If you are a health care provider with a number of your clients elderly, a common complaint is dry mouth. A dry mouth all or most of the time, can be uncomfortable and lead to more serious health problems or indicate that a more serious medical condition may exist. Saliva does more than just keep the mouth wet. Saliva helps digest food, protects teeth from decay, prevents infection by controlling bacteria in the mouth, and makes it possible for one to chew and swallow.
Dry mouth is usually caused by a reduced salivary flow or by changes in the biochemical composition of saliva. Patients suffering from dry mouth usually complain about difficulties when chewing, swallowing or even speaking.
I came across a piece in the Pharmacy Times of USA on the subject by one Virginia Bartok, November 9, 2011. Dry mouth (xerostomia) can change speech patterns, allow dentures to rub, and contribute to dental caries. It also changes dietary preferences. Dry mouth may alter the affected person’s nutritional status, causing vitamin deficiencies and caloric insufficiency—once salivary flow is reduced by half, chewing and swallowing become problematic. Dry mouth can change appearance too- lipstick on the teeth is a clue that the wearer may have xerostomia.
foods, taste alteration, burning, and soreness. A change in oral flora is common, resulting in an infection of Candida albicans (thrush). Buffering of oral acids and the capacity to inhibit cariogenic microorganisms are diminished, subsequently leading to the development of generalized rampant caries in the cervical area.
While there are non-pharmacologic causes of dry mouth such as trauma, autoimmune diseases, endocrine disorders, hyposecretory conditions, mental illness, and radiation treatment, the elderly because of presence of disease conditions and taking of several medications are more prone to dry mouth. Many things cause a sticky, dry mouth— scary movies, dental cotton before a procedure, heredity, snoring, or mouthbreathing during a cold. Medication remains the most frequent cause of dry mouth. Most medications associated with dry mouth affect the sympathetic nervous system, thickening and limiting the flow of saliva.
Three pints of saliva: that is how much the average healthy person makes daily. It is 99% water and 1% proteins, enzymes, and electrolytes. Saliva’s role is more complex than just moistening food as we chew. It contains the enzyme amylase which breaks down select starches into maltose and dextrin, initiates fat breakdown, and starts digestion. Saliva’s calcium and phosphate content restores those leached substances to tooth enamel. It also contains role-specific proteins (eg, antibacterial histatins, protective statherins, lubricating mucins). Right before a person vomits, the brain signals the salivary glands to increase saliva secretion. This decreases oral acidity, protecting the mucosa and teeth from acidic emesis.
When dry mouth becomes chronic, dental health declines and patients may develop infection. Thrush (candida albicans) infection is common, especially in patients who wear dentures, smoke, take corticosteroids, or have diabetes. The loss of salivary proteins and electrolytes accelerates tooth decay.
Several hundred medications can cause or exacerbate xerostomia, including antihypertensive, antidepressants, analgesics, tranquilizers, diuretics, and antihistamines. These drugs affect the saliva’s quantity and possibly quality, but usually the problem is temporary or reversible. The chewing gum manufacturer Wm. Wrigley Jr. Company’s Web site—www .drymouth.info—provides a searchable list of drugs associated with dry mouth.
To provide more information about the link between medications and dry mouth in older adults, a meta-analysis published in the Journal of the Journal of the American Geriatrics Societylooked at 52 related studies, searching Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016.
The research led by Monash University in Australia and the Karolinska Institutet and Stockholm University in Sweden focused on patients aged 60 years and older who participated in intervention or observational studies investigating xerostomia or salivary gland hypofunction as adverse drug outcomes.In the intervention studies, results indicate that drugs most significantly associated with dry mouth were urological medications, antidepressants and psycholeptics. The observational studies found even more types of medications significantly associated with xerostomia and salivary gland hypofunction, including diuretics used to treat hypertension, as well as insomnia drugs. Medications use was significantly associated with xerostomia and salivary gland hypofunction in older adults.The risk of dry mouth was greatest for drugs used for urinary incontinence.
Researchers urged health care providers to monitor and review all medications to identify potential side effects and to adjust doses or change medications when necessary to avoid adverse effects from dry mouth in the elderly. For drug-induced xerostomia, using the lowest effective dose or switching to an alternative medication may help. If dry mouth is associated with correctable causes and correction of underlying causes does not improve the condition, an option will be to see a dentist and have fluoride-containing sealants applied to seal pits, fissures, and rough restorative margins. You may also be advised to have a regular dose of fluoride and an antibacterial dental varnish containing 1% chlorhexidine and 1% thymol to prevent dental caries. Chewing xylitol gum enhances salivary flow and helps control Streptococcus mutans butthe elderly who wear dentures may be unable to chew gum. Patients should be encouraged to conduct a daily mouth examination, checking for red, white, or dark patches, ulcers, or tooth decay.
Sipping water or sucking on ice chips throughout the day may moisturize the mucosa and possibly alleviate symptoms. If this is not effective, artificially moisturizing the mucosa is a possible next step. Saliva substitutes are available in several dosage forms. They are best used at bedtime and periodically throughout the day; their relief is temporary and efficacy varies. Mixing equal parts of water and glycerin and spraying the mixture regularly in the mouth offers periodic relief. In addition to using moisturizers, patients will find that choosing low-sugar, low-acid, moist foods will make eating easier. They should avoid alcohol-containing mouth rinses and washes that may desiccate the oral mucosa and use a commercial mouthwash designed for people with dry mouth instead. At night, running a room humidifier adds moisture to the air and can provide some relief.
Persistent dry mouth can drastically alter the affected person’s life. Sore mucous membranes and gums, cracked lips and split corners of the mouth, and a rough, painful tongue make eating impossible. The teeth may feel like razors, spicy foods set off alarms, there is also sleep disturbance because of the frequent need to get up and sip water.
Warmest Wishes For The Season!!!
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
