In this episode of BackTable ENT, Dr. Shah and Dr. Agan invite two comprehensive dentists, Dr. Abhishek Nagaraj and Dr. Anushka Gaglani, back to the show to discuss diagnosis and treatment of xerostomia.

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SHOW NOTES

First, the doctors explain common causes of xerostomia, which include multiple medications and comorbid conditions. Lifestyle factors, such as mouth breathing, alcohol consumption, tobacco usage, smoking, and dehydration can also contribute to xerostomia. Less common causes of xerostomia include Sjogren syndrome, chemotherapy, radiation, and radioactive iodine exposure. Then, they discuss how to perform a comprehensive xerostomia workup. Xerostomia is formally diagnosed by measuring the rate of salivary flow for 5 minutes. It can also be diagnosed through minor salivary gland biopsy, but this procedure is performed by ENTs or oral surgeons, not dentists. After taking a thorough patient history, dentists may be able to see evidence of xerostomia during physical examination through signs like fissures on tongue, halitosis, ill-fitting dentures, and angular cheilitis.

Then, the dentists explain the different treatments for xerostomia, from lifestyle changes to medications. They recommend that patients drink 60-65 ounces of water daily and brush at least two times a day. Fluoride mouthwashes and sugar-free lozenges may also help stimulate saliva production. Finally, a cholinergic medication like pilocarpine can be used if patients do not get better with non-pharmacologic intervention. Dr. Nagaraj also recommends that patients with xerostomia come in for dental cleaning four times a year instead of only twice because of their increased risk of developing dental caries. Finally, the doctors discuss how to distinguish the sensation of a dry mouth from the true diagnosis of xerostomia.