Xerostomia affects up to 65% of the population, according to the American Academy of Oral Medicine.1 Many patients might experience dry mouth and accept it as a part of their life without seeking treatment or mentioning it to a health-care professional. It is important to recognize the signs of xerostomia to help reduce patients' symptoms and prevent the consequences it carries.
Xerostomia is the reduction of salivary flow. The majority of saliva is produced by the parotid gland, followed by the lingual and submandibular glands. Saliva plays multiple roles in the oral cavity. It carries enzymes to help us digest food. It moistens food to create a bolus for easy passage through the esophagus. It also carries buffering agents to neutralize the pH of the oral environment, which can help prevent demineralization of tooth structure and caries lesions. It protects the oral mucosa and tongue from irritants such as bacteria and fungus. Lastly, it cleanses the teeth of small food particles.1
Hyposalivation is associated with many factors. According to the American Dental Association, more than 400 medications cause dry mouth as a side effect.2 The most well-known prescriptions to cause dry mouth are antipsychotics, anticonvulsants, bronchodilators, and certain hypertension medications.2 Other factors contributing to low saliva flow are aging, smoking, radiation therapy to the neck and head, and some diseases and conditions such as HIV/AIDS, diabetes, rheumatoid arthritis, thyroid dysfunctions, and Sjögren’s syndrome, just to mention a few.2
Oral manifestations of xerostomia include dry or chapped lips, mouth sores, fissured tongue and mucosa, salivary threads while talking, enamel erosion, and rampant caries. Symptoms described by patients are a burning or tingling sensation of the mucosa and tongue, difficulty swallowing dry foods, bad breath, altered taste buds, thirst, and cotton mouth.3
Once you have reviewed a patient's medical history and medication list, there are many products you can recommend. To start off, a wide variety of over-the-counter medications can treat the symptoms of xerostomia. The most popular brands are Biotene (GSK), Act, Colgate, and TheraBreath, and they are available as mouthwashes, lozenges, xylitol mints and gums, gels, and sprays. Most over-the-counter products help to stimulate salivary flow or are used as a saliva substitute. These are typically used as needed throughout the day.
Prescription saliva substitutes, such as Caphosol (Eusa Pharma), NeutraSal (OraPharma), and SalivaMax (Forward Science), are available as well. The FDA has approved two systemic medications that need to be prescribed by a medical professional.2 One of them is pilocarpine, known by its brand name Salagen, which is a tablet to treat oral dryness associated with radiation therapy. The second is cevimeline, also known by its brand name Evoxac, a pill used to treat oral dryness associated with Sjögren’s syndrome. The newest prescription spray available on the market is 3M Xerostomia Relief Spray, which is the only lipid-based solution that coats the mucosa, throat, and tongue to prevent water loss and restore elasticity. All medications, both over-the-counter and prescription, should be taken with caution, as they may have their own side effects and contraindications.
Patients should be encouraged to receive an in-office application of 5% fluoride varnish. Home care should include a prescription-strength fluoride toothpaste, such as Colgate Prevident 5000 or 3M Clinpro 5000. GC America also offers two at-home treatments: GC Dry Mouth Gel to lessen symptoms and MI Paste to be applied as a topical tooth cream after brushing and flossing. MI Paste contains calcium, phosphate, and fluoride to remineralize teeth. A formula without fluoride is also available. Other recommendations you can make include using lip balm, sipping on water or licking ice cubes, and avoiding tobacco, alcohol, and salty or spicy foods.3
Dental professionals should keep an eye out for dry mouth signs as a preventive measure and guide patients through the many options available to reduce their symptoms. Over-the-counter medications might not be a cookie-cutter solution for everyone, and some trial and error might be necessary for patients to find the best product to treat their symptoms without causing any additional side effects.
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References
- Sankar V, Rhodus N; AAOM Web Writing Group. Xerostomia. American Academy of Oral Medicine website. https://www.aaom.com/index.php%3Foption=com_content&view=article&id=107:xerostomia&catid=22:patient-condition-information&Itemid=120. Updated October 15, 2015.
- Center for Scientific Information; American Dental Association Science Institute. Xerostomia (Dry Mouth). American Dental Association website. https://www.ada.org/en/member-center/oral-health-topics/xerostomia. Updated August 27, 2018.
- Sankar V, Rhodus N; AAOM Web Writing Group. Dry Mouth. American Academy of Oral Medicine website. https://www.aaom.com/dry-mouth. Updated October 15, 2015.
Jennifer Pettit, CRDH, is a full-time dental hygienist at HQ Dontics, a prosthodontics office in Miami, Florida. She graduated from Miami Dade College in 2010 and has always had a passion for dental health. She takes pride in educating patients to prevent disease and finding the best solutions to suit their needs.
