Now, xerostomia, xerostomia, however you want to say that,
and you'll hear it multiple different ways. What do you do
Well, first of all, it means dry mouth. Right?
So I want to figure out with a client if I observe that they
have dry mouth
and they tell me, "I just cannot - I always feel like I'm
having a hard time swallowing,
and my mouth feels very dry." Well, think about what
medications they're on.
Look for those anticholinergics.
Another thing you could recommend for them to kind of try to
help stimulate that saliva
is encourage them to choose sugar free gum.
Now, they can such on sugar free hard candies.
That'll also help stimulate the saliva. But that will help
combat dry mouth.
Now, keep in mind if they're doing the sugar free route, for
xylitol can have some really unfortunate GI impacts. Right?
So you don't want them to overdo that on that because
it can cause really pretty significant diarrhea or cramps if
they eat it in large amounts.
One time my dad was going golfing with a friend and they'd
gone on this great trip.
And they found a big in one of the stores on their way down,
they found a bag of sugar free candy.
And they ate way too much.
Let me just suffice to say that they did not make their
first round of golf after eating all that candy.
And they swore that off for the rest of their life
because they could not get out of the restroom to go play
golf on their big vacation.
So warn your patients about that.
That sometimes it can impact their GI tract like that.
So when we talked about considering the medications,
drinking extra water is another way.
So even if I know that you're on anticholinergic medication,
I can let the patient know, "Oh, dry mouth is made even
worse by this medication.
Now, that's a great medication for treating whatever the
patient is using that to treat for.
But we can give you some strategies."
Like we just talked about the gum, they can sip on some
And ask them to focus on breathing through their nose.
That sounds a little weird, but sometimes people are not
how much they breathe through their mouth.
So if you can ask them, "Hey, if you're having a problem
the more you can breathe through your nose,
that's going to help not have that air passing over your
mouth and extra drying it out.
It's kind of like turning a fan off. Right?
So I don't have this air whooshing down through my oral
It's going to come through my nasal cavity.
Now, caffeine, when we start talking about caffeine, people
get mighty upset. Right?
I know that I drink too much, especially when I'm stressed
or I have a lot of deadlines, I drink way too much.
But I want you to keep in mind that caffeine might also be
making their problem worse.
So don't tell someone, especially don't tell someone
who drinks a lot of caffeine to immediately stop that.
Encourage them to wean off that caffeine
because if they're taking really high doses or intakes of
caffeine and they stop abruptly,
they're going to have a really bad day,
or a really bad three days depending on how much caffeine
So encourage them to limit their caffeine intake.
As long as you can take a moderate approach, it should be
And they can balance it off with the things that we're
But be really careful before you tell someone,
"No. You cannot do this." It's not going to help them change
And some of us, when you say, "You can't do that."
You just want to do it even more. It's like the forbidden
So make sure we help them understand how limiting caffeine
will help them with their dry mouth and give them guidance
on how to do that.
Now, there are special mouthwashes for dry mouth that you
might want to take.
There's also over-the-counter saliva substitutes.
And I just kind of made that face because that just feels
weird. Doesn't it?
It's just going to help keep their mouth lubricated.
But it sounds like I don't want any donor spit.
But that's not where we're going. Right?
Over-the-counter saliva substitutes would just be things
that they put in their mouth to help keep it moist.
Now, at nighttime, you can recommend that they use a
because if someone's sleeping, they tend to have their mouth
even more than they would during the day. That's going to
get really dry.
You know, they wake up with that morning breath kind of
So a humidifier will help the air that they are taking in
keep those mucosa's a little bit more moist.
Now, I know we have don'ts here. Right?
So you just want to tell them that if you're using a
decongestant or an antihistamine,
those will also make everything feel much, much drier.
They have those anticholinergic effects.
So depending on where you live, like where I live, I didn't
have allergies until I moved here.
And then we are the state of allergies.
But anytime you change environments, that may be a problem.
So if your geriatric client has recently moved,
they may also be experiencing some unusual allergies
and maybe taking lots of decongestants and antihistamines.
Those will dry everything out, too. So, ask him to stay away
from mouthwash with alcohol.
Again, it just makes their mouth drier and things are worse.
Now, look at this last one. Whoa. If you think people get
upset when we talk about caffeine,
if we start talking about tobacco which is a conversation
that you need to have with your clients,
there's lots of risk factors with tobacco, smoking or
But be very careful as you approach this. You have to do it
You have to give them grace and understand it's a really
hard habit to break.
So don't go in on your, we say, on your high horse and act
self-righteous or judgmental.
Meet the patient where they are. Help them find some
See if they're ready to quit.
And so how I would approach this if I had a client who was
like a long-term,
we call it dipper, someone who chews tobacco.
I would not immediately start with like, "You've got to stop
I'm going to say, "Okay. What are you experiencing that
makes you uncomfortable?"
They're talking about dry mouth. Then I would say "Okay.
Here are things that we know can make it worse.
I notice that you chew tobacco on a fairly regular basis.
So do you think that impacts your dry mouth at all?
That gives me an opening for them to say yes or no.
Then I would say, "Well, how often are you using it?
How difficult would it be for you to cut back on any of
Are you interested in us helping you support that?
Because it does not matter what I tell the patient they
If I don't have them on board, if I don't gain their trust,
and kind of use the things that go along with motivational
they're never going to change a habit. And that's why I'm
We all have habits that are not the best for us.
But as a nurse, you want to help that patient take the next
step toward better health.
Not totally fix them because they're not broken.
We just want to help them recognize the benefits of them
taking the next step
and then be with them and help them take the next step.
But really, recommending drastic things unless it is a life
or death emergency
is rarely effective in people changing their behavior.
So for all of us, no matter how old you are, especially our
Remember, they're more at risk. Their gums may have been -
have a lifetime of inflammation.
Everyone should avoid sugary or acidic foods and drinks.
Whoa. That's a tough one for me because I love diet mountain
and it's got a lot - it's got that acid, that bite, that
citric acid is what I like,
but it's not great on your teeth.
So encourage them to either avoid or really kind of limit
as they can sugary foods or really acidic foods and drinks
because that's going to increase a risk for tooth decay.
When to use a fluoride toothpaste which is fairly common.
And you might want them to check with their dentist to see
if they need a prescription fluoride toothpaste.
So and hopefully, we want them to be getting regular dental
because they can use a fluoride rinse or they can use a
brush on fluoride gel before bedtime.
You see that mouth guard there? Yeah. That looks like a lot
That's a custom-fit fluoride applicator.
So you put the gel in those two retainers, and you bite down
And that's going to help you get a really intense fluoride
That's going to come from a professional like a dentist.
And remind all of us, everyone, no matter what your age
should be visiting your dentist at least twice a year.
So if there is a problem, they can catch it early.
They can make sure they clean the teeth, get rid of any of
And it's going to help be preventative medicine,
so it doesn't turn into a big and usually very costly
problem if you've ever had to have dental work.