Drug-Induced Sialolithiasis-A Big-Data Retrospective Study

Sialolithiasis pathophysiology is multifactorial, with systemic medications often hypothesised as a key contributor, particularly in older adults (Drug-Induced Sialolithiasis). However, robust evidence supporting this theory is limited. This study aimed to investigate the association between common medication classes and sialolithiasis in an older Israeli cohort.

A nationwide retrospective case-control study (2005-2024) was conducted using the Clalit Health Services database. Sialolithiasis cases were matched 1:3 with controls based on age and gender. After stratification using a Gaussian Mixture Model (age > 50.28 years), logistic regression analyses assessed the association between sialolithiasis and antihyperlipidemic, antihypertensive, psychiatric, neurologic and antidiabetic medications. Significance was considered under p-value of 0.05.

The cohort included 32,088 individuals (8015 cases). Multivariable analysis revealed significantly increased odds of sialolithiasis associated with neurologic (OR 1.31, p < 0.001), antihyperlipidemic (OR 1.18, p < 0.001), psychiatric (OR 1.16, p < 0.001) and antihypertensive medications (OR 1.08, p = 0.016). Antidiabetics showed no significant association.

This large-scale analysis strongly supports the theory of Drug-Induced Sialolithiasis. The independent association between these four common medication classes and increased odds of sialolithiasis in older adults suggests that medication-induced hyposalivation is a major, quantifiable risk factor in the aetiology of the condition.