Tailoring dental appointments for patients with xerostomia
Here's a how dental hygienist can recommend the right products to patients with xerostomia.
Xerostomia, or "dry mouth," is becoming more prevalent with our patients. This is primarily due to the rise in medications being prescribed across the general population. Luckily, there are many products on the market to help the body produce more saliva and decrease the sensation of "cotton mouth.” These products include both over-the-counter and prescription medications. However, it can be overwhelming for patients when they are looking for the right product. It is therefore important for us as clinicians to have firm knowledge of available products so we can confidently guide patients. This article will look at products available today as well as techniques to tailor dental appointments to patients with xerostomia.
Finding the right product
Many of our patients are already looking for the right xerostomia-relieving product, and as dental hygienists, many of us are trying to help them. It is not always an easy search. For example, I worked with a patient who took seven products before we found the right one for him. This experience taught me that tailoring appointments for patients with dry mouth could help patients and assist me with my time management. It helped me develop a set of go-to products and focus the oral hygiene education I was giving to patients.
My top four must-have products for patients with dry mouth are as follows:
- Biotène (GSK) or OraCare as a pre-rinse
- Petroleum jelly / Vaseline (Unilever), which is used for the lips
- MI Paste (GC America), which is used in place of a post-rinse
- Tongue scraper
Pre-rinsing with Biotène or OraCare beforehand works as a lubricant during cleaning and helps make appointments more comfortable for patients. Using mouthwash that has alcohol will only increase dryness, so I avoid using these products on patients with xerostomia. I then offer Vaseline for their lips because they are usually cracked, peeling, and dry. This will help them from further damage while we stretch their lips and cheeks during the appointment. After I provide the prophylaxis, I usually will go over oral hygiene instructions. Based on their symptoms, I will provide the right options to help them.
Asking the right questions
Dry mouth can occur from radiation therapy, medications, aging, and other causes. Finding out the source of the condition is important to help us alleviate it as best as we can for patients. I also like to ask patients about their dietary habits, which helps me find understand which products they will be compliant using. Consider the following questions:
- Do they chew gum regularly?
- Do they suck on candies?
- Are they big water drinkers?
- What about coffee and soda?
These questions will help facilitate your oral hygiene instructions and nutritional guidance to minimize their caries risk. When a patient has dry mouth, his or her caries risk is usually high. It is important to help the patient realize this so he or she can make better decisions with food and drink intake.
More helpful products
Remember that when we recommend a product, it is important for patients to use it as prescribed for at least seven days before deciding if the product is working or not. This is because it takes time for the product to get into the body and work. If we don't give it enough time, we do not know if its beneficial.
If a patient likes to drink coffee, which is a diuretic, this will make their dry mouth worse. I encourage these patients to limit themselves to one to two cups of coffee a day. I also encourage them to drink water after coffee to help remove the stains from their teeth. I then recommend sugarless gum or Act Dry Mouth Lozenges (Chattem) depending on their habits. If patients don't want to constantly be using mint lozenges or don't like mint, I usually recommend sugar-free candies.
If your patient is complaining of dry mouth when sleeping, there are dry-mouth discs or XyliMelts (OraCoat) that will stick to their cheeks and slowly dissolve through the night. Biotène Oral Gel is great as well. Biotène has other products—a toothpaste, mouthwash, and moisturizing spray—that are other options.
If Biotène isn't the right product, Oasis Moisturizing Mouthwash (GSK) is another over-the-counter option. Other major manufacturers, such as Colgate, have toothpastes and mouthwash for dry mouth. Then there are products that your office can buy from a supplier, such as Spry (Xlear) and SalivaMax (Forward Science). As an office, you can then sell the products.
PreviDent (Colgate) toothpaste is a prescription-based product that the dentist can prescribe when over-the-counter products aren't working to alleviate symptoms. MI Paste One is a prescription product as well, which can be helpful for patients who also have sensitivity and root exposure. The paste can help remineralize the teeth and help prevent root caries.
As a result of dry mouth, the tongue can be very dry and get fissure lines that fill with biofilm and bacteria. A tongue scraper is a great adjunct to help remove lots of bacteria during morning and evening routines.
Financial aspects can be a factor for patients, so we have to recommend options that work with their budgets. Even when they they are unable to afford the options we would prefer, something is better than nothing. Sometimes, small wins go a long way and help gain trust. Building rapport is so important for increased patient compliance!
Xerostomia can be an awful thing to live with. It can create many problems for the patient on top of ones they are already dealing with. It is important to educate our patients on the causes of dry mouth and help them be as compliant with treatment as possible.
Our job as clinicians is to figure out what the problem is and to offer a solution. Most patients have no idea why dry mouth happens to them or that anything besides drinking water can help them feel better. I always ask for their chief compliant so that I can include a solution to dry mouth too. This helps patients feel that their concerns are valued and shared.
As always, continue to do the great work you do daily. I hope these small tips help make your day-to-day appointments easier with a little bit of tailoring!
Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with a master of science in dental hygiene. She has practiced dental hygiene since 2009.