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Pharm 129 > Xerostomia > Flashcards

Xerostomia Flashcards

1
Q

What is the prevalence of Xerostomia

A

1 in 4/5 adults

happens at any age

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2
Q

Who is more at risk

A
  • older
  • women
  • Sjogren syndrome patients (causes dryness of all mucous membranes)
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3
Q

What salivary gland produces 65% of saliva

A

submandibular

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4
Q

What is saliva made up of

A
  • Water
  • Mucins, electrolytes, other proteins
  • Gustin
  • Bicarbonate & phosphate
  • Calcium & phosphate
  • Salivary enzymes
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5
Q

what are the functions of saliva

A
  • Maintains neutral pH
  • Remineralization of teeth
  • Cleansing and shielding of teeth
  • Lubrication of mouth
  • Local antimicrobial activity
  • Assists in taste, speech, swallowing
  • Facilitates digestion and nutrition
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6
Q

What happens to saliva with xerostomia

A
  • salivary flow is limited or absent
  • saliva quality altered

QUALITY and QUANTITY important

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7
Q

What causes xerostomia

A 
Taking >2 medications
Radiation, chemotherapy
Medical conditions
Nerve damage
Obstruction of salivary glands
Lifestyle: mouth breathing, smoking, dehydration, excessive alcohol/caffeine intake
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8
Q

Drugs associated with xerostomia

A

Antihistamines (chlorpheniramine, diphenhydramine)
Decongestants (pseudoephedrine)
Isotretinoin

Others: benzodiazepines, antihypertensives, anticholinergics, antidepressants, skeleteal muscle relaxants, opioids, antipsychotics

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9
Q

What autoimmune diseases are associated

A 
Celiac disease
Rheumatoid arthritis
Sjogren’s syndrome
SLE (lupus)
Crohn’s disease
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10
Q

What endocrine disorders cause xerostomia

A

Diabetes
Addison’s Disease
Hyperlipidemia

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11
Q

What genetic diseases cause xerostomia

A

Cystic fibrosis, Down Syndrome

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12
Q

Other diseases related to xerostomia

A

HIV
Primary biliary cirrhosis

Parkinson’s, Alzheimer’s, Depression, Alcoholic Cirrhosis, Dehydration, Nutritional deficiencies, HTN

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13
Q

Consequences of xerostomia

A
  • cavities, gingivitis
  • candidiasis
  • Loosening of dentures, causing painful ulcerations
  • impaired eating/talking
  • tooth sensitivity
  • loss of appetite
  • peeled/cracked lips
  • burning tongue
  • sticky/viscous saliva
  • halitosis
  • heartburn, reflux
  • decreased efficacy of SL meds
  • increased risk of non adherence
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14
Q

Signs and symptoms of xerostomia:

saliva

A
  • decreased amount

* foamy or stringy

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15
Q

Signs and symptoms of xerostomia:

Tongue

A
  • dry both day and night
  • rough/raw; red and sore
  • regional or generalized mucosal pain
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16
Q

Signs and symptoms of xerostomia:

Taste

A

•altered or loss of taste

17
Q

Signs and symptoms of xerostomia:

Swallowing

A
  • difficulty eating and swallowing

* acid reflux/ heartburn

18
Q

Signs and symptoms of xerostomia:

Mucosa

A

•sensitivity to acidic, spicy and salty foods

19
Q

Signs and symptoms of xerostomia:

Teeth

A

decay

20
Q

Signs and symptoms of xerostomia:

Lips

A

dry + chapped

angular cheilitis

21
Q

Signs and symptoms of xerostomia:

Breath

A

•increased occurrence of halitosis (sulphur-like smell)

22
Q

Signs and symptoms of xerostomia:

Eyes, nose and skin

A
  • DRY

* decreased sweating

23
Q

Signs and symptoms of xerostomia: other indirect signs

A
  • Fatigue
  • weight loss
  • recurring vaginal infections
24
Q

What questions to ask to detect dry mouth

A
  1. Does the amount of saliva in your mouth seem to be too little?
  2. Does your mouth feel dry when eating a meal?
  3. Do you sip liquids to aid in swallowing dry food?
  4. Do you have difficulty swallowing?

If any answer is YES - hypo-salivation

25
Q

Red flags

A
  • Comorbid Conditions: Sjogren’s syndrome, depression, hyperlipidemia, uncontrolled hypertension or diabetes mellitus, pain worsened by acidic/spicy foods
  • Concurrent radiation therapy
  • Concurrent medication therapy
  • Concurrent oxygen therapy
  • Severe tooth pain
  • Salivary gland swelling
26
Q

Goals of therapy

A
  1. Relieve symptoms and improve mouth comfort (priority if acute)
  2. Prevent consequences complications of dry mouth (priority if chronic)
    • dental caries
    • fungal infection
    • poor nutrition
27
Q

What are modifiable factors involved in caries development

A
  • dental exams
  • host resistance (use fluoride products)
  • oral bacteria (good oral hygiene)
  • diet
28
Q

Nonpharm strategies: How to prevent dryness

A
  • Avoidance of substances that reduce salivation or erode tooth enamel: cariogenic foods, alcohol, tobacco, caffeine, spicy foods
  • Increasing water intake; sucking on ice chips
29
Q

Nonpharm strategies: stimulation of secretions

A
  • Maintaining good oral hygiene: plaque removal through BID brushing, regular flossing, and other devices (e.g., water piks)
  • Chewing gum sweetened with sugar alcohols (e.g., xylitol)
30
Q

Nonpharm strategies: dental prophylaxis

A
  • Use of fluoride-containing anti-plaque mouth rinses, gels, and dentifrices
  • Use of very soft-bristle toothbrushes to reduce enamel abrasion
31
Q

What is the treatment approach for self-care candidates

A
  1. Prevent dryness
  2. Prevent tooth decay
  3. Alleviate symptoms by using artificial saliva products
32
Q

What is first line therapy

A

Nonpharm treatment

33
Q

Examples of nonpharm treatment

A
  • Gels (Biotene gel)
  • Patches (Oramoist dry mouth patch)
  • Xylimelts
  • Sprays (Biotene, MouthKote, Moi-stir)
  • Toothpaste (SLS free)
  • Mouthwash

Most products contain xylitol (except moi-stir - not effective for severe xerostomia)

34
Q

When to follow up

A

1 week

  • if improve, patient should continue with artificial saliva and nonpharm strategies
  • if not, refer to dentist

Pharm 129 (14 decks)

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