Xerostomia (Nursing)

00:01 Now, xerostomia, xerostomia, however you want to say that, and you'll hear it multiple different ways. What do you do for it? 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.

00:28 Look for those anticholinergics.

00:31 Another thing you could recommend for them to kind of try to help stimulate that saliva is encourage them to choose sugar free gum.

00:38 Now, they can such on sugar free hard candies.

00:41 That'll also help stimulate the saliva. But that will help combat dry mouth.

00:46 Now, keep in mind if they're doing the sugar free route, for some people, xylitol can have some really unfortunate GI impacts. Right? So you don't want them to overdo that on that because sometimes, it can cause really pretty significant diarrhea or cramps if they eat it in large amounts.

01:07 One time my dad was going golfing with a friend and they'd gone on this great trip.

01:11 And they found a big in one of the stores on their way down, they found a bag of sugar free candy.

01:17 And they ate way too much.

01:20 Let me just suffice to say that they did not make their first round of golf after eating all that candy.

01:26 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.

01:34 So warn your patients about that.

01:36 That sometimes it can impact their GI tract like that.

01:39 So when we talked about considering the medications, drinking extra water is another way.

01:44 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.

01:53 Now, that's a great medication for treating whatever the patient is using that to treat for.

01:58 But we can give you some strategies." Like we just talked about the gum, they can sip on some water.

02:04 And ask them to focus on breathing through their nose.

02:07 That sounds a little weird, but sometimes people are not aware how much they breathe through their mouth.

02:14 So if you can ask them, "Hey, if you're having a problem with that, 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.

02:27 It's kind of like turning a fan off. Right? So I don't have this air whooshing down through my oral cavity.

02:32 It's going to come through my nasal cavity.

02:35 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.

02:49 But I want you to keep in mind that caffeine might also be making their problem worse.

02:55 So don't tell someone, especially don't tell someone who drinks a lot of caffeine to immediately stop that.

03:01 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 they'd had.

03:17 So encourage them to limit their caffeine intake.

03:21 As long as you can take a moderate approach, it should be fine.

03:25 And they can balance it off with the things that we're talking about.

03:28 But be really careful before you tell someone, "No. You cannot do this." It's not going to help them change their habits.

03:34 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 fruit.

03:42 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.

03:52 Now, there are special mouthwashes for dry mouth that you might want to take.

03:55 There's also over-the-counter saliva substitutes.

03:58 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.

04:06 But it sounds like I don't want any donor spit.

04:09 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.

04:17 Now, at nighttime, you can recommend that they use a humidifier because if someone's sleeping, they tend to have their mouth open even more than they would during the day. That's going to get really dry.

04:28 You know, they wake up with that morning breath kind of thing.

04:31 So a humidifier will help the air that they are taking in keep those mucosa's a little bit more moist.

04:40 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.

04:53 They have those anticholinergic effects.

04:56 So depending on where you live, like where I live, I didn't have allergies until I moved here.

05:03 And then we are the state of allergies.

05:05 But anytime you change environments, that may be a problem.

05:08 So if your geriatric client has recently moved, they may also be experiencing some unusual allergies and maybe taking lots of decongestants and antihistamines.

05:19 Those will dry everything out, too. So, ask him to stay away from mouthwash with alcohol.

05:24 Again, it just makes their mouth drier and things are worse.

05:27 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 chewing.

05:45 But be very careful as you approach this. You have to do it without judgement.

05:50 You have to give them grace and understand it's a really hard habit to break.

05:56 So don't go in on your, we say, on your high horse and act self-righteous or judgmental.

06:01 Meet the patient where they are. Help them find some alternatives.

06:06 See if they're ready to quit.

06:08 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.

06:15 I would not immediately start with like, "You've got to stop that." 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.

06:24 Here are things that we know can make it worse.

06:27 I notice that you chew tobacco on a fairly regular basis.

06:31 So do you think that impacts your dry mouth at all? That gives me an opening for them to say yes or no.

06:38 Then I would say, "Well, how often are you using it? How difficult would it be for you to cut back on any of that? Are you interested in us helping you support that? Because it does not matter what I tell the patient they should do.

06:54 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 interviewing, they're never going to change a habit. And that's why I'm here.

07:05 We all have habits that are not the best for us.

07:08 But as a nurse, you want to help that patient take the next step toward better health.

07:14 Not totally fix them because they're not broken.

07:17 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.

07:25 But really, recommending drastic things unless it is a life or death emergency is rarely effective in people changing their behavior.

07:33 So for all of us, no matter how old you are, especially our geriatric clients.

07:38 Remember, they're more at risk. Their gums may have been - have a lifetime of inflammation.

07:43 Everyone should avoid sugary or acidic foods and drinks.

07:47 Whoa. That's a tough one for me because I love diet mountain dew 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.

07:59 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.

08:12 When to use a fluoride toothpaste which is fairly common.

08:16 And you might want them to check with their dentist to see if they need a prescription fluoride toothpaste.

08:22 So and hopefully, we want them to be getting regular dental care visits because they can use a fluoride rinse or they can use a brush on fluoride gel before bedtime.

08:30 You see that mouth guard there? Yeah. That looks like a lot of fun.

08:35 That's a custom-fit fluoride applicator.

08:38 So you put the gel in those two retainers, and you bite down on it.

08:43 And that's going to help you get a really intense fluoride treatment.

08:48 That's going to come from a professional like a dentist.

08:51 And remind all of us, everyone, no matter what your age should be visiting your dentist at least twice a year.

08:59 So if there is a problem, they can catch it early.

09:02 They can make sure they clean the teeth, get rid of any of the plaque.

09:05 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.