Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management

Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient's situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being

Contusion of the cervical spinal cord following dental treatment of a patient at risk to stroke: A case report

ObjectivesIt is essential that especially elderly patients are correctly positioned in dental chairs, based on medical history and careful observation. MethodWe report a case where reclination of the patient's head resulted in weakness of the limbs. ResultsSubsequent investigation determined traumatic contusion of the cervical spinal cord. ConclusionsThis case highlights the need for accurate anamnesis, close observation and interdisciplinary communication to determine correct positioning. Exceptional circumstances necessitate speedy response to minimise adverse events in elderly patients

Contusion of the cervical spinal cord following dental treatment of a patient at risk to stroke: A case report

OBJECTIVES It is essential that especially elderly patients are correctly positioned in dental chairs, based on medical history and careful observation. METHOD We report a case where reclination of the patient's head resulted in weakness of the limbs. RESULTS Subsequent investigation determined traumatic contusion of the cervical spinal cord. CONCLUSIONS This case highlights the need for accurate anamnesis, close observation and interdisciplinary communication to determine correct positioning. Exceptional circumstances necessitate speedy response to minimise adverse events in elderly patients

Erfassung der Mundgesundheit von ambulant betreuten Senioren durch Hausärzte

Background!#!Despite a high prevalence in the general practitioner (GP) and geriatric field, limitations of oral health of seniors under outpatient care in Germany are not routinely recorded. Since seniors with a high age visit GPs more often than dentists, the question arises whether an interdisciplinary screening instrument can be used to identify reduced oral health in routine practice.!##!Objective!#!The aim of the work was to develop a screening tool for reduced oral health for GPs and to validate this by dental examinations.!##!Material and methods!#!The geriatric outpatient oral health screening (GAMS) was developed as a subjective screening instrument to depict dental aspects relevant for geriatric patients, such as chewing problems, pain, periodontitis, bad breath or dry mouth in dichotomous questions. The urgency of a visit to the dentist is also assessed by the family doctor. A total of 75 patients were included and the GAMS and a dental examination were performed for validation.!##!Results!#!The subjective assessment of patients and dental findings showed reduced oral health especially with recognized risk factors for the development of systemic comorbidities, such as dysphagia and malnutrition, whereas oral health problems were underestimated by patients. Bites, chewing problems and dry mouth showed sufficient correspondence between dental findings and subjective assessment.!##!Conclusion!#!The GAMS could help facilitate the consideration of oral health problems in geriatric patients in a GP setting and promote cooperation with dentists in the sense of European recommendations for action

Impact of care level, setting, and accommodation costs on a newly developed oral care nursing plan format for elderly patients with care needs – Results from a cross‐sectional study

Objectives: A new oral care nursing plan format for improved communication among dentists, nursing staff and caregivers has been developed in Germany. We aimed to (1) describe this plan, (2) investigate the prevalence of oral health problems among elderly patients with care needs documented by the plan, outline the recommendations in the plans and (3) investigate whether the accommodation costs or care needs of patients influenced oral care quality or the need for oral hygiene support documented within the plan. Methods: In this cross-sectional trial, oral care nursing plans were collected from outpatient and inpatient care clinics. Items on the oral care nursing plan were divided into three areas (oral health, oral hygiene needs, and coordination needs and dental therapy) and were correlated with the care level and accommodation costs. Results: Oral care nursing plans were collected from seven dentists (N = 747; 94.5% from inpatient and 5.5% from outpatient care). The plans enabled documentation of well-known oral health and hygiene problems among elderly patients. In their current form, the plans provided recommendations for obvious oral hygiene tasks such as toothbrushing or fluoridating, rather than specialized tasks such as nutritional advice or dry mouth asymptomatic therapeutic approaches. Although accommodation costs were associated with the need for oral hygiene support (not with oral care condition), the care level influenced both measures. Conclusions: The oral care nursing plan can facilitate documentation of oral health and hygiene among elderly individuals with care needs. Further clarification of the plan would help promote careful documentation by dentists. Keywords: ageing; home care services; housing for the elderly; oral diagnosis; oral hygiene

Efficacy of a newly developed mouth gel for xerostomia relief-A randomized double-blind trial

Objectives To determine the efficacy of a new symptom-relieving mouth gel vs. a widely used control gel on xerostomic burden. Materials and methods This randomized, double-blind, crossover trial investigated the efficacy of the test gel (Dr. Wolff Gel) vs. control (Biotene) in participants with xerostomia (n = 32; mean age 60 years). Oral examinations were taken at baseline, and xerostomic visual analogue scales (xVAS), after-use questionnaires and willingness to pay were investigated before and after use. Results Neither gel reduced xerostomic burden (xVAS) after 7-day application. There was some preference for the test gel regarding taste and healthy gum feeling. After 1-time application, there were differences favouring the test gel for symptom-relieving effects between test gel and water (p < 0.001), mucosal adhesion (p < 0.001) and taste persistence (p < 0.001). Overall symptomatic relief with the test gel lasted around 2 hr. Conclusions No mouth gel alleviated the overall xerostomic burden. Nevertheless, the test gel led to short-term perceived symptomatic relief and improved patient-centred outcomes as taste and perceived gum health. The gel will probably mainly be effective at moments that patients mostly suffer from xerostomia. Selection of a product will be based on perceived subjective differences and their value in the context of the overall xerostomic burden