Jackie Whiteley discusses the impact of dry mouth and how the dental team can help.
As dental professionals, we see how coping with oral health complications can severely impact our patients physically, mentally and emotionally.
There are some conditions we see on an almost daily basis and can easily spot and manage, including dental erosion, tooth sensitivity and root surface caries. However, there is one that doesn’t always get the attention it deserves – xerostomia.
Xerostomia (dry mouth) is a common condition thought to affect at least one in four of the population, with an overall prevalence of 40 per cent in the over-65 age group. However, we are seeing a higher incidence of the condition in young people due to an increase in medications for conditions such as depressions and anxiety. With the impact of Covid-19, we are also seeing more patients with dry or sensitive mouths due to mask wearing, stress, anxiety or recovery from covid. This makes it all the more important for us as a dental team to help identify and manage dry mouth in our patients.
According to the Oralieve Dry Mouth Sufferers Survey, April 2020, over one third of sufferers have never been diagnosed by a healthcare or dental professional, and over 75 per cent of sufferers have experienced mental exhaustion and frustration from coping with dry mouth. This condition is causing huge mental health impacts, but we can help play a role in supporting our patients.
Dental professionals can make a huge difference to the lives of dry mouth sufferers by:
- Identifying and risk assessing patients who could be predisposed to the condition
- Recognising the condition clinically – it can be a symptom of a serious systemic disease
- Advising patients on management of their dry mouth
- Offering a referral service for severely affected patients and for those that require further testing
Patient descriptions
When I ask patients if they have a dry mouth, they often report the following:
- Lipstick sticking to their front teeth
- Bad breath
- Waking up with their tongue stuck to the roof of their mouth
- Waking up in the night with such a severe thirst that water alone does not ease it
- Dysphagia (difficulty swallowing)
Empathising with our patients is crucial, as they can become very despondent with the condition. Consider what the patient is experiencing and what they are finding the most distressing – dry mouth can affect quality of life significantly!
How do we know if our patients suffer from a dry mouth? We can ask them:
- Does your mouth usually feel dry?
- Do you regularly do things to keep your mouth moist?
- Do you get out of bed at night to drink fluids?
- Does your mouth usually become dry when you speak?
Answering ‘yes’ to these four questions has been clinically validated to identify 75 per cent of all dry mouth sufferers.
As dental professionals, we should make checking for dry mouth a priority, since many patients will not mention it and the condition can go undiagnosed, leading to higher risk of dental problems.
Medical history
When taking a medical history, look for polypharmacy (especially those taking more than three medications with dry mouth listed as a side effect).
There are over 500 OTC and prescribed medications that list dry mouth as a potential side effect, we need to be aware of these and ask these patients if they have a dry mouth!
Clinical diagnosis
During your intraoral examination (ideally done with a pen torch or decent light on loupes), you should look for:
- Mouth mirror sticking to the tissues, not easily peeled away
- Sticky, stringy, frothy or viscous saliva
- Red and dry tissues, cracked and rough tongue, angular chelitis, ulceration or oral thrush, or a glossy red tongue
- No saliva pooling in the floor of the mouth
- Unexplained caries especially at the gingival margin or on the root surfaces, cervical caries affecting more than two teeth
- Unexplained, unusual, or rapid onset periodontal disease
- Pale gums or white tongue (thrush)
- Cracked fissured tongue
- Chapped or cracked lips
- Hoarseness of voice
- Altered taste
Management
- Identify dry mouth and educate patients to the potential impact of a reduced saliva flow
- Recommend GP-prescribed saliva stimulants to improve saliva flow
- Recommend saliva replacement to aid comfort and manage symptoms
- Oral hygiene instruction, regular monitoring and use of topical fluoride to help prevent further oral damage
- Treat any underlying infection such as oral thrush with antifungal pastilles or gels
- Role of medication – encourage speaking with GP/pharmacist to discuss alternatives and dose
- Referral to oral medicine or ENT and/or for Sjögren’s testing and so on
What should patients look for in a saliva replacement product?
- Fluoride content is at least 1350ppm
- Reproduces enzyme system found in saliva, is antibacterial
- Contains xylitol
- Long-lasting relief especially overnight
- Available on prescription
- Convenient to use
- Alcohol-free
- SLS-free to prevent irritation and burning
- Mild and pleasant in flavour to freshen breath whilst being non-irritating
Dry mouth can have a significant and prolonged physical and psychological impact on patients. It is so important that we help identify, manage and treat their condition through education and support.
References available on request.