June 2015
Volume 11, Issue 6

Treating Sensitivity and Gingivitis from Xerostomia

A new option to relieve and prevent complications from dry mouth

Mark Mensh, DMD

Xerostomia, or dry mouth, is a condition that can have serious implications for oral health and patient quality of life. The prevalence of dry mouth in the general population is difficult to accurately measure; prevalence rates from 0.9% to 64.8% have been reported.1 Its diagnosis is complicated by the fact that xerostomia is reported subjectively and can have various causes, including medication use, salivary gland dysfunction, and certain autoimmune diorders.2,3

Patients with dry mouth can present with a variety of symptoms, including difficulty speaking or swallowing, sore throat, and hoarseness.4 Dentists may also encounter gingivitis, sensitivity, and increased caries rates in patients with dry mouth,5 which can further complicate treatment protocols and cause patients more frustration, discomfort, and time/expense in the dental office.

Dental professionals can suggest that patients use a special gel or rinse designed to keep their mouths moist. If patients are also at risk for developing caries, dentists might also prescribe a toothpaste or mouth rinse that contains fluoride, apply a fluoride gel, or give the patient a fluoride rinse during their office visit.6 Other ways patients may find relief include:6

· chewing sugar-free gum or sucking on sugar-free hard candies to stimulate salivary flow.
· sucking on ice chips.
· sipping water with meals to aid in chewing and swallowing food.
· using alcohol-free mouth rinse.
· avoiding carbonated drinks (like soda), caffeine, tobacco, and alcohol.
· using a lanolin-based lip balm to soothe cracked or dry lips.

A challenge to manage symptomatically, xerosomia’s oral health implications can severely impact patients’ daily health and function and prove to be a source of frustration to dental health professionals.

Case Presentation

A 37-year-old woman presented with an autoimmune neurological disease (complex regional pain syndrome, previously known as reflex sympathetic dystrophy syndrome) that caused her to experience severe dry mouth discomfort and increasing sensitivity. Recent bitewing radiographs (Figures 1 through 4)show the result of her constant battle against caries, as most of her posterior teeth have been restored. The patient had 17 fillings in the past 5 years, with nine of these in the past year alone. The patient described her symptoms as an “extremely dry and very uncomfortable” mouth and “extremely sensitive” teeth that made it very difficult to drink anything cold.

Initial attempts to alleviate her symptoms included the use of both over-the-counter and prescription-strength products. These provided temporary, short-term relief; however, this long-time patient nevertheless experienced a worsening of her condition and symptoms over time.

Upon clinical examination, the patient’s mucosa was tight and dry. She reported that her lips were often dry and cracked, which caused her to constantly use a moisturizer. In addition, her tongue was often dry and felt rough, and she had trouble swallowing and difficulty speaking due to the lack of lubrication from the absence of saliva. She also complained that she was unable to flush debris from her mouth, which often caused her throat to tickle or feel hoarse.

In addition to these ongoing symptoms, the patient was beginning to experience severe gingivitis and increasing sensitivity. She was constantly returning for restorative work to fight an ever-increasing battle against caries.

Treatment

In the past 5 years, attempts at treating the patient’s condition with every available option had only at best relieved her dry mouth discomfort for a short period of time each day, had not been able to reduce her sensitivity or gingivitis, and did not manage or prevent caries as effectively as the author had hoped.

To protect against complications, it has been recommended that dental professionals encourage patients with dry mouth to use a dentifrice that provides as many of the following benefits as possible: strong caries protection, sensitivity reduction, demineralization resistance, and lubrication of mucosa.7 With this in mind, the author decided to give the patient a sample of Enamelon® Preventive Treatment Gel, a new product from Premier Dental Products (www.premusa.com), to discover if this stannous fluoride treatment gel delivering amorphous calcium phosphate (ACP) could help her. According to the manufacturer, Enamelon contains 970 ppm fluoride and is free of sodium laurel sulfate, gluten, and dyes.8 Although it is only available to patients through their dental offices, it is classified as an over-the-counter product.8

After a restorative appointment, the patient was given a 4-oz tube of Enamelon Preventive Treatment Gel and instructed to brush at least in the morning and evening with a dry toothbrush so the product would not be diluted. After 2 minutes of brushing, the patient was instructed to spit and not to rinse, eat, or drink for 30 minutes. The author advised the patient that this product is designed to help prevent caries and gingivitis, relieve sensitivity, and may even help to relieve the discomfort of her dry mouth. It was suggested that the patient replace her current treatment protocol, which provided only temporary relief despite using the product almost six times a day, with Enamelon for several days to test its efficacy in her case. Further, if she felt like it was not helping, she was to immediately return to the protocol that did provide some relief.

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