Xerostomia , Xylitol & Xylophones!

1. Xerostomia, Xylitol & Xylophones! By: Christian Brennan, KeniaPereda, and Wendy Li

2. Learning objectives • Xylitol – What is it? • Research on efficacy and MOA • Video • Xerostomia – What is it? • Research on artificial saliva substitute and causes • OTC products available • Quiz!!!!

3. Xylitol: What is it? • It is a 5 carbon alcohol, sugar sweetener • Derived from various tree bark, plants, and in fruit fibers • Naturally produced in our bodies • Literally means “wood” in greek

4. How Xylitol Works • Xylitol bacterial uptake inhibits metabolismthrough cell structure incorporation (energy consuming process) • Xylitol anticariogeniceffects:1. Inhibits growth of strep mutans2. Reduces dental plaque accumulation3. Reduces acid formation

5. Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli By: Çaglar E, Kavaloglu S, Kuscu O, Sandalli N, Holgerson P, TwetmanS, 2007 • Purpose: - Xylitol chewing gum effects on MS and LB bacteria- Anti-cariogenic effects of xylitol- Synergistic effect of xylitol with probiotics

6. Oral mutans streptococci levels following use of a xylitol mouth rinse: a double-blind, randomized, controlled clinical trial By: Gary Hildebrandt, DDS, MS; Ignatius Lee, DDS, MS; James Hodges, PhD, 2010

7. Clinical Efficacy and Effects of Xylitol Wipes on Bacterial Virulence By: L Zhan, JD Featherstone, J Lo, et al. 2012

8. Results from the Xylitol for Adult Caries Trial (X-ACT)By: James D. Bader, William M. Vollmer, Daniel A. Shugars, et al. 2013

9. The Trick is…. • To consume around 6-10g of xylitol throughout your day, NOT all at once. • Only effective when used continuously • Only an adjunct therapy with fluoride

10. Video http://youtu.be/W_VZZlmuz1I

11. What is it? • Medical term used for “dry mouth” • Occurs when there is a reduced or absent salivary flow • May lead to speech and eating difficulties, halitosis, and an increase in dental caries!

12. Who suffers the most? • Side effect of many medications (cardiovascular, antidipressants, diuretics, antihistamines, etc.) • Radiation therapy • Sjogrensyndrome • Diabetics, smokers, elderly…

13. Signs and Symptoms of Xerostomia - Bad breath- Cheilitis- Cracked lips- Cracking and fissuring of the oral mucosa- Dryness in mouth- Dysgeusia (taste disorders)- Fungal infections in mouth (i.e. Thrush)- Glossodynia (painful tongue)- Increased need to drink water, especially at night - Inflammation of the tongue, tongue ulcers- Lipstick sticking to teeth- More frequent gum disease- More tooth decay and plaque- Problems with speech- Problems swallowing and chewing- Sialadenitis (salivary gland infection)- Sore throat- Sticky and/or stringy saliva

14. Effects of carboxymethylcellulose(CMC)-based artificial saliva in patients with xerostomia.By: D. Oh, J. Lee, Y. Kim, H. Kho.,2008 Purpose:- Assess the effects of CMC-based artificial saliva in patients- Standardized questionnaire and measurements of salivary flow rates.

15. Results and Conclusion • Statistically significant differences in questionnaire: - oral dryness at night or on awakening- oral dryness at other times of the day- effect of oral dryness on daily life • Dry mouthsymptoms improved after the use of the CMC-based artificial saliva • Implications of the study: - not asking enough information to assess dry mouth - salivary flow rate was not attainable from certain patients- the CMC-based saliva did not affect all symptoms

16. Major salivary gland output differs between users and non-users of specific medication categoriesBy: Andy Wolff, LimorZuk-Paz and IlanaKaplan, 2008

17. Xerostomia Products ACT Dry Mouth Rinse, $7.78 Walmart • Indications for use: Patients with dry mouth • Directions:Rinse 10 ml twice a day, one-minute after brushing. Do not eat for 30 minutes after use • Product safety information:If swallowed, contact Poison ControlCenter right away • Contra-indications: None

18. Xylitol Products Dr. John’s Sugar Free Xylitol Lollipops, $12.49/lb Amazon • Indications for use: Patients with high caries risk • Directions:Take the therapeutic dose of 6-10g daily, throughout the day, after meals • Product safety information:Supervise young children to prevent any choking hazards • Contra-indications: May cause slight GI disturbance

19. References • Hildebrandt G, Lee I, Hodges J. Oral mutans streptococci levels following use of a xylitol mouth rinse: a double-blind, randomized, controlled clinical trial. Spec Care Dentist. 2010 Mar; 30(2):53-58. • L Zhan, JD Featherstone, J Lo, et al. Clinical Efficacy and Effects of Xylitol Wipes on Bacterial Virulence. IADR. 2012 Sep; 24(2):117-22. • Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J AM DENT ASSOC. 2013 Jan; 144(1):21-30. • Wolff A, Zuk-Paz L, Kaplan I. Major salivary gland output differs between users and non-users of specific medication categories. Gerodontology. 2008 Dec; 25(4):210-6 • Çaglar E, Kavaloglu S, Kuscu O, Sandalli N, Holgerson P, Twetman S. Effect of chewing gums containing xylitol or probiotic bacteria on salivary mutans streptococci and lactobacilli. Clinical Oral Investigations [serial online]. December 2007;11(4):425-429. • Oh D, Lee J, Kim Y, Kho, H. Effects of carboxymethylcellulose (CMC)-based artificial saliva in patients with xerostomia. International Association of Oral Maxillofacial Surgeons, 2008. • Darby ML, Walsh MM. Dental Hygiene Theory and Practice. 3rd ed. St. Louis (MO): Saunders; c2010. p. 579-598. • National Instituted of Dental and Craniofacial Research. Dry Mouth (Xerostomia) [Internet]. Bethesda (MD.): NIH; 2013 Mar 6 [cited 2013 Mar 6]. Available from: http://www.nidcr.nih.gov/oralhealth/topics/drymouth/ • Images from: Google

20. Quiz time! • Name at least 3 signs and symptoms suffered by the old man in the video.

21. Quiz time! • Name at least 3 signs and symptoms suffered by the old man in the video. • Is xylitol as effective as fluoride and why? What is xylitol’s mode of action?