Xerostomia

Xerostomia is defined as dry mouth resulting from reduced or absent saliva flow. Xerostomia is not a disease, but it may be a symptom of various medical conditions, a side effect of a radiation to the head and neck, or a side effect of a wide variety of medications. Xerostomia is a common complaint found often among older adults, affecting approximately 20 percent of the elderly.

Xerostomia is often a contributing factor for both minor and serious health problems. It can affect nutrition and dental, as well as psychological, health. Some common problems associated with xerostomia include a constant sore throat, burning sensation, difficulty speaking and swallowing, hoarseness and/or dry nasal passages. Xerostomia is an original hidden cause of gum disease and tooth loss in three out of every 10 adults. If left untreated, xerostomia decreases the oral pH and significantly increases the development of plaque and dental caries. Oral candidiasis is one of the most common oral infections seen in association with xerostomia.

Individuals with xerostomia often complain of problems with eating, speaking, swallowing and wearing dentures. Dry, crumbly foods, such as cereals and crackers, may be particularly difficult to chew and swallow. Denture wearers may have problems with denture retention, denture sores and the tongue sticking to the palate. Patients with xerostomia often complain of taste disorders, a painful tongue and an increased need to drink water, especially at night. Xerostomia can lead to markedly increased dental caries, parotid gland enlargement, inflammation and fissuring of the lips, inflammation or ulcers of the tongue and buccal mucosa, oral candidiasis, salivary gland infection, halitosis and cracking and fissuring of the oral mucosa.

Diagnosis of xerostomia may be based on evidence obtained from the patient's history, an examination of the oral cavity and/or sialometry, a simple office procedure that measures the flow rate of saliva. Xerostomia should be considered if the patient complains of dry mouth, particularly at night, or of difficulty eating dry foods such as crackers. When the mouth is examined, a tongue depressor may stick to the buccal mucosa. In women, the "lipstick sign," where lipstick adheres to the front teeth, may be a useful indicator of xerostomia.

Perhaps the most prevalent cause of xerostomia is medication. Xerogenic drugs can be found in 42 drug categories and 56 subcategories. More than 400 commonly used drugs can cause xerostomia. The main culprits are antihistamines, antidepressants, anticholinergics, anorexiants, antihypertensives, antipsychotics, anti-Parkinson agents, diuretics and sedatives. Other drug classes that commonly cause xerostomia include antiemetics, decongestants, analgesics, antidiarrheals, bronchodilators and skeletal muscle relaxants.

The general approach to treating patients with hyposalivation and xerostomia is directed at palliative treatment for the relief of symptoms and prevention of oral complications.

Ex. 9. Translate into English:

Побічна дія, жувати, ковтати, слинні залози, піднебіння, біль у горлі, інфекції ротової порожнини, люди, що носять протези, проста процедура, скаржитися, скарга, слизова оболонка ротової порожнини, слизова оболонка щік, полегшення симптомів.

Ex.10. Answer the following questions:

1.What is xerostomia? 2. Is xerostomia a disease or a symptom? 3. What do individuals with xerostomia often complain of? 4. What may diagnosis of xerostomia be based on? 5. What is the most prevalent cause of xerostomia?

Ex.11. Match the following English medical terms with the Ukrainian ones:

Ex. 12. Complete the sentences using words in italics and translate them:

If the patient’s xerostomia is caused by the _____________of a drug, the dentist can recommend an alternative medication. But this course may not be _______________if the alternate drug has a mode of action similar to that of the original drug. Modification of the dosage regimen is another strategy that may increase _________ flow. The practice of carrying and sipping bottled ________ throughout the day, which has become popular, also may offer ________ for affected patients. When at home, the patient can hold ice chips in his or her ______ to provide moisture and possibly alleviate symptoms.

(relief, side effect, mouth, beneficial, salivary, water)

Ex.13. Insert the missing prepositions (with, of, for, in):

A number __ over-the-counter products that can function as saliva substitutes have been developed specifically ___ patients with xerostomia. Available ___ a variety of formulations—including rinses, aerosols, chewing gum and dentifrices - these products also may promote salivary gland secretions. Commercial mouth rinses that contain alcohol may desiccate the oral mucosa, and patients ____ xerostomia should avoid using them.

Ex.14. Write down key-words from the text “Xerostomia”.

Ex.15. Compose detailed plan to text “Xerostomia”.

Ex.16. Make up the summary to the text “Xerostomia”.

Ex.17. Read the following text and translate it:

The best way to treat your dry mouth depends on what's causing it. There are some things you can do that will relieve dry mouth temporarily, but the best long-term remedy for dry mouth is to address its cause.

The medical term for dry mouth is xerostomia. To relieve your dry mouth:

• Chew sugar-free gum or suck on sugar-free hard candies.
• Limit your caffeine intake. Caffeine can make your mouth drier.
• Don't use mouthwashes that contain alcohol because they can be drying.
• Stop all tobacco use if you smoke or chew tobacco.
• Sip water regularly.
• Try over-the-counter saliva substitutes.
• Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
• Breathe through your nose, not your mouth.
• Add moisture to the air at night with a room humidifier.

Saliva is important to maintaining the health of your teeth and mouth. If you frequently have a dry mouth, steps to protect your oral health may also help your condition. Avoid sugary or acidic foods and candies because they increase the risk of tooth decay. Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste. Use a fluoride rinse or brush-on fluoride gel before bedtime.

If these steps don't improve your dry mouth, talk to your doctor or dentist. It could be that medications or another condition is the cause. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.

Ex.18. Read and translate the following abstract without dictionary:

Since dry mouth is caused by many things, it should not be surprising that there are different ways to treat it. If your physician or dentist can determine the cause of your oral dryness, he/she may be able to provide you with a specific cure.

If the dryness is due to drugs, it may be possible for your doctor to advise you to stop taking those drugs, reduce their intake or switch to another “less drying” medication. Sometimes, especially, in life threatening diseases, it may not be possible to change a patient’s drug intake pattern. If the dryness is due to a specific disease, e.g. diabetes, proper treatment of the disease will decrease the intensity of your oral symptoms. Occasionally, we do not know the causes of the diseases which produce dry mouth. In such cases, we try to relieve the symptoms of the disease rather than treat the disease itself.

Ex.19. Read the following case history and compose the dialogue:

1) A 54-year-old woman complaining of a two-month history of fatigue and general trouble sleeping at night, stating that she wakes up often with a dry mouth and throat. She also states her eyes have been dry, tired and red lately, but she attributes this to her poor sleep patterns. She states she is currently consuming up to seven pints a day of liquids (coffee, tea, water, juice, milk, soda, etc.), and she is very distressed by her severe dry mouth. She wakes several times during the night and averages only four hours sleep. She drinks minimal alcohol and smokes approximately 15 cigarettes per day. She has no other complaints, and her past medical history is significant only for a history of allergic rhinitis for which she takes OTC antihistamines and decongestants.

The following are some examples of questions you might ask.

Do you need to moisten your mouth frequently or sip liquids often?

Does your mouth feel dry at mealtime?

Do you have less saliva than you used to?

Do you have trouble swallowing?

Is it difficult to eat dry foods such as crackers or toast?

Do you suffer from any chronic illness, such as diabetes or hypertension?

When was the last time you had a complete physical examination by your doctor?

What prescription and OTC medications are you currently taking?

What dietary supplements are you currently taking?

How often do you brush your teeth?

Do you wear dentures? If so, how often do you clean your dentures?

When was the last time you saw your dentist for a regular checkup?

Do you have toothaches or other dental pain?

Have you noticed any sores in your mouth or on your lips?

How much water do you drink throughout the day?

2) After discussing her problem with the dentist earlier, she made an appointment with her physician and has subsequently been diagnosed with Sjögren's syndrome (Синдром Шегре́на — аутоімунне системне пошкодження сполучної тканини, що проявляється залученням у патологічний процес залоз зовнішньої секреції, переважно слинних і слізних, і хронічним прогресуючим перебігом). She now returns to discuss management options for her xerostomia.

Task: Compose specific treatment options and counseling tips for her:

• For her allergic rhinitis, suggest nonsedating antihistamines and avoidance of products containing decongestants.

• Go over the self-care measures covered earlier in this discussion (with emphasis on minimizing caffeine consumption and smoking).

• Give advice about good oral hygiene.

• Encourage adequate fluid intake, avoiding caffeine and sugar-containing products and alcohol.

• Encourage her to quit smoking.

• Consider the use of an artificial saliva and/or OTC saliva stimulant.

Ex.20. Ask the questions about the following statements. Begin with the word in brackets:

1. Xerostomia occurs when the salivary glands do not make enough saliva. (When?)

2. Chewing, swallowing, tasting, and talking may be more difficult with a dry mouth. (What activities?)

3. Dry mouth often causes dental problems. (What?)

4. Saliva helps maintain a healthy balance of bacteria in the mouth. (Where?)

5. Saliva also washes away acids and food particles left in the mouth after eating. (What?)

6. A lack of saliva can cause cavities (tooth decay) and gum disease. (What?)

7. Chemotherapy or radiation treatments cause dry mouth by damaging the salivary glands. (How?)

8. It can take six months or longer for the salivary glands to start producing saliva again after the radiation treatment ends. (How long?)

Ex.21. Translate into English:

1. Слина - особлива форма рідини, яка зволожує рот, свого роду природній очищувач ротової порожнини. 2. Вона діє як мастило для тканин і органів порожнини рота, зволожує їжу і полегшує ковтання. 3. Тому при зниженні секреції слини знижуються всі її захисні механізми. 4. Ксеростомія - зниження кількості слини. 5. Ксеростомія може спостерігатися при захворюванні дихальних шляхів. 6. Сухість в роті буває тимчасовою або постійною. 7. Тимчасова сухість рота відчувається вранці від зниженого вироблення слини вночі. 8. Причиною ксеростомії може бути вік (секреція слини з віком знижується). 9. У людей, які протягом тривалого часу страждають на ксеростомію, частіше виникають карієс і пародонтальні захворювання, які в свою чергу призводять до неприємного запаху з рота. 10. При постійній сухості в роті потрібно частіше пити воду, щоб підтримати в організмі і в ротовій порожнині необхідний рівень рідини.