Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-23, 14:27:11 | version 1.38.0
33Dental Tribune Middle East & Africa Edition | November-December 2014 oral health < Page 32 Visit us at: IDS COLOGNE, 10–14 March 2015, Hall 11.2 – Booth N30 & O31 Inibsa_A4_DTMEA614.pdf 1 17.10.14 11:42 (difficulty swallowing), and diffi- culty chewing food secondary to salivary gland hypofunction can lead to changes in food and fluid selection that compromise nu- tritional status. The speech and eating difficulties that develop can impair social interactions and may cause some patients to avoid social engagements. Dys- phagia increases susceptibil- ity to aspiration pneumonia and colonisation of the lungs with Gram-negative anaerobes from the gingival sulcus.12 Management of xerostomia and salivary gland hypofunc- tion The initial step in the manage- ment of xerostomia is the es- tablishment of a diagnosis. This frequently involves a multidisci- plinary team of health care pro- viders who communicate effec- tively, since many patients have concomitant medical conditions and frequently experience com- plications of polypharmacy. The second step is scheduling fre- quent oral health evaluations due to the high prevalence of oral complications.13 Maintenance of proper oral hy- giene and hydration (water is the drink of choice) are helpful. Several habits, such as smok- ing, mouth breathing, and con- sumption of caffeine containing beverages, have been shown to increase the risk of xerosto- mia. Limiting or stopping these practices should lessen the se- verity of dry mouth symptoms. A lowsugar diet, daily topical fluoride use (e.g. fluoride tooth- paste and mouth rinses), anti- microbial mouth rinses, and use of sugar-free gum or candy to stimulate salivary flow, help to prevent dental caries. Patients must be instructed on the frequent use of fluids during eating, particularly for dry and rough foods. Eating and swal- lowing problems secondary to salivary gland hypofunction can impair the intake of fibre-rich foods, restricting some older adults to a primarily soft and carbohydrate diet. Accordingly, patients must be counselled on a well-balanced, nutritionally ad- equate diet and the importance of limiting sugar intake, particu- larly between meals. If there are remaining viable salivary glands, stimulation techniques using sugar-free chewing gum, candies (sweets), and mints can stimulate sali- vary output. Chewing sugar- less gum is an extremely effec- tive and continuous sialogogue, since it increases salivary output and increases salivary pH and buffer capacity. Buffered xylitol- containing chewing gums or mints are often recommended, because xylitol has an anti-car- iogenic effect. Conclusion Saliva not only plays a pivotal role in the maintenance of a healthy homeostatic condition in the oral cavity, but contributes to one’s overall health and well- being. Components from saliva interact in different ways with the dentition to protect the teeth. Patients who lack sufficient sa- liva suffer from many oral dis- eases, of which caries is only one. To alleviate discomfort they are advised to use saliva stimu- lants and substitutes which have the function of lubricating the oral surfaces. Chewing sugar free gum is increasingly being viewed as a delivery system for active agents that could poten- tially provide direct oral care benefits, as it promotes a strong flow of stimulated saliva. The fourth edition of Saliva and Oral Health is available in hard copy or e-book format at www. shancocksltd.com. A full list of references is included in the book. *Underwriting costs for this Sali- va and Oral Health edition were provided by Dr. Michael Dodds and The Wrigley Company. References 1. Jensen SB, Pedersen AM, Vis- sink A, Andersen E, Brown CG, Davies AN, et al.A systematic re- view of salivary gland hypofunc- tion and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer 2010; 18: 1061-1079. 2. Jensen SB, Pedersen AM, Vis- sink A, Andersen E, Brown CG, Davies AN, et al. A systematic re- view of salivary gland hypofunc- tion and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18: 1039-1060. 3. Thomson WM, Chalmers JM, Spencer AJ, Ketabi M. The occurrence of xerostomia and salivary gland hypofunction in a population-based sample of old- er South Australians. Spec Care Dent 1999; 19: 20-23. 4. Atkinson JC, Wu A. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc 1994; 125: 409-416. 5. Dawes C. Circadian rhythms in the flow rate and composition of unstimulated and stimulated human submandibular saliva. J Physiol 1975; 244: 535-548. 6. Ship JA, Fox PC, Baum BJ. How much saliva is enough? Normal function defined. J Am Dent Assoc 1991; 122: 63-69. 7. Ghezzi EM, Lange LA, Ship JA. Determination of variation of stimulated salivary flow rates. J Dent Res 2000; 79: 1874-1878. 8. Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensa- tion of dry mouth in man. J Dent Res 1987; 66 (Spec Issue): 648- 653. 9. Ship JA, Fox PC, Baum BJ. How much saliva is enough? Normal function defined. J Am Dent Assoc 1991; 122: 63-69. 10. Jorkjend L, Johansson A, Johansson AK, Bergenholtz A. Periodontitis, caries and salivary factors in Sjögren’s syndrome patients compared to sex- and age-matched controls. J Oral Re- habil 2003; 30: 369-378. 11. Almståhl A, Wikström M. Oral microflora in subjects with reduced salivary secretion. J Dent Res 1999; 78: 1410-1416. 12. Loesche WJ, Schork A, Ter- penning MS, Chen YM, Stoll J. Factors which influence levels of selected organisms in saliva of older individuals. J Clin Mi- crobiol 1995; 33: 2550-2557. 13. Atkinson JC, Wu A. Sali- vary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc 1994; 125: 409-416.