Fighting Dry Mouth: An Interprofessional Opportunity

Publication ID Published Volume
9308 January 14, 2013 9

Abstract

Dry mouth (xerostomia) is caused by medications, medical diseases, as well as medical treatments. Medications account for approximately 90% of xerostomia cases. With a growing population of people over 65, and many patients taking more than one medication, the consequences of dry mouth to the hard and soft tissues of the oral cavity are becoming one of the fastest growing health problems in our world today. It can affect an individual’s quality of life by affecting their ability to eat, swallow, sleep comfortably, and speak. It is critical that all health care professionals develop competency in the area of xerostomia. They must be able to screen for dry mouth by recognizing the potential causes of xerostomia, as well as its signs and symptoms. They should be able to describe the function of saliva as well as delineate the patho-physiology that results from salivary gland destruction or suppression. It is critical that the health care provider be able to specify pharmacologic agents that may cause dry mouth and evaluate the patient's medical needs vs. the consequences of a severely dry mouth. It will be important to prescribe methods to stimulate and/or replace critically important saliva to minimize the damage to oral hard and soft tissues. The interdisciplinary operation of the health care delivery system to anticipate, recognize, manage and refer the sequelae of xerostomia will be essential. The American Pharmacists Association, the American Dental Association, the Academy of General Dentistry, and the American Academy of Periodontology are currently working to expand awareness of the consequences of dry mouth.

This module presents information on the importance of saliva for normal body function; what happens when salivary function is reduced; what causes this reduction in saliva; and describes roles of the interdisciplinary team in recognition and management of this condition. The module is a PowerPoint recorded in Camtasia by two dentists, a pharmacist, and a physician/psychiatrist. The recording can be utilized by an individual or in groups. The submission also contains a Facilitator’s Guide to Case-Based Learning that includes six points with guided direction on how to utilize the information presented in the module to foster case based learning. This submission contains four cases as an assessment tool with a separate file that contains the answers to the questions along with the explanation of the correct answers. In addition, the guidelines for case based instruction can be utilized by health care professional students or residents in assessing their own assigned patients for the presence of dry mouth, determining the cause, analyzing the effects, and recommending management strategies.

It is suggested that after completing the module and assessment tool, a follow up session be conducted with the medical residents (or other appropriate health care professional students) in which the student is given an assignment to identify patients in their practice whom they recognize as presenting with symptoms of dry mouth OR who are on medications, have medical conditions or treatments that can cause xersotomia. The students/residents would perform a routine history and physical exam with the additional inclusion of screening for dry mouth as directed in the module presentation and slide entitled “Screening Questions for Patients” under the section, Clinical Implications of Xerostomia: Screening and Examination. They should also be able to make recommendations of appropriate interventions to preclude and or help address the symptoms of xerostomia as well as strategies for avoiding the dental sequelae associated with it.
Students sharing their particular case/s would serve as excellent case presentations for follow up in small group learning sessions. This would also allow the student to realize how common of a problem this is.

Two of the authors of this module, a pharmacist and dentist) presented at the West Virginia Pharmacy meeting and a regional meeting that included pharmacists from West Virginia, Ohio, and Pennsylvania. Some of the comments on the written evaluation for these sessions included: informative, very good and helpful, liked the collaboration between pharmacy and dentistry, personal application to my practice and awareness of this issue when working with patients is critical. One pharmacist was in charge of protocol for a group of pharmacies in the state of Indiana. She stated that she would develop protocol for counseling for dry mouth in her pharmacies.

Two of the authors of this module (a dentist and a physician, psychiatrist) presented a Grand Rounds on xerostomia in psychiatry and authored a paper on this topic. The psychiatric providers that attended the grand rounds have continued to report ongoing thanks for the presentation and provided verbal feedback to the presenters that it has been a very helpful clinical topic to discuss with patients and provide treatment suggestions and alternatives to patient care in their outpatient psychiatry clinic. A sign was hung up in the clinic “Are you experiencing Dry Mouth? Ask your health care provider” and this promoted many patient/physician discussions. Many providers have now begun asking patients directly if they have been experiencing dry mouth and have reported shockingly high numbers of patients who say yes. One physician verbally reported that nearly every patient she asked said yes to this question. Providers are now adjusting medication regimens when able, prescribing fluoride toothpaste, recommending sugarless gum with xylitol to patients, and suggesting salivary substitutes as primary intervention strategies.
The presentation also helped increase communication and referrals between the psychiatric department and dentistry. Both dental faculty and physicians are also collaborating more with pharmacists within our university setting about this topic and the multidisciplinary approach has been steadily emerging.

Citation

Veselicky L, Swager L, Morgan S, Dolin D, DeBiase C, Veselicky K. Fighting dry mouth: an interprofessional opportunity. MedEdPORTAL Publications. 2013;9:9308. http://dx.doi.org/10.15766/mep_2374-8265.9308

Contains Information Suitable for Patient Education

Educational Objectives

Following completion of the module, the health care providers will be able to address complications/management of dry mouth (xerostomia) by:

  1. Explaining the patho-physiology of xerostomia.
  2. Listing the signs and symptoms of xerostomia.
  3. Delineating dental caries, gingival conditions and other factors attributed to diminished saliva.
  4. Classifying common pharmacologic agents associated with xerostomia.
  5. Recognizing medical conditions and/or medical treatment/s that result in xerostomia.
  6. Lay out available treatment options and medical management strategies that can prevent or reduce the harmful effects of this malady.
  7. Advocate for the role of the physician, nurse, pharmacist, dental provider or other health care professionals in identifying, preventing, and managing dry mouth as well as referring to an oral health care professional when appropriate.

Keywords

  • Xerostomia, Dry Mouth, Saliva, Caries, Building Oral Health Capacity (BOHC) Collection

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ISSN 2374-8265