Trends and Demographics: Dry Mouth

Trends and Demographics: Dry Mouth

Dry mouth (hyposalivation) is a significant risk factor for poor oral health, contributing to the global oral disease burden, and poor oral health-related quality of life (OHRQL). Hyposalivation is generally considered to be present at a level of <0.7ml/minute for stimulated saliva and for unstimulated saliva at a level of 0.1 ml/minute.1Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent 2001;85:162-69. In this article, we’ll look briefly at the oral health burden, overall prevalence of dry mouth, and then discuss etiologies and the demographics and trends that signal a need for increased vigilance among both younger and older patients.

Oral Health Burden of Dry Mouth

It is well-recognized that dry mouth is a major risk factor for dental caries, with caries risk assessments for young and old patients alike including dry mouth on patient questionnaires and caries risk assessment tools.2American Dental Association. Caries Risk Assessment Form (Age 0-6). Available at: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/oral-health-topics/topics_caries_under6.pdf?rev=adb3b45683794a2bbcb91f4c6e056b25&hash=45FF2CDB95553C95B1F3C642BA7B527C.^,3American Dental Association. Caries Risk Assessment Form (Age >6). Available at: https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/oral-health-topics/topic_caries_over6.pdf?rev=c5b718b48dd644958d9482c96ab8e874&hash=C4B61882C2A4AB23DEE58D1D5A7417D3. However, the oral health burden of dry mouth includes an increased risk for dental erosion and hypersensitivity, halitosis, and oral irritations and infections.4Scully C. Drug effects on salivary glands: dry mouth. Oral Dis 2003;9:165-76.^,5Silva MF, Leite FRM, Ferreira, LB et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Invest 2018;2247-55.^,6Pedersen AML, Sørensen CE, Proctor GB et al. Salivary secretion in health and disease. J Oral Rehabil 2018;45(9):730-46. doi: 10.1111/joor.12664. Furthermore, dry mouth can result in malnutrition due to the difficulty of eating and swallowing and compromised taste in affected patients. Paradoxically, in addition to the systemic health issues associated with dry mouth, malnutrition also promotes dry mouth.7Flink H. Studies on the prevalence of reduced salivary flow rate in relation to general health and dental caries, and effect of iron supplementation. Swed Dent J Suppl 2007;(192):3-50.^,8Iwasaki M, Yoshihara A, Ito K et al.. Hyposalivation and dietary nutrient intake among community-based older Japanese. Geriatr Gerontol Int 2016;16:500-7. Patients with dry mouth report difficulty chewing and swallowing, speaking, smiling and wearing dentures.7Flink H. Studies on the prevalence of reduced salivary flow rate in relation to general health and dental caries, and effect of iron supplementation. Swed Dent J Suppl 2007;(192):3-50.^,9Web MD. Symptom checker. https://symptomchecker.webmd.com/multiple-symptoms?symptoms=cough%7Cdry-mouth%7Choarse-voice%7Cincreased-thirst&symptomids=59%7C85%7C120%7C124&locations=7%7C7%7C7%7C7. Other complaints include varying degrees of oral discomfort, burning mouth, hoarseness, and reduced quality of life.5Silva MF, Leite FRM, Ferreira, LB et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Invest 2018;2247-55.^,9Web MD. Symptom checker. https://symptomchecker.webmd.com/multiple-symptoms?symptoms=cough%7Cdry-mouth%7Choarse-voice%7Cincreased-thirst&symptomids=59%7C85%7C120%7C124&locations=7%7C7%7C7%7C7. ^,10Benn AM, Broadbent JM, Thomson WM. Occurrence and impact of xerostomia among dentate adult New Zealanders: findings from a national survey. Aust Dent J 2015;60:362-7.^,11Jensen S, Pedersen A, Vissink A et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010;18:1039-60. In patients with severe dry mouth, its impact is so overwhelming that patients report considerable mental disturbance.12Dirix P, Nuyts S, Vander Poorten V et al. The influence of xerostomia after radiotherapy on quality of life. Support Care Cancer 2007;16:171-9.

Prevalence of Dry Mouth

In a recent systematic review of 29 studies, 14 studies reported an overall prevalence for dry mouth of 20% (range 15 to 25%) and for xerostomia an overall prevalence of 23% (range 18% to 28%).13Agostini BA, Cericato GO, Silveira ERD et al. How Common is Dry Mouth? Systematic Review and Meta-Regression Analysis of Prevalence Estimates. Braz Dent J 2018;29(6):606-18. doi: 10.1590/0103-6440201802302. In an earlier update, the overall prevalence reported for dry mouth ranged from 10% to 46%.14Hopcraft MS, Tan C. Xerostomia: an update for clinicians. Aust Dent J 2010;55(3):238-44. The reported overall prevalence of dry mouth varies depending on the study and methodology, and dry mouth is recognized as being more common in the elderly. However, dry mouth varies across population groups at various stages of life. Therefore, caution is necessary against the misconception that younger individuals are minimally affected – trends and demographics show otherwise.

Etiologies

The main etiologies of dry mouth include medication use, head and neck radiation, Sjogren’s syndrome and other autoimmune diseases.12Dirix P, Nuyts S, Vander Poorten V et al. The influence of xerostomia after radiotherapy on quality of life. Support Care Cancer 2007;16:171-9.^,15Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:28-46.^,16Jensen SB, Vissink A. Salivary gland dysfunction and xerostomia in Sjögren’s syndrome. Oral Maxillofac Surg Clin North Am 2014;26(1):35-53.^,17Jacobsson LT, Axell TE, Hansen BU et al. Dry eyes or mouth – an epidemiological study in Swedish adults, with special reference to primary Sjogren’s syndrome. J Autoimmun 1989; 2:521-7.^,18García-Carrasco M, Ramos-Casals M, Rosas J et al. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore) 2002;81(4):270-80. However, there are many other etiologies, including chemotherapy, the use of recreational drugs, HIV disease, hepatitis C, hormonal changes, Parkinson’s disease, tumors, nerve damage and diabetes mellitus.15Porter SR, Scully C, Hegarty AM. An update of the etiology and management of xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;97:28-46.^,16Jensen SB, Vissink A. Salivary gland dysfunction and xerostomia in Sjögren’s syndrome. Oral Maxillofac Surg Clin North Am 2014;26(1):35-53.^,19Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry. Oral Dis 2009;15(1):27-37. Less frequent etiologies include thyroiditis, cystic fibrosis and primary biliary cirrhosis.

Disease Prevalence and Age Groups

In assessing the burden of dry mouth in various age groups, it is important to consider the prevalence and trends for diseases and conditions that cause dry mouth and those where treatment results in dry mouth (medication – including chemotherapy, and head and neck radiation). In this section, we’ll look at a number of diseases/conditions and their prevalence by age.

Asthma
Among children, asthma is recognized as the most common childhood chronic disease, with significant increases in its prevalence observed over the last 40 years.20Serebrisky D, Wiznia A. Pediatric Asthma: A Global Epidemic. Ann Glob Health 2019;85(1):6. doi:10.5334/aogh.2416. Overall, about 25 million (7.7% of the U.S. population) had asthma in 2021 (including over 4.6 million children under the age of 18).21Centers for Disease Control and Prevention. National Center for Environmental Health. Asthma Surveillance in the United States, 2001–2021. https://www.cdc.gov/asthma/Asthma-Prevalence-US-2023-508.pdf. Based on current asthma prevalence, in the US the overall prevalence of asthma is highest among individuals 20 to 24 years-of-age, affecting 8% and 10% of males and females, respectively, and lowest in young children up to 4 years-of-age with a prevalence of approximately 2%.21Centers for Disease Control and Prevention. National Center for Environmental Health. Asthma Surveillance in the United States, 2001–2021. https://www.cdc.gov/asthma/Asthma-Prevalence-US-2023-508.pdf. With the exception of very young children, the over-65 age group experiences a lower prevalence for asthma than any other age group (Figure 1).

Cardiovascular disease (CVD)
It is clear that the prevalence of CVD increases with age, however it does impact adults under 65 years-of-age. In 2019, among adults ages 18 to 24, 45 to 54 and 55 to 64 the respective prevalence of CVD was 1.0%, 3.6%, and 9.0%, respectively.22Centers for Disease Control and Prevention. National Center for Health Statistics. Heart Disease Prevalence. https://www.cdc.gov/nchs/hus/topics/heart-disease-prevalence.htm. A further 14.3% of adults aged 65–74, and 24.2% of adults aged 75 and over were affected.

Type 2 Diabetes
Among US adults 18 years and older, the prevalence of Type 2 diabetes increased between 2001 and 2020.23Centers for Disease Control and Prevention. By the Numbers: Diabetes in America. https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html. As of 2020, Type 2 diabetes affected 37.3 million (11.3% of the population). Typically, onset occurs later in life – by age 65+, 25.9% of the population is affected. Nonetheless, while 17.4% of younger individuals have this disease, by age 45 to 64 it affects 13.7%. (Figure 2) Of further concern, 96 million people in the US have prediabetes of which 72.5% are under age 65 and among the 19 to 34 years age group an estimated 1 in 4 has this condition. Type 2 diabetes is also increasing among individuals ages 10 to 19 years-of-age, and in 2016 an estimated 1 in 5 individuals ages 10 to 18 years had prediabetes and 1 in 4 in the 19 to 34 age group.24Andes LJ, Cheng YJ, Rolka DB et al. Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. JAMA Pediatr 2020;174(2):e194498. doi: 10.1001/jamapediatrics.2019.4498.

Sjögrens syndrome
Sjögrens syndrome is a chronic inflammatory autoimmune disease that affects the salivary, lacrimal and other exocrine glands.25Sullivan DA, Bélanger A, Cermak JM, et al. Are Women With Sjogren’s Syndrome Androgen-deficient? J Rheumatol. 2003;30:2413-9. An estimated 4 million people in the US are impacted and while the most frequent symptoms are dry mouth and dry eye, a third autoimmune disease often develops later (diabetes mellitus, rheumatoid arthritis and systemic lupus erythematosus).17Jacobsson LT, Axell TE, Hansen BU et al. Dry eyes or mouth – an epidemiological study in Swedish adults, with special reference to primary Sjogren’s syndrome. J Autoimmun 1989; 2:521-7.^,26Sjogrens Syndrome Foundation. About Sjogrens. Available at: http://www. sjogrens.org/home/about-sjogrens. Sjögrens syndrome is typically diagnosed in middle aged women as well as post-menopausal women, however earlier onset is possible.27Pullen LC. Early Onset of Primary Sjögren’s Syndrome May Carry a Worse Prognosis. The Rheumatologist, February 4, 2019. https://www.the-rheumatologist.org/article/onset-primary-sjogrens-syndrome-may-carry-a-worse-prognosis/. In addition, diagnosis frequently occurs several years after signs begin to appear.28Theander E, Jonsson R, Sjöström B et al. Prediction of sjogrens syndrome years before diagnosis and identification of patients with early onset and severe disease course by autoantibody profiling. Arthritis Rheumatol 2015;67(9):2427-36.

All Cancers
Cancer is a major cause of morbidity and mortality, with 58% of cancers overall diagnosed in adults aged 65 years or older.29Centers for Disease Control and Prevention. United States Cancer Statistics: Highlights from 2019 Incidence. USCS Data Brief, no. 29. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no29-USCS-highlights-2019-incidence.htm. The peak age group for a finding of cancer is age 65 to 74 years. However, younger individuals (predominantly adults) account for 42% of cases. (Figure 3) Treatment may include surgery and includes radiation and/or chemotherapy. For individual cancers the age distribution varies.

Head and Neck Cancer
Head and neck cancer accounts for about 4% of all cancers in the United States. In 2023, an estimated 66,920 individuals (49,190 men and 17,730 women) will be diagnosed with head and neck cancer.30American Cancer Society. Head and Neck Cancer: Statistics. https://www.cancer.net/cancer-types/head-and-neck-cancer/statistics. Head and neck radiation is a mainstay of treatment, and among patients receiving head and neck radiation for cancer treatment, an estimated 93% suffer from severe dry mouth during treatment. The majority continue to suffer long term from xerostomia.31Nederfors T, Isaksson R, Mörnstad H, Dahlöf C. Prevalence of perceived symptoms of dry mouth in an adult Swedish population-relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol 1997;25:211-6.

Breast cancer
Overall, the number of cases of invasive breast cancer and ductal cancer in situ in women 2022 were 287,850 and 51,400, respectively.32American Cancer Society. Breast Cancer Statistics, 2022. https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html. Of these, 40% of invasive breast cancer and 46% of ductal carcinoma in situ cases were in women under age 60. Treatment can include chemotherapy, radiotherapy and/or surgery depending on the type and stage.

Depression
Depression is a major cause of mental disease, affecting a significant percentage of the population. In 2020, the percentage of adults (18 years-of-age and older) with depression was estimated at 17.5% compared to 9.6% in 2011, although the rates did vary with increases and decreases in the intervening years.33USA Facts. Adults with depression. https://usafacts.org/data/topics/people-society/health/health-risk-factors/depression/. The most affected population group is younger adults. For example, in 2019, the highest overall rate to a question regarding experiencing depression in the prior 2 weeks was in the 18 to 29 age group at 21%.33USA Facts. Adults with depression. https://usafacts.org/data/topics/people-society/health/health-risk-factors/depression/. (Figure 4) When considering rates based on the severity of depression, for mild, moderate and severe depression the age group differences vary, and the over-65 age group does not have the highest rates in any category. In addition, during COVID-19 increased levels of depression were found for adolescents (12 to 17 years-of-age), affecting 12.7% of this age group.34Goodwin RD, Dierker LC, Wu M et al. Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap. Am J Prev Med 2022;63(5):726-33. doi: 10.1016/j.amepre.2022.05.014.

While in general disease increases with age (and therefore potential for sequelae and medication use with adverse effects), based on the sample of diseases discussed here a significant percentage of individuals younger than 65 are affected. These examples either cause dry mouth (Type 2 diabetes; Sjogren’s syndrome) or result in the use of medications with dry mouth as a side effect.

Medications and Dry Mouth

Eighty of the 100 most frequently-prescribed medications include xerostomia as a frequent adverse event and more than 500 medications cause dry mouth.35Yuan A, Woo SB. Adverse Drug Events in the Oral Cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119(1):35-47. Salivary production relies on the release of acetylcholine and noradrenaline, which are both impacted by medications.35Yuan A, Woo SB. Adverse Drug Events in the Oral Cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119(1):35-47.^,36Tan ECK, Lexomboon D, Sandborgh-Englund G et al. Medications That Cause Dry Mouth As an Adverse Effect in Older People: A Systematic Review and Metaanalysis. J Am Geriatr Soc 2018;66(1):76-84. doi: 10.1111/jgs.15151. Medication-induced xerostomia is largely the result of anticholinergic medications.35Yuan A, Woo SB. Adverse Drug Events in the Oral Cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119(1):35-47.^,37Porcheri C, Mitsiadis TA. Physiology, Pathology and Regeneration of Salivary Glands. Cells 2019;8(9):976. doi: 10.3390/cells8090976. For example, antidepressants carry a four-fold likelihood of dry mouth.36Tan ECK, Lexomboon D, Sandborgh-Englund G et al. Medications That Cause Dry Mouth As an Adverse Effect in Older People: A Systematic Review and Metaanalysis. J Am Geriatr Soc 2018;66(1):76-84. doi: 10.1111/jgs.15151. Anticholinergic medications include bronchodilators, antihistamines, tricyclic antidepressants, antipsychotics, antiparkinson medications, antispasmodics, antidiarrheals, antivertigo drugs, anti-ulcer drugs, antiemetics, and medications used to treat an overactive bladder and urinary retention.4Scully C. Drug effects on salivary glands: dry mouth. Oral Dis 2003;9:165-76.^,36Tan ECK, Lexomboon D, Sandborgh-Englund G et al. Medications That Cause Dry Mouth As an Adverse Effect in Older People: A Systematic Review and Metaanalysis. J Am Geriatr Soc 2018;66(1):76-84. doi: 10.1111/jgs.15151.^,37Porcheri C, Mitsiadis TA. Physiology, Pathology and Regeneration of Salivary Glands. Cells 2019;8(9):976. doi: 10.3390/cells8090976. (Table 1)

Medications affecting the sympathomimetic system (noradrenaline-related) include antihypertensives, newer anti-depressants (serotonin agonists, or noradrenaline and/or serotonin re-uptake blockers), decongestants (e.g., pseudoephedrine in cold medicines), bronchodilators, and appetite suppressants.4Scully C. Drug effects on salivary glands: dry mouth. Oral Dis 2003;9:165-76. Other medications causing dry mouth include skeletal muscle relaxants, hypnotics, antimigraine drugs, benzodiazepines, opioids, proton pump inhibitors, cytotoxic drugs, aromatase inhibitors, selective estrogen receptor modulators, retinoids, anti-HIV drugs and cytokines. (Table 1)

The impact of medication use in elderly patients

There is no doubt that the elderly population is most affected by medication use overall and by polypharmacy – taking multiple medications either for one indication or for several health issues. In one systematic review of 41 studies, the prevalence of multiple morbidities was estimated to range from 55% and up to 98% in older adults.38Marengoni A, Angleman S, Melis R et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev 2011;10(4):430-9. https://doi.org/10.1016/j.arr.2011.03.003. In another study, 53% of individuals at least 65 years-of-age were affected by polypharmacy and more than 8% were taking at least 10 medications.39Błeszyńska-Marunowska E, Jagiełło K, Grodzicki T et al. Prevalence, predisposing factors and strategies to reduce polypharmacy among older patients in Poland. Pol Arch Intern Med 2022:16347. doi: 10.20452/pamw.16347. Similar findings have been reported in other studies and reviews on polypharmacy in older patients, for both community dwelling and institutionalized individuals.40Thomson WM, Ferguson CA, Janssens BE et al. Xerostomia and polypharmacy among dependent older New Zealanders: a national survey. Age and Ageing 2021;50(1):248-51. https://doi.org/10.1093/ageing/afaa099.^,41Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border: a descriptive, questionnaire-based study. Drugs Aging 2009;26:423-36.^,42Delara M, Murray L, Jafari B et al. Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis. BMC Geriatr 2022;22:601. https://doi.org/10.1186/s12877-022-03279-x. (Figure 5) Diabetes in and of itself can cause dry mouth, however in one study in elderly patients with diabetes 50% of individuals were affected by polypharmacy.43Remelli F, Ceresini MG, Trevisan C et al. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res 2022;34(9):1969-83. doi: 10.1007/s40520-022-02165-1.

The impact of disease and medication use in younger age groups

An increasing number of individuals in younger groups are taking medications with dry mouth as a side effect.44Desai M, Park T. Deprescribing practices in Canada: A scoping review. Can Pharm J (Ott) 2022;155(5):249-57. doi: 10.1177/17151635221114114. Polypharmacy-associated dry mouth is reported to be common in adults 45 to 64 years-of-age, with 54% of individuals in a recent retrospective study taking at least five and up to fourteen medications with anticholinergic effects.45Kakkar M, Barmak AB, Arany S. Anticholinergic medication and dental caries status in middle-aged xerostomia patients-a retrospective study. J Dent Sci 2022;17(3):1206-11. doi: 10.1016/j.jds.2021.12.014. Antidepressants and antipsychotics were the most frequently prescribed. Sixty percent of adolescents with psychiatric problems (age range 9 to 17 years) self-reported xerostomia in another study.46Kaur M, Himadi E, Chi DL. Prevalence of xerostomia in an adolescent inpatient psychiatric clinic: a preliminary study. Special Care Dent 2016;36:60-5. In a third study, the most frequently prescribed medications for patients with schizophrenia were antipsychotics, frequently with the addition of anxiolytics.47Okamoto A, Miyachi H, Tanaka K et al. Relationship between xerostomia and psychotropic drugs in patients with schizophrenia: evaluation using an oral moisture meter. J Clin Pharm Ther 2016;41(6):684-8. doi: 10.1111/jcpt.12449. In addition, an estimated 1 in 36 children is identified with autism, while in a study of patients with autism it was found that approximately 47% of patients took at least one medication, most commonly antipsychotics.48Centers for Disease Control and Prevention. Autism Spectrum Disorder (ASD). Data & Statistics on Autism Spectrum Disorder. https://www.cdc.gov/ncbddd/autism/data.html. ^,49Loo CY, Graham RM, Hughes CV. The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc 2008;139(11):1518-24. Patients with autism are also impacted by polypharmacy.

Another example is breast cancer, with 40% of cases in the under-60 age group.32American Cancer Society. Breast Cancer Statistics., 2022. https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html. Between 79 and 84% of breast cancers test positive for estrogen receptors and patients frequently receive treatment with aromatase inhibitors or selective estrogen receptor modulators as ongoing medication after initial treatment.50Allison KH, Hammond MEH, Dowsett M et al. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol 2020 38:12, 1346-66. https://ascopubs.org/doi/10.1200/JCO.19.02309. Other examples of younger and middle-aged groups impacted by medication use and polypharmacy include children with chronic asthma; autism; neurologically-impaired children; younger adults with osteoarthritis; individuals with depression and neuropsychiatric disorders, living with HIV, multiple sclerosis or other auto-immune diseases, receiving cancer treatment and cancer survivors.51Feinstein JA, Feudtner C, Kempe A, Orth LE. Anticholinergic Medications and Parent-Reported Anticholinergic Symptoms in Neurologically Impaired Children. J Pain Symptom Manage 2022:S0885-3924(22)00952-6. doi: 10.1016/j.jpainsymman.2022.10.013.^,52Ikram M, Shaikh NF, Sambamoorthi U. A Linear Decomposition Approach to Explain Excess Direct Healthcare Expenditures Associated with Pain Among Adults with Osteoarthritis. Health Serv Insights 2022;15:11786329221133957. doi: 10.1177/11786329221133957.^,53Bevilacqua KG, Brinkley C, McGowan J et al. “We are Getting Those Old People Things.” Polypharmacy Management and Medication Adherence Among Adult HIV Patients with Multiple Comorbidities: A Qualitative Study. Patient Prefer Adherence 2022;16:2773-80. doi: 10.2147/PPA.S382005.^,54Chertcoff A, Ng HS, Zhu F et al. Polypharmacy and multiple sclerosis: A population-based study. Mult Scler 2022:13524585221122207. doi: 10.1177/13524585221122207. ^,55Aguglia A, Natale A, Fusar-Poli L et al. Complex polypharmacy in bipolar disorder: Results from a real-world inpatient psychiatric unit. Psychiatry Res 2022;318:114927. doi: 10.1016/j.psychres.2022.114927.^,56Cheng JJ, Azizoddin AM, Maranzano MJ et al. Polypharmacy in Oncology. Clin Geriatr Med 2022;38(4):705-14. doi: 10.1016/j.cger.2022.05.010.^,57Betts AC, Murphy CC, Shay LA et al. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2022 Nov 8. doi: 10.1007/s11764-022-01274-0.

Conclusions

Over recent decades, life expectancy has steadily climbed from 70 years in 1960 to 79 years currently and is expected to increase to 83 years by 2050.58Macrotrends. U.S. Life Expectancy 1950-2023. https://www.macrotrends.net/countries/USA/united-states/life-expectancy. At the same time, the population is aging and 1 in 6 adults is now age 65 or older. Dry mouth is a significant health burden, and the elderly population is significantly affected overall by diseases and medication use (including polypharmacy). Nonetheless, when one considers the prevalence of some of the diseases/conditions for which these medications are prescribed by age group, it becomes clear that a significant number of individuals in age groups under 65 years-of-age are impacted by medication-induced dry mouth and polypharmacy.

It is important to recognize that many younger individuals suffer from diseases that either cause dry mouth or necessitate treatment that has dry mouth as a side effect. In doing so, information can be provided to patients on whether medications they are taking (or a disease/condition they have) are associated with dry mouth, and counselling on oral health, prevention and management.

References

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