10. Dry mouth Flashcards
What can cause dry mouth?
- Can arise as a result of loss of the mucous layer without clinical evidence of dryness. There is usually little relief with artificial saliva preparations or mucosal gel preparations in these patients.
- Caused by drugs that have antimuscarinic effects (tricyclic antidepressants, antipsychotic)
- diuretic drugs
- irradiation of the head and neck region
- damage or disease of the salivary glands (e.g. Sjogren’s syndrome).
–> In these cases, artificial saliva preparations can provide useful relief.
What are simple local measures that might provide symptomatic relief in patients with subjective dryness but good saliva volume?
Do artificial saliva preparations or mucosal gel preparations help in these patients?
Advise pt to
- take frequent sips of cool drinks
- suck pieces of ice or sugar-free fruit pastilles
- use sugar-free chewing gum
= to provide symptomatic relief.
–> In these pt’s artificial saliva preparations or mucosal gel preparations usually provide little relief and therefore the use of artificial saliva preparations is discouraged.
In what patients may artificial saliva preparations or other proprietary saliva-promoting medication help relieve symptoms? (3)
- Pts with dry mouth induced by drug treatment.
- Head and neck radiotherapy
- Disease of the salivary glands.
–> However the effects tend to be of short duration.
The use of lubricant gel preparations, applied to the oral mucosa, can give more-prolonged relief.
On top of trying to relief symptoms of dry mouth, what other advise can prescriptions can be made to help the patient?
Dietary advice
Topical fluoride prescription
Note that some proprietary artificial saliva or mucosal gel preparations may only be prescribed for which groups of patients?
Pts with dry mouth that is associated with:
- Head and neck radiotherapy
or
- Autoimmune xerostomias such as sicca (primary Sjogren’s syndrome).
Which prescriptions can only be made for pts with dry mouth associated with radiotherapy or sicca syndrome? (3)
- BioXtra Gel (no longer in BNF)
- Glandosane Aerosol Spray
- Saliveze Oral Spray
In which patients can saliva stimulating tablets be prescribed to?
For patients with salivary gland impairment and patent (open) salivary ducts.
What should be noted from saliva-stimulating tablets and artificial saliva pastilles containing citric and/or malic acid?
A high frequency of use might lead to dental erosion.
What are options to prescribe for dry mouth? (7)
- Artificial Saliva gel - apply to oral mucosa as required.
- Artificial Saliva oral spray - spray as required.
- Artificial Saliva pastilles - 1 pastille sucked as required.
- AS Saliva Orthana Oral spray - sprayed 3x onto oral mucosa as required.
- Saliva-stimulating tablets - 1 tablet sucked as required.
- ** BioXtra Gel - apply to oral mucosa as required (no longer in BNF)
- ** Glandosane aerosol spray - spray onto oral and pharyngeal mucosa as required.
- ** Saliveze Oral Spray - 1 spray onto oral mucosa as required.
** NB: may only be prescribed for dry mouth associated with radiotherapy or sicca syndrome.
How can Artificial Saliva Gel be prescribed for dry mouth?
Artificial Saliva Gel
Send: 50g
Label: Apply to oral mucosa as required
NB: Avoid use with toothpastes containing detergents (including foaming agents).
How can Artificial Saliva Oral Spray be prescribed for dry mouth?
Artificial Saliva Oral Spray
Send: 100ml
Label: Spray as required
- sugar-free preparation available
How can Artificial Saliva Pastilles be prescribed for dry mouth?
Artificial Saliva Pastilles
Send: 50 pastilles.
Label: 1 pastille sucked as required
- 1 pastille sucked as required
How can AS Saliva Orthana Oral Spray be prescribed?
AS Saliva Orthana Oral Spray
Send: 50ml
Label: Sprayed three times onto oral mucosa as required.
How can Saliva-stimulating tablets be prescribed for dry mouth?
Saliva-stimulating tablets
Send: 100 tablets
Label: 1 tablet sucked as required
**NB: may only be prescribed for dry mouth associated with impaired salivary gland function and patent salivary ducts.
** NO LONGER IN BNF How can BioXtra Gel be prescribed for dry mouth?
BioXtra Gel
Send: 40ml
Label: Apply to oral mucosa as required
- only prescribed for dry mouth associated with radiotherapy or sicca syndrome
How can Glandosane Aerosol Spray be prescribed for dry mouth?
Glandosane Aerosol Spray
Send: 50ml
Label: Spray onto oral and pharyngeal mucosa as required
- only prescribed for dry mouth associated with radiotherapy or sicca syndrome
How can Saliveze Oral Spray be prescribed?
Saliveze Oral Spray
Send: 50ml
Label: 1 spray onto oral mucosa as required
- only prescribed for dry mouth associated with radiotherapy or sicca syndrome
What prescription of topical fluoride are there for pts at high caries risk e.g. due to head and neck radiotherapy?
- Sodium Fluoride Toothpaste, 0.619% (2800ppm)
- Sodium Fluoride Toothpaste, 1.1% (5000ppm)
- Sodium Fluoride Mouthwash, 0.5%
How can sodium fluoride toothpaste, 0.619% (2800ppm) be prescribed?
Sodium Fluoride Toothpaste, 0.619% (2800ppm)
Send: 75ml
Label: Brush teeth for 1 minute after meals using 1cm, before spitting out, twice daily.
From what age can you use 2800ppm toothpaste?
For children 10+ - as for adults.
<10 years not indicated for use because of risk of swallowing and possible poisoning.
How can you prescribe Sodium Fluoride toothpaste, 1.1% (5000ppm)?
Sodium fluoride toothpaste, 1.1% (5000ppm)
Send: 51g
Label: Brush teeth for 3 minutes after meals using 2cm, before spitting out, three times daily.
In what age groups can you prescribe NaF 1.1% (5000ppm) toothpaste?
For children 16+ - as for adults.
<16 years - not indicated for use because of risk of swallowing and possible poisoning.
What advise should be given to patients who are prescribed fluoride toothpaste?
Advise patients to avoid rinsing mouth, drinking or eating for 30 minutes after use, and advise patient that this NaF is a medicine and is only to be used by the person for whom it is prescribed.
How can Sodium Fluoride Mouthwash, 0.05% be prescribed?
Sodium Fluoride Mouthwash, 0.05%.
Send: 250ml
Label: rinse mouth once daily with 10ml for 1 minute and spit out (preferable at a different time from brushing).
NB: advise pt to avoid rinsing mouth, drinking or eating for 15 minutes after use.
What age can NaF MW, 0.05% be prescribed?
SDCEP: 6+
<6 not indicated for use because of risk of swallowing and possible poisoning
Good practitioners guidelines - 8+??
