# Presentation: 234350

## Dry Mouth — Medications as a Cause

*Emerson Robinson, DDS, MPH*
- Regional Dental Consultant
- Region V Health Conference
- June 4-6, 2008
- Minneapolis, MN

## Dry Mouth (Xerostomia)

- Dry mouth also called xerostomia (er-oh-STOH-mee-ah), is the condition of not having enough saliva or spit to keep the mouth moist
- Dry mouth can happen to anyone occasionally, for example, when nervous or stressed
- When dry mouth persists, it can make chewing, eating, swallowing, and even talking difficult
- Dry mouth increases the risk for tooth decay because saliva helps to keep harmful germs that cause cavities and other oral infections in check

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## The Complexities of the Drug-Dry Mouth Relationship...

- Dry mouth is a subjective symptom.
- Quantitative objective data regarding the capacity of drugs to induce dryness are usually obtained from responses given by patients in clinical studies.
- Unfortunately, few such studies have been conducted, but is hardly surprising.

## The Complexities of the Drug-Dry Mouth Relationship

- Dry mouth is often regarded as a petty complaint, so there is allegedly no compelling health-related reason to assess its presence
- Most medical clinicians and pharmacologists place “dry mouth” in a category which usually does not require the care of a physician
- So the urgency to obtain specific information about the frequency are severity of oral dryness is simply not there

## Saliva

- Saliva is a very important part of Oral Health.  Saliva provides three important functions:
- Provides enzymes to help with digestion of food.
- Provides a method to stabilize the pH that  keeps the acid levels in check.
- Provides high levels of oxygen in order to keep oral tissues healthy and fresh.
- Saliva is nature’s way of protecting us from bad breath because healthy saliva contains high concentrations of oxygen—the nature enemy of anaerobic bacteria.

## Slide 7

## What Saliva Does

- The average healthy mouth produces about 600 milliliters of saliva each day.  That is enough to fill a 12-ounce soda bottle.
- Saliva functions in many ways that we may not even be aware of.  Some of  those functions are:
- Lubricates oral tissue
- Cleanses the mouth
- Begins the digestive process with enzymes
- Maintains a neutral oral pH
- Protects oral tissue against microorganism invasion
- Helps remineralize the teeth
- Prevents decay
- Facilitates swallowing
- Acts as a solvent to enhance taste stimuli

## Reasons for Salivary Glands To Under Function

- Medications—over  400 medicines can cause dry mouth
- Diseases such as diabetes, Hodgkin's, Parkinson’s disease, HIV/AIDS, and Sjogens syndrome may lead to dry mouth
- Radiation therapy
- Chemotherapy
- Menopause
- Smoking

## Signs and Symptoms

- A patient with xerostomia may be asymptomatic and not aware that their oral health has been affected
- In the absence of complaints of a dry mouth, the history or presence of several conditions can be diagnostic:
-  Sudden increase in dental caries
- Oral yeast infection (candidiasis)
- Inflamed soft tissue
- Painful oral tissue
- Chapped or cracked lips and tongue
- Swollen salivary glands
- Bad breath

## Slide 11

## Problems Caused by Dry Mouth

**Dental Cavities**
- Damage to the structure of teeth
**Gingivitis**
- Involves inflammation of the gums
**Periodontitis**
- Progression of gingivitis, involving inflammation and infection of the ligaments and bone support of the teeth
**Tooth Abscess**
- Collection of infected material resulting from bacterial infection of the nerve
**Halitosis**
- Bad breath odor that is caused by bacterial growth in the mouth

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## Medications...

- The most common cause of drug-induced dry mouth is the altering of neural pathways that stimulate salivary secretion.
- These drugs that have either an anticholinergic or sympathomimetic effect.
- Stimualtion of the parasympathetic nerves (cholinergic action) produces an increase in fluid volume (serous saliva).
- Stimulation by the sympathetic nerves (sympathomimetic action) produces less volume and viscous saliva.

## Medications...

- Drugs that have an anticholinergic action reduce the volume of serous saliva includes:
- Antihypertensive drugs
- Antihistamine drugs
- Antidepressant drugs
- Antipsychotic drugs
- Antiemetic drugs
- Antispasmodic drugs
- Anti-Parkinsonian drugs

## Medications

- Drugs with sympathomimetic actions produce a more viscous, mucinous saliva with less volume such as:
- Decongestants
- Bronchodilators
- Appetite suppressants
- Amphetamines
- The list of medications associated with xerostomia continues to grow as new drugs are released.

## Slide 18

## Types of Medications That Will Often Produce Dry Mouth

- Antihistamines
- Decongestants
- Pain killers
- Diuretics
- High blood pressure medications
- Antidepressants
- Some anti-diarrhea medications
- Some antipsychotic medications
- Tranquilizers

## How to Know if a Student has Dry Mouth

- Everyone’s mouth feels dry from time to time.  It is when this feeling doesn’t go away that one may have a problem with saliva production.
- Symptoms of dry mouth includes:
- A sticky, dry feeling in your mouth
- Trouble swallowing
- A burning sensation of the tongue
- A dry feeling in the throat
- Cracked lips
- Reduced ability to taste things or a metallic taste in the mouth
- Mouth sores
- Frequent bad breath
- Difficulty chewing/speaking

## How is Dry Mouth Treated...

- The only permanent way to cure dry mouth is to treat its cause
- If dry mouth is the result of MEDICATION, the physician might change the prescription or the dosage
- If the salivary glands are not working properly but still produce some saliva, the physician might prescribe a medicine that helps the glands work better such as parasympathtic stimulating agents called Pilocarpine

## How is Dry Mouth Treated?

- If the cause cannot be eliminated, or until it can be, moisture can be restored to the mouth in a number of different ways
- A dentist may recommend mouth moisturizers such a saliva substitute
- Rinsing with mouthwashes specially formulated to help dry the mouth may also bring relief

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## How is Dry Mouth Treated

- The patient can also:
- Sip water or sugarless drinks often
- Avoid drinks with caffeine, such as coffee, tea, and some sodas
- Chew sugarless gum
- Suck on sugarless hard candy to stimulate saliva flow (if some salivary function exists)
- Do not use tobacco or alcohol
- Be aware that spicy or salty foods can cause pain in a dry mouth
- Use a humidifier at night

## Maintaining Good Oral Health With Dry Mouth

- Gently brush teeth at least twice a day
- Floss teeth every day
- Use toothpaste with fluoride
- Avoid sticky, sugary foods—if eaten, brush immediately afterwards
- Have bi-yearly dental check-ups
- Can use special fluoride solutions to rinse with to help keep teeth healthy

## Overview of Drugs and Dry Mouth...

- The sensation of oral dryness is primary due to salivary gland hypo function
- The changes are mainly caused by systemic diseases and by the intake of dryness-inducing xerogenic medications
- Of the 24 most frequently prescribed drugs in the U.S. in 2001, 63% of the generics and 52% of the brand name drugs were xerogenic

## Overview of Drugs and Dry Mouth

- It has been shown that the prevalence of dry mouth is directly proportional to the total number of drugs taken per day.
***There are about 1800 drugs in 80 drug classes which have the capacity to induce dry mouth.***

## What Concerns Us

- Dry mouth is not new; it is a problem every dentists understands, but patients may or may not be aware of the devastating affects of oral health
- Dentists see it as a problem that is worsening as patients in general are keeping their natural teeth for longer periods or time
- From the dentist’s perspective, the treatment of dry mouth depends on identifying the most likely cause
- More often than not, it is a side effect of medications

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