Any dental pain or discomfort has a significant impact on a person’s quality of life. In particular, it has been linked with several mental health concerns, including anxiety and depression, stress and even suicidal thoughts. Xerostomia is one condition that can have a substantial impact on the sufferer’s health and wellbeing, so it’s important that dental teams can help patients manage the symptoms effectively.
A widespread condition
Xerostomia, or dry mouth, is estimated to affect 40 per cent of people over the age of 55. This is particularly relevant given the physical and mental health concerns that already exist for the older population. A Swedish study found that women had a higher incidence of xerostomia than men.
It can be a chronic issue for sufferers, which impacts every aspect of their lives, from speech to chewing and swallowing. It also increases the risk of tooth decay and dental infection. A leading cause of xerostomia is that it’s an adverse side effect of medication, so it is not always possible for dental professionals to eliminate the source of the issue directly.
For all these reasons and more, it is essential that dental professionals have the skills and confidence to effectively diagnose xerostomia and help patients manage the symptoms on a daily basis.
Assessment of dry mouth
A comprehensive assessment with a thorough medical history is crucial. If a patient regularly takes xerogenic medication, this can be a major indication of dry mouth risk. The patient should also be screened for other conditions associated with dry mouth side effects, such as radiation for head and neck cancer, Sjögren’s syndrome and other systemic diseases like asthma, diabetes, rheumatic diseases, thyroid diseases and eating disorders.
More tailored questionnaires have then been suggested to ascertain the severity of dry mouth symptoms experienced by the patient. An intraoral examination is, of course, useful, during which the practitioner should look for specific signs of xerostomia. These may include:
- Where the mirror sticks to the buccal mucosa or tongue
- Frothy saliva
- A lack of saliva pooling in the floor of the mouth
- Loss of papillae of the tongue dorsum
- Smooth gingiva
- A glossy appearance of the oral mucosa
- Cervical caries on more than two teeth
It is also prudent to measure salivary flow rates. Normal stimulated flow rates average at around 1.5-2.0 ml/min, while unstimulated salivary flow rates should be around 0.3-0.4 ml/min. Hyposalivation is typically diagnosed at stimulated and unstimulated salivary flow rates of <0.5-0.7ml/min and ≤0.1ml/min, respectively.
Management techniques
For many patients who are suffering, there is light at the end of the tunnel. Research demonstrates that xerostomia treatment improves the feeling of dry mouth in over 75 per cent of patients receiving xerogenic medications. This, in turn, greatly enhances their quality of life without discontinuing medication use. For others who may be able to tackle the cause of their dry mouth, improvement rates may be much higher.
Management techniques may either focus on alleviating symptoms or increasing salivary flow – or both in some cases. Pharmacological treatment often involves using sialagogue medications, which stimulate muscarinic receptors and salivation. These are usually only indicated where some salivary gland function remains. They can also cause an array of side effects which must be monitored carefully, including sweating, nausea and rhinitis. Electrical stimulation has also been shown to boost salivary flow rates. However, the related technology is not widely accessible in the dental practice.
Simpler solutions that patients can implement immediately include staying hydrated, sucking on ice cubes or sugar-free ice lollies, using lip balm for dry lips, and using sugar-free chewing gum while also avoiding alcohol-based dentifrices, coffee, acidic foods and smoking.
Specialised oral care can offer further daily discomfort relief. Various sprays, lozenges or gels may be utilised before meals or as needed throughout the day to stimulate salivary flow or even temporarily substitute saliva.
Oraldent offers the Xerostom range of dry mouth solutions to cater to various patients' needs and preferences. The portfolio consists of toothpaste, mouthwash, saliva replacement and mucosa gels, mouth spray and pastilles, all of which contain natural ingredients to deliver daily effective relief from dry mouth discomfort while helping to ensure proper oral care. They have also been shown to increase salivary flow by up to 200 per cent with appropriate use.
Restoring quality of life
No matter which discipline they focus on or how many years they have worked in dentistry, the goal of every dental professional is to help patients improve their health and wellbeing. Dry mouth can have a significant impact on a sufferer every single day. By helping them to alleviate daily discomfort, practitioners can help improve their quality of life.