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XEROSTOMIA Xerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva.
XEROSTOMIA
It affects 17-29% of samples populations based on self-reports or measurements of salivary flow rates. More prevalent in women. Can cause significant morbidity and a reduction in a patients perception of quality of life.
SALIVA
It keeps the teeth healthy by providing a lubricant, calcium and a buffer. It also helps to maintain the health of the gums, oral tissues (mucosa) and throat. It also plays a role in the control of bacteria in the mouth.
% Population
unstimulated stimulated
20-39 yr
40-59 yr
Age
> 60 yr
major and minor salivary glands which may lead to atrophy of the secretory components and results in varying degrees of temporary or permanent xerostomia.
chemotherapeutic agents.
Toxic substanaces in
Diabetes mellitus:
Patients with poor glycemic control, are more likely to complain of xerostomia and may have decreased salivary flow.
Other Conditions
Anxiety or Depression HIV Diabetes, Type 1 or 2 AIDS Primary Biliary Cirrhosis Bone Marrow Transplantation Vasculitis Graft-vs.-Host Disease Chronic Active Hepatitis Renal Dialysis
Moderate Xerostomia
3.
4. Problems eating and swallowing food 5. Difficulty with speech due to mouth soreness. 6. Increased caries and periodontal disease
Diagnosis of Xerostomia
1. Does your mouth usually feel dry? 2. Does your mouth feel dry when eating a meal? 3. Do you have difficulty swallowing dry food? 4. Do you sip liquids to aid in swallowing dry food?
5. Is the amount of saliva in your mouth too little most of the time, or dont you notice it? When unstimulated salivary flow is less than 0.12 to 0.16 ml/minute, a diagnosis of hypofunction is established.
MANAGEMENT
Symptomatic Treatments:
Sip water frequently all day long Let ice melt in the mouth Restrict caffeine intake Avoid mouth rinses containing alcohol Humidify sleeping area Coat lips with lubricant.
Coat the lips with a petroleum jelly like Vaseline, Blistex, or lanolin. Maintain good oral hygiene. Floss daily. Brush at least twice a day. Use toothpaste with fluoride and alcohol free (e.g. Biotene toothpaste).
Avoid Tobacco use, spicy, salty, and highly acidic foods that irritate the mouth.
Saliva Substitutes:
Rx:
Sodium carboxymethyl cellulose* 0.5% aqueous solution [OTC]
Disp: 8 fl. Oz. Sig: Use as a rinse as frequently as needed.
Saliva Stimulants:
The use of sugar free gum, lemon drops or mints are conservative methods to temporarily stimulate salivary flow in patients with medication xerostomia or with salivary gland dysfunction.
Rx:
Biotine chewing gum [OTC]
Disp: 1 package
Sig: Chew as needed. Due to problems of abrasion of the mucosa under the denture and potential adhesion of the gum to the denture, use caution if the patient has removable dentures.
Rx:
Pilocarpine HCl (Salagen) Tablets 5 mg Disp: 21 tablets
Sig: Take 1 tablet tid 1/2 hour prior to meals. Dose may be titrated to 2 tablets tid.
Some authors recommend using 1 tablet of pilocarpine 4-5 times daily.
Rx:
Pilocarpine HCL solution
1 mg/ml
Disp: 100 ml
Pilocarpin HCl
May need 2-3 months to determine effectiveness. Side effects include sweating and diarrhea. Avoid in patients with narrow angle glaucoma, severe asthma, pulmonary diseases.
Rx:
Cevimeline (Evoxac) Capsules 30 mg
Disp: 21 tablets
Sig: Take 1 tablet tid.
Rx:
Bethanechol (Urecholine) tablets 25 mg
Disp: 30 tablets
Sig: Take 1 tablet up to 5 times daily.
Appearances:
Changing pattern of erythematous patches on the tongue dorsum caused by atrophy of the filiform papillae.
Geographic Tongue
Hairy Tongue
Etiology:
Antibiotics Tobacco Chlorhexidine Food debris Oral candidiasis
Hairy Tongue
Treatment:
Proper oral hygiene and tongue brushing. If a fungal infection is suspected, perform a fungal culture and use topical antifungal.
Fissured Tongue
Etiology:
Unknown Appearance: Numerous small furrows and fissures on the dorsum of the tongue. May be attributed to trauma, vitamin deficiencies, salivary gland dysfunction.
Nutritional Deficiencies
Etiology
Vitamin B1, B2, B6, B12 and folic acid deficiency.
Appearance
Loss of filiform papillae produce a painful erythematous and granular appearing tongue. Eventually papillae atrophy leaving a smooth/bald tongue.