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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. 76 – www.inclusivemagazine.com –
BB: For the sake of our audience, can you do a quick anatomy review? CT: Absolutely. We’re just going to go through three major sets of salivary glands surrounding the mouth. The first set we’ll talk about is the parotid glands. There is one large parotid gland on either side, usually located just below the zygomatic arch, and just outside of the coronoid process of the mandible. The parotid duct goes into the molar area, where sometimes patients bite. It’s that duct that goes into the mouth with their molars, and it’s on either side. The second set of salivary glands are the sublingual glands. They go just posterior to the synthesis of the mandible. You can see the sublingual fossa, sometimes called clefts. And this is where the salivary glands are housed. A Wharton’s duct comes right into the floor of the mouth, and that’s where sometimes when you’re doing dentistry you occasionally get spit on. Anatomical view of the parotid gland Courtesy of Primal Pictures Ltd. www.primalpictures.com Anatomical view of the sublingual gland Courtesy of Primal Pictures Ltd. www.primalpictures.com Anatomical view of the parotid duct Courtesy of Primal Pictures Ltd. www.primalpictures.com Anatomical view of the submandibular gland Courtesy of Primal Pictures Ltd. www.primalpictures.com – Treating Xerostomia Patients: A Clinical Conversation with Dr. Christopher Travis – 77
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Inclusive Restorative Driven Implan
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Contents 19 Restoring Mandibular Si
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Publisher Jim Glidewell, CDT Editor
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Contributors ■ Bradley C. Bockhor
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Trends in Implant Dentistry Average
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my first implant with Jack A. Hahn,
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The House that Jack Built Inspired
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Hygienist’s Corner A Probing Ques
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Probe using only 0.15 Ncm of pressu
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Restoring Mandibular Single Teeth w
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Figure 4: Cross-sectional view of p
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Figure 13: Seated provisional resto
Page 27 and 28: Figures 26a, 26b: Acrylic abutment
Page 29 and 30: IMPLANT POSITION IN THE ESTHETIC ZO
Page 31 and 32: type of connection between implant,
Page 33 and 34: SMALL DIAMETER implants Planning fr
Page 35: Mandibular Spacing Maxillary Spacin
Page 38: used before the patient even presen
Page 42 and 43: BB: Sounds like it’s a truly inte
Page 44 and 45: Figure 6: Double-cord tissue retrac
Page 46: It’s a great time to be in dentis
Page 51 and 52: CLINICAL TIP Go online for in-depth
Page 53 and 54: 5a Figures 5a, 5b: A new bite regis
Page 55 and 56: Photo Essay: Immediate and Post-Pla
Page 57 and 58: 4a On the day of surgery, the risks
Page 59 and 60: With the implant securely hand-thre
Page 61: Case #2: Post-Placement Utilization
Page 65 and 66: 7a Once an appropriate osseointegra
Page 67 and 68: CLINICAL TIP When a Flapless Approa
Page 69 and 70: LAB SENSE Go online for in-depth co
Page 71 and 72: Digitally (CAD) Designed vs. Waxed
Page 73 and 74: mitigate the painful and disruptive
Page 77: Go online for in-depth content Trea
Page 81 and 82: A lot of times, having the prosthes
Page 83 and 84: the time, and then I will prescribe
Page 85 and 86: Go online for in-depth content Crea
Page 87 and 88: Figure 3: In2Guide surgical guide c
Page 89 and 90: Figure 13: Implants torqued to full
Page 91 and 92: Figure 22: Teflon plumber’s tape
Page 93 and 94: “Rules of 10” Guidelines for Su
Page 95 and 96: Some added concern is focused on th
Page 97 and 98: The all-on-four concept generally r
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