Dentaltown March 2013 - (Page 124)

hygiene and prevention profile in oral health by Linda Douglas, RDH Nowadays, clinicians encounter increasing numbers of individuals with xerostomia-related problems. According to a recent Hygienetown poll, 73 percent of participants are seeing more patients with xerostomia compared to one year ago. Salivary lubrication, repair, lavage, antimicrobial and buffering properties contribute significantly to the maintenance of the integrity of the hard and soft oral tissue.1 Saliva also moistens and lubricates the food bolus, and the esophagus. A dry mouth can lead to multiple complications,2 for example: cracked lips, angular cheilitis, fissured tongue, dental hypersensitivity, and caries on roots and cusp tips; plus opportunistic infections such as candidiasis. It can also impair speech, taste, mastication and swallowing. Impaired swallowing (dysphagia) could cause oesophageal damage, and compromise nutritional status; dysphagia might also lead to choking, resulting in pulmonary aspiration of food and pneumonia. These problems require a multifaceted approach to management. To achieve this, management of salivary gland hypofunction (SGH) and xerostomia can be based on seven main goals: 1. Hydration (adequate water intake is crucial) 2. Stimulation of salivary flow 3. Saliva substitution 4. Reduce the loss of functional salivary gland tissue 5. Prevent caries, and promote remineralization 6. Prevent soft tissue injury and infections 7. Improve comfort 1. 2. 3. 4. 5. 6. Mandel ID.The role of saliva in maintaining oral homeostasis. J Am Dent Assoc.1989;119:298-304 Dawes C. Physiologic factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res. 1987;66(special issue):648-653 Saliva: its role in health and disease. Working Group 10 of the Commission on Oral Health, Research and Epidemiology (C.O.R.E.) Int Dent J. 1992;42(4 Suppl 2):291-394. Laurence J. Walsh, Clinical Aspects of salivary biology for the dental clinician:Minim Interv Dent 2008; 1: 7-24 Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:28-46 Fox PC. Salivary enhancement therapies. Caries Res. 2004;38:241-246. 124 MARCH 2013 » dentaltown.com There are a variety of xerostomia relief preparations available that help to achieve these goals; this article discusses the constituents of dry mouth relief preparations, and the rationales for their use. Stimulation of Salivary Flow According to the Commission on Oral Health, Research and Epidemiology, stimulation of secretion has a great advantage of providing the benefits of natural saliva.3 Salivary glands are highly responsive to stimulation of taste, masticatory muscles, and sensory nerves of the oral mucosa and periodontal ligament. Stimulation of salivary flow is valuable for responders, who retain some salivary gland activity; most salivary gland hypofunction cases are responders. Masticatory stimulation is achieved by chewing sugarfree gum, preferably with xylitol. A regular chewing gum habit also causes a prolonged increase in unstimulated salivary flow rate.4 Gustatory stimulation5 is achieved by using flavorings, sugar substitutes and buffered fruit acids. Systemic Sialagogues6 might be prescribed, if not contraindicated. Drug-free options for stimulation of salivary flow include acupuncture,7 electronic stimulation8 and hypnosis.9 Increased salivary secretion aids gastric digestion, as when swallowed, saliva stimulates gastric secretions. 7. 8. 9. Johnstone PA, Niemtzow RC, Riffenburgh, RH. Acupuncture for xerostomia: clinical update. Cancer. 2002;94:1151-1156 Efficacy and Safety of an Intraoral Electrostimulation Device for Xerostomia Relief: A Multicenter, Randomized Trial; Frank P. Strietzel, Wolff A, et al. J Rheum, Vol. 63, No. 1, January 2011, pp 180–190 DOI 10.1002/art.27766 J Pain Symptom Manage.2009 Jun;37(6):1086-1092.e1. Epub 2009 Jan 31.Hypnosis for postradiation xerostomia in head and neck cancer patients: a pilot study.Schiff E Mogilner JG Sella E Doweck I Hershko O Ben-Arye E Yarom N SourceDepartment of Internal Medicine B, Bnai Zion Medical Center, P.O. Box 4940, Haifa 31048, Israel. eschiff@bezeqint.net http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown March 2013

Dentaltown.com Highlights
Howard Speaks: Dentistry Could Come Back with a Vengeance
Professional Courtesy: I’m No Anti-Dentite
Continuing Education Update
Second Opinion: Should Endodontists Place Implants?
Needle Stick Question
Am I the Only One Who Didn’t Know How to Use My Loupes?
The Patient Blames Me for Cracking His Tooth
Corporate Profile: {KöR}
CAD/CAM Materials
Dentaltown Research: Cosmetic Dentistry
Do-it-Yourself Finance, Part IV: Savings and Investing
Product Profile: Centrix
Keep Them Coming Back
You Should Know: Likeable Dentists
Multimodality Endodontics
Endodontics for the Recent Graduate: Instrumentation
Continuing Education Porcelain Veneers: From Case Selection to Cementation
8½ Tips for Dental Safety Checklists
How Prepared Are You For a Medical Emergency?
Dental Stem Cell Preservation and the Dawning of Regenerative Oral Medicine
Product Profile: Ivoclar EvoCerem
Narrow Diameter Implant Overdentures with Locator Attachments
In This Issue: Zeroing in on Xerostomia
Perio Reports
Ad Index
Profile in Oral Health: Substances for Targeting Xerostomia
Dentally Incorrect

Dentaltown March 2013