Do You Have a Xerostomia Strategy? Dealing Better with Dry Mouth Patients Starts with Creating a Screening, Diagnosis and Management Protocol

by Lou Shuman, DMD, CAGS, CEO and Founder of Cellerant Consulting

According to the Cleveland Clinic, an estimated four million Americans have Sjögren’s, a systemic autoimmune disease that affects the entire body. Characterized by extensive dryness in the mouth and around the eyes, other complications include profound fatigue, chronic pain, major organ involvement, neuropathies, and lymphomas. Do we know how to support and manage this?

Sjögren’s – pronounced “show-grins” – can increase a patient’s risk of caries and other oral complications, but for Brooke Crouch, RDH (, her dental office was not the resource she hoped for or needed when she was diagnosed with Sjögren’s. Through her own research and self-advocacy, she’s become a trusted voice in helping dental professionals translate Sjögren’s symptoms into dental office strategies.

Lou Shuman: When you and I first spoke about the limitations many practices face in addressing xerostomia (dry mouth), I saw a number of similarities to the gaps related to sleep apnea screening. The dental community needs a protocol for screening, diagnosing, and equipping patients to manage conditions that are increasingly common. I’d love for you to help readers better understand the part they can play.

Brooke Crouch: I was diagnosed with Sjögren’s by an endocrinologist a little over five years ago. He tested me based on constant dry eye complaints; it took almost two years before I started dealing with oral complications. Before that point, I’d never had a filling, never had a cavity, nothing. I was desperate for answers. I’m a hygienist and I could do research and I could reach out to companies to ask for things to be sent to me, but it felt like I was doing all the research and basically creating my own treatment plan and interventions.

Because Sjögren’s is an autoimmune disease, I was primarily seeing a rheumatologist. However, when I started to have eye issues, they sent me to the eye doctor; and when I started to have dental side effects, they told me I needed to see a dentist. While some dental offices are innovative, many are doing the bare minimum – they don’t even stock the prescription toothpaste. There’s no standardized training in our profession for addressing xerostomia.

LS: That is very upsetting to hear what you went through. If a practice wanted to create a toolkit for addressing xerostomia, what might it include?

BC: It is important for practices to know that you can’t only judge dry mouth based on salivary flow. Adequate salivary flow doesn’t mean quality saliva, so practices should carry pH and buffering capacity strips – they just go under the tongue – to test. If a patient has low pH (less than 6), you want to recommend products that help raise it, such as xylitol. OraCoat makes XyliMelts that help lubricate the oral cavity and keep pH raised.

There is a 5000 parts per million toothpaste called FluoriMax from Elevate Oral Care that has xylitol. I recommend pairing that with an electric toothbrush and water flosser, such as Waterpik Sonic Fusion. I also use GC America’s MI Paste, which uses salivary proteins to deliver bio-available calcium and phosphate to the tooth surface during the demineralization and remineralization processes.

LS: Voutia has a device designed to help people who suffer from chronic dry mouth – are they considered more of a supplement or a replacement for the “toolkit” you described?

BC: Voutia can be used 24 hours a day, even while sleeping, but I still use it as a supplement. It has a huge impact on my quality of life. It is brilliantly engineered – not uncomfortable or scary – and a good option for moderate and severe cases.

LS: Just as important as having the right equipment is having the right information. With so many issues presenting in the dental office, how do we put something like xerostomia generally or Sjögren’s specifically on the dental team’s educational radar?

BC: My first goal is to create a course that can be offered to offices that need that extra training. It would provide critical information to the dental team, but also offer guidance in how best to educate patients who are suffering.

I also think there is room for improvement in how dental practices screen for xerostomia. To that end, developing a xerostomia risk assessment—similar to the caries or perio risk assessment—to help dental professionals be proactive in supporting their patients. Hopefully, dental insurance providers are also able to catch up in how they cover care for patients with dry mouth, who require more frequent cleanings and should be on a shorter recall, every three months instead of every six. All these things should be part a dry mouth treatment protocol.

About the Author

Lou Shuman, is the CEO of Cellerant Consulting Group, dentistry’s leading corporate incubator and accelerator. He is a venturer in-residence at Harvard’s i-Lab, chairman of the technology advisory board at WEO Media, a member of the Oral Health advisory board, and founder of the Cellerant Best of Class Technology Awards.

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