Helping Patients to Cope with Xerostomia Causes, care and management – Howard Thomas

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  Posted by: The Probe      6th July 2018

Xerostomia is defined as dry mouth, resulting from reduced or absent saliva flow.  Without saliva, digesting food and keeping the mouth clean becomes a difficult task for a patient. Saliva is the mouth’s most important natural defence, without it patients can have severe trouble eating, sleeping or swallowing.

Saliva possesses many important functions including antimicrobial activity, mechanical cleansing action, control of pH, removal of food debris from the oral cavity, lubrication of the oral cavity, remineralisation and maintaining the integrity of the oral mucosa.

Xerostomia can often be an indication of an underlying medical condition such as Sjögren’s syndrome or a side effect from a large variety of medications including diuretics and sedatives. 

Several hundred current medications can cause xerostomia.  These include antihypertensitives, antidepressants and antihistamines. Cancer therapy can also change the composition of saliva.  Other conditions such as bone marrow transplants or stress anxiety puts patients at risk.

Xerostomia is not a disease but can be a symptom of certain diseases, for example, HIV/AIDS or cancer. It produces serious negative effects on the patient’s quality of life, affecting dietary habits and nutritional status. Patients can find dry food impossible.  The condition can affect one in four people and up to a fifth of elderly patients[1].  Older patients are more likely to develop xerostomia due to the likelihood of taking a greater quantity of medications.  Patients can develop symptoms at any stage in life and without diagnosis, can suffer long-term effects such as congenital abnormalities. Xerostomia is often a contributing factor for both minor and serious health problems including rheumatoid arthritis and thyroid dysfunction.

Risks stemming from reduced saliva flow-rate

One of the key problems faced by dry-mouth patients is dental decay. A decrease in saliva flow rate is the result of hypo-function of the salivary glands. The glands source their fluid from the circulating blood, process it and secrete it into the mouth.

Interference of blood supply to the gland, damage to its secretary function or interruption of stimuli can lead to reduced salivary production.  This can be attributed to anxiety, acute infection, dehydration or a reaction to drugs. 

For general dental practitioners, a reduction of the amount of saliva produced can lead to a variety of clinical problems. Chelitis and parotid gland enlargement are among a few of the many symptoms associated with xerostomia. Inflammation or ulcers of the tongue, buccal mucosa, oral candidiasis and sialadentitis are among the more severe repercussions stemming from a diagnosis. 

Benefits of early diagnosis using sialometry and salivary scintigraphy

Saliva helps to clean the mouth and its anti-bacterial; anti-viral and anti-fungal properties enable it to protect the oral cavity from microbes that attack the teeth.  A slight change in the composition of saliva affects the oral defense system, leading to cavities and periodontal alterations.

Advising patients on the importance of regular dental check-ups avoids long-term problems and complications.  During a routine examination of the oral cavity and/or sialometrythe practitioner can measure the severity of the case.  Fissuring of the tongue and a lack of pooling at the bottom of the mouth are early signs of the problem.  Patients with xerostomia frequently struggle with eating, speaking, swallowing and wearing dentures. Patients often complain of dysgeusia and glossodynia.In sialomscintigraphy, or salivary flow measurement, collection devices are placed over the parotid gland or the submandibula, this provides an improved chance of diagnosing the severity of the situation.

Salivary scintigraphy can also be useful in assessing salivary gland function. Technetium-99m sodium pertechnate is intravenously injected to ascertain the rate and density of uptake and the time of excretion in the mouth.

 

Ameliorating damage caused by low saliva secretion

 

The management of xerostomia typically includes the identification of the fundamental reason. In the event that steps can be taken to minimize the effect of the underlying cause, this should be complete. For many patients, however, little can be done to correct the fundamental cause. For patients whose xerostomia is related to medication use, effective symptomatic treatment may be important to maintain compliance with their medication regime. Symptomatic treatment typically includes four areas: increasing existing saliva flow, replacing lost secretions, control of dental caries and specific measures such as treatment of infections. Palliative treatment can be can also be used but does not cure the condition.

 

Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. These substitutes are available as commercial compounds. Artificial salivas are formulated to mimic natural saliva, which can be a life improving therapy.

 

Xerostrom is a range of products from oral healthcare specialists Curaprox that has been designed to manage xerostomia with minimal effort.  It has been manufactured using naturally derived ingredients such as olive oil for its antiseptic qualities.  The oily properties enable it to lubricate the oral tissues, preventing halitosis and allowing the active ingredients to remain in the mouth for longer. Other natural ingredients such as vitamin E and B5 supply antioxidant and protective capacity.

 

Xerostrom is available in a wide range of products, which are suitable for regular use in daily life.  The products are SLS and alcohol-free which makes the treatment as natural and gentle as possible for patients suffering discomfort from xerostomia.  Active properties such as betaine and allantoin soothe and protect the oral tissues, whilst xylitol fights the bacteria which cause streptoccus mutans.  The products are suited for use at any time of the day or night.

 

 

For free samples or for more information please call 01480 862084, email info@curaprox.co.ukor visit www.curaprox.co.uk

 

 

[1]Cathy L. Bartels, Xerostomia Information for Dentists,

http://oralcancerfoundation.org/dental/xerostomia.htm (2001-2010).


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