Xerostomia linked to use of multiple medications

Approximately ninety-one percent of dentists say patients complaining about dry mouth are taking multiple medications, according to a nationwide member survey conducted by the Academy of General Dentistry (AGD).

Dry mouth, or xerostomia, is caused by a decrease in salivary function. It affects approximately one in four Americans, placing more than 25 percent of people at risk for tooth decay. During the Academy of General Dentistry's (AGD) 57th Annual Meeting & Exhibits in Baltimore, July 8-12, Cindy Kleiman, RDH, BS, will present a course, "Understanding the Oral-Systemic Connection: From Intensive Care to Long-term Care", in which she presents new information about dry mouth.

"The number of xerostomia cases has increased greatly over time because people are taking more and more medications," said Kleinman. "General dentists are seeing this trend in their offices, which is why they are trying to learn all they can about this condition. The more they know, the better they will be at diagnosing and treating patients."

There are more than 400 prescription and non-prescription drugs associated with xerostomia, according to Raymond K. Martin, DDS, MAGD. "Anti-depressants, painkillers, diuretics, antihistamines, tranquilizers and anti-hypersensitives can all contribute to dry mouth," said Dr. Martin. "People who take several of these medications are more susceptible."

As indicated by the AGD survey, the most common symptoms reported by patients include constant thirst and difficulty eating, swallowing, or speaking. Foamy or stringy saliva, irritation of the tongue, burning of the tissues inside the mouth, painful ulcerations and dentin hypersensitivity (extreme sensitivity in one or more teeth) are also dry mouth symptoms. Over time, xerostomia sufferers may experience extensive tooth decay, tooth loss or gingivitis (gum disease) due to the lack of saliva.

Out of the nearly 500 general dentists who responded, 89 percent believe prescription medications are the primary contributor to dry mouth. Aging, dehydration and salivary gland disease were also cited as major contributors. The survey of AGD members also revealed that:

• Approximately two-thirds consider dry mouth to be a very serious condition, as it relates to the promotion of tooth decay;
• Approximately 68 percent say constant thirst is the most common symptom communicated by patients; 44 percent say patients have difficulty eating, swallowing or speaking;
• More than 92 percent report that patients attempt to increase salivary production by drinking water; less than 58 percent say patients try taking over-the-counter saliva substitutes, chewing sugar free gum, or sucking on hard candy; and
• More than 60 percent of those surveyed consider diagnosing a patient with xerostomia after he or she exhibits or reports symptoms of dry mouth.

Xerostomia can be a side effect of a variety of diseases and medical conditions, including HIV/AIDS, Alzheimer's disease, Sjögren's syndrome, anemia, rheumatoid arthritis, hypertension, diabetes, Parkinson's disease, cystic fibrosis, stroke and mumps. Certain cancer treatments, nerve damage, dehydration, smoking and chewing tobacco have also been connected with dry mouth.

"It's not always easy to diagnose xerostomia because of the subjective nature of the condition," said Gigi Meinecke, DMD, FAGD. "That is why it's so important for patients to discuss symptoms with their dentist, even if they do not experience them on the day of the office visit."

The AGD reports a number of actions dry mouth sufferers can take to alleviate the condition:

• Brush and floss twice a day
• Chew sugarless gum or suck on non-citrus flavored or sour sugarless candy
• Drink plenty of water
• Brush with a fluoride toothpaste to protect your teeth
• Use over-the-counter saliva substitutes
• Avoid alcohol and caffeine
• Avoid smoking
• Avoid overly salty foods
• Avoid citrus juices (e.g., orange, grapefruit, tomato)
• Avoid dry foods (e.g., toast, crackers)
• Breathe through your nose instead of your mouth as often as possible
• Use moisturizer regularly on your lips
• Sleep with a humidifier in your room to add moisture to the air
• Visit your dentist regularly