In recent years, have you seen an increase in the numbers of your patients who suffer from dry mouth?
In the past, head and neck radiation was considered to be the most common cause of xerostomia. In recent years, however, medications have become the most common cause, especially among the geriatric population. They include cardiovascular medications, antidepressants, sedatives, central analgesics, anti-Parkinson’s medications, anti-allergy medications and antacids.
When asked if they’ve noticed an increase in the number the patients who have xerostomia, 87 percent of respondents to August JADA’s question of the month said they have. A few readers mentioned they had seen increases of 15 to 35 percent over the past couple of years. "I’m not sure [whether] the incidence is greater or my awareness is heightened and my observation frequency has increased," said another.
"This is a significant and understated problem," said a reader. "People who have it are quietly tolerating it."
Many readers attributed the rise in xerostomia cases to the medications their patients take. They specifically mentioned medications used to treat hypertension, asthma, diabetes, allergies, cancer, human immunodeficiency virus, and psychological and psychiatric disorders, as well as anti-inflammatories. They also commented that they have noticed that these types of medications are affecting more older patients. "In addition to decreased quantity of saliva in our older patients, quality of saliva due to meds and illness is detrimentally affected," said one. "Without a doubt, xerostomia is becoming an endemic problem within our older population."
"I notice it even in younger patients who take psychotropic and asthma medications," said another.
Some readers gave examples of the effects xerostomia has had on their patients. "At an alarming rate, xerostomia is causing some interproximal tooth caries that are impossible to restore, and teeth are drying out and breaking off," said one.
Others said they have diagnosed root caries, sensitivity, cracked-tooth syndrome, soft-tissue lesions and yeast, and have noticed excessive gingival tissue overgrowth and soft lines in dentures that are drying out in one-half the normal time.
Some readers offered suggestions on how to treat xerostomia. "I deal with it on an individual basis through the use of dietary counseling, fluoride use and improved oral hygiene," said one.
"I recommend fluoride treatment and artificial saliva," said another.
One respondent even mentioned working with other health practitioners to create awareness. "We (local dentists) meet yearly with our local medical doctors to discuss xerostomia and make them aware of our patients’ problems," he said.
Eleven percent of respondents said they have not noticed an increase in xerostomia cases in their practices. "We attend to a great deal of seniors and have not noticed an increase in xerostomia," said one.
"It is not something my patients bring up when I ask if anything is causing concern orally," commented another.
Two percent of readers said they did not know if they have seen more patients who have xerostomia. "What I have seen is a great increase in caries in medicated people; for example, caused by psychotropics, blood pressure and other changes attributable to old age," said one reader. "Dentists don’t know how to treat this problem."
In October 2000, the ADA House of Delegates adopted resolution 87H-2000, which called on the ADA to study xerostomia, including how to communicate more effectively with health care providers, patients, drug manufacturers, insurers and membership.
In response, the ADA’s Council on Scientific Affairs prepared a supplement report that was presented to the 2001 House. In addition, the council outlined short-term initiatives that will be taken in 2002 to help remind dentists about the common causes of xerostomia. These initiatives include
- – preparing and publishing a revised patient education brochure that addresses the problem of xerostomia and how dentists can make patients who have the condition more comfortable;
- – emphasizing xerostomia in the ADA’s "Adult Oral Health Awareness" promotion;
- – developing a statement on xerostomia and a "frequently asked questions" link for the public section of ADA.org;
- – preparing articles for ADA publications;
- – training ADA spokespeople on communicating about the problem of xerostomia to the press and other media outlets.
Long-term initiatives also were proposed. They suggest creating working relationships with other organizations such as the National Institute of Dental and Craniofacial Research, the American Association of Retired Persons and the American Medical Association to promote patients’ and health care practitioners’ awareness of the xerostomia problem.
