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Treating Xerostomia Patients
Xerostomia
at a glance
Dryness of the mouth resulting from diminished
or arrested salivary secretion. Several factors,
both natural and induced, can lead to the
occurrence of xerostomia.
SYMPTOMS
• Lipstick on teeth caused by lack of salivary
function
• Thick, ropey, mucous-like saliva
• Dry mouth
• Sore, thick throats and difficulty talking
• Malodor or bad breath
• Candida albicans – fungus normally present on the
skin and in mucous membranes such as the vagina,
mouth, or rectum. Becomes an infectious agent
when there is some change in the body environment
that allows it to grow out of control
• Oral candidiasis (thrush) or vaginal candidiasis
(vaginitis) – fungal infection commonly referred to as
a yeast infection
BB: I also read on the Sjögren’s Syndrome Foundation website
that they estimate there are 4 million Sjögren’s patients out
there, and that 9 out of 10 are women —
CT: — who are post-menopausal. That’s right. I’ve been in
practice almost 31 years, and I would say about half of the
women in my practice, which would be about a third or
more of my practice, have a Sjögren’s type of symptom,
including sialoliths, which are salivary gland stones. Of
course, that can be checked out by sialography, and can be
dealt with in that respect.
BB: I read on the foundation’s website that, on average, it takes
seven years to be diagnosed with Sjögren’s. So as dentists serving
our patients, we can be on the forefront of diagnosis. If we have
patients who come in with dry mouth or dry eyes, those types
of things should be red flags that we should automatically pick
up on. Have you ever been the primary clinician spotting that?
CT: I have. I’ve told a patient that she may have Sjögren’s
syndrome, and she was tested and — boom! — she had
it. And one of the reasons is because a lot of the time, the
physician will not test for Sjögren’s specifically. But once
the patient tests positive for Sjögren’s, they can be treated
properly and not necessarily shotgunned with a whole lot
of drugs.
Smoking and chewing tobacco, especially, can hamper
salivary flow terribly. And, of course, smoking and chewing
isn’t good for the mouth anyway — you can develop cancer.
Another thing is snoring and wearing a sleep apnea
appliance. Of course that can be a yin and a yang: you want
to stop snoring so you wear an appliance, yet it can also
lead to salivary flow dysfunction.
BB: They’re breathing through their mouths all night, so
obviously there are going to be potential complications.
CT: That’s right. People with strokes can get it because they
lose their nervous input into the salivary glands. Also, Bell’s
palsy from the facial nerve can be a problem, as well as
other little palsies. So, neuromas and so on can cause issues
as well.
BB: You named off general categories of pharmaceuticals. Are
there particular drugs that, when you’re looking at a patient’s
chart, almost pop out at you as being related to xerostomia?
CT: Yes, especially antidepressants, anti-anxiety drugs:
ZOCOR ® (Merck & Co. Inc; Whitehouse Station, N.J.),
Xanax ® (Pfizer; New York, N.Y.) — you’ve got some of those
medications that you have to be careful with, especially if
the patient does have a lack of salivary flow. And if some
of the diagnostics include periodontal disease and caries,
along with the lack of the salivary flow, then we have to be
careful. A lot of times the patient can’t get off the meds, so
we have to do a sort of palliative treatment. Really, in the
last decade there has not been a lot of research in this area.
One of the reasons is that the scientists who want to do
research want to make money and get grants. Well, there’s
not a lot of money in salivary dysfunction. But there should
be because it affects a lot of things.
BB: I wanted to talk a little bit more about aging. It’s not
aging, per se, that can cause the potential for xerostomia. Can
you expand on that?
CT: Usually, aging has a tendency to go hand in hand with
patients’ limited health issues, and the medications they
may have to take regarding some of their health issues —
high blood pressure, for instance. Also, antihistamines and
decongestants, because people tend to get more allergic to
things as they get older. Another is anti-diuretics. People
become incontinent and sometimes have to be treated as
well. That seems to go hand in hand, but aging in itself is
not the criteria for salivary gland dysfunction.
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