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Management of xerostomic patient in prosthodontics

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Management of xerostomic patient in prosthodontics

  1. 1. Guide : Prof. Dr. Sarita Joshi Presented By Dr. Anjana Maharjan 2nd Year Resident, NAMS Management of Xerostomic Patients in Prosthodontics
  2. 2. Xerostomia Condition associated with both a decrease in the amount of saliva produced and an alteration in its chemical composition, therefore causing dry mouth “Xero” Dry “Stomia” Mouth
  3. 3. Medications with anticholinergic activity Psychiatric comorbidities such as mood and anxiety disorders Medical comorbidities such as HIV/AIDS, diabetes, renal failure and Sjögren’s syndrome Radiation for head and neck malignancies Causes
  4. 4. Signs/Symptoms Dry mouth Cracking at corners of mouth Burning sensation on tongue associated with fissuring of tongue Alteration of taste
  5. 5. Problems encountered in denture patients  Retention in complete denture  Increases frictional forces between dentures and oral mucosa  Prone to denture stomatitis
  6. 6. Management Symptomatic treatment Address underlying causes Stimulate residual gland function Saliva substitutes Encourage oral hydration Optimize oral hygiene
  7. 7. Symptomatic treatment
  8. 8. Address underlying causes  Physician consultation  Alter drug dosages  Substitute medication causing xerostomia  Control of systemic disorder
  9. 9. Stimulate residual gland function  Sugarless gums (xylitol / sorbitol) and candies  Cholinergic agonists : Pilocarpine Cevimeline
  10. 10. Pilocarpine HCl Dose : 5mg tid up to 90 days Cevimeline HCl Dose- 30mg tid up to 6 weeks
  11. 11. Johnson J T, Ferretti G A, Nethery W J, et al. Oral pilocarpine for post-irradiation xerostomia in patients with head and neck cancer. New Eng J Med 1993; 329: 390-395 In the study done, 44% of patients reported improved salivation while on a dose of 5.0 mg Pilocarpine tid day
  12. 12. Saliva substitutes  Glycerin and lemon  Carboxymethyl cellulose  Mucin  Newer products with enzyme systems such as lactoperoxidase, lysozyme, and glucose oxidase
  13. 13. Commercial Salivary Substitute Xerostom  Basic ingredient - xylitol  Available as toothpaste, mouthwash, pastilles, oral spray and gum
  14. 14. Dry mouth GC Basic ingredients:  Polyglycerol  Sodium citrate Wet Mouth Basic Ingredients:  Glycrine  Cellulose Gum
  15. 15. Biotene Gums, Mouthwash and Toothpaste Oralbalance Moisturizing gel
  16. 16. Epstein J B, Emerton S, Stevenson-Moore P. A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy. Oral Oncol 1999; 35: 132-137  Compared use of Oralbalance gel and Biotene toothpaste against control of carboxymethylcellulose gel and commercial toothpaste  Patients using Oralbalance and Biotene reported these two products to be more effective than the controls
  17. 17. Prosthodontic Management
  18. 18. Fixed Prosthodontics In dry environment, fixed non tissue bearing prosthesis are preferred where indicated FPDs should have full coverage retainers and easily cleaned pontics and connectors Margins of retainers should be supragingival
  19. 19. Health of residual teeth and periodontal tissues Use of gingivally approching clasp avoided Tooth supported denture with minimal tissue coverage Metal denture bases are preferred Removable Partial denture
  20. 20. Complete denture Procedures -aim at optimizing retention and stability Use dentures with metal bases Use of soft liners to improve comfort Use of denture adhesives to augment retention Frequent recall – As more prone to candidal infections
  21. 21. Saliva Reservoir-Technique Upadhyay R, Kumar L, and Rao J, Fabrication of a functional palatal saliva reservoir by using a resilient liner during processing of a complete denture, JPD 2012;108:332-335
  22. 22. Encourage oral hydration  Humidifiers, especially during sleep
  23. 23. Optimize oral hygiene Biotène Dry Mouth Toothpaste contains salivary enzymes Antimicrobial mouthwashes (alcohol-free)
  24. 24. Conclusion  Clinicians should be aware of the signs and symptoms, diagnostic procedures, etiologies, sequelae and appropriate therapeutic regimens  Effective evaluation and appropriate treatment will promote acceptable levels of comfort and function
  25. 25. Acknowledgement Prof. Dr. Sarita Joshi Coordinator, Prosthodontics NAMS, Bir Hospital Asst . Prof. Dr. Pramod Raj Joshi Asst. Prof. Dr. Siddartha Dixit Asst. Prof .Dr . Dipak Thapa Residents of NAMS

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