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Posted: March 21, 2008

When There’s Not Enough Saliva

Dealing with Common Elderly Dry Mouth Condition

While nearly half of our elderly suffer from a dry mouth, the condition all too often goes undetected and therefore untreated.

Dry mouth, technically known as xerostomia, is not a disease but a condition that develops when the salivary glands in the mouth simply do not produce the saliva needed to keep the mouth moist and comfortable. It’s not unusual to experience a dry mouth on occasion at any age, especially in times of stress or when nervous or upset.

But for the elderly, this constant feeling of “cottonmouth” is not a normal part of aging -- and it can be dangerous if not treated. Xerostomia can result in weight loss, speech impairment, poor nutritional status, infection, and respiratory problems.

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“One reason why xerostomia goes undetected is that Medicare pays nothing for the dental care of persons age 65 and over,” says Dr. Helaine Smith, a dentist who maintains a practice in Boston.

Critical Need for Saliva

To better understand the problems inherent to dry mouth, it helps to know a bit more about how saliva helps our bodies stay healthy. Although saliva largely consists of water, it also contains more than 60 substances that help prevent bacterial infection, yeast infections and viruses of the mouth. Saliva provides the lubrication and enzymes necessary for chewing, swallowing and digesting food. It also helps prevent tooth decay by washing away bacteria.

If you suspect that your loved one may suffer from xerostomia, Dr. Smith offers a few pointers on detection. “First, if you look into the mouth of a person who has xerostomia, you’ll see that the mouth is bright red, the color of sunburn instead of the shiny, wet coral pink that we expect to see in a healthy mouth,” she says. “The most common complaint for persons with xerostomia is that they feel their mouths are constantly dry. And they may complain that food feels ‘big’ going down the throat.”

Other symptoms of xerostomia may include any of the following: bad breath, cracked lips, dark colored urine, a tongue that is dry, raw or red; and/or a burning sensation in the mouth.

What causes the salivary glands to reduce or stop producing saliva, leading to dry mouth? Smoking, mouth breathing, or consumption of caffeinated beverages or alcohol can be causes of xerostomia, as can nerve damage to the mouth or throat from surgery, radiation therapy or chemotherapy.

Many Dry Mouth Causes

Xerostomia can be caused by an underlying health condition such as diabetes, arthritis, AIDS, Parkinson’s disease or depression. It may also be an outcome of Sjoren’s syndrome, an autoimmune disorder where the body cannot produce saliva or tears. If you see signs of xerostomia in your loved one, let their physician, as well as their dentist, know right away so any underlying disease can be identified and treated.

“Beyond these factors, there are over 450 medications, both prescription and over-the-counter, which can cause the problem of xerostomia,” says Dr. Smith. Some of these medications include anti-depressants, anti-Parkinson’s agents, diuretics, pain relievers and anti-histamines.

On average, seniors in the United States use two to six prescription medications and one to three over-the-counter medications daily. Given this fact -- the prevalence of xerostomia, up to 10% of the general population and as high as 46% of the elderly -- should come as no surprise.

“Overall, geriatricians are attuned to good oral health. They check for problems with dentures, any sign of infection or recessed gums, poor nutritional status,” says Dr. Smith. “ But if you’re an adult in your 40’s, 50’s and early 60’s then your primary physician never asks about oral health, and if you’re neglecting good oral care when you are younger, then everything is going to be so much more complicated when you are older – including the problems that come with xerostomia.”

Meds in Spotlight

Once detected, the first and best step in treating dry mouth is to request an evaluation of all medications, both prescription drugs and over-the-counter products your loved one currently uses. A review of medications may lead to changes that can help reduce or eliminate the problem of xerostomia.

Good dental care is also key to helping alleviate or eliminate the dry mouth condition. Brush, floss, and keep dentures clean. There are special brands of toothpaste and mouthwash that help fight bacteria and minimize gum irritation, so check for the best fighters.

To help increase saliva production, sugarless gums and candies are more helpful than simply drinking water. Some chewing gums contain the same enzymes as found in saliva and can aid in the digestion of food. Water does provide temporary relief, but it does not help to increase the production of saliva, the root problem of xerostomia.

Saliva Substitutes

Over-the-counter mouth sprays, gels or lozenges are often helpful, and many contain calcium or fluoride for tooth protection. These saliva substitutes, or oral lubricants, can increase comfort as they effectively moisten and lubricate. But again, like water, they do not enable the body to increase its production of saliva.

To achieve greater amounts of saliva production, there are prescription medications that effectively work on the glands responsible for the production of saliva. But keep in mind that achieving maximum benefit from these medications may take up to three months.

Even if the signs of xerostomia are not present in your aging parent, Dr. Smith advises that older adults continue to have regular check-ups for dental care. “With people living longer than ever, it’s important to maintain good oral care to avoid problems in the future,” she says. “In my practice, I look at a 70-year-old man and think: What can I do to help this person to be comfortable for the next 20 years -- because the chances are good that’s how long he’ll live.”

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Paula S. McCarron has more than 20 years of experience in health care, including nursing homes and hospice. She lives in Chelmsford, Massachusetts, and can be reached at paulamccarron@gmail.com .

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