DIAGNOSIS AND MANAGEMENT

Slides:



Advertisements
Similar presentations
Pregnancy and Your Oral Health
Advertisements

Seniors Oral Health. Seniors Oral Health Introduction Maintaining healthy teeth and gums at any age is an important part of preserving your overall good.
10 Simple Ways to Promote Senior Smiles. 1. Drink fluoridated water. Fluoride in drinking water makes everyones teeth stronger. Check to see if tap water.
Presented by: Cheryl Ann Peters. * A chronic, systemic and inflammatory autoimmune disease in which immune cells attack and destroy exocrine glands that.
Defined as the subjective sensation of oral dryness associated with the reduction or absence of saliva output. Xerostomia is a common problem, not a disease.
Dry Mouth and Related Oral Conditions John T. Frey, D.D.S. How To Dance in the Rain Conference Grand Rapids, MI ◊ September 6, 2014.
Powered by: Powerhealths.com a friendly Health Information blog Gojihighlights.com a natural supplement for your health from Goji berry Powerhealths.com.
SALIVA (Composition and Functions) BY. Dr. Shahzadi Tayyaba Hashmi DNT 353.
Recurrent Aphthous Ulcer
Oral Health Basics Brushing Technique & Oral Health Products Session 2 Audience: Care providers (e.g. CCAs, HSWs, PCWs) ‘ Brushing Up on Mouth Care ’ Education.
Oral Problems Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme.
Introduction and Physiological anatomy of Gastro Intestinal tract Every cell of living system needs energy Unicellular organisms: Exists in the sea of.
HEALTHY CHOICES: Care of Your Teeth Ms. Mai Lawndale High School.
Dentistry The Teeth, Gums, and Mouth Wesley S. Mullins, D.D.S. November 23, 2004.
“You cannot be healthy without oral health.” Surgeon General’s Report on Oral Health ~May WDSF 2011 ©
CSUF Pre-Dental Society Dental Outreach Program Commonwealth Elementary Fullerton, CA TODAY!! 12:45pm – 2:00pm Outreach Points: 3 points.
BIOLOGY OF THE HUMAN DENTITION
Oral Care. Aims By the end of the session the participant will:  Be familiar with the structures within and around the mouth  Be aware of the negative.
HIV Diagnosis and the Oral Cavity Cesar Augusto Migliorati DDS, MS, PhD.
Diana Travieso Palow, MPH, MS, RN Carol Stewart, DDS, MS Claudette Grant, MEd, CCRC, RN Oral Health Care Patient Education Jeanne Adler, MSN, ARNP-C.
BY: DR HINA ADNAN Renal disease and dental care. RENAL DISEASE People whose kidneys do not function properly occasionally receive dialysis, a process.
Healthy Mouths for Dependent People. Why good oral health is important. Recognise the factors that contribute to poor oral health. Confidently carry out.
Why do we need teeth? Chew Talk Appearance  Maintaining healthy teeth and gums at any age is an important part of preserving your overall good health.
The Olympic Area Agency on Aging & Washington Dental Service Foundation G ood oral health contributes to good overall physical health.
Dental Hygiene for the year old woman
Oral Conditions and Their Treatment
Introduction to the Salivary Glands Dennis E. Lopatin, Ph.D Dept. of Biologic & Materials Sciences.
By Emily Wong.  is defined as dry mouth resulting from reduced or absent of saliva.  Lubricates oral cavity  Helps chew food  Prevents decay  Regulate.
Why do we need teeth? Chew Talk Appearance  Maintaining healthy teeth and gums at any age is an important part of preserving your overall good health.
By Sahba Kazerani & Spencer Close. Why Promote Oral Health? Improve overall health and well-being Recognise common oral diseases Prevent dental pain Reduce.
Welcome Home. Welcome to Oral Health.
Happy, Healthy Smiles Denise Reyes CSUF Dietetic Intern.
INTRODUCTION Diabetes is a common disorder showing an exponential increase. It has various oral manifestations that impact the overall level of oral care.
Find out more at
ORAL HYGIENE Dr. Shahzadi Tayyaba Hashmi
Oral surgery and patient care(part2) BY.DR.HINA ADNAN DNT 472.
DIABETES How diabetes can/will affect your oral health Why your mouth is dry; and how that will affect your mouth Root caries What we can do.
diabetes Prior classification of diabetes 1.Diabetes mellitus a. type1-insullin-dependent diabetes mellitus b. type2-noninsullin- dependent diabetes mellitus.
(COMPOSITION AND FUNCTION Dr. Shahzadi Tayyaba Hashmi
Dr. Shahzadi Tayyaba Hashmi
Pregnancy and Your Oral Health. When should I see the dentist?  You could hurt yourself or your baby by NOT going to the dentist  Any time  Check-ups.
PREMALIGNANT CONDITIONS OF ORAL CAVITY
Make a difference: Clean Mouth = Healthy Body
Clinical Pharmacy Lec:3
STATISTICS 42% adults 65 and older visit a dentist annually 68% of teenagers have experienced tooth decay average adult has 21.5 decayed or filled tooth.
Module 2 Oral Health & Disease. Definitions Oral Health Prevention –Primary –Secondary –Tertiary.
Important Gum Disease Prevention Tips for Kids. Gum Diseases  Gum diseases are not exclusive to adults. Even teens and kids can develop gum problems,
Dental Care Tips For Healthy Teeth. You should take care for your teeth. Follow these tips for proper care Use a Fluoride Toothpaste Take Balanced Diet.
Drugs Used to Treat Oral Disorders Chapter 32 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
GI Health Concerns. Anorexia Eti: Disease or GI side effects of a drug S/S: decreased appetite TX: correct underlying cause ** Different than anorexia.
Copyright ©2010 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. CHAPTER Gerontological Nursing, Second Edition Patricia.
Digestive Disorders Oral Disorders. Digestive System Purpose: To break down food and absorb nutrients Purpose: To break down food and absorb nutrients.
The Link Between Diabetes And Oral Health Care. Diabetes and Oral Care Oral health care is an aspect of health that is.
Systemic Lupus Erythematosus. SLE or Lupus - is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts.
Oral health and senior citizens
Oral Care for Patients with Diabetes Diabetes and Periodontal Disease
Dr. Abdelmonem Altarhony
Modern means of individual oral hygiene
Healthy Teeth and Mouth
Oral complications of diabetes
Management of oral cancer
Sjogren’s Syndrome and Xerostomia – An Overview
Xerostomia In the name of God.
Dental Health Related & Dental Care.  ​​​​​​​​​​​​​​​​​ Practicing good dental health is important to maintaining a healthy mouth, teeth and gums. It.
Digestive Disorders Oral Disorders.
Your Smile Says Everything About You
ARTIFICIAL SALIVA /MOUTH MOISTENER
3.04 Sensory functions and disorders of the tongue and skin
ANTIFUNGAL THERAPY.
Presentation transcript:

DIAGNOSIS AND MANAGEMENT OF XEROSTOMIA IN THE ELDERLY PATIENT

Salivary Gland Dysfunction and Xerostomia (Dry Mouth)

XEROSTOMIA Xerostomia (dry mouth) is defined as a subjective complaint of dry mouth that may result from a decrease in the production of saliva.

XEROSTOMIA It affects 17-29% of samples populations based on self-reports or measurements of salivary flow rates. More prevalent in women. Can cause significant morbidity and a reduction in a patient’s perception of quality of life.

SALIVA It keeps the teeth healthy by providing a lubricant, calcium and a buffer. It also helps to maintain the health of the gums, oral tissues (mucosa) and throat. It also plays a role in the control of bacteria in the mouth.

It helps to cleanse the mouth of food and debris. It provides minerals such as calcium, fluoride, and phosphorus. It helps in swallowing and digesting food.

Lack of saliva will make the mouth more prone to disease and infection. Lead to a burning feeling.

Antimicrobial Factors in Human Whole Saliva Non-immunoglobulin Factors Origin Lysozyme Salivary glands, crevicular fluid (PMNs) Lactoferrin Salivary glands, crevicular fluid (PMNs) Salivary peroxidase Salivary glands SCN- Salivary glands, crevicular fluid H2O2 Salivary glands, crevicular fluid (PMNs), bacterial and yeast cells Myeloperoxidase Crevicular fluid (PMNs) Cl- Salivary glands, crevicular fluid Agglutinins, aggregating proteins Salivary glands Histidine-rich polypeptides Salivary glands Proline-rich proteins Salivary glands Immunoglobulin Factors Secretory IgA Salivary glands IgA, IgG, IgM Crevicular fluid

Ionizing radiation can injure the major and minor salivary glands which may lead to atrophy of the secretory components and results in varying degrees of temporary or permanent xerostomia. Toxic substanaces in chemotherapeutic agents.

Diabetes mellitus: Patients with poor glycemic control, are more likely to complain of xerostomia and may have decreased salivary flow.

Dry Mouth With Strawberry Tongue

Severe Dry Mouth (Strawberry Tongue)

Other Conditions Anxiety or Depression HIV Diabetes, Type 1 or 2 AIDS Primary Biliary Cirrhosis Bone Marrow Transplantation Vasculitis Graft-vs.-Host Disease Chronic Active Hepatitis Renal Dialysis

Salivary Gland Dysfunction and Xerostomia Clinical Appearance: Oral mucosa appears dry, pale, or atrophic. Tongue may be devoid of papillae with fissured and inflamed appearance. New and recurrent dental caries. Difficulty with chewing, swallowing, and tasting may occur. Fungal infections are common.

Pale Fisured Tongue Due To Severe Dry Mouth

Moderate Xerostomia

Warning Signs in Xerostomia 1. Dry, burning mouth and throat Dry, cracking lips, especially in the corners. The cracks may be tender and/or bleed Problems with denture wearing

Problems eating and swallowing food Difficulty with speech due to mouth soreness. 6. Increased caries and periodontal disease

Diagnosis of Xerostomia It has been estimated that a 50% reduction in salivary secretion needs to occur before the xerostomia becomes apparent. An affirmative response to at least one of the five following questions about symptoms has been shown to correlate with a decrease in salivary flow:

1. Does your mouth usually feel dry? 2. Does your mouth feel dry when eating a meal? Do you have difficulty swallowing dry food? Do you sip liquids to aid in swallowing dry food?

5. Is the amount of saliva in your mouth too little most of the time, or don’t you notice it? When unstimulated salivary flow is less than 0.12 to 0.16 ml/minute, a diagnosis of hypofunction is established.

MANAGEMENT The general approach to treating patients with hyposalivation and xerostomia is directed at palliative treatment for the relief of symptoms and prevention of oral complications:

Consult with physician to decrease drug dose, alter drug dosages, or substitute one xerostomic medication for a similar-acting drug with fewer salivary side effects.

Symptomatic Treatments: Sip water frequently all day long Let ice melt in the mouth Restrict caffeine intake Avoid mouth rinses containing alcohol Humidify sleeping area Coat lips with lubricant.

Coat the lips with a petroleum jelly like Vaseline, Blistex, or lanolin. Maintain good oral hygiene. Floss daily. Brush at least twice a day. Use toothpaste with fluoride and alcohol free (e.g. Biotene toothpaste).

Avoid Tobacco use, spicy, salty, and highly acidic foods that irritate the mouth.

Saliva Substitutes: Rx: Sodium carboxymethyl cellulose* 0.5% aqueous solution [OTC] Disp: 8 fl. Oz. Sig: Use as a rinse as frequently as needed. *Generic carboxymethyl cellulose solutions may be prepared by a pharmacist.

Commercial Salivary Substitute Commercial oral moisturizing gels (OTC) includes: OralBalance. XERO-Lube Salivart Moi-Stir Orex Optimoist

Commercial Oral Moisturizing Gels [OTC]: Laclede Oral Balance

Oral Balance Ingredients Polyglycerylmethacrylate (moisturizing agent) Lactoperoxidase (antibacterial) Glucose Oxidase (antibacterial) Lysozyme (antibacterial)

Saliva Stimulants: The use of sugar free gum, lemon drops or mints are conservative methods to temporarily stimulate salivary flow in patients with medication xerostomia or with salivary gland dysfunction.

Rx: Biotine chewing gum [OTC] Disp: 1 package Sig: Chew as needed. Due to problems of abrasion of the mucosa under the denture and potential adhesion of the gum to the denture, use caution if the patient has removable dentures.

Rx: Pilocarpine HCl (Salagen) Tablets 5 mg Disp: 21 tablets Sig: Take 1 tablet tid 1/2 hour prior to meals. Dose may be titrated to 2 tablets tid. Some authors recommend using 1 tablet of pilocarpine 4-5 times daily.

Rx: Pilocarpine HCL solution 1 mg/ml Disp: 100 ml Sig: Take 1 teaspoonful tid.

Pilocarpin HCl May need 2-3 months to determine effectiveness. Side effects include sweating and diarrhea. Avoid in patients with narrow angle glaucoma, severe asthma, pulmonary diseases.

Rx: Cevimeline (Evoxac) Capsules 30 mg Disp: 21 tablets Sig: Take 1 tablet tid.

Rx: Bethanechol (Urecholine) tablets 25 mg Disp: 30 tablets Sig: Take 1 tablet up to 5 times daily.

Conditions Affecting the Tongue

Conditions Affecting the Tongue Geographic tongue Hairy tongue Fissured tongue Varices Vitamin deficiencies

Benign Migratory Glossitis (Geographic tongue) Etiology: Unknown May be associated with psoriasis and Reiter’s syndrome. Appearances: Changing pattern of erythematous patches on the tongue dorsum caused by atrophy of the filiform papillae.

Geographic Tongue

Hairy Tongue Etiology: Antibiotics Tobacco Chlorhexidine Food debris Oral candidiasis

Black/Brown Hairy Tongue

Brown Hairy Tongue

Hairy Tongue Treatment: Proper oral hygiene and tongue brushing. If a fungal infection is suspected, perform a fungal culture and use topical antifungal.

Fissured Tongue Etiology: Unknown Appearance: Numerous small furrows and fissures on the dorsum of the tongue. May be attributed to trauma, vitamin deficiencies, salivary gland dysfunction.

Nutritional Deficiencies Etiology Vitamin B1, B2, B6, B12 and folic acid deficiency. Appearance Loss of filiform papillae produce a painful erythematous and granular appearing tongue. Eventually papillae atrophy leaving a smooth/bald tongue.