Dry Mouth Quiz - Symptoms and Treatments

Oral Health

• Gum diseases are inflammatory conditions
• Gingivitis is caused by bacteria buildup in dental plaque, affecting gum tissue.
• Calculus (tartar) forms when plaque builds up on teeth
• Gingivitis does not damage the tooth supporting tissues
• Gingivitis is usually mild and can be reversed with proper oral hygiene.
• Chronic periodontitis involves supporting tissues around teeth.
• Chronic periodontitis leads to irreversible tissue damage and bone loss, potentially resulting in tooth loss.
• Progression is gradual.

Disease Progression of Gingivitis

• Plaque buildup occurs each day.
• If not brushed away, bacteria forms calculus
• Calculus holds bacteria
• Enzymes and toxins cause inflammation
• Inflammation in the gum (gingiva) over years can lead to damage
• Tooth root erodes and teeth loosen
• This is known as periodontitis.

Symptoms of Gingivitis

• Inflammation in the gums.
• Swollen, red and sore gums
• Bleeding easily with brushing, flossing, or eating hard food.
• Plaque visibility
• No fever and no other symptoms

Suspect Periodontitis

• Halitosis (bad breath).
• Difficulty chewing and eating.
• Pain
• Loose or drifting teeth
• Sign of infection - abscess or pus

Epidemiology of Gingivitis

• Poor nutrition.
• Ineffective oral hygiene.
• Pregnancy.
• Diabetes.
• Smoking.
• Immunocompromised
• Age
• Drugs that cause dry mouth.
• Stress
• Local factors

Questioning Patients with Gingivitis

• Confirm symptoms consistent with gingivitis.
• Bleeding - with or without injury
• Toothbrushing technique.
• Other medications. e.g warfarin, heparins, NSAIDS, or phenytoin which causes gum hypertrophy.

Differential Diagnosis of Gingivitis

• Oral malignancy
• Herpetic gingivostomatitis
• Desquamative gingivitis
• Bleeding disorders
• Platelet disorders
• Vascular conditions
• Gum hypertrophy
• Drug adverse reactions (ADR)
• Hormonal changes
• Allergic reactions
• Denture-related trauma or candidiasis

Management of Gingivitis

• Advise on regular review with dentist.
• Identify and manage risk factors (e.g., smoking).
• Oral hygiene advice.
• Brush teeth twice a day for two minutes.
• Use appropriate electric toothbrushes with small heads
• Replacement of toothbrushes 1-3 months, or sooner if signs of wear
• Use fluoride toothpaste
• Dental floss or interdental brushes.
• Mouthwash (optional) unless inflammation is evident.

Treatment of Gingivitis

• Dental cleaning (scaling and polishing).
• Smoking cessation advice.

Dry Mouth (Xerostomia)

• Dry, sticky feeling in mouth or throat
• Insufficient saliva which feels thick or stringy
• Rough, dry tongue
• Sore throat
• Bad breath
• Difficulty swallowing or chewing
• Cracked lips
• Burning sensation in mouth.
• Altered sense of taste.
• Oral infections.

Causes of Dry Mouth (Xerostomia)

• Dehydration caused by fluid loss
• Vomiting and diarrhea
• Hypercalcaemia
• Uncontrolled diabetes Mellitus
• Medications
• Medical conditions like Sjogren's syndrome, HIV or Hep C infections
• Stress or anxiety
• Psychogenic causes such as anxiety (short-term)
• Poor oral intake (e.g. Dysphagia)
• Radiation or surgery that injures salivary glands.
• Obstructions to or infections of salivary glands
• Malignancy affecting salivary glands

Long Term Effects of Dry Mouth

• Dental caries.
• Oral candidiasis
• Infection of major salivary glands
• Altered taste sensation (dysgeusia).
• Impaired sense of smell (dysosmia).
• Bad breath (halitosis).
• Burning or tingling of mouth (oral dysesthesia)
• Thick and sticky saliva
• Dry or damaged mouth mucosa.
• Difficulty chewing and swallowing
• Mouth soreness

Non-Drug Treatments for Dry Mouth

• Increased water intake
• Sugar free boiled sweets, gum, pastilles
• Petroleum jelly
• Avoiding mouth breathing
• Avoiding caffeine, alcohol, tobacco
• Humidifier

Drug Treatments for Dry Mouth

• Saliva replacement gel
• Oral sprays (e.g. biotene)
• Gel or aerosol sprays.
• Xerotin oral spray
• Glandosane aerosol spray
• Saliveze oral spray
• Chlohexidine gluconate mouthwash

Cold Sores

• Transmission by direct contact between people
• Virus lies dormant in sensory ganglia
• Activated or triggered by factors
• Cold sore lesion reappears
• Infections of the skin around mouth or nose.

Epidemiology of Cold Sores

• Viral infection – herpes simplex virus (HSV)
• Between 20-40% of people have had herpes simplex labialis at some point in their lifetime
• Approx 2 episodes per year but 5-10%<6
• Some experience symptoms once.
• May have the virus but not manifested into infection.

Signs and Symptoms of Cold Sores

• Itchy, burning, or tingling at the site
• Skin eruption (10-14 day process)
• Blister or vesicle
• Red, fluid-filled bladder
• Cracks over, dries, itchy, sore
• Skin heals in 7-10 days

Differential Diagnosis of Cold Sores

• Viral infection (e.g. common cold).
• Menstruation
• Dental or surgical procedures
• Immunosuppression or weakened immunity
• Impetigo.

Treatment of Cold Sores

• Aciclovir (5% w/w, topical).
• Apply 5 times a day (usually 5 days, up to 10 days).
• Hygiene - wash hands before and after.

Non-Drug Advice for Cold Sores

• Contact avoidance
• Prevention is better than cure
• Hygiene.
• Share with the patient what triggers flare ups.
• Advice on how to manage symptoms.
• Educate on when to refer a patient

Referral Points for Cold Sores

• Symptoms lasting longer than 14 days.
• Increased symptoms like fever and difficult swallowing
• Spreading infection to other parts of body
• Symptoms such as multiple lesions
• Immunocompromised patients

Mouth Ulcers (Aphthous Ulcers)

• Cannot be passed from person to person
• Unknown cause
• Often recurrent, episodic, and/or a persistent
• Can be triggered by genetics, stress factors, trauma, deficiencies, or inflammatory conditions.
• Can occur in all ages

Epidemiology of Mouth Ulcers

• Very common - 75-85% of aphthous ulcers.
• Round or ovoid, grey-white in colour.
• Affect non-keratinized mucosa (e.g., cheeks, tongue, inside lips)
• Small (2-4 mm; shallow) with a clearly rimmed margin.

Characteristics of Minor Ulcers

• Very common
• Round or ovoid
• Grey-white in colour
• Affect non-keratinized mucosa (e.g., cheeks, tongue, inside lips)
• Small (2-4 mm); shallow with a clearly rimmed margin
• Usually heal in 7-10 days with minimal scarring.

Characteristics of Major Ulcers

• Less common (10-15% of aphthous ulcers)
• Larger (1–3 cm)
• Greater duration (10 days to 6 weeks or longer).
• More significant pain and dysphagia.
• Can occur in groups (up to 6) on oral sites including the palate and dorsum of the tongue.

Characteristics Herpetiform Ulcers

• Uncommon
• Multiple pinhead sized sores that join to make a larger area of ulceration.
• Painful.
• Can affect any oral site, including palate & dorsal tongue.

• 10 days to heal.

Differential Diagnosis of Mouth Ulcers

• Oral malignancy.
• Aphthous-like ulcers (recurrent).
• Other systemic conditions: Vitamin B12 deficiency, folate deficiency
• Coeliacs disease; IBD Crohn's; Ulcerative Colitis.
• Systemic diseases: Immunodeficiency, Epstein-Barr virus.
• Primary oral herpes simplex.
• Adverse drug reactions (e.g., NSAIDs, Nicorandil, Beta blockers).
• Chickenpox
• Hand, foot, and mouth disease

Treatment of Mouth Ulcers

• Gels, pastes, mouthwashes, liquids
• Local anaesthetic, e.g. lidocaine, benzocaine
• Antibacterial (e.g., chlorhexidine or benzalkonium).
• Protective base (e.g., carmellose)
• Avoiding spicy foods, citrus fruits, acidic drinks.
• Using a soft-bristled toothbrush

General advice for mouth ulcers

• Avoid spicy foods; acidic food and drinks
• Use a straw to drink to avoid liquids touching ulcers
• Use a soft toothbrush
• Get regular dental check-ups
• Avoid toothpastes with SLS
• Saltwater mouthwashes

Headaches

• Location, Speed of onset, Duration, Frequency, Severity, Aggravating or relieving factors.

• Impact on daily living, Social, emotional, and psychological impact, Medications, and other symptoms.

Types of Headaches

• Migraine: Moderate to severe, throbbing pain, usually unilateral.
• Tension: Mild to moderate, dull ache, bilateral.
• Cluster: Severe, piercing, unilateral pain, often behind one eye.

Cluster Headaches

• Severe, unilateral pain, often behind one eye
• Duration: 15 minutes to 3 hours
• Frequency: Once every other day to 8 times a day; often with circadian rhythm
• Often at same time of day or cluster at same time each year
• Associated with autonomic symptoms (lacrimation, rhinorrhea, facial sweating, agitation)

Chronic Headaches

• Headache on 15 days or more per month.
• Most chronic headache results from transformation of episodic headache disorders.
• Most common causes are medication overuse, chronic tension headaches, and chronic migraine.

Medication Overuse Headaches

• Analgesic overuse causes increased pain receptors.
• Increased sensitivity to pain from frequent analgesics use (e.g. over-the-counter pain relief - ibuprofen).
• Usually occurring every day after it starts and becomes unremitting.
• May mimic clinical features of tension or migraine headaches, frequently mild or moderate
• Does not impact daily activities.

Secondary Headaches

• Pathology causes irritation and stretching of meninges.
• Caused by inflammation (meningitis, encephalitis)
• Tumours
• Haematoma (head injury)
• Space occupying lesions: Tumours/cerebral abscesses compress brain tissue
• Increasing intracranial pressure
• Eye strain
• Glaucoma
• Sinus (sinusitis)
• Muscle strain or pulled ligaments in neck/upper back
• Shingles affecting scalp or eyes
• Hypertension (rarely)
• Subarachnoid/subdural haemorrhage

Symptoms of Secondary Headaches

• Spasms or fatigue of ciliary and periorbital muscles of eye
• Referred pain from jaw (dental pain)
• Sinusitis
• Muscles strain or pulled ligaments in the neck/upper back
• Shingles affecting scalp or eyes
• Temporal arteritis
• Hypertension
• Haemorrhage (subarachnoid/subdural)

Test your knowledge on dry mouth, also known as xerostomia. This quiz covers symptoms, treatments, and causes of this condition. Answer questions about non-drug therapies, common oral issues, and the role of saliva in oral health.