Byline: Jennifer Kurtz is a Speech Language Pathologist and stage IV oral cancer survivor practicing at Overlake Medical Center near Seattle, Washington. Her experience has given her an unexpected, yet unique, perspective on the clinician’s role in the management of the Head & Neck Cancer population and has motivated her to advocate for aggressive, collaborative, multi-disciplinary care of all patients across a broad continuum.
Xerostomia describes the subjective sensation of oral dryness and is commonly called “dry mouth.” The typical causes of dry mouth include medications, radiotherapy to the head and neck for cancer treatment, and systemic diseases.
Xerostomia can have a profound, negative impact on quality of life. The lack of salivary production impacts the ability to eat, sleep, speak, and swallow (Lew & Smith, 2007). Adequate salivary flow allows us to speak clearly without our lips sticking to our teeth and to mix saliva with food when we chew to enable easy transfer through the oral cavity as we swallow. Inadequate salivary function can create a number of complications such as:
- poor dentition (i.e., condition of the teeth)
- higher risk of oral infections
- sleep disturbances
- mouth pain (Deasy et al., 2010)
A dry mouth can lead to taste changes, which in turn can decrease appetite, and can lead to weight loss, malnutrition, and social isolation (Lew & Smith, 2007).
Saliva also has important antimicrobial properties. Chronic dry mouth can increase the risk for dental problems, erosion of the enamel of the teeth and other dental defects (Wu, 2008). Saliva flow lubricates the soft tissues of the oral cavity, protecting the mucosa and gingiva from extreme dryness, abrasions and ulceration. Good oral care and frequent professional cleanings are especially important for those who suffer dry mouth.
Tips for Managing Dry Mouth
There are two goals of treatment for dry mouth:
- Stimulation of functional glandular tissue to produce increased saliva
- Saliva replacement with oral lubricating agents
Methods of Stimulating Increased Saliva
- Salivary flow can be stimulated through the use of medications prescribed by your doctor. Salivary stimulants such as Pilocarpine (Salagen®) and Cevimeline (Evoxac®) are the most widely studied pharmacological interventions for dry mouth. Pilocarpine is often prescribed in either tablet or lollipop form, allowing for a consistent increase in salivary flow with tablet administration or on an as needed basis with the lollipop.
- Citric acid and slightly acidic beverages can be helpful in stimulating salivation (de Mata et al., 2009)
Methods of Replacing Saliva
Saliva Substitutes:
- Products such as Xero-lube™, Optimoist™, Oasis™, and Mouth Kote™ are just a few of the many topical dry mouth products available in pharmacies and online.
- Meat tenderizers administered in water or papaya, which both contain the enzyme papain, can help reduce the thickness of secretions.
- Frequent sips of water
- Aloe Vera juice drinks
- Xylimelts™ – moisturize the mouth and coat it in a soothing oral lubricant to provide comfort for hours. The discs stick to the inside of your cheek or along the gum line so XyliMelts™ can even be used while you sleep
- Ice Chips™ candy – made with xylitol
- Simply chewing can stimulate saliva flow (Mese, & Matsuo, 2007). Chewing several times a day, rather than relying on a full liquid diet, can be helpful and should be encouraged. Try chewing sugar free gum.
- High quality oils such as coconut oil, olive oil, grape seed oil and avocado oil can be helpful in lightly coating oral tissue creating a barrier that holds moisture.
- Wearing a mouth guard at night has been shown to be helpful in alleviating nighttime symptoms of dry mouth (Yamamoto et al., 2008).
Other Suggestions
- Use soft bristled toothbrushes and fluoride toothpaste to minimize oral irritation.
- Avoid alcohol, tobacco and large amounts of caffeine as they have a drying effect and can worsen symptoms.
- Humidity has also been shown to be beneficial (Yamamoto et al., 2008).
- Sleep with a bedside vaporizer or household humidifier to reduce oral dryness.
References
Da Mata, A.D., Da Silva Marques, D.N., Silveira, J.L., Marques, J.F., De Melo Campos Felino, E.T., Guilherrme, N.M(2009). Effects of gustatory stimulants of salivary secretion on salivary pH and flow: A randomized controlled trial. Oral Diseases, 15(3), 220-228. doi:10.1111/j.1601-0825.2009.01513.x
Deasy, J. O., Moiseenko, V., Marks, L., Chao, K. S., Nam, J., & Eisbruch, A. (2010). Radiotherapy dose-volume effects on salivary gland function. International Journal of Radiation Oncology, Biology, Physics, 76(3 Suppl), S58-63.doi:10.1016/j.ijrobp.2009.06.090
Lew, J., & Smith, J. A. (2007). Mucosal graft-vs-host disease. Oral Diseases, 13(6), 519-529.
doi:10.1111/j.1601-0825.2007.01412.x
Mese, H., & Matsuo, R. (2007). Salivary secretion, taste and hyposalivation. Journal of Oral Rehabilitation, 34(10), 711-723. doi:10.1111/j.1365-2842.2007.01794.x
Wu, A.J. (2008). Optimizing dry mouth treatment for individuals with Sjögren’s syndrome. Rheumatic Disease Clinics of North America, 34(4), 1001-1010.
Yamamoto, K., Nagashima, H., Yamachika, S., Hoshiba, D., Yamaguchi, K., & Yamada, H.(2008). The application of a night guard for sleep-related xerostomia. Oral Surgery, Oral Medicine, Oral Pathology, and Endodontology, 106(3),11-14.