This letter relates to ‘Older adults at risk of medication-related dry mouth’.
Dry mouth may be a problem in the ageing general population. But it can also present a lifetime difficulty for people with intellectual or learning disabilities.
In general, people with intellectual or learning disabilities have poorer oral health and oral hygiene than the general population. When a person develops a dry mouth (whatever the cause), their saliva may become thick and sticky, which may make it difficult to speak or swallow. They may also have a ‘prickly’ or burning sensation in their mouth and become sensitive to certain foods. A dry mouth can become sore, and there is a higher risk of tooth decay and gum disease.
People of all ages with intellectual or learning disabilities may have difficulty describing and communicating their dry mouth and practising good oral and dental hygiene. Data indicate that people who have intellectual disabilities have more untreated dental caries and a higher prevalence of gingivitis and other periodontal diseases than the general population. Periodontal disease gives rise to periods of acute infection and pain, which may result in changes in behaviour, and refusal to eat or swallow food whole. This can have an impact on the mental and physical health of a person with an intellectual disability.
Dry mouth associated with medications and some physical conditions can affect dental and oral health. Saliva helps to neutralise the acid that attacks teeth and is an important part of dental health. Saliva also helps to break down food while chewing, allowing the person to swallow more easily. Some people find that they have problems with swallowing when their saliva flow is affected.
Saliva is also important in fighting tooth decay. It tackles the bacteria that form dental plaque and cause tooth decay and gum disease. Having less saliva also affects the taste of food and makes it harder to eat drier foods. This can have an impact on nutritional status, body mass index and physical health. Dry mouth can also affect speech in people with intellectual disabilities who may already have communication difficulties. It can make people with intellectual or learning disabilities, of any age, more likely to have bad breath and this can affect their participation in the social environment.
Each person, young and old, with an intellectual or learning disability should have a written or individual person-centred oral and dental care and wellness plan. This should include a record of professional care to be provided by each professional, and the daily oral care to be provided in the person’s home environment. Oral and dental care plans should be part of healthcare and wellness plans. Multi-disciplinary input will be required from pharmacists (in relation to medications), dietitians (in relation to nutrition), occupational therapists (in relation to dexterity and ability to use a toothbrush, for example), speech and language therapist (in relation to feeding, eating, drinking and swallowing ability, for example) and others.
Managing dry mouth:
- Saliva replacements may be useful;
- The use of sugar-free chewing gum (if appropriate) and sugar-free fluids (including sugar-free oral liquid medication) should be advised;
- The mouth should be examined frequently;
- Fluoride rinses should be considered to reduce risk of dental caries;
- An opinion should be sought from an appropriate dental specialist if required;
- Medication review if medications are implicated in dry mouth.
Bernadette Flood,
Pharmacist in a long-term residential care centre for ageing people with intellectual/learning disabilities, Republic of Ireland
