Dry Mouth Complications in Older Adults: A Significant Challenge.

Dry mouth, clinically known as xerostomia, is a prevalent and often underestimated oral health concern among older adults. While it is not considered a disease per se, its consequences can significantly affect quality of life and overall health, particularly in aging populations. The American Dental Association (ADA) provides essential insights into its causes, complications, and preventive strategies.

Xerostomia affects approximately 30% of individuals aged 65 and older, and its prevalence increases to 40% among those over 80 (ADA). Not a direct consequence of aging itself, this condition is mainly driven by polypharmacy, i.e., the use of multiple medications. Medications commonly linked to dry mouth include antihistamines, decongestants, pain relievers, diuretics, antidepressants, and antihypertensives (ADA+1). A 2018 systematic review highlighted that specific classes—urologic medications, antidepressants, and psycholeptics—showed strong associations with xerostomia in older adults (ADA).

The impact of reduced saliva flow extends far beyond an uncomfortable, parched mouth. Saliva plays multiple protective roles—cleansing the oral cavity, neutralizing bacterial acid, providing minerals for tooth integrity, and delivering antimicrobial agents (MouthHealthyADA). Without these functions, older adults face heightened risks of:

• Dental caries, especially root caries due to gingival recession and exposed root surfaces—prevalent in nearly 50% of adults aged 75 and over.

• Mucositis, cracked lips, fissured tongue, and oral pain.

• Increased susceptibility to infections, such as oral candidiasis (thrush).

• Difficulty chewing, speaking, and swallowing, which impairs nutritional intake and may contribute to malnutrition.

Clinically, xerostomia in elderly patients may complicate denture use, causing sore, ill-fitting dentures that exacerbate discomfort.

Managing dry mouth involves identifying underlying causes—such as medication side effects or health conditions—and implementing tailored interventions. The ADA recommends:

• Encouraging older adults to sip water regularly throughout the day and avoid dehydrating substances like alcohol, caffeine, and acidic beverages.

• Using sugar-free gum or lozenges to stimulate saliva production.

• Applying over-the-counter oral moisturizers, such as sprays, mouthwashes, lozenges, or gels; ideally, those bearing the ADA Seal of Acceptance.

• Employing topical fluoride—via rinses, high-fluoride toothpaste, or in-office varnish—to protect teeth from decay.

• Adjusting medication regimens when possible under medical supervision to reduce xerogenic side effects.

Early clinical intervention is crucial to prevent the cascading consequences of xerostomia among older adults. The ADA emphasizes comprehensive assessment, as dry mouth often stems from multifactorial origins (e.g., medications, systemic diseases, breathing patterns) and may require individualized trial-and-error management approaches.

In summary, dry mouth is a common and impactful condition in older adults, largely driven by medication use and compounded by age-related oral changes. Its complications, including increased decay, oral infections, nutritional challenges, and discomfort, underscore the need for proactive, tailored care. Through hydration strategies, saliva-stimulating aids, fluoride use, and thoughtful medication review, healthcare providers can significantly improve oral health and quality of life in this vulnerable population.

References

American Dental Association. (n.d.-a). Xerostomia (Dry Mouth). ADA Library – Oral Health Topics. ADA

American Dental Association. (n.d.-b). Aging and Dental Health. ADA Library – Oral Health Topics. ADA

American Dental Association. (n.d.-c). Dry Mouth. MouthHealthy – Oral Health Information from the ADA. MouthHealthy

American Dental Association. (n.d.-d). Xerostomia and its effects on oral health. ADA News: Helping Patients Manage Xerostomia. ADA News

American Dental Association. (n.d.-e). Oral health concerns for older adults. ADA Science Institute.haywoodcountync.gov