A recent survey conducted by Oralieve among healthcare professionals (HCPs) has revealed a significant increase in the prevalence of dry mouth, also known as xerostomia.
The survey gathered insights from 573 HCPs; nearly 70% of these were dental professionals, along with other HCPs including nurses, cancer teams, speech and language therapists (SLTs), and GPs. The most striking finding was that over 80% of HCPs reported seeing an increase in cases of dry mouth among their patients.
When asked about the main factors for causing dry mouth in their patients, over 70% cited medicine side effects and polypharmacy. Other reasons given for the growing prevalence of the condition included diabetes, menopause, treatment for head and neck cancer, Sjögren's syndrome, and mouth breathing and snoring.
Let’s take a closer look at what factors are driving the growth in patients suffering dry mouth and why HCPs should be on the look-out for symptoms of this increasingly common condition.
Polypharmacy and medication use
Many medications have a xerogenic effect and are potentially associated with dry mouth, including those used for a number of chronic conditions. Medications such as antihypertensives, antidepressants, anticoagulants, and NSAIDs are known to reduce saliva production, leading to discomfort, oral health issues and other effects associated with dry mouth. [Villa]
With the UK population growing older, there is a rise in long-term medication and polypharmacy (taking multiple medications at the same time). The increasing number of patients taking multiple medications to manage chronic illnesses means that dry mouth is emerging as a frequent and often overlooked side effect.
A study of prescription medication in England showed that 51% of women and 44% of men regularly take prescription drugs, with 25% of women and 24% of men taking at least three prescription drugs. [HSE England]
More than half of people aged 65 and over, take at least three prescription medications, that figure increases to over 70% for those aged 75 plus, and more than a third of patients aged over 75 take at least six medicines. There is an increasing use of medication and polypharmacy and there is also a strong correlation of polypharmacy with ageing. [HSE England]
An ageing population
Allied to the increase in polypharmacy is the ageing of the UK population, with more of us living longer than ever before.
The number of people aged 65 and over has increased by almost 50% since the early 1980s and there are almost three times as many people aged 85 and over as there were 40 years ago. [Ageing better] These trends look set to continue over the next 40 years, with the section of the population aged 80 and over growing most rapidly. [Ageing better] Census results show the continued ageing of the population with the proportion of people aged 65 years and over in England and Wales growing from 16.4% in 2011 to 18.6% in 2021. [ONS]
Dry mouth is usually related to salivary gland (SG) hypofunction and is a common complaint in elderly patients, although there’s little evidence that the ageing process itself is linked to salivary gland hypofunction. [Cassolato, Choi] However, with an ageing population comes more medication use and other age-related conditions that cause dry mouth, and studies reveal that xerostomia is prevalent in 30% of the general population aged over 65 years. [Jacob]
As there are more older people in our society, there is likely to be an increase in medication use and polypharmacy with its subsequent impact on the prevalence of xerostomia.
Diabetes
Dry mouth is a common complication of diabetes, with around 42% of people with diabetes experiencing the symptoms of dry mouth. Among those with type 1 diabetes the prevalence is 37% and 46% in those with type 2 diabetes. [Lessa] Dry mouth in patients with diabetes is associated with variations in glycaemic control, polyuria, autonomic dehydration and the xerogenic effects of some diabetes treatments. [Garrido, Jacob]
With diabetes diagnoses having doubled in the last 15 years, it’s estimated that more than 5.8 million people in the UK are living with diabetes, which is an all-time high.
Additionally, nearly 1.3 million people could be living with type 2 diabetes who are yet to be diagnosed. [Diabetes UK]
With the prevalence of diabetes likely to continue to grow, so will the number of patients seeking relief from diabetes-related dry mouth – so be sure to ask your patients with diabetes about dry mouth symptoms.
Menopause
The menopause is associated with several physiological changes in the body which are attributed to a reduction in levels of oestrogen and progesterone. These can include hot flushes, osteoporosis, cognitive impairment as well as dry mouth. [Jacob]
Studies have shown that the prevalence of dry mouth increases in menopausal women and that it can even alter the composition, buffering capacity, and pH of saliva. Stimulated salivary flow rates is shown to be significantly lower in menopausal women than those who are premenopausal. [Jacob]
The menopause usually occurs between the ages of 45 and 55 and current estimates suggest the average age for a woman to reach the menopause in the UK is 51 years. With around 5.1 million women in the UK aged between 45 and 55 years, a large range of women are potentially menopausal and an estimated 1.2 million women are experiencing menopausal symptoms at any one time. [HoC]
That’s a lot of women potentially suffering with dry mouth.
Mouth breathing and snoring
Another causal factor that HCPs mention in the survey is mouth breathing. Mouth breathing and snoring due to functional impairment of the upper airways or sleep apnoea have been shown to increase the risk of dry mouth. [Tanasiewicz] Snoring and sleep apnoea is significantly related to being overweight or obese, because excess weight can narrow the airways, making it harder to breathe when you lie down. [Pico-Orozco]
As with most countries across the world, there’s a continuing upward trend in the UK of the number of people being overweight or obese. In fact, levels of obesity have almost doubled since 1993. In 2022, it was estimated that 35% of the adult population were overweight and 29% were obese. [Office for Health Improvement]
Once again, that’s a significant number of people who may be needing help with managing the symptoms of dry mouth.
Head and neck cancer
Around 12,400 new cases of head and neck cancer are diagnosed in the UK each year. [NHS]
Cancer can develop in many areas within the head and neck, including the mouth, lips, throat and salivary glands. [NHS] It is often treated with radiotherapy, but this can inflame the salivary glands and induce dry mouth. In fact, one study of patients who had radiotherapy found that 92% complained of a dry mouth. [Dirix] Across other types of cancer types, certain oral problems, including dry mouth, become more common as the patient’s condition progresses. [Jones]
Autoimmune disorders
Chronic autoimmune conditions, including rheumatoid arthritis, sarcoidosis, systemic sclerosis, and especially Sjögren’s Syndrome are known to be significant in the development of dry mouth. [Tanasiewicz]
Sjögren’s Syndrome which the HCPs cited in the Survey is a chronic autoimmune disorder in which the body attacks its own moisture-producing glands and can result in dry eyes and dry mouth. [Cassolato]
Other causes
Other conditions or lifestyle choices that have been seen to increase the risk of xerostomia include Parkinson’s disease, Alzheimer’s, HIV, alcohol or drug use and smoking. [Tanasiewicz]
Summary
Dry mouth may be considered an ‘orphan symptom’, which is a condition in which generally prevalent symptoms are often underreported by patients or HCPs and under addressed by clinical practice. [Walsh]
However, the Oralieve HCP Survey highlights the increasing prevalence of dry mouth and the importance for dental practitioners and HCPs to be aware of its diagnosis and treatment in order to help their patients.
For more information about the Oralieve range of products, click here.
References:
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