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Xerostomia: Looking with fresh eyes to reduce dry mouth A peer-reviewed article written by Alisa Cooper, DC

PUBLICATION DATE: APRIL 2019

EXPIRATION DATE: MARCH 2022

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Xerostomia: Looking with fresh eyes to reduce dry mouth LEARNING OBJECTIVESThis course is designed to help dental professionals do the following:1. Understand the etiology of xerostomia2. Identify the signs and symptoms of xerostomia3. Compare treatments for xerostomia4. Educate patients about xerostomia and offer compassionate support5. Recommend safe, effective products to help patients manage the condition

at home

ABSTRACTXerostomia is a term that describes the feeling of having a dry mouth, whether as a perceived sensation or the result of salivary gland hypofunction. Regard-less of cause, it manifests as a cluster of signs and symptoms encountered in dental practice frequently. While occasional mouth dryness is normal, chronic dry mouth can have devastating consequences on oral health and quality of life. Dental professionals can have a profound impact on xerostomia patients by preventing and mitigating related oral complications. Furthermore, dental professionals can educate patients on how best to cope with the condition. This course emphasizes clinical presentation, etiology, and available treatments for xerostomia. Also included is a review of popular oral health products—along with patient comments—to help practitioners guide patients through the plethora of over-the-counter treatment options.

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D E N T A L A C A D E M Y O F C O N T I N U I N G E D U C A T I O N

INTRODUCTIONMost people experience a dry mouth from time to time, whether it be from dehydration, mouth breathing due to allergies, or consum-ing dehydrating beverages. It is also common for people’s mouths to go dry if called upon to speak publicly, when the body’s fight-or-flight response makes it difficult to muster the moisture needed for articulation. While a few deep breaths and a sip of water may solve temporary dryness, when the condi-tion is chronic, the effects can be life-altering.

In the first section of this course, we will look at how dental professionals can recog-nize xerostomia. We will then look at etiol-ogy of xerostomia. Finally, we will look at xerostomia treatment.

RECOGNIZING XEROSTOMIAXerostomia is the term used to describe a collection of signs and symptoms associated with mouth dryness. Derived from the Greek words xeros for “dry” and stoma for “mouth,” xerostomia includes both the subjective feel-ing of having a dry mouth as well as an objec-tive decrease in saliva flow.1-3

IncidenceXerostomia, which increases with age for both sexes, affects approximately 20% of the population. Elderly females experience a higher prevalence of dry mouth, which may be due to postmenopausal decline in hormones.3 The fact that more seniors experience xerostomia is due to a complex interplay between aging, systemic diseases, and polypharmacy, the simultaneous use of several prescription medications for one or more conditions.2,4 Studies show that the world’s geriatric population is growing. As dental professionals strive to meet their patients’ needs, it is important to have a thorough understanding of xerostomia.2

The role of saliva To fully understand the effects of xerosto-mia on health and well-being, it is impor-tant to review the functions and benefits of saliva. The normal daily production of saliva ranges between 0.5 and 1.5 liters and consists of an aqueous fluid rich in electro-lytes, minerals, enzymes, buffering agents, immunoglobulins, and urea.1 Saliva is pro-duced by three primary salivary glands, the

parotid, submandibular, and sublingual. It is involved in lubrication, digestion, taste, buffering, protection, and clearance.3

Saliva eases normal frictional movements and provides the lubrication that makes swallowing, speaking, and eating possible and comfortable.5 Besides initiating diges-tion, saliva is the solvent that allows for taste sensation and the enjoyment of food. At a pH of 6–7, saliva neutralizes acids to rem-ineralize the teeth and maintain a healthy oral microbiome. Protecting the oral mucosa from injury, trauma, burns, and infection, saliva also washes away food debris to ward off oral malodor and prevent dental car-ies and gum disease.1–3,5 A lack of adequate saliva impairs these crucial functions, lead-ing to adverse effects on dental health and quality of life.

Signs and symptomsSigns and symptoms of xerostomia can range from mild discomfort to significant pain and dysfunction. Besides a dry mouth and throat, the patient may have trouble speak-ing, chewing, and swallowing, and have a diminished or abnormal taste sensation (dysgeusia).3 Some patients complain of burning in the mouth and intolerance for spicy, dry, acidic, or crunchy foods.4

Xerostomic patients frequently experi-ence cotton mouth and chapped, peeling, or cracked lips ( figure 1), and inflamma-tion at the corners of the mouth (angular cheilitis; figure 1). Many experience hoarse-ness, coughing, and difficulty wearing their dentures. When saliva is lacking, prostheses generally become less stable and surround-ing tissue more vulnerable to trauma and ulceration. Additionally, xerostomia requires hydration throughout the day and night, resulting in multiple bothersome trips to the bathroom.3–6

Following a detailed case history, an oral examination will provide evidence of xero-stomia. Telltale signs include the absence of saliva pooling on the floor of the oral cavity and/or saliva that appears stringy or frothy. A dry, red, or cracked tongue may be lack-ing normal papillae or be coated white7 with candidiasis ( figure 2).

Figure 1: Angular chelitis

Figure 2: Candidiasis

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Additionally, the gums may be pale and the oral mucosa may be glossy and smooth. Gin-givitis, periodontitis, and dental erosion of the cervical and incisal/cuspid tips may be seen in chronic xerostomia.4,5,7 Table 1 summarizes the signs and symptoms of xerostomia.3,5–7

ETIOLOGY OF XEROSTOMIAMedicationThe most common cause of xerostomia is prescription medication. More than 400 medications are known to cause dry mouth, with over 70% of individuals who take them suffering from this side effect.1,4,8 The most common culprits include tricyclic antidepres-sants, antipsychotics, beta blockers, antihis-tamines, and antihypertensives. Additionally, drugs prescribed for smoking cessation, to control acne, to reduce symptoms of Parkin-son’s, and to treat an overactive bladder can also result in mouth dryness. Nonsteroidal anti-inflammatories (NSAIDS), such as ibu-profen and naproxen, taken for garden-variety

pain may also induce xerostomia.1,4,8

A correlation exists between increasing dry mouth symptoms and the number of medica-tions used. For example, in 20- to 80-year-old patients taking no medications, 17% had per-ceived symptoms of dry mouth. That number increased to 33.5% for those taking three med-ications and to 67% for those taking seven or more. Unfortunately, polypharmacy is most prevalent among senior citizens, for whom xerostomia is more likely caused by medica-tions rather than aging.4,6,8

RadiotherapyXerostomia often occurs in patients being treated with radiotherapy for head and neck cancers. These cancers thrive in the moist mucosal lining of the oral and nasal cavities, paranasal sinuses, pharynx, and larynx. Although head and neck cancers can originate in the salivary glands, they are rare. Radiation passing through these superficial glands to reach malignant tumors

compromises salivary function—often per-manently.9,10 Figure 3 below depicts the main salivary glands. Note the superficial loca-tion that makes them vulnerable to dam-age during radiotherapy for deeper head and neck tumors.

Radiotherapy-induced damage to the salivary glands is evident in half of patients within the first week of treatment.1 For many patients, decrease in salivation continues over time, leading to permanent xerosto-mia, loss of taste, and consequent challenges obtaining adequate nutrition.1,9

Sjögren’s syndromeXerostomia is a predominant symptom for individuals suffering from Sjögren’s syn-drome, a complex autoimmune condition of unknown etiology. While widespread organ involvement is common, the condition is most well-known for attacking secretory cells of salivary and lacrimal glands, leading to the characteristic dry mouth and dry eyes.1,11,12

Figure 3: Salivary gland anatomy36

Table 1: Signs and symptoms of xerostomia

Dry feeling in mouth and/or throat

Frequent thirst

Frequent coughing

Difficulty speaking, chewing, swallowing (dys-phagia)

Abnormal taste sensation (dysgeusia)

Sensitivity to spicy foods

Hoarseness, sore throat

Chapped, cracked, and/or peeling lips

Pale gums

Stringy and/or sticky saliva

Bad breath

Sores at corners of the mouth (cheilitis)

Difficulty wearing dentures

Coated, white tongue (candidiasis)

Burning, tingling sensation in the oral cavity, tongue

Painful tongue (glossodynia), tonuge fissures, and ulcers

Dry, rough, or red tongue

Increased tooth decay, erosion, and gum disease

Mouth sores

Swollen and/or painful salivary glands

Halitosis

Bacteria reproduce in the �ssuresand cause halitosis

Fissuredtongue



A combination of influences may underlie the hyperactive immune response typical of Sjögren’s syndrome. With a predilection for women over men at a ratio of 9:1, middle-aged females are most at risk.11 Regardless of cause, attempts are made to stimulate the salivary glands and/or to provide suitable saliva substitutes. Since xerostomia in these patients can be devastating, the focus of den-tal professionals is to help patients maintain oral health and minimize complications.12 Figure 4 illustrates a sore, cracked tongue often seen in patients with Sjögren’s syn-drome along with accompanying halitosis.

Other contributing factorsLifestyle habits can result in xerostomia that is transient or potentially reversible. Smok-ing, drinking alcohol, using mouthwashes containing alcohol, and consuming caffein-ated beverages can all contribute to the expe-rience of oral dryness. So too can chronic dehydration, snoring, mouth breathing due to allergies or congestion, and the wearing of mouthguards or dentures while sleeping.2,4

Anxiety and depression are psychologi-cal factors that can influence salivary gland function and result in xerostomia. In cases of anxiety, increased cortisol levels alter the proteins in saliva, which leads to xerostomia. With depression, anticholinergic mecha-nisms directly decrease salivary flow.13 Con-versing with patients about how common habits and psychological factors contribute to xerostomia may provide impetus for life-style modifications, stress management, and ancillary treatment.

Xerostomia occurs in many chronic sys-temic diseases. It is seen in patients with diabetes mellitus, hepatitis C, hyperten-sion, Epstein-Barr virus, sarcoidosis, HIV, kidney disease, and Parkinson’s. Common in Alzheimer’s and stroke patients, dry mouth is mostly a perceived sensation. Patients with connective tissue disorders such as rheuma-toid arthritis and systemic lupus erythema-tosus may also experience xerostomia.3,14,15

Eating disorders, such as anorexia and bulimia nervosa, affect the oral cavity and can cause xerostomia. Bulimia nervosa is characterized by episodes of unrestrained eating followed by forced vomiting. This binge/purge syndrome is seen mostly in young adult women who struggle to

maintain an unrealistic self-image and body weight. Bulimia may affect as many as 5 mil-lion Americans annually, including 10-20% of all college females.16

Dental professionals may encounter bulimic patients with tooth erosion. This results from the presence of gastric contents in the oral cavity over time. Ensuing dam-age to the salivary glands leads to hyposal-ivation and xerostomia, promoting dental

caries, erosion, and dysphagia. Figure 5 shows eroded teeth in a patient with bulimia.

Diminished salivary flow may also be caused by overuse of diuretics and laxa-tives and the dehydration that comes with fasting, as in anorexia, and vomiting, as in bulimia.17 In addition to restoring eroded teeth, dental professionals make necessary referrals for medical treatment and psycho-logical counseling.16

© Rob3000 | Dreamstime.com

Figure 4: Cracked, fissured tongue

Figure 5: Veneers and composites were placed in a patient who had previously been diagnosed with an eating

disorder and subsequently began bulimic practices again.37



Illicit drugs cause xerostomia and its adverse effects on dental health.18 Opiates are known for causing constipation, but dry mouth is another symptom endured while in the throes of addiction. Even suboxone (buprenorphine), the drug used to help addicts medically withdraw from opiates, causes dry mouth, predisposing to gingivi-tis, periodontitis, and tooth loss.19

Methamphetamines stimulate a hypervigilant sympathetic nervous system response that results in xerostomia and con-sequent tooth erosions. Additionally, the term “meth mouth” refers to a constella-tion of oral symptoms, including excessive teeth grinding, jaw clenching, and TMJ and related muscle spasms among its 35 million users worldwide.18

Cannabis (marijuana) use increases the risk of xerostomia and candidiasis. Chronic users may eventually suffer from premature tooth loss along with difficulty speaking and eating due to hyposalivation.20 As the popu-larity of these drugs continues to rise, dental professionals are increasingly called upon to treat related oral conditions while encour-aging long-term rehabilitative treatment.18

Approximately 1.5 million Americans suf-fer from burning mouth syndrome, or BMS, a painful oral disorder that can result in xerostomia. Affecting primarily peri- and postmenopausal women, two thirds of BMS victims suffer from xerostomia, and some experience abnormal taste sensation. Burn-ing, itching, and stinging in the oral cavity, especially the tongue, can arise spontane-ously and last for at least four to six months. Originally thought to be a psychiatric disor-der, the incidence of BMS in various medical conditions suggests a multifactorial etiology. A menopausal decline in estrogen, which protects mucous membranes, may explain its prevalence in middle-aged women.21

TREATMENT AND MANAGEMENT OF XEROSTOMIAThe treatment of xerostomia often begins with implementing lifestyle changes. Attempts are made to maintain adequate hydration by drinking at least eight 8-ounce glasses of quality water per day. Also, sip-ping water throughout the day rather than gulping large amounts periodically is advised. Swallowing large quantities of water

activates the micturition reflex. This stimu-lates the bladder to release its water before the body can absorb it at the cellular level to hydrate the body.22,23

Important dietary modifications include avoiding spicy, sugary, sticky, dry, and crumbly foods and replacing them with nutrient-dense, hydrating foods such as cit-rus fruits, watermelon, celery, cucumbers, salads, and stews.

Avoiding dehydrating beverages such as coffee, soda, and alcohol in excess and incor-porating lemon water, aloe vera juice, herbal teas, and coconut water are also beneficial.24,25 Limiting tobacco use, addressing root causes of snoring and mouth breathing, and employ-ing a humidifier at night are recommended.2,4

When medications are the cause of xero-stomia, dosages may be reduced, and medi-cations with a different mechanism of action may be considered.1,4 Some may obtain relief by limiting medications to daytime use or taking their medications in divided doses throughout the day.1,7 It is also advisable for patients to work with their health-care pro-viders to reduce reliance on prescription drugs since individuals taking four or more are more likely to suffer from xerostomia.2,4

When xerostomia is severe, sialagogues may be prescribed. These medications stim-ulate salivary flow when salivary glands retain some functional capacity. Pilocar-pine (Salagen®) benefits approximately 50% of patients with xerostomia following radiotherapy for head and neck cancers.1-3,6 Available orally in pastilles and lozenges, pilocarpine must be taken on a lifelong basis. Unfortunately, common side effects include sweating, skin flushing, nausea, diarrhea, headache, dizziness, dyspepsia, and urinary frequency. Pilocarpine must be used cau-tiously in those with pulmonary and cardiac disease and is contraindicated in patients with narrow-angle glaucoma.1,3-5,7,11,26.

Cevimeline (Evoxac®) is a sialagogue that can be used as an alternative to pilocarpine since it is better tolerated by the heart and lungs. While 70% of those using cevimeline experience side effects, most report them as mild to moderate and limited to causing sweating and dyspepsia.1,3,26

Many nonmedical treatments exist for xerostomia. Saliva substitutes and stim-ulants include lozenges, xylitol-sweetened

chewing gum, glycerin-containing lubri-cants, adherent oral disk technology, alco-hol-free mouthwashes, rinses, toothpastes, and oral sprays.1-4 Dental professionals can introduce patients to safe and effective prod-ucts that can reduce symptoms and improve quality of life. The table below highlights some popular products along with patient comments.27-34

Electrostimulation is a nonmedical modality that holds promise for the relief of severe xerostomia. Intraoral removable devices provide electric stimulation to the oral mucosa, resulting in a measurable decrease in oral dryness. Traditional acu-puncture may increase saliva flow lasting for up to six months. With additional treat-ments, this improvement may last for up to three years.

Studies also suggest that hyperbaric oxy-gen treatments decrease xerostomia and tissue necrosis following radiotherapy. Addi-tional research is needed to ascertain the effectiveness of these modalities as natural, sustainable ways to combat xerostomia.3,26

Lastly, meticulous oral care is central to the treatment of xerostomia. Frequent dental checkups minimize tooth decay, periodontal disease, and infections. Tooth brushing, flossing, mouth rinsing, and the use of a Waterpik and tongue scraper are vital for self-care at home.1–4 Oil pulling, an Ayurvedic practice known for improving oral health, may also help. It entails pulling coco-nut, olive, or sesame oil through the teeth and swishing for up to 20 minutes before expectorating and rinsing to remove toxins. Anecdotal evidence is favorable, but further research is needed to determine its efficacy in addressing xerostomia.35

CONCLUSIONXerostomia, a common condition stemming from a variety of causes, can have devastat-ing consequences on oral health and quality of life. While no cure exists, many treatment options are available to reduce its adverse effects. Dental professionals can be a vital resource for xerostomia patients by optimiz-ing their oral health, providing education about the condition, and offering compas-sionate support.



Table 2: An assortment of dry mouth products

DESCRIPTION PATIENT COMMENTS

PRO

DU

CT/M

AN

UFA

CTU

RER

Xylim

elts

XyliMelts are disks made with xylitol, a natural sweetener that helps stimulate saliva flow and may reduce the risk of tooth decay. The disks adhere to the teeth or gums and can be worn day or night to temporarily relieve dry mouth.

XyliMelts moisturize and coat the mouth by releasing xylitol over time.

Individuals allergic to adhesive may need to proceed with caution. Xylitol is lethal to dogs and must be kept out of their reach.

“After years of dry mouth sprays and lozenges, my hygienist recom-mended XyliMelts and gave me a sample. I called back and told her they were wonderful and so simple. You can even put one on both sides for an extended time.

“Being a veterinarian, it was either “cotton mouth” or choking on lozenges. Now I can drink water and use XyliMelts through lengthy procedures.”

Bio

tène

The Biotène line of products includes a moisturizing gel, oral rinse, and mouth spray formulated to moisturize and refresh the mouth by matching the pH of saliva.

Biotène toothpaste is formulated to be moisturizing and nonirritat-ing. Biotène products are considered generally safe. Like all other oral care products, they should not be swallowed and must be kept out of reach of children.

“I have serious problems with dry mouth from the medications I take. While this stuff certainly isn’t something I would want to con-sume as a ‘treat,’ it definitely does the job it’s supposed to!

“A few quick sprays into my mouth after brushing my teeth in the morning, and no problems with my lips sticking to my teeth!”

Xle

ar

Xlear is a leading manufacturer of xylitol-based products in North America. Their non-GMO dental line of oral care products, Spry, contains xylitol.

Products include Peppermint Gum, Cool Mint Oral Rinse, Berry Blast Mints, and Fluoride-free Peppermint Toothpaste. For best results, Spry recommends using the full assortment of products throughout the day to ensure ongoing exposure to moisturizing xylitol.

“I've used Spry Xylitol Rinse for about a year and I now depend on it to relieve dry mouth while I sleep. I use a toothpaste for sensitive teeth and it does not conflict with that.

“I've had no problems with my teeth since using this regularly.

“It says to keep the rinse in your mouth for one minute, and it can have a tingling, burning sensation, but it is worth it to be able to sleep through the night without waking up as though the Sahara Desert was in my mouth and throat.”

Clo

SY

S

CloSYS Oral Health System is comprised of gentle products designed for sensitive mouths: alcohol-free oral rinses (flavored and unflavored); CloSYS “Silver,” a fluoride rinse; CloSYS toothpaste (available with or without fluoride); and a Fresh Breath oral spray.

CloSYS limits plaque, neutralizes sulfur compounds that cause malodor, and reduces bacteria that contribute to gum and systemic diseases. CloSYS has also been shown to alleviate oral mucositis and relieve xerostomia.

“Due to Sjögren’s, the tip of my tongue was always cracked and sore. I had embarrassing cotton mouth and constant thrush. My hygienist told me about CloSYS and it ended up being life changing for me.

“My mouth isn’t as dry, and the thrush is kept at bay. My tongue doesn’t crack, and I don’t require copious amounts of water that had me running to the bathroom all the time. I know Sjögren’s pa-tients who have lost their teeth, but CloSYS has enabled me to keep mine. I am so grateful.”

Ste

llaL

ife

StellaLife offers VEGA Oral Care Solutions, an all-natural line of oral health products that contain homeopathic ingredients with anti-inflammatory and antimicrobial properties to reduce pain and optimize oral health.

VEGA Oral Care Gel temporarily reduces pain, swelling, and bruising. The VEGA Oral Rinse effectively fights bacteria, and the Oral Hydra-tion Mist hydrates the oral cavity and freshens the breath.

“I purchased (StellaFresh) to help with dry mouth and to preserve my teeth after chemotherapy treatments, and this product works extremely well.

“It repaired my sore gums and inner jaw, which was cut up from lack of moisture, and my tongue, which I burnt on hot water be-cause my tongue was so sensitive from having a dry mouth.

“I will continue to use this after every chemo treatment and beyond.”

Hyd

ris

Hydris is Colgate’s product line specifically tailored for dry mouth conditions. Hydris Mouthwash is a mint-flavored rinse designed to keep the mouth hydrated for four hours.

Hydris Dry Mouth Hydrating Toothpaste also provides relief from dry mouth for up to four hours while freshening the breath and prevent-ing cavities.

“Great product. Definitely makes a difference in keeping my mouth moist due to a medicine I take that can be a problem. Have been us-ing for a couple of weeks, but even after the first use, was hooked.

“It is a bit thicker than regular mouthwash but not to the point of be-ing unpleasant. Fresh taste and lasts till bedtime – I'm in!”



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http://www.worldnutrition.net/blog/hydrate-for-health. Accessed Jul. 31, 2018.23. Thomas L. (2018). Micturition reflex - neural control of urination. [online]

News-Medical.net. Available at: https://www.news-medical.net/health/Micturition-Reflex-Neural-Control-of-Urination.aspx. Accessed Jul. 31, 2018.

24. 8 most hydrating drinks besides water. (2018). [Blog] NDTV Food Desk. Available at: https://www.food.ndtv.com/food-drinks/8-most-hydrating-drinks-besides-water-1774730. Accessed Jul. 31, 2018.

25. Donoho Dental Associates, PC. (2016). Thirsting for Answers? Try these 6 home remedies for dry mouth. [online] Available at: http://http;//www.donohodental.com/thirsting-answers-try-6-home-remedies-dry-mouth/. Accessed Jul. 31, 2018.

26. Scully C. (2013). Dry Mouth (Xerostomia and Hyposalivation). In: C. Scully, ed., Oral and Maxillofacial Medicine, 3rd ed. [online] Churchill Livingstone, pp.91-97. Available at: http://https//doi.org/10.1016/B978-0-7020-4948-4.00008-8. Accessed Jul. 31, 2018.

27. XyliMelts for dry mouth (2018). [online] Oracoat.com. Available at: https://www.oracoat.com/products/xmdm. Accessed Jul. 31, 2018.

28. Watson S. (2018). Does Biotene cure dry mouth? [online] HowStuffWorks. Available at: https://health.howstuffworks.com/wellness/oral-care/products/biotene-cure-dry-mouth.htm. Accessed Jul. 31, 2018.

29. Biotene.com. (2018). Biotène® #1 Dentist Recommended Dry Mouth Brand | Biotène®. [online] Available at: https://www.biotene.com/. Accessed Jul. 31, 2018.

30. Amazon.com. (2018). Customer reviews Biotene oral rinse. [online] Available at: https://www.amazon.com/Biotene-Mouth-Oral-Rinse-Fresh/product-review. Accessed Jul. 31, 2018.

31. Xlear. (2018). Spry dental defense - leaders in oral care xylitol products. [online] Available at: http://www.xlear.com/spry-dental-defense/. Accessed Jul. 31, 2018.

32. Closys.com. (2018). CloSYS - oral hygiene products, toothpaste, oral rinse & fresh breath spray. [online] Available at: https://closys.com/. Accessed Jul. 31, 2018.

33. Stellalifehealing.com. (2018). Stellalife Consumer Reviews, available at: https://stellalifehealing.com/pages/consumers- Accessed Jul. 31, 2018.

34. Colgate.com. (2018). Dry mouth mouthwash & rinse | Colgate® Hydris™. [online] Available at: https://www.colgate.com/en-us/products/mouthwash/hydris. Accessed Jul. 31, 2018.

35. Bradford A. (2015). Oil Pulling: Benefits & Side Effects. [online] Live Science. Available at: https://www.livescience.com/50896-oil-pulling-facts.html. Accessed Aug. 1, 2018.

36. Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2).DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work

37. Burkhart NW. Bulimia: Decreasing the damage to the enamel. RDH website. https://www.rdhmag.com/articles/print/volume-31/issue-1/columns/bulimia-decreasing-the-damage-to-enamel.html. Published January 1, 2011. Accessed March 5, 2019.

ALISA COOPER, DC, is a chiropractor, clinical nutritionist, and certified Emotional Freedom Techniques practitioner with more than 25 years’ experience helping others achieve and maintain optimal health and wellbeing. Dr. Cooper’s informative presentations, books, articles and blogs empower and educate others on various topics and trends in health care today. Dr. Cooper maintains a private practice and freelance writing career.


Q U E S T I O N S

ONLINE COMPLETIONUse this page to review the questions and answers. Return to www.DentalAcademyOfCE.com and sign in. If you have not previously purchased the program select it from the “Online

Courses” listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete

all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for

viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.

QUICK ACCESS CODE 15337

1. The term “xerostomia” refers to which of the following?a. The subjective feeling of having a dry

mouthb. An objective decrease in salivac. An increase in saliva resulting in droolingd. Both A and B

2. Who is most likely to experience xerostomia?a. Young femalesb. Elderly femalesc. Young malesd. Elderly males

3. What percentage of the population suffers from xerostomia?a. 10%b. 20%c. 30%d. 40%

4. The world’s geriatric population is:a. Increasingb. Decreasingc. Staying about the samed. Not relevant to the topic of xerostomia

5. Which is not a common cause of xero-stomia in seniors?a. Polypharmacyb. Agingc. Anxietyd. Systemic disease

6. Which of the following is a constitu-ent of saliva?a. Buffering agentsb. Mineralsc. Both A and Bd. None of the above

7. Which is a function of saliva?a. Lubricationb. Digestionc. Protectiond. All of the above

8. Which of the following statements is false?a. The normal pH of saliva is 5-6b. Saliva helps maintain the oral microbiomec. Saliva can be instrumental in preventing

dental cariesd. Taste sensation is related to adequate

amount and composition of saliva

9. Patients with xerostomia may com-plain of:a. Mild discomfortb. Significant pain and dysfunctionc. Burning sensations in the oral cavityd. All of the above

10. Which term describes an abnormal taste sensation?a. Dysphagiab. Dysgeusiac. Cheilitisd. Glossodynia

11. Which is not characteristic of xerostomia?a. Sticky salivab. Oral malodorc. Dysphagiad. Insensitivity to spicy foods

12. The most common cause of xerosto-mia isa. Agingb. Radiotherapy for head and neck cancersc. Medicationd. Systemic disease

13. How many medications are known to cause xerostomia?a. Over 400b. Over 300c. Over 200d. Over 100

14. What percentage of people taking more than seven medications experi-ence xerostomia?a. 17%b. 34%c. 50%d. 67%

15. Which of the following statements is false?a. Radiation damage to salivary glands may

be permanentb. Salivary gland tumors are commonc. Salivary gland damage affects approxi-

mately 50% of patients in the first week of radiotherapy for head and neck cancers

d. Salivary glands are superficially located anatomical structures

16. Which of the following statements about Sjögren’s syndrome is true?a. Its etiology is well knownb. It affects more men than women by a ratio

of 9:1c. Xerostomia in these patients is often severed. It targets only the oral cavity

17. Which of the following is not a com-mon cause of xerostomia?a. Smokingb. Geographic locationc. Depression and anxietyd. Excessive alcohol intake


Q U E S T I O N S

ONLINE COMPLETIONUse this page to review the questions and answers. Return to www.DentalAcademyOfCE.com and sign in. If you have not previously purchased the program select it from the “Online

Courses” listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete

all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for

viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.

QUICK ACCESS CODE 15337

18. Dental professionals treating patients with bulimia may encounter which of the following?a. Dental cariesb. Severe tooth erosionc. Psychological conflictd. All of the above

19. Which of the following statements is false?a. Opiates cause constipation and xerostomiab. Marijuana’s effects on the oral cavity are

temporaryc. Methamphetamines stimulate the sympa-

thetic nervous system d. Dentists treat oral complications of

addiction

20. Which of the following statements is true about burning mouth syndrome?a. It presently affects half a million Americansb. It is primarily a psychiatric disorderc. It commonly affects postmenopausal

womend. All BMS patients suffer from xerostomia

21. The initial approach to treating xero-stomia commonly begins with:a. Medicationb. Electrostimulationc. Acupunctured. Lifestyle changes

22. Which of the following would be the worst food choice for someone with xerostomia?a. An arugula and beet saladb. A fruit saladc. A freshly baked scone d. A vegetable crudité

23. If used on a regular basis, which of the following beverages would be least likely to contribute to a dry mouth condition?a. Margaritab. Cappuccinoc. Coca-Colad. Coconut water

24. When medications are the cause of xerostomia, which of the following strategies should be initiated?a. Search for an alternate medicationb. Reduce the dosagec. Take the medication in divided dosesd. All of the above

25. Which of the following statements about sialagogues is false?a. Sialagogues treat anxiety and depressionb. Cevimeline and pilocarpine are sialagogues c. Sialagogues require some degree of func-

tional salivary gland tissued. Sialagogues may cause unwanted side

effects

26. Which of the following is not recom-mended for addressing symptoms of xerostomia?a. Chewing gum sweetened with xylitolb. Alcohol-based mouthwashc. Toothpaste containing fluorided. Adherent oral disks

27. Which of these nonmedical modali-ties for treating xerostomia warrants further research?a. Hyperbaric oxygen treatmentsb. Traditional acupuncturec. Oil pullingd. All of the above

28. Which of the following is tantamount to preventing complications seen with xerostomia?a. Vigilant oral careb. Frequent dental checkupsc. Healthy lifestyle choicesd. All of the above

29. Which of these statements about xerostomia is false?a. Xerostomia is a common condition with

potentially devastating consequencesb. Dental professionals can have a positive

impact on xerostomia patientsc. There are few treatment options and

resources available for patients with xerostomia

d. The treatment of severe xerostomia may require an interdisciplinary approach

30. Which statement is true concerning popular over-the-counter products for treating xerostomia?a. XyliMelts, Biotène, Xlear, Spry, CloSYS,

Hydris, and Vega Oral Care Solutions are all viable options

b. Dental professionals can introduce patients to safe, effective oral care products

c. Patients are likely to appreciate sugges-tions and samples

d. All of the above

Customer Service 800-633-1681

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16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.

For IMMEDIATE results, go to www.DentalAcademyOfCE.com to take tests online.

QUICK ACCESS CODE 15337 Answer sheets can be faxed with credit card payment to

918-212-9037.

Payment of $59.00 is enclosed. (Checks and credit cards are accepted.)

If paying by credit card, please complete the following: MC Visa AmEx Discover

Acct. Number: ______________________________

Exp. Date: _____________________

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If not taking online, mail completed answer sheet to PennWell Corp.

Attn: Dental Division, 1421 S. Sheridan Rd., Tulsa, OK, 74112

or fax to: 918-212-9037

AGD Code 730

ANSWER SHEET

Xerostomia: Looking with fresh eyes to reduce dry mouth

Name: Title: Specialty:

Address: E-mail:

City: State: ZIP: Country:

Telephone: Home ( ) Office ( )

Lic. Renewal Date: AGD Member ID:

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 3 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 800-633-1681

EDUCATIONAL OBJECTIVES1. Understand the etiology of xerostomia

2. Identify the signs and symptoms of xerostomia

3. Compare treatments for xerostomia

4. Educate patients about xerostomia and offer compassionate support

5. Recommend safe, effective products to help patients manage the condition at home

COURSE EVALUATION1. Were the individual course objectives met?

Objective #1: Yes No Objective #2: Yes No

Objective #3: Yes No Objective #4: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them.

______________________________________________________________________________

13. Was there any subject matter you found confusing? Please describe.

______________________________________________________________________________

14. How long did it take you to complete this course?

______________________________________________________________________________

15. What additional continuing dental education topics would you like to see?

______________________________________________________________________________

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.COURSE EVALUATION and PARTICIPANT FEEDBACK

We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please e-mail all questions to: [email protected].

INSTRUCTIONSAll questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination.

COURSE CREDITS/COSTAll participants scoring at least 70% on the examination will receive a verification form verifying 3 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is 4527. The cost for courses ranges from $20.00 to $110.00.

PROVIDER INFORMATIONPennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at www.ada.org/cotocerp/

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# 320452

RECORD KEEPINGPennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt.

Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

CANCELLATION/REFUND POLICYAny participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

IMAGE AUTHENTICITYThe images provided and included in this course have not been altered.

© 2018 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell

PUBLICATION DATE: APRIL 2019

EXPIRATION DATE: MARCH 2022

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