Xerostomia Flashcards
What is the prevalence of Xerostomia
1 in 4/5 adults
happens at any age
Who is more at risk
- older
- women
- Sjogren syndrome patients (causes dryness of all mucous membranes)
What salivary gland produces 65% of saliva
submandibular
What is saliva made up of
- Water
- Mucins, electrolytes, other proteins
- Gustin
- Bicarbonate & phosphate
- Calcium & phosphate
- Salivary enzymes
what are the functions of saliva
- 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
What happens to saliva with xerostomia
- salivary flow is limited or absent
- saliva quality altered
QUALITY and QUANTITY important
What causes xerostomia
Taking >2 medications Radiation, chemotherapy Medical conditions Nerve damage Obstruction of salivary glands Lifestyle: mouth breathing, smoking, dehydration, excessive alcohol/caffeine intake
Drugs associated with xerostomia
Antihistamines (chlorpheniramine, diphenhydramine)
Decongestants (pseudoephedrine)
Isotretinoin
Others: benzodiazepines, antihypertensives, anticholinergics, antidepressants, skeleteal muscle relaxants, opioids, antipsychotics
What autoimmune diseases are associated
Celiac disease Rheumatoid arthritis Sjogren’s syndrome SLE (lupus) Crohn’s disease
What endocrine disorders cause xerostomia
Diabetes
Addison’s Disease
Hyperlipidemia
What genetic diseases cause xerostomia
Cystic fibrosis, Down Syndrome
Other diseases related to xerostomia
HIV
Primary biliary cirrhosis
Parkinson’s, Alzheimer’s, Depression, Alcoholic Cirrhosis, Dehydration, Nutritional deficiencies, HTN
Consequences of xerostomia
- 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
Signs and symptoms of xerostomia:
saliva
- decreased amount
* foamy or stringy
Signs and symptoms of xerostomia:
Tongue
- dry both day and night
- rough/raw; red and sore
- regional or generalized mucosal pain
Signs and symptoms of xerostomia:
Taste
•altered or loss of taste
Signs and symptoms of xerostomia:
Swallowing
- difficulty eating and swallowing
* acid reflux/ heartburn
Signs and symptoms of xerostomia:
Mucosa
•sensitivity to acidic, spicy and salty foods
Signs and symptoms of xerostomia:
Teeth
decay
Signs and symptoms of xerostomia:
Lips
dry + chapped
angular cheilitis
Signs and symptoms of xerostomia:
Breath
•increased occurrence of halitosis (sulphur-like smell)
Signs and symptoms of xerostomia:
Eyes, nose and skin
- DRY
* decreased sweating
Signs and symptoms of xerostomia: other indirect signs
- Fatigue
- weight loss
- recurring vaginal infections
What questions to ask to detect dry mouth
- Does the amount of saliva in your mouth seem to be too little?
- Does your mouth feel dry when eating a meal?
- Do you sip liquids to aid in swallowing dry food?
- Do you have difficulty swallowing?
If any answer is YES - hypo-salivation
Red flags
- 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
Goals of therapy
- Relieve symptoms and improve mouth comfort (priority if acute)
- Prevent consequences complications of dry mouth (priority if chronic)
• dental caries
• fungal infection
• poor nutrition
What are modifiable factors involved in caries development
- dental exams
- host resistance (use fluoride products)
- oral bacteria (good oral hygiene)
- diet
Nonpharm strategies: How to prevent dryness
- Avoidance of substances that reduce salivation or erode tooth enamel: cariogenic foods, alcohol, tobacco, caffeine, spicy foods
- Increasing water intake; sucking on ice chips
Nonpharm strategies: stimulation of secretions
- 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)
Nonpharm strategies: dental prophylaxis
- Use of fluoride-containing anti-plaque mouth rinses, gels, and dentifrices
- Use of very soft-bristle toothbrushes to reduce enamel abrasion
What is the treatment approach for self-care candidates
- Prevent dryness
- Prevent tooth decay
- Alleviate symptoms by using artificial saliva products
What is first line therapy
Nonpharm treatment
Examples of nonpharm treatment
- 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)
When to follow up
1 week
- if improve, patient should continue with artificial saliva and nonpharm strategies
- if not, refer to dentist
