dental management with dry mouth

1. Xerostomia
Prepared by : Mhamad rostam

2. What is xerostomia ?
Xerostomia is defined as dry mouth resulting
from reduced or absent saliva flow.
Xerostomia is not a disease, but it may be a
symptom of various medical conditions
xerostomia
It may or may not be associated with
decreased salivary gland function. Xerostomia
is a common complaint found often among
older adults, affecting approximately 20
percent of the elderly. However, xerotomia
does not appear to be related to age itself as
much as to the potential for elderly to be taking
medications that cause xerostomia as a side
effect.

3. Salivary gland
Saliva in the mouth is a biofluid
produced mainly by three pairs of
major salivary glands--the
submandibular, parotid and
sublingual glands--along with
secretions from many minor
submucosal salivary glands

4. Parotid gland
Major source when eating
Serous acini only
Submandibular gland
The most responsible when no stimuli
Serous (primarily) + mucous acini
Sublingual gland
Only 2-3% of saliva
mucous (primarily) + serous

5. Saliva is the viscous, clear, watery fluid secreted from the parotid,
submandibular , sublingual and smaller mucous glands of the
mouth. Saliva contains two major types of protein secretions, a
serous secretion containing the digestive enzyme ptyalin and a
mucous secretion containing the lubricating aid mucin.The pH of
saliva falls between 6 and 7.4. Saliva also contains large amounts
of potassium and bicarbonate ions, and to a lesser extent sodium
and chloride ions. In addition, saliva contains several antimicrobial
constituents, including thiocyanate, lysozyme, immunoglobulins,
lactoferrin and transferrin
Salivary component

7. Saliva possesses many important functions including:
antimicrobial activity
mechanical cleansing action
control of pH
removal of food debris from the oral cavity,
lubrication of the oral cavity
remineralization and maintaining the integrity of the oral mucosa
Functions of saliva

8. Xerostomia is often a contributing factor for both minor and serious health problems.
It can affect nutrition and dental, as well as psychological, health. Some common
problems associated with xerostomia include a constant sore throat, burning
sensation, difficulty speaking and swallowing, hoarseness and/or dry nasal passages.1
Xerostomia is an original hidden cause of gum disease and tooth loss in three out of
every 10 adults.11 If left untreated, xerostomia decreases the oral pH and significantly
increases the development of plaque and dental caries.Oral candidiasis is one of the
most common oral infections seen in association with xerostomia.
Complications of Xerostomia

9. Oral dryness (most common)
Halitosis
Burning sensation
Loss of sense of taste or
Abnormal taste
Difficulty in swallowing
Tongue tends to stick to the
palate
Decreased retention of denture
Symptoms

10. Signs
Mucosa: dry or glossy
Duct orifices: viscous and opaque saliva
Tongue:
glossitis  fissured  red with
papilla atrophy
Angular cheilitis
Rampant caries:
Periodontitis
Candidiasis

11. Aging
Foods & drugs
Systemic factors
Radiotherapy
Sjogren’s syndrome
Other salivary gland diseases
Etiology

12. more frequent in women.
Acinar tissue was replaced by fat
and connective tissue.
,
When become elder, mucin
secretion increase.
Aging

13. Foods:
alcohol, coffee, smoke
Drugs:
Anti-depressants
Anti-histamine
Anti-cholinergic
sympathomimetic drugs
Anti-inflammatory
Foods & drugs

14. Sjogren’s Syndrome
(autoimmune disease)
Uncontrolled diabetes and
hypertension
Parkinson’s Disease
use
Mouth breathing
Systemic factors:

15. Oral, tonsil, and throat cancer
treatments often require large
concentrated doses of radiation
to shrink the tumors.
Radiation

16. Diagnosis
History Symptoms
SFR Labial biopsy
Sialography

17. Dietary:
Avoid drugs that may produce xerostomia
Avoid dry & bulky foods
High fluid intake & rinsing with water
Avoid alcohol, smoking and sugar
Take protein and vitamin supplements
Environment:
Maintain optimal air humidity in the home
UseVaseline to protect the lips
Management

18. Prescribe medication that stimulates saliva.Your doctor may prescribe
pilocarpine (Salagen) or cevimeline (Evoxac) to stimulate saliva production
Products that help Sugar free gum -We recommend chewing four sticks per day
for 10 minutes each
. XylimeltsThese are small tablet that you put on your gum.They stimulate gums
to produce saliva.
Biotine Rinse - Use Biotine up to 5 times a day. BiotineToothpaste, Gels, Sprays
These contain lubricants that help keep your mouth moist
MEDICATION

19. Advise the patient to undergo a topical fluoride application and to rinse
their mouth after eating to avoid caries. Patients should be aware that
xerostomia is a lifelong condition and that they should maintain good
oral hygiene. And tooth brashing
Advice

20. Thank you