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DIAGNOSIS AND MANAGEMENT OF XEROSTOMIA IN THE ELDERLY PATIENT. Salivary Gland Dysfunction and Xerostomia (Dry Mouth). 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

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slide1

DIAGNOSIS AND MANAGEMENT

OF XEROSTOMIA IN THE

ELDERLY PATIENT

slide4
XEROSTOMIA
  • Xerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva.
slide5

XEROSTOMIA

  • It affects17-29%of samples populations based on self-reports or measurements of salivary flow rates.
  • More prevalent inwomen.
  • Can cause significant morbidity and a reduction in a patient’s perception ofquality of life.
saliva
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 controlof bacteria in the mouth.
slide7

It helps to cleanse the mouth of food and debris.

  • It provides minerals such as calcium, fluoride, and phosphorus.
  • It helps in swallowing anddigesting food.
slide12

Antimicrobial Factors in Human Whole Saliva

Non-immunoglobulin FactorsOrigin

Lysozyme Salivary glands, crevicular fluid (PMNs)

Lactoferrin Salivary glands, crevicular fluid (PMNs)

Salivary peroxidase Salivary glands

SCN- Salivary glands, crevicular fluid

H2O2 Salivary glands, crevicular fluid (PMNs),

bacterial and yeast cells

Myeloperoxidase Crevicular fluid (PMNs)

Cl- Salivary glands, crevicular fluid

Agglutinins, aggregating proteins Salivary glands

Histidine-rich polypeptides Salivary glands

Proline-rich proteins Salivary glands

Immunoglobulin Factors

Secretory IgA Salivary glands

IgA, IgG, IgM Crevicular fluid

slide13

Ionizing radiation can injure the major and minor salivary glands which may lead to atrophy of the secretory components and results in varying degrees of temporary or permanent xerostomia.

  • Toxic substanaces in chemotherapeutic agents.
slide14
Diabetes mellitus: Patients with poor glycemic control, are more likely to complain of xerostomia and may have decreased salivary flow.
slide17
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
salivary gland dysfunction and xerostomia
Salivary Gland Dysfunction and Xerostomia
  • Clinical Appearance:
    • Oral mucosa appears dry, pale, or atrophic.
    • Tongue may be devoid of papillae with fissured and inflamed appearance.
    • New and recurrent dental caries.
    • Difficulty with chewing, swallowing, and tasting may occur.
    • Fungal infections are common.
slide21
Warning Signs in

Xerostomia

1. Dry, burning mouth and throat

  • Dry, cracking lips, especially in the corners. The cracks may be tender and/or bleed
  • Problems with denture wearing
slide22
Problems eating and swallowing food
  • Difficulty with speech due to mouth soreness.

6. Increased caries and periodontal disease

slide23
Diagnosis of Xerostomia
  • It has been estimated that a 50% reduction in salivary secretion needs to occur before the xerostomia becomes apparent.
      • An affirmative response to at leastone of the fivefollowing questions about symptoms has been shown to correlate with a decrease in salivary flow:
slide24

1. Does your mouth usually feel dry?

2. Does your mouth feel dry when eating a meal?

  • Do you have difficulty swallowing dry food?
  • Do you sip liquids to aid in swallowing dry food?
slide25

5. Is the amount of saliva in your mouth too little most

of the time, or don’t you notice it?

  • When unstimulated salivary flow is less than0.12 to 0.16 ml/minute,a diagnosis of hypofunction is established.
slide26
MANAGEMENT
  • The general approach to treating patients with hyposalivation and xerostomia is directed atpalliative treatment for the relief of symptoms and prevention of oral complications:
slide27

Consult with physicianto decrease drug dose, alter drug dosages, or substitute one xerostomic medication for a similar-acting drug with fewer salivary side effects.

slide28
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.
slide29

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 andalcohol free (e.g. Biotene toothpaste).
slide31

Saliva Substitutes:

Rx:

Sodium carboxymethyl cellulose* 0.5% aqueous solution [OTC]

Disp: 8 fl. Oz.

Sig: Use as a rinse as frequently as needed.

*Generic carboxymethyl cellulose solutions may be prepared by a pharmacist.

commercial salivary substitute
Commercial Salivary Substitute
  • Commercial oral moisturizing gels (OTC) includes:
  • OralBalance.
  • XERO-Lube
  • Salivart
  • Moi-Stir Orex
  • Optimoist
oral balance ingredients
Oral Balance Ingredients
  • Polyglycerylmethacrylate

(moisturizing agent)

  • Lactoperoxidase (antibacterial)
  • Glucose Oxidase (antibacterial)
  • Lysozyme (antibacterial)
slide37

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.

slide38

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.

slide39

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.

slide40

Rx:

Pilocarpine HCL solution

1 mg/ml

Disp: 100 ml

Sig: Take 1 teaspoonful tid.

pilocarpin hcl
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.
slide42

Rx:

Cevimeline (Evoxac) Capsules 30 mg

Disp: 21 tablets

Sig: Take 1 tablet tid.

slide43

Rx:

Bethanechol (Urecholine) tablets 25 mg

Disp: 30 tablets

Sig: Take 1 tablet up to 5 times daily.

conditions affecting the tongue45
Conditions Affecting the Tongue
  • Geographic tongue
  • Hairy tongue
  • Fissured tongue
  • Varices
  • Vitamin deficiencies
benign migratory glossitis geographic tongue
Benign Migratory Glossitis (Geographic tongue)
  • Etiology:
    • Unknown
    • May be associated with psoriasis and Reiter’s syndrome.
  • Appearances:
    • Changing pattern of erythematous patches on the tongue dorsum caused by atrophy of the filiform papillae.
hairy tongue
Hairy Tongue
  • Etiology:
    • Antibiotics
    • Tobacco
    • Chlorhexidine
    • Food debris
    • Oral candidiasis
hairy tongue53
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
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
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.