Challenges & Solutions for Xerostomia Patients: From a Hygienist with Sjogren's Syndrome

You're listening to the Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing the varying degrees of xerostomia and their effects on a person's oral health. We will discuss the range of solutions available for this condition, which are designed to increase patient comfort and ultimately improve quality of life. Our guest is Brooke Crouch, a dental hygienist with over a decade of clinical experience. Brooke is a key opinion leader, author, national speaker, and above all, patient advocate. Brooke is passionate about educating dental professionals on the effects of xerostomia and speaks from both a provider and patient perspective. We'll be learning more about that perspective shortly. Brooke, it's a pleasure to have you on the show. Yeah, thank you for having me, Phil. I'm happy to be here and happy to be having this conversation. Xerostomia is really something that's subjective in the patient's mind, is it not? Exactly. And so that's one thing that's actually makes it so tricky to be able to measure xerostomia. The statistics are so broad. It's like one place you'll see where it's like one in four. Some might quote something much higher, some might quote less, but it's so subjective. It's one of those things where we're relying on our patients to report that to us. And so many times as a provider, we'll see a patient and we can tell, looking in their mouth, that there's very little salivary flow, but they don't even report it. as something that they would complain about. So it's very subjective, but xerostomia and low salivary flow is certainly something that puts our patients at very, you know, they're very high risk patients. They're patients we have to have this conversation with and address sooner than later. Yeah, no, there's no question about it. And it's interesting because I just did a podcast recently with someone who's an expert on sleep apnea. And he's a dentist and he converted a lot of his practice to sleep medicine. And he found that a lot of his dental work was not reaching its full capacity as far as or its full duration of success. And some of the stuff he was doing was failing kind of early, at least earlier than his expectations. And he accounted that to some of the airway obstructive. behavior that a patient goes through during the nighttime, which was kind of destroying a lot of his dental work. So dry mouth is kind of similar in that way, right? Because if someone's suffering from dry mouth and it's not addressed, like you said, the manifestation of this can start to show up in failed dental work or just caries that's just kind of out of control. Absolutely. What are some of the varying degrees of dry mouth, whether it's moderate in most people? or maybe a little bit severe in others. What's the range? It's going to vary greatly depending on the person. You know, it might be something that is very mild that a patient might not even complain about, or it may be very situational, you know, if it's allergy season or something like that. Or it may be, you know, so severe that, and you will see, we all have seen those patients where you look in the mouth and your mirror sticks to that buccal mucosa because there's just no, the tissue's so dry. There's no saliva being produced. And then of course, you know, some of those same severities, someone like myself who has Sjogren's syndrome, I'm also going to be one of those patients that's going to have very little salivary flow as our patients that suffer from cancer, if they've undergone chemo or radiation. So there's definitely a varying degree of severity with serostomia and different things that are going to help that depending on the severity. So you having Sjogren's and obviously one of the main symptoms of Sjogren's is dry mouth, right? So did you get it as a dental hygienist? Did you start to really focus in on dry mouth as something you want to further investigate with your patients because of your condition? Absolutely. Hands down. You know, I think that becoming the patient, I was diagnosed with Sjogren's syndrome a little over five years ago. And at that time, I really wasn't dealing with a lot of xerostomia. right then that has come over the years. But when you become the patient and you are dealing with a lot of, you know, I'm a very high risk patient for decay. So prevention and, and those things are at the top of my mind when I'm talking to my patients, because I know what I deal with. So that quality of life, I think patients they'll talk to us about xerostomia and because it is so subjective, we don't, you know, we have to just look at that. on a per patient basis but it is a quality of life that their patients are dealing with when you suffer from such a low salivary flow for whatever reason it is a quality of life issue much less if you add on all the dental decay and all the oral complications that come along with those things so do you find that patients are reaching out to their dentist for help when they have dry mouth could you tell us about that a little bit Sure. I think that if you've got the severe cases like myself, yes, I think that they do. They are reaching out for help. They're looking for recommendations. They're looking for what they should be doing. And the thing is, a lot of times when patients are reaching out, they're reaching out because of their symptoms. They're reaching out because they're uncomfortable. They don't even... a lot of times the dental effects and how high risk that their xerostomia makes them for dental decay. So I do think patients are reaching out. I think they're reaching out because they want to be more comfortable. And I'm always glad when I have a patient that I can share my knowledge with. So if a patient reaches out to you, what do you do as a first step? How do you evaluate the patient to understand what the best treatment is going forward? Sure. And that really comes down to getting to the root cause. And so if someone complains about that to me, I'm going to start asking a lot of questions. I'm going to start asking, we're going to take a closer look at your medical history. We're going to really get to the root of the cause of the xerostomia. And that will kind of help me make some recommendations and make changes into whether it be diet or things they're using at home. Right. So some of these, causes could be related to medications they're taking. Absolutely. Could you go over a couple of the main causes of this? Absolutely. Definitely medications is a lot of times what we see a side effect being. Antidepressants is one of the number one. I just recently did a presentation on xerostomia and the list of medications that xerostomia is one of the first side effects of was just, it was mind-blowing because so many of our patients are on these medications. Antidepressants were up there, antihypertensives. antihistamines which allergy season you know so many of our patients are on medications where xerostomia is one of the first side effects and then we've also got of course our patients that have dealt with cancer treatment and i always you know i think we tend to think of our head and neck cancer patients they are going to be our patients that are suffering the most. But I also like to highlight that any patients, any patients that have had cancer that have undergone chemo or radiation, a lot of those patients, they have dealt with oral side effects. And so, you know, I always stress to have a conversation about xerostomia with any of your patients that have undergone treatment for any type of cancer, because I've talked to a lot of patients that have undergone all different kinds of cancer treatments, and they do complain of oral complications. that seem to linger. So we should be having that conversation with them as well. So when you identify a patient that their root cause is related to the medications they're taking, do you reach out to their physician about this who's prescribing those meds? Yeah, sure. So usually what I do is because... Most of the time they are on that medication for a really good reason. And so I try to work with some things they could be doing at home, whether and then that's kind of where some product recommendations will come into play. I'll start talking about different things they should be doing at home, different things they should be using and put them. I kind of tailor my treatment more so on a really good regimen at home than changing the medication. Could you give us an example of some? familiar remedies for xerostomia? Sure. So some familiar things and some things that are on my list that are pretty normal recommendations for patients. Of course, a prescription-strength toothpaste is something that is 5,000 parts per million toothpaste that they could be using to up that at home. When we look to xerostomia products, there is... there are so many options. They come in all different forms. We're looking at sprays. And when it comes to a spray, I always recommend Elevate's All Day Spray because of the xylitol content. There are gels out there. There are lozenges, xylomelts. The Oricope makes a xylomelts. It's a self-adhering disc, so it's great to be used for a lot of patients. So I kind of go more of the route of trying to find the right fit for the patient. kind of talking through what they're willing to do at home. And then it also comes to availability. What can they get over the counter? Because there are some things they can't get over the counter, but I direct them in the right direction on how to get these products in their hands. Have you found success with these kinds of remedies with these patients? I have found success with the remedies with these patients. And the thing with xerostomia and what I always tell patients when we start these conversations is that I'm not going to cure your xerostomia, but I can help relieve your symptoms and I can get you to be, you know, to where you're much more in a much more comfortable state. And with a lot of these remedies that I just mentioned, you know, these are remedies that are, they're topical remedies. They are things that are going to have to be reapplied. And depending on the severity, like we talked about, is, you know, they may be using these products constantly throughout the day. There's no one size fits all approach to this. And it's going to really come down to the severity of the patient and what they are, you know, what their quality of life is like. Right. And how about when it comes to eating? The normal salivary flow obviously increases before a meal to accommodate that. Absolutely. Yeah. So when you have low salivary flow, how does it affect, you know, the ability to eat and enjoy your food? that's a great point and that is something that is very true um it's very difficult to clear you know food out of your mouth when you've got xerostomia and i'm you know that's another thing that Um, using something like a water pick or a water flosser to help get all that food out. Um, and that it does make it more difficult. Food doesn't taste the same. You know, your, your dryness, there's a lot of foods that I know me personally, I'll avoid just because of my dryness. So anything that's real sticky or, you know, really carb heavy, like a lot of breads, things like that. Patients will tend to stick away from different things because of their xerostomia. And you can also, you know, you can probably even tell with me, a dry throat is something that a lot of patients with xerostomia, especially on the more severe side, that's another major complaint. And you think about that when we're talking, you know, we're talking with, you know, patients, friends, whoever, when you've got that really dry throat, it's uncomfortable. And so our patients that deal with that just tend to deal with a dry throat. And also with xerostomia. just an overall discomfort. There are times where, you know, mucositis, just a lot of discomfort and inflammation tends to affect our xerostomia patients much more often. So tell us about some of the new technologies that are available on the market now that can help our patients with xerostomia. Sure. So, you know, this is where it gets really exciting because like I said, you know, we've got tons of products out there that really range, you know, from different forms, but new technologies. And the one I'm most excited about is Vutia. Vutia is a device that's worn and I've personally been using Vutia. Vutia is, there's really nothing like it. It's FDA cleared. It's been beta tested for four years now with amazing results. It's a device that's worn 24-7, or it can be. You can wear it as often as you need to, but it can be worn 24-7, including through the night. And so it's a device that you wear. You wear a little earpiece that is actually really comfortable, and there's a very discreet microtube that kind of comes across your cheek and feeds into your mouth. I like to thread mine through my premolars, and then it delivers a constant drop. So you get that continuous exposure to water to improve moisture. And it's amazing. It is absolutely for our patients that are dealing with constant, you know, xerostomia. So maybe our severe patients, but again, we're talking about quality of life when it comes to xerostomia. So maybe a patient may not to, you know, you or I think is a severe xerostomia. If you're really uncomfortable with your xerostomia, you know, this could be something to try. If there's someone that's been, that's tried a bunch of products and just can't seem to get relief, this would be a good option for that person. The great thing about that is that, you know, there's no, there's no need for like a prescription. It's, it's super easy to use, to set up. It's, it's been a really amazing addition to all of my routine. Just so the audience knows, the name Voutia, is that how it's pronounced, Voutia? That's right. Yeah, it's spelled V-O-U-T-I-A, V-O-U-T-I-A, Voutia. So how does it work? Sure. So it's a device, and it's got a little water bottle. And the water bottle and the device, so it's a device that you turn on. You can adjust the setting. So you adjust it to your needs based off of your level of xerostomia. So the device, there's a tube that goes in and then that's what's kind of feeding and goes directly to that little micro tube that feeds across your cheek and into the mouth. How visible is the tube? You said you could wear that all the time so that you can wear it at night when you sleep and also during the day. Is it something that's obvious to the eye? So it's actually not obvious to the eye. The tube is a very like light orange kind of color. It's very discreet. I'll carry mine and like a little pouch. So you can do like a side bag and you can feed the tubes back behind your ear and kind of put it down your shirt. You put the tube down the back of your shirt. So no one sees the tube, you know, hanging anywhere. It's very discreet. When I've worn mine, I've been on calls before and people can't tell that I have it on at all. So it's very, it's very. very easy to discreetly carry around and have with you. When I've walked with a friend to exercise, I'll just put like a little side bag on and I've got that continuous moisture. And you do have to, of course, refill the bottle as that runs out, but it's really an amazing option for patients. I was talking to you offline before the podcast and I mentioned when you told me about this device, the prevalence of Xerostomia must be quite extensive. for a company to do this kind of innovation and invest in the R&D to build something like this and take it to market. I mean, what's the name of the company that makes Vutia? So the company that makes that is Virginia Head & Neck Therapeutics. Okay, so that's the company that actually makes Vutia. And you can go to Vutia.com if they want to learn more about it. That's exactly right. Yeah, and you mentioned something earlier offline about the owner or founder or patent holder. I'm not sure, you know, what... he's involved, but he's actually a dentist. That's exactly right. We've got two founders with Vutea and one's an oral surgeon and one is a general dentist. And he came up with this idea because of his own personal battle through cancer treatment and the side effects, the oral side effects that he experienced and everything he had been hearing from his patients. He knew he had to do something different and create something that would make a difference. Yeah. It's really amazing how when you're healthy. And it goes with everything in your body. I mean, we try not to, but we do take a lot for granted. We get up in the morning. Hopefully, most of us feel well. There's always issues at every age. But salivary flow is just something that's one of those things you don't even think about until you don't have it. And it's such a serious issue. As you know more than anyone, you're going through it. I could only imagine. And it's so important as dental professionals to be aware of not only the physical. uh handicapped of this but the emotional stress and you know unpleasantness putting it mildly associated with such a condition and it really behooves us all to look into our patients needs regarding dry mouth and i think you expressed that very well and it's very nice to know that there's products like lutea and just some of the more familiar remedies that we could use um where would someone find just the basic remedies at home that you mentioned? How would a dentist, one of our listeners or hygienists find that information? Sure. So you'd have to kind of dig a little bit to find some of those, but I would say, you know, you can go to Elevate's website, which was elevate.com and then Xylimelts, which is spelled X-Y-L-I-M-E-L-T-S. So those you can look at those two options by going to their website. And then, of course, Waterpik has several options for water flossers for patients that tend to have a really hard time clearing food from their mouth. And if you think about it, also any patients that are dealing with xerostomia and that are dealing with if they're in that inflamed state like I talked about. Sometimes getting a toothbrush in the mouth is just not an option. There's too much discomfort. And that's where some of these water products, you know, including Vutea, where being able to wear that and at least have that moisture, that constant moisture can really make an impact for our patients. Because again, like you said, it's a quality of life. And until you have experienced it, you really can't imagine what our patients are going through. So it's a tough condition. It really is. It's so nice of you to come and visit us online for this podcast, Brooke. I'm sure our audience will be motivated to look into their patients' issues that come in that complain of xerostomia. And I'm sure they take it very seriously anyway, but it's always nice to hear it in a podcast from someone like you who, from your perspective, is involved with it, not only with your patients, but in your personal life. Thanks so much, Brooke. We hope to have you on another... Yeah, we hope to see you again on the Phil Klein Dental Podcast.. That sounds great. Thanks for having me.