Reduced salivary flow is common in patients taking multiple medications and has consequences for both caries risk and the performance of restorative treatment.
Prevalence and causation
Several hundred medications list reduced salivary flow among their effects, including many antihypertensives, antidepressants, antihistamines, diuretics and agents for urinary and respiratory conditions.
Risk increases with the number of medications taken concurrently rather than with any single agent, which makes it particularly prevalent in patients over sixty.
Clinical consequences
Saliva provides buffering, clearance, remineralisation and antimicrobial activity. Its reduction produces a marked increase in caries risk, characteristically at the cervical margins and root surfaces.
Root caries in a patient who has been caries-free for decades is a presentation that should prompt review of medication and salivary function.
Implications for restorative treatment
Margins of crowns and veneers are at elevated risk in a xerostomic environment, and this influences both material selection and the recommended maintenance interval.
Denture retention is impaired, and mucosal discomfort under a prosthesis is more frequent.
Management
Review with the prescribing physician may identify alternatives or permit adjustment of timing. Where medication cannot be changed, management is preventive: high-fluoride dentifrice, more frequent professional review, salivary substitutes and stimulation.
Sugar-free chewing gum stimulates flow where residual gland function exists. Frequent sipping of sugared or acidic drinks, a common self-management strategy, is actively harmful.
Report a dry mouth explicitly at assessment. It alters caries risk, material selection and maintenance intervals, and it is frequently not volunteered because patients do not regard it as a dental matter.
To determine whether this procedure is indicated in your particular case, we invite you to request a clinical assessment.
