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the time, and then I will prescribe those agents.
BB: And do you typically do that in coordination with the
patient’s physician?
CT: Always. In fact, I call the patient’s physician and tell them
that I would like to prescribe this kind of medication, and
then we’ll go over the list together. Of course, I usually have
a list a mile long of the medications the patient is already
taking, and if I see some conflict, then I will definitely call
the physician.
BB: What this leads into, depending on how the patient
presents, is that this could dictate or affect the type of denture
or prosthesis you’re going to use when restoring that patient.
Can you talk about what you do with these patients? Obviously,
dentures are very problematic for them. How do you treat them
and when might implants be appropriate?
TREATMENT Options
Products that help relieve dry mouth:
• Oral rinses and sprays that contain carboxymethyl
cellulose
• Prescription-strength fluoride toothpaste
• Antifungal agents
Salivary-stimulating drugs/products:
• Pilocarpione or cevimeline – cholinergic agonists that
help to create saliva flow
• Anetholetrithione – drug that stimulates saliva flow
CT: I’ll start with natural teeth that have carious prevalence
due to a lack of salivary gland function. With extensive
cervical caries, I would probably do full-coverage restorations
to make sure the margins are in the sulcus of the
teeth, because the bug that creates the cervical caries
really doesn’t get into the sulcus. The sulcus has its own
bactericidal effects so you don’t have that problem in the
sulcular areas.
BB: When you’re prepping those teeth, how far subgingival are
you placing that margin?
CT: One millimeter. You don’t want to get involved with the
biological width. You don’t want to get too involved with
the emergence profile and angle. You really want it perfect
so you don’t have any periodontal problems. If the caries
is not extensive, then I will probably do some composite
bondings and make sure that the patient uses PreviDent
every evening, brushes it on their teeth and just spits out
the excess and goes to bed — no rinsing. When using
PreviDent or any of these fluoride rinses or pastes, it’s very
important not to rinse it out, just spit out the excess.
Now, if the patient has partial or full anodontia, removable
prostheses can be a problem because the dentures
themselves can actually hamper the salivary gland flow.
They stop salivary gland flow.
A lot of times, having the prosthesis off the mucosa is
something the patient can tolerate really well. And, of
course, implants don’t have caries, and they don’t have the
periodontal applications in the same way that salivary gland
dysfunction goes hand in hand with periodontal disease. So,
that’s when we would do a hybrid prosthesis either through
a guided type of restoration, or create a bar overdenture
that may be off the ridge a little bit more.
– Treating Xerostomia Patients: A Clinical Conversation with Dr. Christopher Travis – 81