Management of Xerostomia

• What is Hyposalivation?

  reduced production of saliva
• What is Xerostomia?

  dry mouth
• What is Asialism?

  Absence of saliva
• What is the usual flow rate in hyposalivation?

  <0.7ml per min stimulated flow

  <0.1ml per min unstimulated flow
• What are some causes of reduced salivary flow?

  Factors affecting the salivary centres

  Factors affecting the autonomic nerve supply to the salivary gland

  Factors affecting the salivary gland function directly

  Factors producing changes in the fluid or electrolyte balance
• What are three major factors affecting the salivary centres?

  Emotions - anxiety, fear, excitement & depression

  Organic disease -tumours

  Drugs -A wide range of drugs cause reduced salivary flow
• What factors affect the autonomic nerve supply to the salivary gland?

  Trauma -Through injury or surgery

  Tumours Encephalitis - inflammation of the brain/ autoimmune response

  Drugs -A wide range of drugs cause reduced salivary flow
• What factors can directly affect the salivary gland function?

  • Irradiation
  • Head & neck radiotherapy
  • Obstructions - Salivary calculi, Cyst
  • Infections - Mumps Aplasia
  • Congenital absence of salivary gland
  • Sjögrens Syndrome
  • Autoimmune disorder
  • Tumours
  • HIV
• What is Sjogrens Syndrome?

  Autoimmune disorder causing dryness of the mucous membranes, purpuric spots on the face & bilateral swelling of the parotid glandMost frequently see in menopausal womenAssociated with arthritis
• Why is Xerostomia common in HIV patients?

  - salivary gland disease- secondary to medication
• What factors produce changes in the fluid/electrolyte balance?

  Diabetes Mellitus - Insipidus - Dehydration - Sweating - Diarrhoea -vomiting - Uraemia - Changes urea & nitrogenous waste in the blood - Cardiac failure - Changes electrolyte balance - Oedema -Changes electrolyte balance
• What are temporary causes of hyposalivation?

  • Dehydration
  • Mouth breathing
  • Oxygen therapy
  • Drugs
  • Excessive use of diuretics
  • Trauma
  • Duct calculisialoadentis
• What are permanent causes of Hyposalivation?


  • Aplasia
  • Sjögrens syndrome
  • Systemic disorder
  • Lupus erythematosis
  • Diabetes
  • Reynauds syndrome
  • Parkinsons
  • HIV
  • Radiotherapy
  • Surgery
• What medications can retard salivary flow?

  1) Diuretic e.g. Acetazolamide

  2) Antihistamine

  3) Antidepressent e.g. Amitriptyline

  4) Tranquillisers

  5) CNS stimulant e.g. Amphetamine

  6) Appetite suppressants

  7) Antipsychotic e.g. Chlorpromazine

  8) Antibiotic e.g. Tetracyclinee

  9) Antihypertensive e.g. Clonidine

  10) Anti-Parkinsonian e.g. Benapryzine
• What are the functions of saliva?

  Ph balance/buffering capacity, Remineralisation

• What are some patient symptoms of Xerostomia?

  • oral dryness
  • Burning sensation/soreness
  • Problems wearing dentures
  • Halitosis
  • Thirst - resulting in increased fluid intake & licking of lips
  • Difficulty with: Speech, Swallowing, Mastication, Impaired or altered taste, Sensitivity
• What is Dysphagia?

  difficulty swallowing
• What is Dysphonia?

  difficulty speaking
• What is Dysgeusia?

  distortion of taste
• 0What are the oral implications of Xerostomia?

  • Increased amount of plaque which may cause gingivitis & periodontitis
  • Increased risk of primary & secondary caries, esp. root, cervical & proximal caries
  • Increase in candidal infection in denture wearers
  • All antibacterial properties & lubrication are reduced therefore an increased risk of trauma
• What can patients with Sjogrens syndrome suffer from?

  Cervical, proximal & incisal caries, Marginal gingivitis, Gross caries, Coated tongue, Candida on palate, General erythematous appearance of oral mucosa

  
• What can patients post radiotherapy suffer from?

  • Gross primary caries & minimal secondary caries
  • Gross caries incisal, proximal & cervical
• What is Xerostomia?

  A subject feeling of dryness of the mouth, having a variety of aetiology, resulting in diminished or arrested salivary secretion or asialism
• What is Asialism?

  Absence of saliva
• What is Sialogogue?

  An agent which promotes the flow of saliva
• Functions of Saliva

  Lubricant, Protection, Cleansing, Taste, Speech, Digestion, Ph balance/buffering capacity, Remineralisation
• What are some symptoms of patients with xerostomia?

  • Feeling of oral dryness, tongue sticking to other tissues
  • Difficulty in speech, mastication & swallowing
  • Thirst leading to increased intake of fluids & licking of lips
  • Burning sensation & soreness of oral mucosa
  • Problems wearing dentures
  • Halitosis
  • Change in dietary habits to alleviate symptoms
• What are some clinical problems associated with Xerostomia?

  • Increased susceptibility to periodontal disease
  • Increased accumulation of plaque & debris
  • Prone to root caries
  • Mucosa easily traumatised
• How can Xerostomia be managed?

  1) Elimination or correction of aetiological factors

  2) Personnel care & prevention program, Saliva stimulation, Artificial saliva
• How can Xerostomia be managed by elimination/correction of aetiological factors?

  1. Medical History: systemic disorder, medication, trauma, lifestyle etc, continuous or intermittent, accompanied by pain or swelling
  2. Intra-oral examination: Enlargement of glands or lymph nodes, Presence of calculi, 2Severity
  3. Liase with referring clinician
• How can Xerostomia be managed by a personal care & prevention program ?

  1) Educate patient on effect of xerostomia so they can inderstand the need for good OH & dietary limitations

  2) Rigorous OHI, to individual need

  3)Soft toothbrush if soft tissues inflamed

  4)Avoid toothpaste with Sodium Lauryl Sulphate
• What can be recommended if OHI is very painful?

  Chemical plaque control - mouthwashes(Be mindful of chemical content of mouthwashes as alcohol is an astringent)CHx - 10% alcohol

  
• What dietary advice can be given to patients with Xerostomia and why?

  • High risk of primary & secondary caries
  • Reduce intake & frequency of sugar
  • Elderly particularly prone to snacking on sweet treats

  
• What should be considered to aid Xerostomia patients if their diet is uncontrolled?

  Home fluoride therapy:

  • Omni-gel or Gel Kam 0.4% stannous fluoride
  • Fluoriguard 0.05% NaF daily mouthwash
  • Duraphat 0.2% weekly mouthwash
  • Duraphat toothpaste 2800ppm/0.619%

  
• What is used in the professional application of fluoride?

  Topical fluoride varnish 2.26%

  APF Gels (Acidulated phosphate fluoride) 1.23%

  
• What are some helpful tips to help moisten the mouth?

  • Sipping water or sugar free drinks
  • Sucking ice cubes
  • Eating watery foods such as Cucumber Celery
  • Salad oils in cheeks such as Olive oil
  • Recommend stimulant or substitutes

  
• What substances can dry the mouth further?

  - Smoking - Alcohol (mouthwashes included)- Dry, bulky or spicy food
• What denture care advice can help Xerostomia patients?

  • Thorough cleaning, leave out at night
  • Reduce refined carbohydrate intake to help prevent candida
• How can dental clinicians adapt when treating patients with Xerostomia?

  1)Take care not to dry mouth further

  2)Limit use of cotton wool rolls, dry guards or gauze and soak before removing to prevent damage to mucosa

  3)Wet mirror before using it for retraction

  4)Water on higher setting during treatment

  5)Allow patient frequent rinses

  6)Lips should be coated with vaseline
• What are Saliva Stimulants?

  Sialogogue is an agent that promotes the flow of saliva

  Stimulants are only of use if glandular function still remains

  EG: Non-cariogenic sorbital/sugar free gum, Xerostomia chewing gum, Acidic sweets - for the edentulous only