Compounding Pharmacists Can Protect Patients’ Health by Assessing Causes of Dry Mouth
When one’s mouth resembles sandpaper, their tongue feels thick no matter what they do and they just can’t produce saliva—they are exhibiting the classic symptoms of dry mouth. Many individuals shrug it off as dehydration, sip some water and go on with life. The problem with such common symptoms is that the issue is easy to ignore. Then when it persists long enough to become a bother, chances are that individuals will go down to the local pharmacy and buy gum, hard candy or OTC treatments.
For as many as half of your patients, these self-care options aren’t enough because dry mouth isn’t a minor and temporary annoyance—it arises from an underlying disease or medications. Compounding pharmacists are often the first point of contact for these patients. You can help protect their health by reaching out to assess the causes of dry mouth.
What Patients Don’t Know About Dry Mouth
If your patients understood the importance of saliva beyond its obvious role in eating, they might not wait until they struggled to swallow before seeking treatment. Sure, saliva is 99 percent water, but the other 1 percent is packed with electrolytes, enzymes and proteins. The digestive enzyme amylase breaks down carbohydrates, calcium and phosphate in saliva promote remineralization, and the proteins include antibacterial peptides and lubricating mucins. Saliva neutralizes organic acids and protects teeth and gums from drying out. The bottom line for patients is this—saliva helps prevent caries and infection.
By the time patients feel the effect of dry mouth, the flow of saliva when stimulated by smell, taste or thought has dropped by more than half its normal amount. As a result, patients experience:
- Persistent dry mouth or thick saliva
- Difficulty swallowing and chewing food, especially dry foods like crackers
- Burning or tingling on the tongue or in the mouth
- Cracked lips or fissured tongue
- Severe bad breath
- Mouth sores
- Changes in taste perception
- Increased desire to drink water
When dry mouth isn’t treated, the risk of dental caries, gum disease and oral thrush increases. Those who don’t consult with a health care professional may change their eating habits, which ultimately leads to vitamin, mineral and caloric deficiencies. For all of these reasons, the patients buying OTC treatments desperately need your intervention and guidance.
Untangling the Multiple Causes of Dry Mouth
Dry mouth, or xerostomia, affects anywhere from 5.5 to 46 percent of the population, so it’s hard to determine the number of OTC-buying patients you may encounter. As a pharmacist, you’re in the perfect position to proactively intervene because medications are the most common causes of dry mouth. Since the risk of persistent xerostomia goes up in tandem with the number of medications, assessing for dry mouth should become a regular part of medication reviews.
Dry mouth can be caused by about 500 prescription medications, plus-or-minus 100. The message is clear—patients filling prescriptions need to be screened for dry mouth. Polypharmacy results in synergistic effects that inhibit salivary secretions, an issue you’re likely to encounter in older patients taking multiple meds to treat more than one chronic health condition.1 The classes of medications associated with dry mouth include:
- Antiparkinsonian drugs
Underlying Health Conditions
- Cancer—Patients undergoing chemotherapy or radiation are highly susceptible to dry mouth and mucositis. The expertise of compounding pharmacists is vital because these patients depend on compounded oral rinses containing lidocaine, diphenhydramine, nystatin and corticosteroids, to name just a few.
- Diabetes—People with type 1 diabetes have a significantly higher prevalence of dry mouth, with a salivary flow rate that’s 70 percent lower than normal.2 On average, type 2 diabetics had a flow rate that was 20 percent lower.
- Rheumatoid conditions—collagen-vascular and connective tissue diseases such as Sjogren’s syndrome, which is an autoimmune disease that attacks exocrine glands and typically causes xerostomia and dry eyes.3 Sjogren’s is hard to diagnose, so be on the lookout for patients with dry mouth and dry eyes lasting at least three months and concomitant dry skin, rash or joint pain—recommend they talk to their doctor.
- Immune system dysfunction—AIDS
- Neurologic disorders—Parkinson’s disease
If you rule out other possibilities, ask your patients about common lifestyle habits as possible causes of dry mouth:
- Mouth breathing
- Alcohol consumption
- Caffeinated beverages
Treatment Options and Recommendations for Patients with Dry Mouth
Treatment for dry mouth must consider as many options as there are causes, so it targets the underlying disease, adjusts medications when needed—and if possible—and aims to relieve symptoms. Keep these tips in mind:
- Change drugs—If drugs can’t be changed, consider whether the schedule can be modified to achieve maximum effect during the day. This may cut down on dry mouth at night, which is when caries are most likely to occur.
- Change medication formula—Compounded liquids are easier for patients to take, although sublingual forms should be avoided.
- OTC decongestants and antihistamines—Should be avoided.
- Aging—While aging is associated with dry mouth, polypharmacy and chronic health conditions are the contributing factors rather than the aging process.
- Dental care—Don’t hesitate to ask about oral hygiene and whether they visit the dentist regularly. Let patients know they have a higher chance of developing cavities and that diligent oral hygiene is essential. Encourage them to use a fluoride rinse and recommend toothpaste with calcium and phosphorus.
Patients with mild dry mouth may get relief from sipping sugarless beverages, chewing xylitol-containing gum and applying petroleum jelly to their lips or under dentures. Otherwise, pharmaceutical treatments should be considered:4
- Cholinergic agonists—Cevimeline 30 mg has less cardiac receptor activity and a longer half-life, although it may cause nausea. Pilocarpine 5 mg is used only after ophthalmologic and cardiorespiratory contraindications are ruled out. It’s most likely to cause sweating, flushing and polyuria.
- Salivary replacement therapy—This includes artificial saliva, moisturizing gels and sprays and moisturizing toothpaste, whether OTC brands or compounded options.
- Antifungals—When inflammation or candidiasis develops, antifungals such as fluconazole, nystatin and clotrimazole are prescribed.
Pharmacist Outreach Leads to Early Treatment
Whether you catch patients during medication reviews or target those purchasing OTC saliva substitutes, reaching out is well worth the effort. As you assess the causes of dry mouth and encourage early treatment, you help prevent serious health problems. And don’t forget that compounded options may be exactly what your patient needs for optimal healing.
Pharmaceutica North America provides high-quality bulk APIs, including antifungals and lidocaine, and custom compounding kits. Contact us today to talk about how we can support all your customer’s pharmaceutical needs.
- “Oral Manifestations of Drug Reactions,” April 2016, http://emedicine.medscape.com/article/1080772-overview ↩
- “Prevalence of Xerostomia and the Salivary Flow Rate in Diabetic Patients,” March 2014, http://www.ncbi.nlm.nih.gov/pubmed/24913113 ↩
- “Sjogren’s Syndrome,” March 2007, http://www.uspharmacist.com/article/sj%C3%B6grens-syndrome ↩
- “Xerostomia,” 2015, https://www.merckmanuals.com/professional/dental-disorders/symptoms-of-dental-and-oral-disorders/xerostomia ↩