Dry mouth? It’s good to talk! Kimberley Lloyd- Rees
Featured Products Promotional FeaturesPosted by: Dental Design 9th October 2019
Dry mouth is one of those things that a patient might not think is important enough to mention. This is perhaps a textbook example of how a good patient/practitioner rapport is key to the delivery of high-quality preventive dentistry; although dry mouth (or xerostomia) is a symptom and not a disease in itself, it should always be reported. Most cases of dry mouth will be uncomfortable rather than painful, but people with a persistent dry mouth are more prone to caries, periodontal complications and a range of oral infections. If they wear dentures, xerostomia can cause problems with retaining them.
The gold-standard preventive appointment will include a conversation about allthe things that are bothering an individual about their oral health, no matter how apparently insignificant they may seem. Not only will a dental practitioner usually be able to recommend simple measures to relieve their symptoms, the discussion may be the starting point for further investigation, to check that there is nothing more serious going on.
Maintaining a flow of high-quality saliva is essential for whole-mouth health. Saliva has several important functions, such as helping to rinse away food debris, lubrication for ease of eating, swallowing and talking, plus remineralisation.[i]Saliva can maintain the pH of the mouth at its ‘normal’ range between 6.2 to 7.6. This is important as studies have found a correlation between a higher pH and chronic generalised gingivitis.[ii]Oral conditions caused by xerostomia (aside from increased dental caries) include halitosis, mouth ulcers, infection of the salivary glands and oral candidiasis. Healthy saliva also contains various important antimicrobial constituents.[iii]
Dry mouth can be caused by a range of things. Certain medication can impede salivary flow. These include some antipsychotics and antidepressants, as well as drugs prescribed for epilepsy.[iv]Where the prescription cannot be changed, symptomatic relief can be found by recommending the patient takes regular sips of cool water through the day, uses sugar-free sweets or chewing sugar-free gum to stimulate salivary flow, or sucks ice cubes/lollies. The same relief methods can be advised for chemotherapy patients. Dry mouth is common side effect of certain types of cancer treatment, particularly if the cancer is/was in the head and neck. Cancer treatment can leave people with a range of oral symptoms, including radiation caries when the quantity and quality of saliva has been affected by radiation therapy and has also failed to improve once treatment has ended. Oral care and cancer treatment is a whole, separate area for discussion, but an uncomfortably dry mouth can usually be easily managed.
Avoidable causes of dry mouth including the over-consumption of high-sugar food and drink. Ditto a high-salt diet and regularly drinking too much alcohol – salt and alcohol are diuretics, leading to dehydration. Anorexia nervosa, where the diet is so restricted that an individual becomes malnourished, is associated with various potential dental risks, including xerostomia. A discussion of healthy eating habits should be part of all routine appointments; as for drinking habits, the NHS recommends that we should drink 6-8 glasses of water a day to prevent dehydration, while cutting down on, or avoiding high-sugar and high-salt drinks altogether.
Regarding alcohol, waking up with a raging thirst is the common feature of a hangover. The current recommendation from the Chief Medical Officer is no more than 14 units per week (for men and women); ideally spread over several days. Even if you don’t regularly over-indulge, the sensible advice of alternating alcoholic drinks with a glass of water on a night out can ease hangover symptoms, as can water before bed.
For alcoholics seeking treatment, who will regularly be experiencing the symptoms and side-effects of dry mouth/dehydration, their preventive programme should be carefully tailored to complement their general programme of recovery. It should be noted that several recreational and illegal drugs, such as cannabis, cocaine and MDMA can also cause xerostomia and related conditions.[v],[vi]
Other causes of dry mouth including heavy snoring and obstructive sleep apnoea, smoking and ‘vaping’ and hay fever.[vii]Older patients are more susceptible to xerostomia for a range of reasons and its impact on their oral health can be very serious at an advanced age.[viii]
Simple ideas for patients include checking their hydration levels, trying the tips for symptomatic relief, looking at their diet and taking control of other lifestyle choices that may be the cause. They should use oral hygiene products that are effective as well as gentle, including mouthwashes that are alcohol-free – recommend to them the TANDEX range.
Most importantly, encourage them to talkabout their dry mouth. Xerostomia without an obvious reason (such as cancer treatment) is rarely a sign of something serious, but maintaining a healthy salivary flow is important. Make your patient discussions comprehensive, full and frank and you can help them maintain optimal oral health as well as develop a great relationship between you both.
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References
[i]The Oral Cancer Foundation. Xerostomia. Link: https://oralcancerfoundation.org/complications/xerostomia/(accessed July 2019).
[ii]Baliga S, Muglikar S, Kale R. Salivary pH: A diagnostic biomarker. Journal of Indian Society of Periodontology. 2013 Jul;17(4): 461.
[iii]Journal of Indian Society of Periodontology. 2013 Jul;17(4): 461.
[iv]NICE. Treatment summary. Treatment of dry mouth. Overview. Link: https://bnf.nice.org.uk/treatment-summary/treatment-of-dry-mouth.html(accessed July 2019).
[v]Saini GK, Gupta ND, Prabhat KC. Drug addiction and periodontal diseases. Journal of Indian Society of Periodontology. 2013 Sep; 17(5): 5 87.
[vi]Robinson PG, Acquah S, Gibson B. Drug users: oral health-related attitudes and behaviours. British Dental Journal. 2005 Feb 26; 198 (4): 219-24.
[vii]NHS. Dry mouth, link: https://www.nhs.uk/conditions/dry-mouth/(accessed July 2019).
[viii]Ship JA, Pillemer SR, Baum BJ. Xerostomia and the geriatric patient. Journal of the American Geriatrics Society. 2002 Mar; 50 (3): 535-43.
Author: Kimberley Lloyd- Rees graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.
