2021b). Among older adults, the prevalence among women seems to be greater than the prevalence among men (de Campos, et al., 2019). The prevalence of xerostomia in institutionalized older adults is elevated compared to the general population with the use of multiple medications that cause hyposalivation as a major cause (Lavigne, 2018). Intensity-modulated radiotherapy, a new radiation technology used to treat patients with oropharyngeal and nasopharyngeal cancers, spares salivary glands from the normal intensity of radiation therapy and potentially decreases oral dryness in patients undergoing head and neck radiation therapy (Abel, et al., 2017). Dental professionals may wish to talk to the patient’s oncologist regarding the type of radiation therapy being planned and how they might work together as a team to achieve the best outcomes for the patient. Secondary causes of dry mouth do not have a direct impact on salivary glands, but nonetheless produce hyposalivation. Secondary causes include more than 400 different medications, stress and anxiety, depression, nasal congestion/mouth breathing, and smoking (American Dental Association, 2021b; de Campos 2019; Kumar & Gupta, 2018). Symptoms of dry mouth include difficulty eating, speaking, or swallowing. Patients may report thirst and a need for liquids to help them swallow food. Because saliva is buffering and remineralizing, dry mouth may lead to an increased risk of caries, particularly root caries in older adults. Dry mouth also increases the risk of halitosis (bad breath), periodontal disease, Candida (fungal) infections, and oral mucositis. Denture wearers may experience difficulty with denture retention and increased discomfort from dry mouth (American Dental Association, 2021b; Kumar & Gupta, 2018; Kumar, et al., 2017). alcoholic, caffeinated, and carbonated beverages, as these substances exacerbate dehydration and aggravate symptoms of dry mouth and should also avoid spicy or salty foods to avoid minimize oral irritation (Geisinger & Doobrow, 2022; American Dental Association, 2021b). The use of a nighttime humidifier may relieve dryness while sleeping(Agostini, et al., 2018). Salivary stimulants may be prescribed to relieve oral dryness. Pilocarpine (brand name Salagen) and cevimeline (brand name Evoxac) are examples of prescription salivary stimulant medications. Pilocarpine may be administered in tablet or lozenge form. Pilocarpine is usually administered at a dose of 5 mg three times a day for at least three months while cevimeline is administered at a dose of 30 mg three times a day for at least three months (American Dental Association, 2021b). The frequency of administration may challenge patient compliance, as does the time lapse before there is an improvement in salivary flow. However, dentists should practice caution when prescribing pilocarpine due to potential side effects and contraindications. Side effects of this medication include flushing, sweating, gastrointestinal upset, decreased blood pressure, excessive tearing, and urinary frequency (Panarese & Moshirfar, 2021).
has a reported range of 0.9% to 64.8% (American Dental Association, 2019b)with females reporting xerostomia more frequently than males (Niklander, et al., 2017). The prevalence of xerostomia among adults over the age of 65 has been cited as approximately 30% and up to 40% for those 80 years of age or older (American Dental Association, Etiology Dry mouth is not generally considered a normal result of aging, even though the number of salivary gland cells decreases with age (de Campos, et al., 2019 Medications and diseases are more likely than aging alone to result in hyposalivation. Primary causes of dry mouth have a direct impact on salivary glands, causing clinically observable reduced saliva. These primary causes (Geisinger and Doobrow, 2022; Sjögren’s Syndrome Foundation, n.d.; Verhuls, et al., 2019) include: ● Sjögren’s syndrome. ● Diabetes. ● Salivary gland disorders. Diagnosis Because of the high prevalence of dry mouth among older adults, astute dental clinicians will carefully interview and examine their patients for xerostomia and hyposalivation. Clinical signs of dry mouth include: ● Lack of moist, “glistening” oral mucosal tissues. ● Dry, fissured tongue. ● Dry lips, possibly with cracked corners. Management Assessment and treatment of dry mouth is important for all patients, but particularly for older patients who may be taking multiple medications. Management of dry mouth often requires interprofessional collaboration. Because medications are the most frequent cause of dry mouth (American Dental Association, 2021b; Wynn, et al., 2021) dentists may consider consultation with the patient’s physician to determine if medications causing hyposalivation could be eliminated, adjusted, or replaced. ● Alzheimer’s disease. ● Parkinson’s disease. ● Head and neck radiation. ● Systemic chemotherapy cancer therapy (The Oral Cancer Foundation, 2022). ● Hormonal fluctuations caused by pregnancy. ● Menopause (Kumar & Gupta, 2018). ● Increased dental caries. ● Dry, red, inflamed gums. ● “Ropy” saliva. ● Halitosis (bad breath). If the cause of dry mouth cannot be eliminated, palliative measures are indicated. Many over-the-counter products are available that may relieve symptoms of xerostomia. Salivary substitutes, for example, may soothe and moisturize oral tissues. Currently available salivary substitutes include Oral Balance Gel (GlaxoSmithKline), Oral Balance Moisturizing Liquid (GlaxoSmithKline), Biotène Moisturizing Mouth Spray (GlaxoSmithKline), Mouth Kote Dry Mouth Spray (Parnell), Oralube Saliva Substitute (Oral Disease Research Laboratory), Moi-Stir Oral Swabsticks (Kingswood Laboratories), Moi-Stir spray (Kingswood Laboratories), Optimoist spray (Colgate-Palmolive), and Xero-Lube spray (Scherer Laboratories). Frequent sips of water should also be suggested to relieve dryness. Patients should be asked about their daily fluid intake and advised as to the appropriate amount of daily water intake needed to reduce the risk of dehydration. Patients should also be advised to reduce intake of
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