Xerostomia

Question 1

What is the prevalence of Xerostomia

Answer 1

1 in 4/5 adults

happens at any age

Question 2

Who is more at risk

Answer 2

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

Question 3

What salivary gland produces 65% of saliva

Answer 3

submandibular

Question 4

What is saliva made up of

Answer 4

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

Question 5

what are the functions of saliva

Answer 5

• 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 6

What happens to saliva with xerostomia

Answer 6

• salivary flow is limited or absent
• saliva quality altered

QUALITY and QUANTITY important

Question 7

What causes xerostomia

Answer 7

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

Question 8

Drugs associated with xerostomia

Answer 8

Antihistamines (chlorpheniramine, diphenhydramine)
Decongestants (pseudoephedrine)
Isotretinoin

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

Question 9

What autoimmune diseases are associated

Answer 9

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

Question 10

What endocrine disorders cause xerostomia

Answer 10

Diabetes
Addison’s Disease
Hyperlipidemia

Question 11

What genetic diseases cause xerostomia

Answer 11

Cystic fibrosis, Down Syndrome

Question 12

Other diseases related to xerostomia

Answer 12

HIV
Primary biliary cirrhosis

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

Question 13

Consequences of xerostomia

Answer 13

• 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

Question 14

Signs and symptoms of xerostomia:

saliva

Answer 14

• decreased amount

* foamy or stringy

Question 15

Signs and symptoms of xerostomia:

Tongue

Answer 15

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

Question 16

Signs and symptoms of xerostomia:

Taste

Answer 16

•altered or loss of taste

Question 17

Signs and symptoms of xerostomia:

Swallowing

Answer 17

• difficulty eating and swallowing

* acid reflux/ heartburn

Question 18

Signs and symptoms of xerostomia:

Mucosa

Answer 18

•sensitivity to acidic, spicy and salty foods

Question 19

Signs and symptoms of xerostomia:

Teeth

Answer 19

decay

Question 20

Signs and symptoms of xerostomia:

Lips

Answer 20

dry + chapped

angular cheilitis

Question 21

Signs and symptoms of xerostomia:

Breath

Answer 21

•increased occurrence of halitosis (sulphur-like smell)

Question 22

Signs and symptoms of xerostomia:

Eyes, nose and skin

Answer 22

• DRY

* decreased sweating

Question 23

Signs and symptoms of xerostomia: other indirect signs

Answer 23

• Fatigue
• weight loss
• recurring vaginal infections

Question 24

What questions to ask to detect dry mouth

Answer 24

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

Question 25

Red flags

Answer 25

- 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

Question 26

Goals of therapy

Answer 26

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

Question 27

What are modifiable factors involved in caries development

Answer 27

- dental exams - host resistance (use fluoride products) - oral bacteria (good oral hygiene) - diet

Question 28

Nonpharm strategies: How to prevent dryness

Answer 28

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

Question 29

Nonpharm strategies: stimulation of secretions

Answer 29

* 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)

Question 30

Nonpharm strategies: dental prophylaxis

Answer 30

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

Question 31

What is the treatment approach for self-care candidates

Answer 31

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

Question 32

What is first line therapy

Answer 32

Nonpharm treatment

Question 33

Examples of nonpharm treatment

Answer 33

- 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)

Question 34

When to follow up

Answer 34

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