The first port of call to consider in oral drug delivery is the buccal cavity, and buccal delivery remains of interest for a small range of drugs used for cardiovascular control, smoking cessation and pain control. The primary function of the mouth is guarding of the gut by moistening the food to a soft, shaped bolus: the mucosa must therefore be tough and act as protective layer rather than an absorptive membrane. In areas of maximum abrasive stress, the mucosa will become keratinized. Prolonged exposure to tobacco smoke produces excess keratinization, as does poor dental hygiene. The water inlet channels, which hydrate the digesta, must have high capacity and react instantly: this is the function of the three main sets of glands assisted by minor glands.
Saliva is a viscous, watery fluid which is hypo-osmotic compared to plasma. One to two liters are discharged every day into the mouth and the composition and pH varies with the rate of secretion as illustrated in Fig. 2.3. The pH as shown varies from 7.4 and 6.2; however, the bacterial action can create local pockets where the pH falls below 5 and the tooth enamel starts to demineralize. Saliva acts as a diluent and the bicarbonate component raises pH. In addition, bacteria in the dental plaque metabolize components in saliva and raise the local pH: when this protection is lost a condition known as xerostomia, a diffuse and severe caries results.
The saliva produced by the glands varies. "Serous" saliva contains more protein particularly amylase, is watery and subserves the sense of taste by beginning digestion; the saliva stream also needs to produce mucins to resist drying at rest and to lubricate the structures to allow speech. Taste sensation in the tongue, palate and upper esophagus provide an input to the brain allowing involuntary responses such as gagging, retching and excess salivation to remove material. In the dog, the mouth is also used for thermo-regulation.
The classical routes of buccal delivery are summarized in Fig. 2.4 and specific examples are given in Chap. 16. The access to saliva, the variation in patterns of keratinization and squamous cell thickness, and the abrasive forces associated with speech and chewing are important factors in variation in performance.
Fig. 2.3 The change in saliva pH and osmolality with increasing flow
Fig. 2.4 Buccal routes of delivery
Buccal Gingival Sub-Lingual
The mucosa or inner lining of the mouth is divided into four zones. The first part of the gut has a lining of the squamous epithelium which extends from the mouth to the stomach. The many layers of cells are analogous to dermal tissue and drugs will only penetrate if residence is prolonged. The exception is the tissue under the tongue, as used in sublingual delivery, where the epithelium is thin. The vessels of the face drain directly to the heart and thus avoid the hepatic portal system, which provides a number of obvious advantages.
An important property is mouth feel and taste, since the released drug will be in intimate contact with the tongue. Variability in performance may be associated with changes in saliva flow and movements of the mouth when talking. The marked variation in the thickness and keratinization of the epithelial lining is also exaggerated in rodents, and pig and dog are more suitable models for human buccal tissue. The characteristics of buccal delivery are summarized in Fig. 2.5.
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