Dealing with Dry Mouth by Jen Post

Bringing awareness to a silent condition

by Jen Post

For many people, their saliva goes unnoticed. Talking, chewing and tasting all happen imperceptibly and automatically, thanks to the blend of fluids our mouths naturally produce. Because saliva production is a critical factor for both oral health and overall well-being, saliva quality and quantity are key, especially when it comes to treating and preventing xerostomia, or dry mouth.

Unfortunately, up to 65 percent of the general population experiences varying degrees of dry mouth because of insufficient saliva. The condition can make patients’ daily lives miserable, with reported symptoms including a burning feeling in the mouth and lips sticking to the teeth. Dry mouth also can make unavoidable actions like chewing and speaking difficult and uncomfortable.

Xerostomia is both a symptom of some diseases and a side effect of numerous medications. Especially common in older patients, xerostomia is also prevalent among people of any age who take certain over-the-counter and prescription medications. However, many cases of xerostomia lie undetected to practitioners because patients don’t communicate their symptoms. Dentists and hygienists have a unique opportunity to help those who may be suffering in silence.

Xerostomia is a problem that’s not being addressed effectively, and there isn’t a lot of awareness about its actual prevalence. Knowledge is lacking among sufferers about the condition, its causes and treatment options. This is where oral health professionals can step in to identify the signs and ubiquity of dry mouth and to help patients manage the symptoms.

In the following, we will explore the causes of xerostomia, diagnostic measures dentists can take and the innovative treatment solutions that exist today.

Causes and early detection of xerostomia
Understanding the causes of dry mouth can aid in the early detection process. And the key to alleviating the discomfort that stems from dry mouth is early detection and treatment, both of which can also prevent progressive worsening of the condition over time.

The three leading causes of xerostomia are age, treatment medications and existing health conditions. Xerostomia can be traced to the ingredients in more than 700 medications, both prescription and over-the-counter. A common side effect of many “anti” medicines (including antidepressants, antinausea drugs and antihistamines), dry mouth can also result from other common drugs such as allergy suppressants, high blood pressure medications and pain relievers.

Existing health conditions such as diabetes, asthma and Sjögren’s syndrome are also common causes of xerostomia. Patients of all ages who may be experiencing radiation therapy for head and neck cancer are likely to exhibit dry mouth symptoms.

In my experience as a hygienist, I’ve seen many patients suffer dry mouth because of diabetes. Simply put we have a huge problem on our hands; by 2020, it’s expected that 1 in 3 will have some form of metabolic blood glucose dysfunction, meaning they’ll be diabetic or prediabetic—and at increased risk for dry mouth.

How to speak up for your patients
Why do so many cases go undetected— or unreported—by patients? Countless patients don’t openly discuss the troubles they’re experiencing because they think the symptoms are a natural part of aging, or that the condition can’t be treated. Many also don’t know the lasting effects of xerostomia and the toll it can take on their health. For example, not only does insufficient saliva cause immediate discomfort, it can also lead to tooth decay over time.

Dentists can help patients recognize early indicators of dry mouth by probing with questions or observing clinical signs. Many dentists already make it a standard to ask patients, “Is your mouth dry?” This can be an effective launch pad into further education.

Other questions to gauge dry mouth in patients include:

• “Are you frequently thirsty?”

• “Do you often feel a sticky, tacky sensation in your mouth?”

• “Are you having difficulty swallowing? If so, is it more noticeable at night?”

• “Do you drink beverages all day to quench your thirst, but only get temporary relief?”

Knowing what to look for in the primary stages can also help dentists determine if their patient may be suffering from dry mouth. Xerostomia is fairly easy to spot when it’s clear what to look for. When the patient is in your chair, check to see if the mirror sticks to their tongue or buccal mucosa. Other displays may include frothy saliva, absence of saliva pooling in the floor of the mouth, and glassy oral mucosa. It’s also worth noting if the tongue is lobulated or fissured or has generalized shortened papillae.

Advocating for patient health through engagement and education can help uncover undiagnosed xerostomia. Identifying the signs of dry mouth is the first step to bringing relief through treatment.

Finding effective care solutions

Those experiencing dry mouth are likely willing to try just about anything that will bring fast and effective relief, and there are many treatment solutions available on the market today. These solutions range from rinses and sprays to prescription-strength toothpaste, salivary stimulants and systemic medications.

A few current products in the United States include:

• Over-the-counter water-based solutions, including Act Dry Mouth Mouthwash, Biotène Dry Mouth Oral Rinse, Colgate Hydris and Lubricity. These products are easy to obtain from local drugstores.

• Prescription-strength saliva substitutes such as Caphosol, NeutraSal and SalivaMax are professionally dispensed ampoules or packets of supersaturated calcium phosphate that help relieve xerostomia symptoms with few reported side effects. These products can help patients be more comfortable when drinking, chewing and speaking, but can require mixing and rinsing several times per day. Patients should avoid eating or drinking for about a half-hour after using the product for best efficacy.

• Prescription tablets or capsules that increase saliva flow, such as Exovac and Salagen, use pilocarpine to stimulate saliva production. Indicated for the treatment of xerostomia in patients with Sjögren’s syndrome, these two medications have been reported by patients as effective, following the recommended dose of three or four times daily. The most commonly reported side effects include excessive sweating, nausea and diarrhea.

• A new prescription lipid-based spray from 3M utilizes lipids, a class of organic molecules that are insoluble in water and more closely resemble human saliva, to deliver xerostomia relief for up to four hours in a portable, ready-to-use spray.

Patients who experience only mild symptoms of xerostomia can sometimes manage the condition without medication, by making lifestyle changes. The American Dental Association suggests sipping water or sucking on ice chips, using lip lubricants frequently (about every two hours), and avoiding salty, spicy, sticky, sugary or hard-to-chew foods. The ADA also recommends using a humidifier at night, chewing sugar-free gum or sucking on sugar-free mints (xylitol), and avoiding irritants such as alcohol, tobacco and caffeine.

It should be noted that some at-home remedies could actually end up harming patients in the long run. Acidic candy, for example, could bring temporary comfort but inevitably worsen the condition. And sipping water throughout the day to dampen the mouth can also result in frequent bathroom trips and disrupted sleep.

Many people experiencing dry mouth will self-medicate, but this often makes their symptoms come back more intensely, because their treatment choice contains ingredients that could cause xerostomia, which can be a difficult cycle.

Patients may not understand the options that could treat their symptoms, and with so many innovative products today delivering liberation from the discomfort of dry mouth symptoms, the key is to identify the management system that works best for your patients. Give them a solution that delivers relief paired with convenience; otherwise, they will likely skip the treatment altogether.

Looking ahead: Bringing a voice to xerostomia
Xerostomia has been labeled as “a silent condition with 24/7 discomfort.” By impeding one’s ability to swallow, talk, eat and chew, its symptoms can have a significant impact on the daily activities of those it affects. But, that doesn’t have to be the case.

Oral care professionals, including dentists and hygienists, are in the distinctive position to help people who are now suffering silently. Speaking up about xerostomia will bring the critical awareness to identify the condition’s prevalence, aid early detection and allow patients to receive the long-lasting relief they deserve, faster.