Introduction
Xerostomia, also known as dry mouth, is a common condition that affects a significant number of patients in dental practice. It is characterized by a reduction in the amount of saliva produced by the salivary glands, leading to a dry and uncomfortable feeling in the mouth.
While it may seem like a minor issue, having a dry mouth can have serious consequences on a patient’s oral health and long term dental outcomes. As health professionals, it is important to understand the causes, symptoms, and treatment options for xerostomia to provide the best possible care for our patients.
The Impact on Oral Health
Saliva plays a crucial role in maintaining oral health. It helps to lubricate the mouth, neutralize acids that can cause tooth decay, and wash away food particles and bacteria. Without adequate saliva, patients may experience a range of oral health problems, including:
- Increased risk of tooth decay and gum disease
- Difficulty chewing, swallowing, and speaking
- Mouth sores and infections
- Halitosis
- Oral candidiasis
In addition to these oral health issues, xerostomia can also have a negative impact on a patient’s overall quality of life. It can lead to difficulty sleeping, difficulty eating certain foods, and social anxiety due to bad breath and difficulty speaking.
7 Causes and Risk Factors
Xerostomia can be caused by a variety of factors, including medications, radiation therapy, and autoimmune disorders. Some of the most common risk factors include:
- Aging
- Prescription and over-the-counter medications
- Radiation therapy for head and neck cancer
- Autoimmune disorders, such as Sjogren’s syndrome
- Nerve damage
- Dehydration
- Smoking and tobacco use
Top 5 Medications that Cause Xerostomia
At DentalRx our specialty is medication history. When we look at a patients list of medications we are monitoring for all medications that have a high risk of decreasing saliva production. The most common medications that we see in patients are:
- Antidepressants
- Antihistamines
- Inhalers for asthma and COPD
- Blood pressure medications
- Opioid pain medications
At DentalRx our pharmacists are trained to identify patients who are at high risk of oral complications and can help select appropriate treatment options for your patients. When we see patients who are taking medications with a high propensity to cause xerostomia, DentalRx pharmacists set alerts on each patient’s EMR profile so that they can be provided with potential treatment options to manage their symptoms.
If you own a dental clinic and would like to use DentalRx services to improve your patients’ care, you can contact us here.
Diagnosis
After a thorough medical and dental history has been taken, a diagnosis can be confirmed by the attending dental professional. A physical examination can be done to check the patient’s oral cavity, as well as the salivary glands, to determine the degree of dryness. Additionally, a salivary flow test may be conducted to determine the amount of saliva being produced. The severity of xerostomia can also be classified according to the following categories:
- Mild: saliva flow rate is above 0.2ml/min
- Moderate: saliva flow rate is between 0.1-0.2ml/min
- Severe: saliva flow rate is below 0.1ml/min
While a salivary flow test is not a routine procedure in dental clinics, it is useful to understand its availability and outcomes for classification.
Treatment and Management
There are several treatment options available to help manage symptoms and improve oral health. Some of these include:
- Over-the-counter saliva substitutes and moisturizing mouthwashes
- Prescription medications to stimulate saliva production
- Treatment of underlying medical conditions
- Lifestyle changes, such as quitting smoking and staying hydrated
- Regular dental check-ups and cleanings to prevent tooth decay and gum disease
As health professionals, it is important to educate patients about the causes and symptoms of xerostomia and to work with them to develop an individualized treatment plan that meets their needs.
Additionally; with new legislation approving pharmacist prescribing in BC pharmacists can now provide additional value to practitioners like dentists. Prescriptions for oral candidiasis and aphthous ulcers, two common consequences of dry mouth, can now be written and fulfilled by pharmacists. At DentalRx we are completely embracing this updated scope of practice and are excited to bring this value to dental clinics across the Vancouver district.
If you would like to learn more about how pharmacist prescribing can help improve your dental clinic, please see our updated clinical services here!
Prevention
Prevention of xerostomia involves identifying and addressing the underlying cause, as well as making certain lifestyle changes. For example, patients who smoke or use tobacco products should be advised to quit, with for example the help of the BC Smoking Cessation Program provided by pharmacists. DentalRx has partnered with local community pharmacies such as Steveston Pharmasave to provide these free life changing programs for your patients.
Additional Resources
For more information on xerostomia and its treatment, check out the following resources:
Personally I am a large proponent for materials provided by the BC Cancer Association. They are extremely thorough and offer comprehensive overviews for all classifications of xerostomia.
For your patients’ education, you can also direct them to the blog post we wrote for Harmony Dental Studio outlining dry mouth in patient friendly language found here.
Conclusion
Xerostomia is a common condition that can have serious consequences on a patient’s oral health and quality of life. As health professionals, it is our responsibility to understand the causes, symptoms, and treatment options for xerostomia and to provide the best possible care for our patients. By working collaboratively with other health professionals we can help patients maintain good oral health and improve their overall quality of life.