Why dry mouth in the elderly is hard to identify, but can’t be ignored

In Australia, our population is ageing. In order to support our overall health, this means we need our teeth and mouth to remain healthy for much longer.

There are many oral health issues that can particularly impact the aged and elderly population. Some are obvious – like tooth decay, tooth loss or gum disease – while others can be much more difficult to identify and therefore treat. One example of a condition that is hard to identify is ‘dry mouth’. While the name might give the impression that this condition is merely an inconvenience, it can, in fact, have very serious health consequences.

What is dry mouth?
Xerostomia is the professional term for dry mouth. As a condition, it has been defined as a personal perception of dry mouth. Salivary Gland Hypofunction (SGH) is a physiological condition where there is a reduction in the quality or quantity of salivary flow. Xerostomia may or may not be accompanied by SGH.

Low saliva flow is most commonly caused by inadequate hydration, although other factors can also play a part.

These can include the side-effects of certain medications or damage to the salivary glands by disease, or treatments like radiation therapies.

Complex medical conditions, compromised health and the simultaneous use of multiple medications are common among the elderly. This makes them highly susceptible to the risk factors and consequences related to dry mouth.

Why is saliva so important?
Saliva plays an important role in protecting and lubricating the mouth, and assists us with eating, chewing, swallowing, taste and digestion. It also has many other significant purposes, including:

• assisting with speech
• managing acid levels in the mouth
• protecting against bacterial and fungal infections
• protecting tooth enamel
• transporting nutrients, enzymes and minerals.

Conversely, a lack of adequate saliva can contribute to negative outcomes. These can vary from mild conditions, through to more serious complications. Some examples of these issues are:

• bad breath
• oral soft tissue soreness
• burning mouth
• altered taste
• dental decay
• gum disease
• oral infections such as thrush
• difficulty retaining dentures, and soft tissue infections occurring under dentures
• bacterial disease resulting from complex restorative surgery.

In many cases the symptoms of dry mouth are alleviated by drinking sweetened and acidic drinks, sucking on lozenges or eating lollies – all of which contribute to dental decay.

With a reduction in the protective factors provided by saliva, and an increase in risk factors like sugar, acids and poor oral hygiene, there is a much higher risk and incidence of dental decay and oral disease in the aged and elderly.

How to detect dry mouth
When it comes to dry mouth, early detection is paramount in order to help avoid some of the significant quality of life issues it can cause.

Regardless of living circumstances, family members and carers should be aware of how to identify low saliva and its consequences.

The easiest way to identify dry mouth is to simply ask questions like:

• Does your mouth feel dry?
• Do you have difficulty in chewing or swallowing food?
• Do you have trouble wearing dentures?
• Have you noticed any decrease in taste sensation?
• Do you need to sip or drink to help swallow your food?

The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) is a tool that can be used by staff and carers in residential care situations. The ICF checklist can assist in identifying chewing, eating, swallowing, and speech issues. It can also assist with determining oral pain or weight loss and a level of self-care ability.

For those in high care, where communication can be difficult or limited, identifying symptoms can be the only method of early detection for dry mouth. Symptoms to look out for can include:

• dry, cracked, raw inflamed tongue and / or lips
• refusal to eat
• choking on food
• inability to swallow
• food pooling in the mouth.

Ideally, regular checks by an oral health professional are recommended to ensure these individuals are monitored. For the aged and elderly, maintaining adequate oral health is vital to ensure an ability to smile, talk, eat, socialise and function at a level synonymous with a happy and dignified lifestyle. Whilst these levels are subjective, it is important for family and carers living and working with the aged and elderly to support a basic level of oral health and functionality.

Jo Purssey is an Oral Health Therapist who has worked in private general dental practice throughout her career. Jo is also a founding member of the Oral Health Advisory Panel.

The Oral Health Advisory Panel (OHAP), is a group of independent healthcare professionals with the aim of raising awareness of the importance of good oral health and its impact on general wellness. The Panel aims to take oral health beyond the dental clinic.

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