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Zeroing in on Xerostomia





By Back Mike Wong • June 17, 2019

Saliva plays many roles in the oral cavity. Composed of 99.5% water, this biofluid is endowed with elements such as electrolytes, mucus, proteins and enzymes. Together, they help to maintain oral hygiene through continuous bathing of the mouth in antimicrobial, optimally pH-balanced fluid, countering acidic conditions favored by cariogenic bacteria.

Without saliva we would be hard pressed to taste, eat, swallow, digest and even speak. Unfortunately, as we age, many of us suffer from a reduction of salivary flow. This can lead to dry mouth, or what is known as xerostomia, which can either be perceived dry mouth, or true hyposalivation.1

Etiology

It’s no accident that xerostomia appears to be a side effect of aging. Generally speaking, the older we get, the more medications we end up taking, many of which list dry mouth as a side effect. In fact, the American Academy of Oral Medicine reports that over 1100 prescription or over-the-counter medications present this risk. And when more than one of these medications is taken on a daily basis, the problem is compounded. It also doesn’t help that gums tend to recede with age, exposing roots to potential cariogenic atrocities.2

Other factors that may result in xerostomia include diseases such as diabetes and Sjogren’s syndrome, smoking, surgery, and cancer treatments involving head and neck irradiation, which can irreversibly damage salivary glands.3

Xerostomia reportedly affects about 30% of patients diagnosed with dry mouth over the age of 65, with more women affected than men.1,4 It can be an uncomfortable condition, starting with symptoms ranging from dry mucosa and thick saliva to cracked soft tissues and bad breath.1

Symptoms of full-blown xerostomia include frequent thirst, difficulty eating, swallowing; wearing dentures and speaking, oral irritation, burning sensations and pain.1,4–6

Treatments

In treating cases of medication-induced xerostomia, alternative medications or dosage adjustments may help.3 Other strategies include regular dental care, avoidance of sugar and caffeine, sipping fluids, hydrating while eating, using a humidifier, and sucking or chewing sugar-free candies or gums to stimulate salivary flow.3

Though they don’t provide antibacterial protection, oral moisturizers may also help relieve symptoms of dry mouth.7 Recent studies, however, have found that many oral moisturizers register a pH of well below 7 — acidic enough to cause tooth erosion — cause for concern in the dental community.8 But when such saliva substitutes are highly viscous and do not contain citric acid, remineralization is still possible, through mechanical protection.9,10

Neutral pH dentifrices can be beneficial in maintaining oral hygiene. Products containing arginine bicarbonate, calcium carbonate, amorphous calcium phosphate, casein phosphopeptide-ACP, calcium sodium phosphosilicate, and tricalcium phosphate can foster neutral pH and/or support remineralization while reducing the risk of caries.1                                 

Other treatments may involve the use of Pilocarpine, the only FUS Food and Drug Administration–approved drug for use as a sialogogue in cases of radiation-induced xerostomia. Acupuncture is also said to offer benefits11 and gene therapy is also being investigated.12

In the course of treating dry-mouth patients with sealants or restoratives, it’s often necessary to keep treatment areas isolated from any oral fluids. Isolite 3 offers illumination and isolation through soft-tissue containment and continuous suction. And thanks to Isolite’s flexible mouthpiece, patients are less likely to taste medicaments, while the throat is shielded, minimizing the risk of accidental ingestion.

As members of the boomer generation continue into their golden years, more are likely to wind up with dry mouth or xerostomia. Savvy practitioners can get in front of the situation by equipping themselves and their patients with the right knowledge and armamentaria.

 

REFERENCES

  1. Gadalla H. Treating dry mouth. Dimensions of Dental Hygiene. July 2018;16(7):25-30.
  2. The American Academy of Oral Medicine. Xerostomia. 2019. Available at: https://www.aaom.com/index.php%3Foption=com_content&view=article&id=107:xerostomia&catid=22:patient-condition-information&Itemid=120
  3. The American Academy of Oral Medicine. Xerostomia. Available at: https://www.aaom.com/index.php%3Foption=com_content&view=article&id=107:xerostomia&catid=22:patient-condition-information&Itemid=120. Accessed March 18, 2019.
  4. Baer AN, Walitt B. Sjögren syndrome and other causes of sicca in the older adult. Clin Geriatr Med. 2017;33:87–103.
  5. Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2015;11:45–51.
  6. Saleh J, Figueiredo MA, Cherubini K, Salum FG. Salivary hypofunction: an update on aetiology, diagnosis and therapeutics. Arch Oral Biol. 2015;60:242–255.
  7. American Dental Association. Oral Moisturizers. Available at: http://www.ada.org/~/media/ADA/Publications/Files/Oral_Moisturizers.ashx. Accessed March 18, 2019.
  8. Delgado AJ, Aslam M, Ribeiro AD, Olafsson VG, Pereira PN. Potential Erosive Assessment of Dry Mouth Lozenges and Tablets on dentin. Available at: https://cdn.shopify.com/s/files/1/0035/3832/files/Delgado_AADR_2018_Acidity_of_dry_mouth_lozenges.pdf?10451805702918068836. Accessed March 18, 2019.
  9. Aykut-Yetkiner A, Wiegand A, Attin T. The effect of saliva substitutes on enamel erosion in vitro. J Dent. 2014;42:720–725.
  10. Pitts EI, Furgeson D. Saliva, remineralization and dental caries. Decisions in Dentistry. 2019; 5(4):38–41.
  11. Ravida A, Suarez Lopez del Amo F. Long-term effects of head and neck radiation on oral health. Decisions in Dentistry. 2018;4(5):37-42.
  12. Decisions in Dentistry. Exploring Gene Therapy to Treat Radiation-Induced Xerostomia. Avallable at: http://decisionsindentistry.com/2018/03/gene-therapy-xerostomia/. Accessed March 18, 2019.