By Tony Edwards, DrBicuspid.com editor in chief

September 11, 2018 -- When your older patients aren't eating or cite difficulty swallowing, the cause may be a condition such as lichen planus or xerostomia, noted Jacqueline Plemons, DDS, in a presentation at the California Dental Association's CDA Presents 2018 meeting in San Francisco on September 7. She explained to attendees how they can help these patients.

Dr. Plemons has a private periodontal practice in Dallas. She is also a professor in the department of periodontics at the Texas A&M College of Dentistry.

Communication with the patients and their physician is key to understanding any possible medication interactions or side effects, according to Dr. Plemons. Paying attention to the dosage also is important.

"You should use the least amount of medication as possible," she said.

The most common oral condition in older patients is lichen planus, which is seen in up to 2% of patients, Dr. Plemons said. It occurs more often in women and has an unknown etiology. Other healthcare practitioners may mistake this for other similar-looking conditions, she noted. This condition can't be completely cured but will wax and wane. Dr. Plemons recommends that her patients avoid spicy or acidic foods and also avoid whitening or tartar-control toothpastes.

"Bland is better for these patients," Dr. Plemons explained.

She often recommends a topical steroid gel for treatment. Sometimes she will ask her patients to use a delivery tray to increase the exposure.

Xerostomia is another common condition, and it has many possible causes.

"Drugs, anxiety, mouth breathing while they sleep, caffeine, alcohol, and tobacco are all possible causes," Dr. Plemons said.

“There are more than 400 medications that can cause the loss of production of saliva.”
— Jacqueline Plemons, DDS

If a medication is a likely cause, determining exactly which medication can be difficult.

"There are more than 400 medications that can cause the loss of production of saliva," Dr. Plemons said.

Patients with xerostomia are at increased risk for caries and periodontal disease, among other conditions, she noted. Treatments might include nystatin oral suspension or clotrimazole oral troches if the patients have a severe case.

"Nystatin is very sweet, so I usually only have them use it for a limited time period," she stated.

In addition, Dr. Plemons cautioned the audience that many of their older patients may be on statins, so they need to check with their patient's physician to see if the statins can be stopped for a few weeks while the xerostomia is being treated.

These oral conditions may increase patients' anxiety, so it's important to treat the patients and also reassure them if possible, Dr. Plemon noted.

"Some people might think that older people have nothing to worry about, but that's not true," she said. "They worry and have questions."


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