral IFN-alpha for the treatment of xerostomia in patients with Sjögren's syndrome. J Interferon Cytokine Res. 18:1998;255-262.
198. Ship J.A., Fox P.C., Michalek J.E., Cummins M.J., Richards A.B. Treatment of primary Sjögren's syndrome with low-dose natural human interferon-alpha administered by the oral mucosal route a phase II clinical trial. IFN Protocol Study Group . J Interferon Cytokine Res. 19:1999;943-951.
199. Smith J.K., Siddiqui A.A., Modica L.A., Dykes R., Simmons C., Schmidt J., et al. Interferon-alpha upregulates gene expression of aquaporin-5 in human parotid glands. J Interferon Cytokine Res. 19:1999;929-935.
200. Fox P.C., Datiles M., Atkinson J.C., Macynski A.A., Scott J., Fletcher D., et al. Prednisone and piroxicam for treatment of primary Sjögren's syndrome. Clin Exp Rheumatol. 11:1993;149-156.
201. Miyawaki S., Nishiyama S., Matoba K. Efficacy of low-dose prednisolone maintenance for saliva production and serological abnormalities in patients with primary Sjögren's syndrome. Intern Med. 38:1999;938-943.
202. Izumi M., Eguchi K., Nakamura H., Takagi Y., Kawabe Y., Nakamura T. Corticosteroid irrigation of parotid gland for treatment of xerostomia in patients with Sjögren's syndrome. Ann Rheum Dis. 57:1998;464-469.
203. Maeda A., Yamanouchi H., Lee J.B., Katayama I. Oral prednisolone improved acetylcholine-induced sweating in Sjögren's syndrome-related anhidrosis. Clin Rheumatol. 19:2000;396-397.
204. Zandbelt M.M., van den Hoogen F.H., de Wilde P.C., van den Berg P.J., Schneider H.G., van de Putte L.B. Reversibility of histological and immunohistological abnormalities in sublabial salivary gland biopsy specimens following treatment with corticosteroids in Sjögren's syndrome. Ann Rheum Dis. 60:2001;511-513.
205. Fox R.I., Chan E., Benton L., Fong S., Friedlaender M., Howell F.V. Treatment of primary Sjögren's syndrome with hydroxychloroquine. Am J Med. 85:1988;62-67.
206. Kruize A.A., Hene R.J., Kallenberg C.G., van Bijsterveld O.P., van der Heide A., Kater L., et al. Hydroxychloroquine treatment for primary Sjögren's syndrome a two year double blind crossover trial . Ann Rheum Dis. 52:1993;360-364.
207. Tishler M., Yaron I., Shirazi I., Yaron M. Hydroxychloroquine treatment for primary Sjögren's syndrome its effect on salivary and serum inflammatory markers . Ann Rheum Dis. 58:1999;253-256.
208. Fox R.I., Dixon R., Guarrasi V., Krubel S. Treatment of primary Sjögren's syndrome with hydroxychloroquine a retrospective, open-label study . Lupus. 5:1996;S31-36.
209. Levy G.D., Munz S.J., Paschal J., Cohen H.B., Pince K.J., Peterson T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis Rheum. 40:1997;1482-1486.
210. Albert D.A., Debois L.K., Lu K.F. Antimalarial ocular toxicity - a critical appraisal. J Clin Rheumatol. 4:1998;57-62.
211. Lakhanpal S., Duffy J., Griffing W.L., Conn D.L., Luthra H.S. Sjögren's syndrome treatment with D-penicillamine and hydroxychloroquine . J Rheumatol. 12:1985;1028-1029.
212. Manoussakis M.N., Moutsopoulos H.M. Antimalarials in Sjögren's syndrome - the Greek experience. Lupus. 5:1996;S28-30.
213. Bell M., Askari A., Bookman A., Frydrych S., Lamont J., McComb J., et al. Sjögren's syndrome a critical review of clinical management . J Rheumatol. 26:1999;2051-2061.
214. Fox R. Sjögren's syndrome current therapies remain inadequate for a common disease . Expert Opin Investig Drugs. 9:2000;2007-2016.
215. Price E.J., Rigby S.P., Clancy U., Venables P.J. A double blind placebo controlled trial of azathioprine in the treatment of primary Sjögren's syndrome. J Rheumatol. 25:1998;896-899.
216. Drosos A.A., Moutsopoulos N.M. Effectiveness and safety of using cyclosporin A in the treatment of primary Sjögren's syndrome. Ter Arkh. 60:1988;77-80.
217. Chu S.M., Huang J.L., Lin S.J., Hsueh C. Successful treatment of Sjögren's syndrome with cyclophosphamide pulse therapy report of one case . Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 39:1998;268-270.
218. Imai F., Suzuki T., Ishibashi T., Tanaka M., Akiyama Y., Dohi Y. Effect of sulfasalazine on B cell hyperactivity in patients with rheumatoid arthritis. J Rheumatol. 21:1994;612-615.
219. Skopouli F.N., Jagiello P., Tsifetaki N., Moutsopoulos H.M. Methotrexate in primary Sjögren's syndrome. Clin Exp Rheumatol. 14:1996;555-558.
220. Peuckmann V., Fisch M., Bruera E. Potential novel uses of thalidomide focus on palliative care . Drugs. 60:2000;273-292.
221. Porter SR, Jorge J Jr. Thalidomide - a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001.
222. Fox R.I., Michelson P. Approaches to the treatment of Sjögren's syndrome. J Rheumatol Suppl. 61:2000;15-21.
223. Rigby S.P., Griffiths D.J., Weiss R.A., Venables P.J. Human retrovirus-5 proviral DNA is rarely detected in salivary gland biopsy tissues from patients with Sjögren's syndrome. Arthritis Rheum. 40:1997;2016-2021.
224. Steinfeld S.D., Demols P., Van Vooren J.P., Cogan E., Appelboom T. Zidovudine in primary Sjögren's syndrome. Rheumatology (Oxford). 38:1999;814-817.
225. Porter S.R., Scully C. HIV topic update protease inhibitor therapy and oral health care . Oral Dis. 4:1998;159-163.
226. Fox P.C., Cummins M.J., Cummins J.M. Use of orally administered anhydrous crystalline maltose for relief of dry mouth. J Altern Complement Med. 7:2001;33-43.
227. Ichikawa Y., Tokunaga M., Shimizu H., Moriuchi J., Takaya M., Arimori S. Clinical trial of ambroxol (Mucosolvan) in Sjögren's syndrome. Tokai J Exp Clin Med. 13:1988;165-169.
228. Steinfeld S.D., Demols P., Appelboom T. Infliximab in primary Sjögren's syndrome one-year follow-up . Arthritis Rheum. 46:2002;3301-3303.
229. Atkinson J.C., Baum B.J. Salivary enhancement current status and future therapies . J Dent Educ. 65:2001;1096-1101.