This document discusses the management of patients with xerostomia (dry mouth) in prosthodontics. It defines xerostomia and lists its common causes such as medications, medical conditions, and radiation therapy. Signs and symptoms include dry mouth, mouth cracks, tongue burning, and taste alteration. Problems for denture patients include reduced retention and increased friction. Management involves symptomatic relief, addressing underlying causes, stimulating residual gland function, using saliva substitutes, encouraging hydration, and optimizing oral hygiene. Prosthodontic treatments aim to improve retention, stability, and comfort through techniques like using metal denture bases and soft liners. Frequent recalls are needed due to increased risk of denture

1. Guide : Prof. Dr. Sarita Joshi
Presented By
Dr. Anjana Maharjan
2nd Year Resident, NAMS
Management of Xerostomic
Patients in Prosthodontics

2. Xerostomia
Condition associated with both a decrease in the
amount of saliva produced and an alteration
in its chemical composition, therefore causing
dry mouth
“Xero”
Dry “Stomia”
Mouth

3. Medications with
anticholinergic activity
Psychiatric comorbidities
such as mood and anxiety
disorders
Medical comorbidities
such as HIV/AIDS,
diabetes, renal failure and
Sjögren’s syndrome
Radiation for head
and neck
malignancies
Causes

4. Signs/Symptoms
Dry mouth
Cracking at corners of mouth
Burning sensation on tongue
associated with fissuring of tongue
Alteration of taste

5. Problems encountered in denture
patients
 Retention in complete denture
 Increases frictional forces between
dentures and oral mucosa
 Prone to denture stomatitis

6. Management
Symptomatic
treatment
Address
underlying
causes
Stimulate
residual
gland
function
Saliva
substitutes
Encourage
oral
hydration
Optimize
oral hygiene

7. Symptomatic treatment

8. Address underlying causes
 Physician consultation
 Alter drug dosages
 Substitute medication causing xerostomia
 Control of systemic disorder

9. Stimulate residual gland function
 Sugarless gums (xylitol / sorbitol) and
candies
 Cholinergic agonists :
Pilocarpine
Cevimeline

10. Pilocarpine HCl
Dose : 5mg tid up to 90 days
Cevimeline HCl
Dose- 30mg tid up to 6 weeks

11. Johnson J T, Ferretti G A, Nethery W J, et al. Oral pilocarpine for post-irradiation
xerostomia in patients with head and neck cancer. New Eng J Med 1993; 329: 390-395
In the study done, 44% of patients reported
improved salivation while on a dose of 5.0 mg
Pilocarpine tid day

12. Saliva substitutes
 Glycerin and lemon
 Carboxymethyl cellulose
 Mucin
 Newer products with enzyme systems such
as lactoperoxidase, lysozyme, and glucose
oxidase

13. Commercial Salivary Substitute
Xerostom
 Basic ingredient - xylitol
 Available as toothpaste, mouthwash,
pastilles, oral spray and gum

14. Dry mouth GC
Basic ingredients:
 Polyglycerol
 Sodium citrate
Wet Mouth
Basic Ingredients:
 Glycrine
 Cellulose Gum

15. Biotene
Gums, Mouthwash and
Toothpaste
Oralbalance
Moisturizing gel

16. Epstein J B, Emerton S, Stevenson-Moore P. A double-blind crossover trial of Oral Balance
gel and Biotene toothpaste versus placebo in patients with xerostomia following
radiation therapy. Oral Oncol 1999; 35: 132-137
 Compared use of Oralbalance gel and
Biotene toothpaste against control of
carboxymethylcellulose gel and commercial
toothpaste
 Patients using Oralbalance and Biotene
reported these two products to be more
effective than the controls

17. Prosthodontic Management

18. Fixed Prosthodontics
In dry environment, fixed non tissue bearing
prosthesis are preferred where indicated
FPDs should have full coverage retainers and
easily cleaned pontics and connectors
Margins of retainers should be supragingival

19. Health of residual teeth and periodontal tissues
Use of gingivally approching clasp avoided
Tooth supported denture with minimal tissue
coverage
Metal denture bases are preferred
Removable Partial denture

20. Complete denture
Procedures -aim at optimizing retention and
stability
Use dentures with metal bases
Use of soft liners to improve comfort
Use of denture adhesives to augment retention
Frequent recall – As more prone to candidal
infections

21. Saliva Reservoir-Technique
Upadhyay R, Kumar L, and Rao J, Fabrication of a functional palatal saliva reservoir
by using a resilient liner during processing of a complete denture, JPD
2012;108:332-335

23. Encourage oral hydration
 Humidifiers, especially during sleep

24. Optimize oral hygiene
Biotène Dry Mouth Toothpaste
contains salivary enzymes
Antimicrobial mouthwashes
(alcohol-free)

25. Conclusion
 Clinicians should be aware of the signs and
symptoms, diagnostic procedures, etiologies,
sequelae and appropriate therapeutic
regimens
 Effective evaluation and appropriate
treatment will promote acceptable levels of
comfort and function

26. Acknowledgement
Prof. Dr. Sarita Joshi
Coordinator, Prosthodontics
NAMS, Bir Hospital
Asst . Prof. Dr. Pramod Raj Joshi
Asst. Prof. Dr. Siddartha Dixit
Asst. Prof .Dr . Dipak Thapa
Residents of NAMS