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Sjögren's Disease
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
Management of dry mouth. The management of dry mouth relies primarily on nonpharmacologic interventions to ameliorate oral discomfort, facilitate eating, and prevent dental caries. Current practice guidelines emphasize the importance of fluoride as a caries-prevention strategy, using neutral-pH preparations, including mouthwash, gel, or sprays (167, 176, 177). The secretagogues pilocarpine and cevimeline have benefit in patients with glandular functional reserve but are often limited in utility by their side effects (178–181). Sialendoscopy with steroid and/or saline irrigation of the gland is an emerging management option for SjD-related salivary hypofunction. Much of the benefit of sialendoscopy relates to dilatation of ductal strictures and removal of ductal debris. A systematic review included six studies of 125 SjD patients and 25 controls and concluded that sialendoscopy provided at least temporary improvement of the symptoms in most cases (182). Heterogeneity of the study outcome measures was a limitation of this review. No significant adverse outcomes were reported.
Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
Swallowing problems may become worse during acute illnesses. Drowsiness due to sedating drugs should be considered. Look in the mouth to exclude dental problems (e.g. tooth decay and pain), poorly fitting dentures (gums shrink when weight reduces) or thrush. A dry mouth may be caused by medications (e.g. anticholinergics) or dehydration, which can further reduce swallowing ability.
General physical
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
The complaint of thirst rings alarm bells in doctor and patient alike. Diabetes clearly needs to be excluded but the differential may need to be extended beyond this in the light of negative initial tests. Dry mouth tends to create less concern but can sometimes herald significant pathology and may be a serious nuisance to the patient.
High anticholinergic burden and hyposalivation and xerostomia in the elderly
Published in Acta Odontologica Scandinavica, 2023
Juuso Stenbäck, Antti Tiisanoja, Anna-Maija Syrjälä, Kaija Komulainen, Sirpa Hartikainen, Pekka Ylöstalo
In the older population, both an objectively measured low salivary secretion (hyposalivation) and a subjective feeling of dry mouth (xerostomia) are common conditions [9]. These conditions predispose people to poor oral health by increasing the risk for oral diseases, including dental caries [10]. Common causes for dry mouth are iatrogenic (drugs, radiation) and psychogenic (depression, anxiety) factors, general diseases (Sjögren’s syndrome, Parkinson’s disease), and dehydration [11,12]. Among older people, the main causes for dry mouth are thought to be aging, use of drugs, and polypharmacy (five or more drugs daily) [13,14]. More than 400 drugs (including anticholinergic drugs) have been considered to affect salivary secretion and a recent systematic review reported that 106 substances had at least moderate evidence of causing hyposalivation or xerostomia [5,15]. The mechanism by which anticholinergic drugs cause hyposalivation and xerostomia is by blocking muscarine receptors in the salivary glands [16].
Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus
Published in Disability and Rehabilitation, 2022
Jackie McRae, Christina Smith, Suzanne Beeke, Anton Emmanuel
Poor oral care and the experience of dry mouth add to patient discomfort with impact on eating, swallowing and speaking [28,62]. Causes are linked to the side effects of medication and ventilation that are routinely required in ICU [63] as well as autonomic dysfunction seen in SCI [27]. For individuals with cSCI in acute care, this is a significantly negative experience, especially as care is dependent on others to provide relief [28]. Long-term issues with oral hygiene and dental health in those with SCI cause pain and have an impact on quality of life with an increased need for dental treatment [64,65]. Preventative measures and education are important to reduce this, whilst expert consensus supported twice-daily oral care as routine. The use of artificial saliva to relieve dry mouth is often used for long-term conditions such as Sjorgen’s Syndrome [66] and Head and Neck radiotherapy [67] but did not attract consensus by the expert panel. This may be because these products are not universally available or currently used in acute settings. Further research into the contribution of artificial saliva for those experiencing dry mouth due to polypharmacy would be beneficial as these offer simple options for self-management to bring relief.
A novel diagnostic technique of measuring labial minor salivary gland secretions using sodium fluorescein dye: Implications for patients with dry eyes
Published in Seminars in Ophthalmology, 2022
This prospective study was approved by the institutional ethics committee (LEC-12-20-556) and adhered to the tenets of the Declaration of Helsinki. Forty healthy volunteers (males and females; aged 10–60 years) and consecutive patients diagnosed with SS and SJS presenting to dry eye clinic were enrolled in this study. Healthy controls were divided into four groups based on the age. All subjects were healthy, had no symptoms of dry mouth, and were free of any dentures or salivary gland diseases. None of them were on any systemic medications. The diagnosis of SJS was made as per the criteria reported by the authors earlier.12 The diagnosis of SS was made as per ACR-EULAR 2016 diagnostic criteria. Patients with SS and SJS underwent detailed slit-lamp examination, dry eye diagnostics [ocular surface disease index (OSDI), Schirmer I test, and fluorescein staining], and slit-lamp photographs of the ocular surface. Patients were asked if they experience any dry mouth-related symptoms. Subjects were asked not to eat, drink, or smoke for at least 60 min before collection. Patients with SJS who have undergone mucous membrane grafting were excluded. The saliva flow rates were measured from the lower labial MSGs in all subjects. An experienced researcher (S.S) performed the test after obtaining informed consent.