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News and Views

Wet and Dry - Xerostomia and Drooling;S(; And BDA CDS Joint Winter Sludy Day, Friday 6th December 1996

Professor Angus Walls, President of the Gerodontic,Study Group, chaired the day and opened the nicci-ing by weleoining the large audience, of just overone hundred, to Iho (bird annual joint study day ofthe two groups.

Professor Ron Spiers, of Ihc Royal College ofSurgeons, set the scene with an exceptionally clearand extremely comprehensive lecture on saliva andoral health. He discussed the origins of saliva, causesof salivation, it's tlow rate and composition. He wenton to expertly illustrate factors affecting the fiow rateand composition. The importance of saliva and it'seffect on oral health was emphasised. Prof Spierssucceeded in making a very complicated subject seemmuch more straightforward than any text. Hedescribed saliva as a detergent, washing awayfemientable sugars and diluting and buffering the acidproduced by plaque. He explained the lubricantproperties and antibacterial components of saliva.Each time the concept was illustrated with an"everyday event' and he managed to describe theprocesses so graphically that one could almost hearthe audience swallow! Prof Spiers shared andexplained some of the latest research in saliva. Hequoted an American colleague when referring to thegroup of researchers involved in the subject in theUnited states as the "Salivation Army." His abilityand skills in communicating his expertise andknowledge on the subject with the audience wereextremely enlightening especially to the physiologyphobics in the audience. The second speaker wasChristine Yeoman from the University of SheffieldDental School who continued with an extremely highquality presentation on the subject 'Dry mouth. Causeor effect?'. She described the multiple aetiologicalfactors of dry mouth including psychological,physiological, medical and pathological causes in aninteresting and systematic way. Her excellentpresentation skills and use of clinical examplesenabled one to understand the significance of the eftectof a dry mouth on an individual and their quality oflife. She expertly explained the signs and symptomsof dry mouth with particular reference to Sjogren'ssyndrome which is her special interest and the subjectof her PhD. thesis. Christine then gave very usefuladvice on examining the mouth and mucosas fordryness. She also recommended and de.scribed thefurther investigations which are necessary before

making a diagnosis. The need for collaboration withmedical colleagues for managing the more complexconditions such as 's' was emphasised. John Rogersof King's College Hospital, ended the morning sessionwith an excellent presentation on the management ofdry mouth. He shared his extensive experience inmanaging and providing oral care for this group ofpatients. He recommended that any management planmust be manageable by and appropriate to the patient.Management must be preventive as well as palliativeand people with dry mouths often have other problemse.g. rheumatoid arthritis which makes it difficult forthem to hold a toothbrush or denture brush. Johnillustrated the various toothbrush handle modificationsthat are available and described the 'do it your selfmethods of modifying them. He recommended u.seof fluoride, a number of different mouthwashes andartificial salivas in order to replace oral comfort Hereminded us of the usefulness of water for frequentsipping, sugar free chewing gum and Toothfriendlysweets. John then de.scribed the use of prosthesesadapted to hold reservoirs of artificial saliva, tluorideand KY jelly. He then went on to discuss restorativemanagement and recommended glass ionomermaterials as they leach fluoride. He warned againstuse of some impression materials in mouths that aredry. If complete dentures can be avoided, trauma tothe tissues will be reduced. If not, John recommendedusing maximum mucosal coverage with balancedocclusion and smooth denture surfaces. Toothsupported partial dentures should be well polishedwith no sharp edges and with clasps flush with thedenture to avoid trauma to the cheeks and theshortened dental arch theory used whenever possible.Implants are unfortunately contraindicated in patientswith Sjogren's because of the adverse reaction of thesoft tissues that has been reported.

Caroline Pankhurst. also of King's CollegeHospital, started the afternoon with an extremelyinformative and well researched lecture on Taste andBurning Mouth'. She reminded us of the aetiology,signs and symptoms of burning mouth syndrome. Shedescribed its epidemiology (3% of the generalpopulation may be affected) and explained some ofthe associated factors. Anaemias and diabetes mayalso be precipitating factors. In addition to the manydrugs that can induce both altered taste and burningmouth, allergies and the menopause may be

Gerodontology

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conlributing factors. As well as dcnUirc design laults,paralunctional habits and occlusal interferences. Theimportance ofdistinguishing a patient with BMS Ironione with a local or systemic disease for which burningnu)uth is one of the symptoms was emphasised.Chronic anxiety and depression and otherpsychosocial factors such as stress, marital problemsand significant life events may also lead to burningmouth and a HAD sale was recommended for use asa psychological assessment. There arc over 200medical conditions and about 40 different drugs e.g.mctronidazole and tctracyclinc thai affect taste. Athorough clinical examination with furtherinvestigations when necessary was recommended.However, Caroline pointed out that the mucosa oftenlooks clinically normal. Treatment should include useof antidepressants. psychotherapy, treatment ofCandida and underlying systemic problems if present.

The next invited speaker was Christine Burchillwho spoke on the patient's perspective of living witha dry mouth. She talked about the way in whichSjogren's syndrome affects her life, both at work andhome. She also explained the effect of dry mouth oneating and drinking and reinforced the messages ofthe other speakers. She described her coping strategiesfor her dry mouth including chewing gum {whenappropriate), sugar free sweets as well as frequentsips of drink. Artificial salivas and gels had helped toimprove her oral comfort. Christine shai'ed with ussome of her experiences and helped to give insightinto living, as she does, with her condition ofSecondary Sjogren's Syndrome in connection withdiscoid lupus and primary biliary cirrhosis.

Winston Peters of WHAC and Bournemouth NHSTrust ended the day with an impressive presentationon drooling and its' management. He described theproblem of drooling as too much of something goingsomewhere where we don't want it. Surgery includes,ligalion of ducts, removal of glands and redirectionof the ducts. He advised on the necessary criteria priorto surgery. He reported his findings from a patientoutcome survey after salivary gland surgery. Winstongave a fascinating report of the documented historyof treatment for drooling and hypersalivation. Thereare two schools of thought regarding the cause of thispathological, uncontrolled flow of saliva. Someconsider it is due to the lack of neuromuscular control,i.e. of the lips, tongue and pharynx. Others regard itto be an overproduction of saliva. Backgroundconditions include Cerebral Palsy, cerebrovascularattacks, major surgical resections, learning andemotional difficulties and Parkinson's disease. Othernon surgical treatments suggested were medication,which includes atropine, betablockers and scopolamine(no longer available). Winston managed admirably, withhis lively and entertaining presentation, to retain theattention of all at the end of this concentrated day.There was also a poster presentation by Mr Peter Frostof UMDS London entitled 'An Intraoral LubricatingSystem for Patients with Xerostomia". The annualgeneral meeting of the Gerodontic Study group tookplace at the close of the day.

Debbie LewisHon Secretary

Gerodontic Study Group

Diary, Events, News and Views

Appropriate items are welcomed. Requests for inclusion should be addressed to:

Jonathan A. Ship, Dept. of Oral Medicine, Pathology and Surgery, University of Michigan, Room 2010, AnnArbor.MI 48109-1078, USA OR

Miss Shinogati, Japanese Society of Gerodontology, Tokyo Meu-opolitan Geriatric Hospital, 2 Sakae-Cho,Itabashi-ku, Tokyo 173, Japan OR

Robin Heath, St Bartholomew's and the Royal London School of Medicine and Dentistry, Turner Street,London El 2AD, UK.

Volume 13, No. 2