Xerostomia and How Dental Hygienists investigate it
Xerostomia
We live our daily lives by doing the usual things we do such as going to work or school, walking, running, eating, and even talking. We do understand how our body enables us to do these things. However, many people may not be aware that the last two activities that were mentioned such as eating and talking may be hard to do if there is something lacking in our system. A person can talk clearly because of the saliva that helps him smoothens his throat. Thus, we can be able to chew and swallow our food with the help of our saliva. Conversely, there is a condition that could make it hard for a person to talk or swallow the food he eats. He could be suffering from Xerostomia or a dry mouth due to lack of saliva secretion in the mouth. This condition is not a disease but could be one of the symptoms of different medical condition. In this writing, we discussed the definition of Xerostomia in relation to other medical conditions. We also discussed that there are methods that dental professionals conduct to determine if the patient already has a Xerostomia. Furthermore, effects have been determined when it comes to the patient’s treatment process as well as to his overall quality of living.
Definition of Xerostomia and its impact on patients
As mentioned earlier, Xerostomia is not a disease. It is defined as drying of the mouth because of reduced saliva or even its absence. Xerostomia happens due to various reasons such as a symptom of a person’s pre-existing medical condition or a side effect due to radiation to the neck and head (Oral Cancer Foundation). Xerostomia normally happens to older patients, which affects 20 percent of the elderly people. A patient who suffers any of the diseases mentioned could be in a difficult situation, which can make it more difficult for him if Xerostomia occurs due to his treatment or medication process. It has a direct impact to the patient as there are various activities that could make it hard for him to do.
A person who has Xerostomia may suffer difficulty in speaking due to the dryness of his mouth, which can also affect his throat. Eating can also be a challenge for a person that has Xerostomia as it could make him difficult to chew and swallow his food. Additionally, a person that has a dry mouth has a higher risk of having tooth decay (nih.gov). That is because a normal person’s saliva will keep him from harmful germs, which may cause cavities as well as other oral infections. The absence of saliva in the mouth means the absence of two major proteins such as serous and mucous secretion. These two proteins contains both lubricating acids and digestive enzymes that help us in absorbing the nutrients from the food we eat (Oral Care Foundation).
It is not only that Xerostomia affects the food digestion. Swager and Morgan (2001) say that Xerostomia also affects the patient’s medical and psychiatric health. Patients who have this condition may start to notice a dryer mouth when they wake during the night in which may disrupt his sleeping cycle (Swager & Morgan, 2011). Therefore, if this event could happen more frequently, the patient might not be able to think efficiently and may lead to other serious medical problems. Emotional issues could also be another impact of having Xerostomia (dental-professionals.com). Furthermore, Swager and Morgan (2011) conclude that untreated Xerostomia can have serious adverse impacts on the patient’s overall health, which includes prolonged systemic inflammatory conditions. Xerostomia acts as an indicator that there is something unusual in the human body that needs to be treated or is currently being treated.
Causes of Xerostomia
There are several reasons why Xerostomia occurs. Mainly, it happens due to improper function of the person’s salivary glands. As an effect, the mouth does not have enough saliva that keeps it wet. There are various reasons why such gland is not working properly. One reason is the being one of the side effects of several medicines (nih.gov). There are at least four hundred different medicines that can directly affect the salivary glands’ ability to produce saliva in the mouth. For instance, medicines that are being used for the treatment of depression and high blood pressure are two of the most common causes of Xerostomia.
Aside from the medicines being taken by the patient, the diseases themselves also cause Xerostomia occurrence. For example, HIV and AIDS affect the salivary glands, which eventually decrease its capability to produce enough saliva in our mouth. Another medical condition that affects the salivary glands is Cancer. The reason behind its effects is that the treatment processes of cancers such as Radiation therapy and chemotherapy.
The salivary glands are at risk of being damaged once it is exposed to radiation treatment. Similar with chemotherapy, drugs and medication procedures make the patient’s saliva be thicker, which cause the mouth to feel dry (Horne, n.d.). Additionally, a person who suffers from an injury to the neck or head is more likely to have damaged nerves, including the nerve that commands the salivary glands to produce saliva.
The improper production of saliva is also triggered not just by the existing medical conditions. It can also be triggered psychological condition of the person such as anorexia and bulimia (medicinenet.com). A natural medical occurrence such as pregnancy, as well as breast feeding, can also cause Xerostomia due to dehydration and changes in hormone. Therefore, causes of Xerostomia vary depending on the person’s medical, psychological and anatomical condition. This is because the salivary glands and other human body parts are interconnected in which an abnormal function of one organ can affect the other such as the salivary glands.
That is why, if a person experiences a severe dryness of the mouth, it is better to consult either his physician or dentist in order to determine if such condition is already a Xerostomia. There are various methods that practitioners use when it comes to investigating patients and people with this complaint.
Methods used to investigate patients with dry mouth complaints
Patients who have Xerostomia normally complain either because of a dry mouth or a sticky feeling inside it. Complaints are being raised by patients due to difficulties that it brings to the patients’ everyday activities. That is why practitioners are using some methods in order to come up with their diagnosis in relation to the patient’s complaints. These are:
- Identification of the complaint’s history (Visvanathan & Nix, 2010).
In this method, the practitioner will investigate the patient’s experiences by letting the patient answer some questions such as below:
- Does the mouth feel dry?
- Does the mouth also feel dry when eating?
- Is it difficult to swallow dry foods?
- Is the swallowing depends on sipping liquids?
- Is the saliva in the mouth quite less most of the time?
- Identification of underlying causes
This method is when the practitioner will enquire regarding the patient’s daily liquid intake. It will also determine whether dehydration or other condition such as mouth breathing due to nasal obstruction cause the patient’s Xerostomia.
- Identifying if the patient is under a certain medication
This method is when the patient is asked if there he is currently treating a certain medical condition, which can affect his salivary glands in supplying moisture in the mouth.
- Connection with Systemic Disease
The practitioner uses this method to rule out the systemic causes of patient’s Xerostomia. For instance, investigation may focus on patient’s medical history such as having a primary or secondary Sjogren’s syndrome (biotene.com).
Treatment Options
The prevalence of Xerostomia can be treated using various options. Kaluzny et al. (2014) assert that when it comes to therapeutic approach, it is restricted to symptomatic therapy. However, therapies encompass oral hygiene along with fluoride agents as well as antimicrobials in order to prevent dental caries. There are also saliva substitutes than is used so as to relieve the Xerostomia’s symptoms. Additionally saliva stimulation can also be done using sialagogic agents (Kaluzny et al., 2014). Another treatment option is by using BIOXTRA, which is synthetic saliva and is one of the newest approaches to substitute the saliva in the mouth (Kaluzny et al., 2014). Furthermore, using hyperbaric oxygen is another option in treating Xerostomia and is use to prevent radionecrosis to decrease the occurrence of dry mouth. The condition can also be treated using Ethyol, which is a medication process that prevents or reduces the radiation side effects (ASCO). Alternatively a person that has a Xerostomia can also suck sugar-free candies and chewing sugarless gums for salivary glands stimulation.
Conclusion
Experiencing a dry mouth is not just a simple challenge. Potentially, the effect of the medication process on the patient’s pre-existing medical condition could be more difficult as he can feel its side effects such as Xerostomia. Dry mouth impacts the population in terms of assuming the challenges to undergo a medical treatment due to its side effects. In the future, patients will be more aware that there are possible ways to lessen the effects of the medication process, given that practitioners must set their expectation from the beginning of the procedure.
References
American Society of Clinical Oncology. (n.d.). Dry Mouth or Xerostomia | Cancer.Net. Retrieved from http://www.cancer.net/navigating-cancer-care/side-effects/dry-mouth-or-xerostomia
Biotene. (n.d.). Dry Mouth Diagnosis | Biotène. Retrieved from http://www.biotene.com/healthcare-professional/diagnosis
GlaxoSmithKline. (n.d.). Dry Mouth: Causes, Effects, Treatment and Diagnosis. Retrieved from http://www.dental-professional.com/Conditions_DryMouth.aspx
Horne, S. B. (n.d.). Dry Mouth: Get the Facts about this Common Oral Condition. Retrieved from http://www.medicinenet.com/dry_mouth/article.htm#what_causes_dry_mouth
Kaluzny, J., Wierzbicka, M., Nogala, H., Milecki, P., & Kopec, T. (2013). Radiotherapy induced Xerostomia: Mechanisms, diagnostics, prevention and treatment – Evidence based up to 2013. Polish Otorhinolaryngology, 2-11.
National Institute of Dental and Craniofacial Research. (n.d.). Dry Mouth (Xerostomia). Retrieved from http://www.nidcr.nih.gov/oralhealth/topics/drymouth/
National Institute of Dental and Craniofacial Research. (n.d.). Dry Mouth. Retrieved from http://www.nidcr.nih.gov/oralhealth/topics/drymouth/drymouth.htm#6
The Oral Cancer Foundation. (n.d.). Xerostomia. Retrieved from http://www.oralcancerfoundation.org/complications/xerostomia.php
Swager, L. W., & Morgan, S. K. (2011). Psychotropic-induced dry mouth: Don’t overlook this potentially serious side effect. Current Psychiatry, 54-58.
