Diagnosing and managing dry mouth

Featured Products Promotional Features

  Posted by: Dental Design      1st January 2024

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.[i] 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% of people over the age of 55.[ii] This is particularly relevant given the physical and mental health concerns that already exist for the older population. [iii] A Swedish study[iv] also found that women had a higher incidence of xerostomia than men.

It can be a chronic issue for suffers, which impacts every aspect of their lives, from speech to chewing and swallowing. It also increases the risk of tooth decay and dental infection.[v] A leading cause of xerostomia is that it’s an adverse side effect of medication,[vi] 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 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,ii Sjögren’s syndrome[vii] and other systemic diseases like asthma, diabetes, rheumatic diseases, thyroid diseases and eating disorders.[viii]

More tailored questionnaires have then been suggested in order to ascertain the severity of dry mouth symptoms experienced by the patient.[ix] [x] An intraoral examination is, of course, useful, during which the practitioner should look for specific signs of xerostomia. These may include:[xi]

  • 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.x

Management techniques

For many patients who are suffering, there is light at the end of the tunnel. Research[xii] demonstrates that xerostomia treatment improves the feeling of dry mouth in over 75% 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 the use of 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.[xiii] 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.[xiv]

Specialised oral care can offer further daily discomfort relief. Various products in the form of sprays, lozenges or gels may be utilised before meals or as needed throughout the day to stimulate salivary flow or even temporarily substitute saliva. A trusted provider of such products is Oraldent, who offers the innovative Xerostom range of dry mouth solutions to cater to various patient needs and preferences. The portfolio consists of a 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% with appropriate use.[xv]

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.

For more details, please visit Oraldent.co.uk, call 01480 862080 or email info@oraldent.co.uk

[i] Yang SE, Park YG, Han K, Min JA, Kim SY. Dental pain related to quality of life and mental health in South Korean adults. Psychol Health Med. 2016 Dec;21(8):981-92. doi: 10.1080/13548506.2015.1098781. Epub 2015 Oct 10. PMID: 26456324.

[ii] Loat S. Facts and Tips: Dry mouth. Oral Health Foundation. 2019. https://www.dentalhealth.org/blog/facts-and-tips-dry-mouth[Accessed November 2023]

[iii] Cannon I, Robinson-Barella A, McLellan G, Ramsay SE. From Drugs to Dry Mouth: A Systematic Review Exploring Oral and Psychological Health Conditions Associated with Dry Mouth in Older Adults with Polypharmacy. Drugs Aging. 2023 Apr;40(4):307-316. doi: 10.1007/s40266-023-01017-5. Epub 2023 Mar 21. PMID: 36943673.

[iv] Adolfsson A, Lenér F, Marklund B, Mossberg K, Çevik-Aras H. Prevalence of dry mouth in adult patients in primary health care. Acta Odontologica Scandinavica. 2002: 80(8); 605-610 https://doi.org/10.1080/00016357.2022.2069282

[v] National Institute of dental and Craniofacial Research. Dry Mouth. https://www.nidcr.nih.gov/health-info/dry-mouth#:~:text=Dry%20mouth%2C%20also%20called%20xerostomia,swallowing%2C%20and%20even%20talking%20difficult. [Accessed November 2023]

[vi] Mulligan R. Dental care for geriatric patients: xerostomia in elderly populations. Epidemiology. Herman Ostrow School of dentistry of USC. https://ostrowonline.usc.edu/dental-care-for-geriatric-patients-with-xerostomia/ [Accessed November 2023]

[vii] Ngo DYJ, Thomson WM. An Update on the Lived Experience of Dry Mouth in Sjögren’s Syndrome Patients. Front Oral Health. 2021 Nov 2;2:767568. doi: 10.3389/froh.2021.767568. PMID: 35048069; PMCID: PMC8757894.

[viii] Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014 Dec 22;11:45-51. doi: 10.2147/TCRM.S76282. PMID: 25653532; PMCID: PMC4278738.

[ix] Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc. 1987 Oct;115(4):581-4. doi: 10.1016/s0002-8177(87)54012-0. PMID: 3477595.

[x] Thomson WM, Chalmers JM, Spencer AJ, Williams SM. The Xerostomia Inventory: a multi-item approach to measuring dry mouth. Community Dent Health. 1999 Mar;16(1):12-7. PMID: 10697349.

[xi] Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014 Dec 22;11:45-51. doi: 10.2147/TCRM.S76282. PMID: 25653532; PMCID: PMC4278738.

[xii] Ito K, Izumi N, Funayama S, Nohno K, Katsura K, Kaneko N, Inoue M. Characteristics of medication-induced xerostomia and effect of treatment. PLoS One. 2023 Jan 12;18(1):e0280224. doi: 10.1371/journal.pone.0280224. PMID: 36634078; PMCID: PMC9836311.

[xiii] Talha B, Swarnkar SA. Xerostomia. [Updated 2023 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545287/

[xiv] NHS. Dry Mouth. https://www.nhs.uk/conditions/dry-mouth/ [Accessed November 2023]

[xv] SHIP, J.A., MCCUTCHEON, J.A., SPIVAKOVSKY, S. and KERR, A.R. (2007). Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth. Journal of Oral Rehabilitation, [online] 34(10), pp.724–732. Available at: https://pubmed.ncbi.nlm.nih.gov/17824884/#:~:text=No%20clinically%20significant%20adverse%20events,population%20with%20polypharmacy%2Dinduced%20xerostomia. [Accessed 1 Jun. 2023].

No Comments

No comments yet.

Sorry, the comment form is closed at this time.