Dental Tribune UK Edition, October 11-17, 2010, No.25 Vol.4

Time to talk about dry mouth? Approximately 20% of people suffer symptoms of dry mouth1 , primarily related to disease and medication use. More than 400 medicines are associated with dry mouth2 especially if 3 or more are used together.3 Ask your patients Some patients develop advanced coping strategies for dealing with dry mouth, unaware that there are products available that can help to provide protection against dry mouth, like the Biotène system. Diagnosis may also be complicated by the fact physical symptoms of dry mouth may not occur until salivary flow has been reduced by 50%.4,5,6 Diagnosing dry mouth Four key questions have been validated to help determine the subjective evaluation of a patient’s dry mouth:7 1 Do you have any difficulty swallowing any foods? 2 Does your mouth feel dry when eating a meal? 3 Do you sip liquids to aid in swallowing dry food? 4 Does the amount of saliva in your mouth seem to be too little, too much or you do not notice? Clinical evaluations can also help to pick up on the condition, in particular: • Use of the mirror ‘stick’ test – place the mirror against the buccal mucosa and tongue. If it adheres to the tissues, then salivary secretion may be reduced • Checking for saliva pooling – is there saliva pooling in the floor of the mouth? If no, salivary rates may be abnormal • Determining changes in caries rates and presentation, looking for unusual sites, e.g. incisal, cuspal and cervical caries. Dry mouth can be a leading cause of bad breath and may lead to caries or gum disease. The Biotène System The Biotène formulations supplement natural saliva, providing some of the missing salivary enzymes and proteins in patients with xerostomia and hyposalivation to replenish dry mouths. The Biotène system allows patients to choose appropriate products to fit in with their lifestyles: Products specially formulated for dry mouth: • Biotène Oralbalance Saliva Replacement Gel – For relief of dry mouth • Biotène Oralbalance Liquid Hygiene Products: • Biotène Fluoride Toothpaste • Biotène Moisturising Mouthwash The range is specially formulated for individuals experiencing dry mouth or related oral irritations: • Alcohol free • Sodium Lauryl Sulfate • Mild flavour (SLS) free The Biotène range: • Helps maintain the oral environment and provide protection against dry mouth • Helps supplement saliva’s natural defences for dry mouth 1. Billings RJ. Studies on the prevalence of xerostomia. Preliminary results. Caries Res. 23:Abstract 124, 35th ORCA Congress 1989 2. Eveson JW. ‘Xerostomia’. Periodontology 2000. 48: 85-91 3. Sreebny LM, Schwartz SS. ‘A reference guide to drugs and dry mouth – 2nd edition’. Gerodontology 1997. 14: 1; 33-47 4. Dawes C. ‘How much Saliva Is Enough for Avoidance of Xerostomia?’. Caries Res 2004. 38: 236-240 5. Dawes C: Physiological 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 6. Wolff MS, Kleinberg I: The effect of ammonium glycopyrrolate (Robinul)-induced xerostomia on oral mucosal wetness and flow of gingival crevicular fluid in humans. Arch Oral Biol 1999; 44;97-102. 7. Fox PC, Busch KA, Baum BJ. ‘Subjective reports of xerostomia and objective measures of salivary gland performance’. JADA 1987. 115:581-584 . BIOTÈNE is a registered trade mark of the GlaxoSmithKline group of companies. Selected samples available from gsk-dentalprofessionals.co.uk SM1817_5 Biotene Press Ad - Dental Tribune.indd 1 30/4/10 16:12:37 available, including ultrasound and Cone Beam Computed To- mography (CBCT), and their advantages and disadvantages. Then it was the turn of Prof Gordon Proctor, Professor of Salivary Biology; Head of Sali- vary Research Unit, Department of Clinical Diagnostic Sciences, King’s College London Dental Institute. He discussed Drug re- lated hyposalivation: a review of physiology and sites of drug action. Prof Proctor highlighted the relationship between drug therapy and salivary flow rates. He discussed the findings from various studies looking at this relationship, including one spe- cific paper by Wolff et al Major salivary gland output differs be- tween users and non-users of specific medication categories (published in Gerodontology in Feb 2008). Viral Infection Speaking just before the coffee break was Prof Jennifer Webster- Cyriaque, Associate Professor, Departments of Dental Ecology and Microbiology and Immunol- ogy, University of North Carolina Chapel Hill Schools of Dentistry and Medicine. Viral infections of salivary glands resulting in hy- posalivation took a look at vari- ous viral infections that can af- fect saliva production, including HIV, Herpes and Polyomaviruses including BKV. One of the main challenges, said Prof Webster- Cyriaque, is determining how vi- ruses get into and infect the sali- vary cells. Following the coffee break, where there was a chance to net- work and discuss the morning’s presentations, came Prof Roland Jonsson, Vice-chairman of the Gade Institute at the University of Bergen. His lecture dealt with Im- munopathology resulting in hy- posalivation. He mainly focused on Sjogren’s Syndrome, stating that it is a condition that is not easy to diagnose in its early stag- es. He stressed that biopsies are very important for diagnosis and understanding the pathogenesis of the condition. Detailing vari- ous studies, Prof Jonsson hypoth- esised that it might be a virus that triggers the inflammation. Again focusing on Sjogren’s Syndrome, Dr Elizabeth Price then followed Prof Jonsson’s presentation with Systemic dis- ease associations of hyposaliva- tion. Dr Price has a specialist in- terest in Sjogren’s Syndrome and runs a specialist Sjogren’s clinic at the Great Western Hospital in Swindon. She discussed the con- dition in more detail, and high- lighted that along with dry eyes and mouth, tiredness and fatigue are also common symptoms. She also discussed the condition’s as- sociation with thyroid disease and osteoarthritis. Next, Prof Sue Lightman, MRC Senior Clinical Fellow/ Senior Lecturer at the Institute of Ophthalmology and Consult- ant Ophthalmologist at Moor- fields Eye Hospital in London, looked at Ocular associations of hyposalivation. She detailed how quickly dry eyes can occur and how conditions such as Sjogren’s Syndrome is initiated. The final speaker of the ses- sion was Dr Philip Fox, Visiting Scientist at the Department of Oral Medicine, Carolinas Medi- cal Center, in Charlotte, NC, and an independent biomedical con- sultant focusing primarily in the area of clinical trial design and analysis. This was the part of the session where it took a more practical turn as it focused on the treatment of patients suffering with xerostomia. The first thing clinicians have to remember, said Dr Fox, is at the end of the day we have to treat patients. One thing clinicians can do is encour- age patients to chew and stimu- late the masticatory function. Prof Fox also looked at other dif- ferent ways of trying to manage xerostomia including different formulations, such as Biotene, produced as gels, gums and mouth rinses. He concluded by saying that one of the most im- portant issues a clinician can consider is the patients and what makes the mouth feel moist and comfortable for them. Detailed look This session was a very detailed investigation at some of the causes of xerostomia and hy- posalivation and allowed delegates to get a better un- derstanding of how these condi- tions affect salivary flow; as well as get an update in the thinking behind many of the products clinicians can recommend to patients for relief. DT 11Event ReviewOctober 11-17, 2010United Kingdom Edition