Understanding the relationship between dry mouth and polypharmacy
Xerostomia, the perception of dry mouth, and dysgeusia, a change in taste, are both common complaints in the elderly, especially those taking several medications concurrently. A scientific study in Brazil investigated the prevalence of xerostomia and dysgeusia in the elderly in order to assess their association with polypharmacy (defined as the simultaneous, continuous long-term use of 3 or more different drugs).
Continue reading to find out what the researchers concluded about xerostomia/dysgeusia and their relationship to polypharmacy.
Causes of Xerostomia and Dysgeusia
Brazilian researchers reported that 50% of the population over age 60 suffer from xerostomia, the self-perception of dry mouth. Causes include radiotherapy treatment of the head and neck region, Sjogren’s syndrome, metabolic disorders like diabetes and rheumatoid arthritis, and certain classes of drugs like antidepressants, anxiolytics, opioids, antihypertensives, diuretics, and antihistamine drugs.
Dysgeusia is characterized as a change in taste, which includes both the altered perception of taste or a complete lack of taste. This condition is often caused by specific groups of drugs, including antineoplastic agents, systemic antibiotics, and drugs indicated for the treatment of nervous system diseases. Other causes include infection, nerve damage, vitamin or mineral deficiencies, chronic acid reflux, neurologic and metabolic disorders, dental prosthesis, and even xerostomia.
During the recent COVID pandemic, about 43% of patients with COVID reported dysgeusia.
About the Study
Researchers interviewed residents of the Multidisciplinary Elderly Center of the University Hospital of Brasília who were aged 60 and above. The sample calculation was based on the elderly population in Brazil in 2017, with the only exclusion criterion being cognitive deficit or dementia.
Researchers asked the patients about their health problems, medications used, and their experiences of xerostomia and dysgeusia. Researchers used descriptive statistics to determine
the prevalence of the symptoms surveyed, and the chi-squared test to investigate the relationship between xerostomia and dysgeusia and polypharmacy.
Study Results
Out of 96 older people evaluated, 62.5% had xerostomia and 21.1% had dysgeusia. The average number of medications used was 4±3 medications per individual. The researchers concluded that polypharmacy is associated with xerostomia but not dysgeusia. Additionally, the study showed it was possible to associate xerostomia with the use of antihypertensive drugs.
Why Are Studies Like This Important?
In Brazil, the elderly represent about 15% of the country’s population, and the number is expected to increase. This reflects the current global trend of an increasing elderly population. According to the United Nations Department of Economic and Social Affairs, the number of people aged 65+ is projected to more than double by 2050, reaching 1.6 billion.
In light of the growing elderly population around the world, multidisciplinary attention is necessary from health professionals, not only to increase longevity but to improve the quality of life.
In general, elderly people are often affected by multimorbidities and more exposed to polypharmacy, making them prone to different drug interactions and adverse reactions, including xerostomia and dysgeusia.
Both of these conditions significantly impact the quality of life. Xerostomia includes a long list of complications, including a burning sensation in the mouth, halitosis, caries lesions, periodontal disease, taste disorders, candidiasis, speech and eating difficulties, and more.
Xerostomia also reduces the ability to differentiate between excessive concentrations of salt and sugar, which can worsen chronic diseases such as diabetes and high blood pressure.
Dysgeusia, while perhaps not as severe as xerostomia, can also have a negative impact on quality of life. Aside from losing the pleasure of tasting food properly, prolonged dysgeusia can also lead to unhealthy weight loss and nutritional deficiencies.
Dry Mouth Therapy Options
Xerostomia is the result of malfunctioning salivary glands, which can happen for any number of reasons: disease, injury, cancer treatment, medications, and more. Since the root cause is often immutable —i.e. people generally cannot stop cancer treatments, taking certain medications, or reverse diseases — healthcare professionals typically focus on increasing saliva in the mouth, either naturally or through artificial means.
There are two main methods of increasing saliva in the mouth:
- Encouraging the body’s natural production of saliva: There are several ways to increase the body’s natural production of saliva:
- Electrostimulation via the SaliPen, which delivers small, painless electrical currents to stimulate the body’s salivary glands.
- Prescription medications known as sialogogues work by increasing the production and flow rate of saliva.
- Introducing artificial saliva: Mouthwashes, sprays, and throat lozenges don’t increase the body’s natural production of saliva. Rather, they provide artificial saliva, which may not be as good as natural, but it can still provide relief for the various discomforts caused by dry mouth.
Dysgeusia Therapy Options.
Unlike xerostomia, for which medical professionals don’t seek to treat the underlying cause, but the symptom of reduced saliva production, when it comes to dysgeusia, it’s the opposite. Dysgeusia is often a symptom of an underlying cause that can be treated: infection, vitamin or mineral deficiencies, chronic acid reflux, neurologic and metabolic disorders, dental prosthesis, and even xerostomia.
If the underlying cause can be treated, dysgeusia will go away. In cases where it can’t be treated, medical experts recommend eating foods with one or very few ingredients, avoiding spicy and sweet foods, and preservatives. Smoking is also associated with dysgeusia, and should be stopped to achieve maximum results.
FAQS
What is polypharmacy?
Polypharmacy is when someone takes three or more prescription drugs simultaneously and continuously.
Are xerostomia and dysgeusia associated with polypharmacy?
A recent study from Brazil evaluated 96 older people taking three or more medications, and found that 62.5% had xerostomia and 21.1% had dysgeusia. The researchers concluded that polypharmacy is associated with xerostomia but not dysgeusia.
What causes xerostomia?
Xerostomia has several causes, including radiation treatment or injury of the head and neck region, Sjogren’s syndrome, metabolic disorders like diabetes and rheumatoid arthritis, and certain classes of drugs.
What causes dysgeusia?
There are several causes of dysgeusia, including certain classes of drugs, infection, nerve damage, vitamin or mineral deficiencies, chronic acid reflux, neurologic and metabolic disorders, dental prosthesis, and xerostomia.
Is dysgeusia related to COVID-19?
Yes. Dysgeusia gained prominence recently due to the COVID-19 pandemic, when approximately 43% of patients reported a change or lack of taste.
Why is it important to research xerostomia and dysgeusia?
Xerostomia and dysgeusia both impact people’s quality of life. Studying these conditions gives health professionals a better chance at alleviating symptoms and increasing people’s quality of life.
How is xerostomia treated?
There are many different types of xerostomia therapy options, including electrostimulation, medication, lozenges, chewing gum, and more. The treatment your healthcare provider chooses will depend on the cause of your xerostomia, your medical history, and your current health situation.
How is dysgeusia treated?
Like xerostomia, the treatment course for dysgeusia depends on the cause. Usually, if the underlying cause of dysgeusia is treated, the symptom will go away.
Where can I purchase the SaliPen?
The SaliPen, an FDA-approved electrostimulation device that increases saliva production, can be purchased here.
