Management of Xerostomia

 1. Preventive Strategies for Xerostomia

It is better to prevent Xerostomia than to treat it . Maintaining basic oral hygiene has a major effect on preventing xerostomia. Some basic oral hygiene practices other than brushing twice a day include visiting the dentist every 4 to 6 months for regular checkups. It is also the responsibility of the dentist to educate patients about the role of sugar and refined foods as risk factors for dental caries. Let’s learn about management of xerostomia.

2. Clinical Management of Xerostomia

 Clinical management of xerostomia involves following four methods:

Preserving saliva

To preserve saliva, we have to first find out the cause of decreased salivation in the oral cavity. Intake of carbonated drinks like coke and alcohol may lead to dry mouth. 

Salivary substituents

Salivary substitutes are products that make the oral cavity moist, and similar to constituents of saliva. Some examples include mouthwash, toothpaste, lozenges, gels, and animal mucin products or other moisturizing agents like carboxymethylcellulose.

Advise people with severe dry mouth to take salivary substitutes in gel form for overnight usage and in liquid form for day time usage.   

Salivary stimulants

Actually, salivary stimulants are advised in conditions where the salivary glands which produce saliva are damaged. Salivary stimulants are categorized into the following

• Acid-driven salivary stimulant – using malic acid and citric acid to cause acidic environment in the oral cavity to produce salivary stimulation.
• Mechanically-driven salivary stimulant – using sugarless chewing gums and artificial sweeteners like sorbitol and aspartame to create mechanical stimulation of saliva thereby decreasing the need for friction required by oral mucosa. These salivary stimulants are very helpful as they increase the pH of plaque thereby reducing the chances of caries formation in the teeth.
• Pharmaceutically-driven salivary stimulant –  cevimeline and pilocarpine are cholinergic agents that produce salivation. But they have adverse effects on systemic functions. For example, Do not prescribe pilocarpine for patients with asthma and gastric ulcers, but prescibe Cevimeline, as it known to have fewer side effects. 

Alternatively, mucoadhesive polymers like Chitosan are used as an oral mucoadhesive drug delivery system to make local drug delivery effective thereby reducing the chances of systemic side effects. The oral mucosa has increased blood flow and is less prone to damage as the oral mucosa has faster cellular turnover. This mechanism of mucoadhesion has two stages:

1. Contact or wetting stage – which is a stage in which the mucoadhesive polymer makes contact with the mucous membrane.
2. Consolidation stage – in this stage the mucoadhesive polymer will bond with the mucous membrane and form mucin chains.

Liposomes cover these mucoadhesive polymers to promote effective salivary stimulation and adhesiveness in the oral mucosa.

Salivary Reservoirs

Split dentures have salivary reservoirs incorporated in dentures during denture fabrication for denture wearers. Denture wearers should fill the reservoirs with artificial saliva regulary and wash it every week with 1 percent sodium hypochlorite. Use orthodontic wires to clean the saliva-draining holes.

However, the above methods are advised for managing the condition better, but the condition cannot be reversed.