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Treating Xerostomia Patients
HABITS/CONDITIONS that can
INHIBIT salivary flow
• Smoking
• Chewing tobacco
• Wearing sleep apnea appliances
• Postmenopausal stage of life (women)
• Aging
DRUGS THAT CAN INHIBIT
SALIVARY FLOW
• Over-the-counter medications – antihistamines,
decongestants, anti-diuretics
• Prescription medications for anxiety or depression,
cancer therapy, radiation therapy
• Antiviral drugs for HIV
Trevose, Pa.) or something similar, to get rid of it, because
it’s a continuous infective condition, and it’s a tough call.
BB: What are some of the complications patients suffer through
when they have dry mouth or xerostomia?
CT: Oh, it makes it very difficult. They can’t eat very well.
The complications are systemic in nature, sometimes — they
don’t want to eat because they can’t, and they can’t chew
their food well. It’s the first stage of digestion, so these
people have systemic problems from eating improperly.
They have problems wearing dentures — sometimes they
can’t wear them at all. Of course other complications are
periodontal disease or cervical caries that have to be treated
in a little different fashion.
Many times, as I said previously, the patient with complications
can get candida albicans, or candidiasis, which
makes it very difficult to wear dentures. And then the
tongue can get very painful and enlarged. Sometimes the
taste buds on the tongue don’t perform properly and don’t
give off a good taste. Those types of complications can
come about, and you need to be familiar with those so you
can symptomatically treat them, if possible.
BB: Earlier we were talking about dry mouth caused by sleep
apnea appliances, but can dry mouth also exacerbate this?
CT: It can. The tongue has the tendency to get sticky, so it
will stick to the soft palate of the throat and keep people
from breathing properly through their nose. They start
snoring, and might actually stop breathing for a certain
period of time. That’s when the sleep apnea symptoms start.
BB: We’ve talked about the causes and the complications. How
are you treating the xerostomia patients in your practice?
CT: Initially we start with palliative treatment. We want
them to brush their teeth and floss properly — make sure
everything is really clean. Fluoride pastes like PreviDent
are very important to keep caries down to a minimum.
Another thing is to be able to buy products like Biotène ®
(GlaxoSmithKline; Philadelphia, Pa.) or Spry ® (Xlear; Orem,
Utah), or Thayers ® Dry Mouth Spray (Thayers; Westport,
Conn.), or any of those products that contain carboxymethyl
cellulose. It allows a sort of lubrication in the mouth. I
really like using Biotène in my practice. Also, Omni used to
have TheraSpray. It’s the same kind of product, containing
carboxymethyl cellulose that allows for more lubrication in
the mouth, and actually helps in caries prevention as well.
Other products can be a little bit more gutsy — you can
take medications like pilocarpine, or cevimeline, which is a
cholinergic agonist, and those medications can help create
more saliva flow. However, they do have side effects. Other
salivary-stimulating drugs would be anetholtrithione. It’s a
good drug, but it has the tendency to cause flatulence. So
you’ve got to watch that; the side effects are not necessarily
pleasant. But I like some of those, and I will go ahead and
prescribe a pilocarpine every once in a while if indicated. We
have to know what kind of medical history a given patient
has, because if the patient has glaucoma, for example, you
certainly don’t want to give them pilocarpine because that
could exacerbate their problem.
BB: You’ve named off some over-the-counter-products, sprays,
and lozenges, and you’ve gone into pharmaceuticals. So maybe
you can go into more specifics regarding the over-the-counter
products. When you’re prescribing these to your patients, what
instructions are you giving them?
CT: I usually go PRN, because if you buy the Thayers
products or the Spry or the Salese (Nuvora; Santa Clara,
Calif.) or the Biotène — and I like Biotène — I just tell
them, “Take it with you in your purse” — they’re mainly
women. They can of course brush their teeth at home with
all of the salivary stimulating products, but I like them to
use them as needed. If they start feeling a dry mouth, then
they can go ahead and spray their mouth. Maybe before
lunch, maybe before breakfast and before dinner they can
use the products — and at bedtime.
BB: OK, those are the artificial salivas. How often are you
actually prescribing pharmaceuticals?
CT: Not as often as I do the palliative agents for nonprescription
drugs. Again, pilocarpine and cevimeline do
have side effects so you have to be careful with respect to
the health history of the patient. And I might do that for a
patient who just has no saliva, cannot eat, and is in pain all
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