Prosthodontics & Occlusion · patient case question
Which advice should NOT be given to this dry-mouthed patient?
Patient case: New Dentures That Never Felt Right
Patient: 71-year-old female
Chief Complaint: “These dentures make my face look collapsed and I whistle when I talk.”
Background: Maxillary complete denture and mandibular RPD made three years ago elsewhere. Chronic dry mouth.
Medications: Amitriptyline, oxybutynin, atenolol
Vital Signs: BP 134/78 mmHg · HR 68 bpm · RR 16 · T 98.4°F
Findings: Reduced lower facial height with deep nasolabial folds and angular cheilitis. The maxillary denture drops on wide opening. The posterior border ends short of the vibrating line. Mucosa is dry and tacky; the mirror sticks to the buccal mucosa.
Show answer and explanation
Correct answer: D. Increase salty foods to stimulate salivary flow
- A. This IS good advice. Frequent sips of plain water are the simplest and most reliable measure.
- B. This IS good advice. Sugar-FREE gum, particularly with xylitol, mechanically stimulates residual salivary flow and xylitol additionally reduces cariogenic bacteria.
- C. This IS good advice. A humidifier reduces overnight mucosal drying, which is when symptoms are usually worst, especially in a mouth-breather.
- D. CORRECT — this is what should NOT be advised. Salty foods IRRITATE already dry, atrophic mucosa and cause burning and discomfort. Spicy, acidic, very dry and salty foods, alcohol and alcohol-containing mouthwashes, caffeine and tobacco should all be avoided in xerostomia.
Note: Complete the picture for this patient: identify and, with her physician, review the causative drugs — amitriptyline and oxybutynin are both strongly anticholinergic. Add saliva substitutes, prescription-strength fluoride (5000 ppm) because caries risk is high, and consider pilocarpine or cevimeline where residual gland function exists.
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