Anyone who has experienced dry mouth would agree it is a nuisance, but they may not be aware that it may be contributing towards devastating overall health outcomes in the elderly.
It is an issue explored in a new article featured in the October edition of Australian Prescriber, in which dental experts Dr Alan Deutsch and Dr Emma Jay examine how commonly prescribed medications in the elderly population may be causing some unintended side-effects.
“Many people may not be aware that there are medicines which are often used by frail older people that reduce saliva production,” Deutsch says.
“These include medicines for urinary incontinence, antidepressants and antipsychotics. They can cause a dry mouth, which can lead to dental problems.”
It is an instance of iatrogenesis, a secondary disorder caused by a medication intervention, and it is especially common in instances of polypharmacy, where a patient is taking five or more prescription medications at the same time.
“Indeed, over half of people taking more than five medicines have a dry mouth,” Deutsch says.
Polypharmacy is incredibly common in older Australians, affecting 40 per cent of persons aged 75 years and over.
Whilst dry mouth can affect basic functions such as speech, digestion and swallowing, research suggests its chronic effects are more complex and far-reaching.
A result of systemic failure
Leonie Short, a dental therapist and director of Seniors Dental Care Australia, told Aged Care News that frequent consultation with dental professional is a vital need for all seniors, in and out of residential aged care.
“Professional advice and support from a dentist or oral health therapist will ensure that the patient reduces the side effects of dry mouth, prevents tooth decay, is more able to eat and swallow a range of foods, can speak more easily, and has a high quality of life.”
But there are a variety of administrative factors standing in the way of this.
Deutsch and Jay point to a lack of communication between aged care providers and their residents’ dentists.
“Currently there is no protocol to notify dentists when their patients enter residential care,” Deutsch and Jay write.
“Some dental records, particularly dental implant specifications and oral health assessments, including dental X-rays, should be linked into medical records and transferred to the patient’s residential aged-care facility.
“It is important for the dentist to communicate about treatment with the care team at the aged care facility.”
However, many elderly Australians find it difficult to access dental care altogether, with private providers often too expensive for those living on a pension.
The public system also fails older Australians, not efficient enough to provide baseline, preventive care.
In their submission to the Royal Commission into Aged Care Quality and Safety, The Australian Dental Association notes:
“Although over 60 per cent of Australians become eligible for treatment through state-run public dental services once they access the aged or disability pension, the reality is that there are long waiting lists for anything but emergency dental.”
In response, the commission has advised the establishment of a Senior Dental Benefits Scheme.
Under the proposed scheme, pensioner concession card holders aged over 65 and commonwealth seniors card holders would receive an individual entitlement to subsidised public or private dental treatment, including basic dental examinations.
However, the scheme will not be launched until 2023.
Practical advice for practitioners and families
Short says that consultation with dental professionals needs to become front and centre in providing comprehensive care for elderly patients.
“It is important that a nurse or medical practitioner encourage patients to consult a dental practitioner for advice and review before starting a drug that can cause dry mouth,” she says.
To mitigate dry mouth and its insidious flow on effects, Deutsch and Jay present a new, six-step protocol for doctors:
- Review the medicines and consider stopping some when appropriate
- Switch to medicines without a saliva-reducing effect
- Reduce the doses of these medicines if possible
- Time the dose to when saliva production is highest
- Divide the doses into smaller doses throughout the day
- Check for interactions with other medicines that cause the saliva-reducing medicines to stay in the body longer.
Short notes that in the treatment of existing dry mouth, dentists can recommend a personalised management strategy which may include some of the following:
- Adequate hydration
- Good oral hygiene
- Topical remineralising agents to prevent tooth decay
- Symptomatic relief of dry mouth
- three- to six-monthly dental check-ups
Short also suggests a variety of oral rehydration products, most of which are reasonably priced and are available in supermarkets, pharmacies and online.
“Recommended products include Oral7 mouthwash, toothpaste and gel; Oralieve mouthrinse, gel and spray; GC dry mouth gel; and Biotene oral rinse, spray, toothpaste and gel.
“And some products are dual purpose – XyliMelts are stick-on melts that provide symptomatic relief for dry mouth and prevent tooth decay with the addition of a natural sweetener, xylitol.”