Treating dry mouth: What’s the point?

More and more attention is being paid to dry mouth. Dry mouth is affecting a growing number of patients of all ages and sets the stage for caries, erosion, periodontal diseases, and fungal infections. Not a week goes by where the discussion doesn’t turn to dry mouth in an online chat room.

Dry mouth causes major quality-of-life issues. Imagine not being able to chew crusty bread or a raw carrot comfortably. Imagine not being able to utter a sentence without your lips sticking to your teeth. Imagine not wanting to eat because your food tastes like cardboard. Imagine having your sleep disturbed through the entire night because your mouth is bone dry. Imagine living with stale bad breath, day in and day out.

Dry mouth syndrome is an umbrella term that encompasses both hyposalivation and xerostomia, terms that are not synonymous. Hyposalivation is the actual clinical presentation and is characterized by insufficient saliva or a complete lack of moisture. Xerostomia is different. Xerostomia is a patient’s perception of a dry mouth.

While there are people who do not have enough oral moisture, there are others who have adequate flow. An imbalance in oral proteins, electrolytes, or other salivary components. Since all dry mouth issues are not the same, it is important to understand these distinctions when trying to help a patient gain some measure of control over oral dryness.

Nevertheless, people who have dry mouth syndrome are uncomfortable, and it is our job to help provide solutions. In order to do this, we need to understand the goals we’re trying to achieve for each individual patient. There are distinct issues to consider:

• Is the goal to stimulate salivary flow?

• Is elevating and maintaining oral pH at 7 another goal?

• What about hydrating and moisturizing the oral mucosa?

• Is the goal remineralization, or is it establishing an optimal electrolyte balance in the saliva?

• Is there a microbial issue that needs to be considered?

A taste test for products

There is not one perfect product that will achieve all of these objectives. Before you start making recommendations, understand exactly how product ingredients work. Be familiar with the taste, texture, and application process. One patient’s favorite dry mouth product might not appeal to others. Asking a patient to accept our recommendations in good faith can backfire. What if the patient dislikes the taste, finds the texture unbearable, or considers the application process tedious? Not addressing these issues can be a recipe for disaster. Have you ever heard a patient complain about the cost of a product? Has anyone complained about the flavor of a product you recommended? One recommendation won’t win them all.

So what about creating a strategy that will boost compliance and ensure success? We can all follow a sampling model inspired by Baskin-Robbins. At Baskin-Robbins, patrons are allowed to taste multiple frozen concoctions before making the final selection. Servers gladly hand customers little tastes on tiny pink spoons. It’s easy to create the same kind of experience in a clinical setting. This just takes a bit of planning.

First, make a list of your favorite dry mouth products, both over-the-counter and prescription. The majority of products are OTC, with the exception of products that contain higher levels of fluoride and supersaturated calcium phosphate rinses. Some are readily available in your local drugstore, while others will need to be purchased online. Some companies have small sample sizes available for purchase. In other situations, you will need to have a regular-sized bottle or tube of a product available. Products can include liquid rinses, sprays, gels, pastes, and lozenges.

The “taste test” is easy. Ask the patient about flavor and texture preferences. All you need are inexpensive plastic spoons, cotton-tipped applicators, and very small paper cups.

Liquids can be dispensed into cups. It is easy to spray products into a spoon. The patient can lick the spoon to determine if the flavor or texture is acceptable. A cotton-tipped applicator works well for testing a dab of a gel or paste. It’s also a good idea to tailor your recommendations to the patient’s lifestyle. An on-the-go person might prefer a small pocket spray or a lozenge, while another might gravitate to a daily rinse routine or a twice-daily chocolate-flavored chew.

Everyone will have different needs and preferences. And why not have a question-and-answer sheet? This could detail the goals for a dry mouth product, feature a checklist of your recommended products, and explain how to purchase those products.

Yes, it will take time to implement a system like this, but patients are bound to notice that you and your practice are going the extra mile help them improve their health and the quality of their lives. Your efforts will reap rewards and further cement patient relationships. As the relationships grow, so will patients’ confidence in your practice’s treatment recommendations. So what is the point? The point is really understanding dry mouth and finding better ways to alleviate this horrible problem.

Here is a list of great products that can work well for patients with dry mouth issues (see Table 1). Every patient is different, and their needs vary. While the list does not mention every product on the market, it is a good place to start. Take time to familiarize yourself with the benefits of each of the different options that you can offer patients.