xerostomia

Question 1

What is xerostoma? how prevalent is it?

Answer 1

• 50% reduction in saliva produced & altered saliva composition/quality

Prevalence:

• > 1 in 405 aduls
• > can occur at any age, most prevelant in older patients and owmen

* 100% of sjogrens syndorme patients

Question 2

why is a health tongue and saliva important?

Answer 2

• TOngue
  
  • imp for papillae functions
• 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

Question 3

what produces saliva?

Answer 3

3 pairs of large glands: parotid, submandibular, sublingual

Question 4

what is saliva made of?

Answer 4

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

Question 5

etiology of xerostoma

Answer 5

• Medications & therapies
  
  • takeing 2 or more meds
  • radiation and chemo
• Medical conditions
  
  • nerve damage (from injurt/surgery)
  • obstruction of salivary glands
• Lifestyle
  
  • mouth breathing; nasal obstruction
  • smoking; dehydration
  • excressive alcohol or caffeine use

Question 6

Drug causes of xerostomia and salivary gland dysfunction

Answer 6

• OTCs ***
  
  • antihistamina: chlorpheniramine and diphenhydramine
  • decongestants: pseudoephedrine
• lots of other meds (dont need to know

Question 7

what diseases can cause xerostomia & salivary gland dysfunction

Answer 7

• autoimmune disease (celiac, RA, Sjogrens, chrons)
• endocrine disorders
• genetic diseases
• others

Question 8

implications of xerostomia and saliary gland dysfunction

Answer 8

• oral infections (caries and gingivitis)
• mucus membrane infections (cadidiasis)
• loosening of dentures, causing painful ulcerations
• impaired ability/willingness to eat or tlak
• tooth sensitivity
• altered taste and smell
• loss of appetite w/ evental decline in nutritional status
• atrophic erythematous oral mucosa
• peeled and cracked lips
• burning tongue
• sticky and visocus saliva
• halitosis
• heartburn and reflex
• decrease eficacy of SL meds
• inc risk of med non ahernace

Question 9

direct signs and symptoms of xerostoma

Answer 9

• Saliva
  
  • dec amount
  • foamy or stringy
• Tongue
  
  • dry day and ngiht
  • rough/raw -> red and sore
  • regionsal or generalized mucosal pain
• Taste:
  
  • altered or loss
• Swallonging
  
  • diff eating and swallowing
  • acid reflex/ heart butn
• mucosa
  
  • sensitivity to acidic, spicy and salty foods
• Teeth
  
  • decay
• Lips
  
  • Dry, chapped, angular cheilitis
• Breath
  
  • inc occurence of halitosis

Question 10

indirect sigsn and symptoms of xerostoma

Answer 10

• Eyes/nose and skin
  
  • dry
  • decrease sweating
• Other
  
  • fatigue, weight loss, recurring vaginal infections

Question 11

Questions to aid in early detection of dry mouth

Answer 11

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

*if any are yes they have some degree of dry mouth

Question 12

xerostoma red flags

Answer 12

• comorbid conditions (Sjogren’s syndrome, depression, hyperlipidemia, uncontrolled hypertension or diabetes mellitus, pain worsened by acidic/spicy foods)
• concurrent radiation therapy
• concurrent medication therapy or oxygen therapy
• severe tooth pain

salivary gland swelling

Question 13

what are the gaols of therapy for xerosterma

Answer 13

1. relieve symptoms and improve mouth comfort
2. prevent consequences and complications of dry mouth: dental caries, fungal infection, poor nutrition

Question 14

non pharm prevention strategies

Answer 14

• Prevent dryness
  
  • aocid substances that dec salivation or erroth enamel
    
    • cariogenic foods, alc, tobacco , caffeine, spicy
    • inc water intake
• Stim secretions
  
  • have good oral hygrien
  • chew gum sweetened with xylitol
• Dental prophylaxis
  
  • use of fluoride containing anti-plauqe mouth rinses, gels and dentrifices
  • use of very soft bristle tooth bushes to reduce enamel abrasion

Question 15

Decribe the treatment approach for self care candidates

Answer 15

1. prevent dryness
   
   • avoid substances that reduce salivation or cause irritation or erode tooth enamel
2. Prevent tooth decay
   
   • practice good oral hygiene and use topical fluride products
3. Alleviate symptoms
   
   • use artifical saliva products

Question 16

first line therapy for xerostoma

Answer 16

• non prescription therapy

*want a fluroide free, SLS free oral product that contains xylitol

Question 17

what to cousel on for xerostoma self care candidates

Answer 17

1. educate on lifestyle modifications and products available without Rx
2. work with toher HC professionals to determiens if medications contributing can be replaced for dsicontnues and provide guidnece for doing so
3. ensure pat have realistic expectations for itnerventions and understand when to seek further medical care

Question 18

when to monitor

Answer 18

• reasses after 1 week: signs of improvement, oral hygiene, pilocarpine (excessive solinergic sdie effects)
• refer patients to dentist if: sysmptoms persist or worsen with self treatment, patietns have complciations from xerostoma

Question 19

*look at the patient case for practice