Residents With Dry Mouth

Dental professionals should also communicate the care recommendations described below to nursing staff for residents with specific conditions or needs, such as xerostomia, history of stroke, and cognitive impairments. Older adults are more likely to experience chronic health conditions that require medical interventions.² Many of these interventions result in xerostomia, or dry mouth, where there is insufficient salivary flow to maintain adequate moistness in the mouth.¹² This leads to multiple symptoms and oral health risks. Xerostomia is often a pharmaceutical side effect to common drugs such as antihypertensives, anticholinergics, antidepressants, and diuretics that are prescribed for many nursing home residents and care-dependent patients.¹³ Xerostomia is also prevalent in patients who have undergone head and neck radiation for cancer treatment, as well as those with Sjogren syndrome. Patients who rely on others for assistance with eating and drinking, and those who have difficulty swallowing, are at risk of dehydration, which can lead to xerostomia as well.

Dry mouth symptoms are numerous and lead to multiple sequalae. Patients experience discomfort from reduced lubrication in the oral cavity, which can lead to a higher incidence of trauma, particularly in those with dentures and other oral appliances. It can also inhibit communication, which can cause other problems to remain unreported or misunderstood by caregivers. The lack of salivary flow reduces the clearance of food debris, bacterial plaque, and acidity. This leaves the dentition prone to higher rates of caries and the periodontium at greater risk for periodontal infection and destruction. The resultant pain, tooth loss, and oral and systemic infections cause illness, lower nutrient intake, and a reduced quality of life.¹⁴

Some instances of xerostomia can be prevented or treated after monitoring for signs of dry mouth. For instance, if the symptom is a side effect of a medication, this should be reported to the patient’s physician to evaluate if the medication or dosage is appropriate for the patient. There are also saliva stimulants that can be prescribed to increase salivary flow. Other practical measures that are recommended include ensuring that residents have plenty to drink, and some will need assistance or reminders. Caffeinated beverages can contribute to dehydration and dry mouth, so these should be avoided. All signs and symptoms of xerostomia, such as oral dryness or stickiness, or difficulty eating, swallowing, or speaking, should be reported to the resident’s nurse so the patient can be evaluated, and the appropriate measures added to the treatment plan.

Xerostomia must be addressed in every patient, but there are many cases where it cannot be prevented or eliminated, as when radiation, essential medication, or another condition causes the symptom to persist. In these cases, methods of mitigation to increase moisture and or stimulate salivary flow are critical. First and foremost, the resident must stay hydrated. In addition, xylitol products such as mouth rinses, lozenges, or tablets can help patients by stimulating salivary flow, acting as a non-cariogenic sweetener, inhibiting cariogenic bacteria, and neutralizing oral pH.¹⁵ Saliva substitutes can also be used to lubricate the oral cavity and reduce discomfort. As with all residents, caregivers must ensure that frequent and thorough oral care is performed for these patients, particularly as they are more prone to dental caries and the other more immediate symptoms that accompany xerostomia.

Important Reminders for Caregivers:

• Report dry mouth to the resident’s nurse. This is a common problem in older adults and often due to polypharmacy (taking multiple medications).

• Provide frequent sips of water throughout the day because these residents don’t have enough saliva, which is a major cause of tooth decay.

• Perform mouth care after each meal.

• Notify the resident’s nurse of sores or discomfort caused by dentures, which are worsened in the presence of xerostomia.

• Follow the plan of care, using mouth rinses, oral gels, lozenges, or other products to relieve dry mouth.