What is Xerostomia

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Xerostomia (Dry Mouth)

Xerostomia is not a disease but can be a symptom of certain diseases. It can produce serious negative effects on the patients quality of life, affecting dietary habits, nutritional status, speech, taste, tolerance to dental prosthesis and increases susceptibility to dental caries. The increase in dental caries can be devastating in many patients and therefore special care must be made to control this condition.

Causes for Xerostomia include:

-Medications – Several hundred current medications can cause xerostomia. These include antihypertensives, antidepressants, analgesics, tranquilizers, diuretics and antihistamines c.

-Cancer Therapy – Chemotherapeutic drugs can change the flow and composition of the saliva. Radiation treatment that is focused on or near the salivary gland can temporarily or permanently damage the salivary glands.

-Sjogren’s syndrome - An autoimmune disease, causes xerostomia and dry eyes.

-Other conditions -such as bone marrow transplants, endocrine disorders, stress, anxiety, depression, and nutritional deficiencies may cause xerostomia.

-Nerve Damage – Trauma to the head and neck area from surgery or wounds can damage the nerves that supply sensation to the mouth. While the salivary glands may be left intact, they cannot function normally without the nerves that signal them to produce saliva.

Treatment:

1. Identify the xerostomic condition and the cause. Some of the causes may be ameliorated and this will aid therapy. But in many situations, it will be difficult to eliminate the causes. Thus, it will be necessary for the Dentist to control the results of xerostomia. This is especially true about the increase in dental caries.

2. Palliative treatment can be used but does not cure the condition:

-pilocarpine (Salagen) 5mg, qid, prescription required.

-special food preparation – blended and moist foods are easier to swallow

artificial saliva (available over-the-counter).

-sipping plain water is usually preferred over artificial saliva by most patients.

-Biotene brand, over-the-counter, dry mouth products (toothpaste, alcohol- free mouth rinse and Oralbalance lubricating gel).

-avoidance of alcohol-based mouth rinses

-use of water and glycerin mixed in a small aerosol spray bottle.

3. Since a marked increase in dental caries is a common occurrence, it is important that this side effect is controlled. This will involve using the risk assessment and treatment strategies outlined in the cariology course.

-Establish if the patient is Xerostomic from symptoms and determine salivary flow rate.
-The xerostomic patient is classified into a risk assessment as outlined in the course material. However, this patient should be classified at high risk even if there are only several incipient lesions. This is done only in this type of patient because of the high caries risk.
-Determine if this patient is caries active or not active and follow the high risk protocol in the main outline in this course. When the ms infection is under control use a remineralization protocol along with the monitoring.

-Additional suggestions:
-Both an ms and lactobacillus tests are indicated.
-Carefully observe color, texture and location of lesions.

-Seal pit and fissures and rough restorative margins with fluoride containing sealents.
-CHX treatment may have to be prolonged along with use of fluoride.
-Prolonged use of Xylitol gum is importance since its use enhances salivary flow and helps control mutans strep.
-Enhance use of hard cheese in diet.
-Use sucralose in cooking.