Symptomatic therapy
In the absence of natural salivation, it is essential to try to protect the oral hard and soft tissues by salivary substitution. Saliva substitutes, also called artificial salivas, are frequently recommended for patients complaining of dry mouth (xerostomia).
Although many studies suggest that saliva substitutes are useful in the management of xerostomia, clinical experience has shown that these products are not well accepted by patients. Most patients do not continue to use the substitutes regularly, relying instead on water or other fluids to relieve their symptoms. One reason may be that most saliva substitutes are more viscous than natural saliva and may be uncomfortable for an individual with dry mucosal surfaces. Another reason may be that the need for frequent application to keep the mouth moist makes these substitutes inconvenient and expensive. Also, the artificial salivas fail to provide the broad spectrum of antimicrobial and other protective functions of natural saliva. There is a pressing need for more effective saliva substitutes and better delivery systems.
Meanwhile, frequent sips of water or other fluids for the relief of oral dryness are often as effective as saliva substitutes. Patients should be advised to carry fluids with them at all times. (The water bottles used by cyclists or plastic glasses with snap-on lids are convenient.) Often, this simple suggestion will bring substantial relief at minimal cost, will improve mucosal hydration, and ease swallowing and speaking.
Individuals could (and should) be cautioned to avoid not only fluids containing sugar but also those containing alcohol or caffeine, as these too may worsen the xerostomia or increase the risk of caries.
A common complaint is dryness and cracking of the lips. If applied regularly, petroleum jelly-based compounds may be helpful. Patients may prefer lanolincontaining creams, which help hydrate the tissues. Patients should be advised to use room humidifiers, especially at night, as an aid to relieving frequent symptoms of dryness of the throat and tongue. For institutionalized patients, demented, and other severely handicapped patients, a recently introduced aid is Saliswab (available in Europe), which acts as a combined salivary substitute and stimulating agent. In contrast to Lemon-Glycerin Swabs, it is not erosive.
The practitioner must be prepared to manage the complications of salivary hypofunction: increased caries, oral candidiasis, altered oral function, and pain. Initially, patients with xerostomia do not have extensive restorative treatment needs because it takes some time for clinical caries to develop. Therefore, it is important to diagnose impaired salivary function and xerostomia as early as possible and introduce intensive needs-related preventive programs before caries has developed.
In patients who have already developed several carious lesions, restorative treatment should be carried out in stages, beginning with excavation of caries and placement of provisional restorations using slow-release fluoride materials, such as glass-ionomer cements or resin-modified glass-ionomer cements, combined with an initially intensive, individually tailored preventive program. Once carious activity is under control, the next stage is definitive therapy¾restorations in the form of complete crowns and fixed partial dentures. Most patients with severely impaired salivation and
xerostomia should be regarded as lifelong high-caries-risk patients; they must continue on an intensive maintenance preventive program.
