What do anti-histamines, anti-hypertensives...

What do anti-histamines, anti-hypertensives and anti-depressants all have in common?

It would probably be easier to list the medications that do not have dry mouth (xerostomia) as a side effect!  Many prescription and over the counter medications used to treat depression, allergies, hypertension, high cholesterol,  the common cold can cause dry mouth.  So what impact does this have on your patient?

Your patient is not always a reliable indicator.  It would be necessary for patients to deplete nearly half of their salivary flow before they notice a problem with dryness, such as insufficient saliva to easily swallow food.  But long before that, important protective effects against decay and other infections are diminished.  Bottom line:  Patients taking any of these medications, or any medication with xerostomia as a listed side effect, assume there is some loss of salivary flow.

Patients with dry mouth are now at High Risk for cavities. With less saliva, tooth repair does not occur normally, so decay occurs more easily. Additionally patients frequently turn to hard candy or a sweet drink to keep their mouths moist (acid fruit juice is especially destructive).  Sadly, this simply feeds the bacteria that cause cavities, adding to the problem.  

What can you do? When patients are prescribed these medications, make them aware of the possible side effect.   If the patient has been on these medications previously, assess their knowledge of the dry mouth side effect.  Provide your patient with the following helpful hints.  Brush with a fluoride toothpaste at least twice a day (3-4 is better) and “Spit, don’t rinse” with water after brushing.  Sugar is damaging and suggest to the patient to sip water or sugar free drinks between meals.  Chewing sugarless gum, preferably with xylitol, is a good idea.  Lozenges with xylitol that stick to the mucosa and slowly dissolve are available and many find these products helpful, especially overnight. 

What their dentist will do. Dentists trained in a risk-based approach will usually place these patients on prescription toothpaste with 5000 ppm fluoride (OTC is 1200 ppm) with extra calcium and phosphate to replace that lost from saliva. They will often monitor them closely, including fluoride treatments every 3 months.

Dry mouth is more than unpleasant.  It can cost a patient their teeth. A nurse who knows the patient’s prescriptions is in a position to provide crucial oral health counseling that will make a long term difference in their life.