Australian Dental Journal

The official journal of the Australian Dental Association

Australian Dental Journal 2020; 65: 189–195

doi: 10.1111/adj.12750

Use of medicines associated with dry mouth and dental

visits in an Australian cohort
AK Moffat,* J Apajee,* NL Pratt,* N Blacker,* VT Le Blanc,* EE Roughead*
*Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide,
South Australia, Australia.

ABSTRACT
Background: Poor recognition of medicine-induced dry mouth can have a number of adverse effects, including difficulties
with speech, chewing and swallowing dry foods, gum disease, dental caries and oral candidosis. This study examined the
prevalence of use of medicines that cause dry mouth and claims for dental services funded by the Department of Veter-
ans’ Affairs (DVA) in an Australian cohort.
Methods: We used the DVA administrative health claims data to identify persons using medicines that can cause dry
mouth at 1st of September 2016 and determine their DVA dental claims in the subsequent year. Results were stratified
by gender, residence in community or residential aged cared facility and number of medicines.
Results: We identified 50 679 persons using medicines known to cause dry mouth. Of these, 72.6% were taking only
one medicine that may cause dry mouth, and 21.6% were taking two. Less than half (46.2%) of all people taking at
least one of these medicines had a dental claim in the following year. A smaller proportion of women (35.9%) made
claims than men (56.9%), v2 = 2248.77, P < 0.0001.
Conclusions: Targeted interventions raising awareness of the relationship between some medicines and dry mouth, and
the importance of dental visits are warranted.
Keywords: Oral health, dry mouth, medicines, dental.
(Received 8 January 2020; Revised 6 February 2020; Accepted for publication 6 February 2020.)

serious oral complications including gum disease, den-

INTRODUCTION
tal caries, oral candidosis and difficulties with den-
Maintaining good oral health is important for overall tures.7,8
health and well-being.1 Poor oral health can have a Medicines are one of the most common causes of
variety of adverse effects, including pain, infection, dry mouth.1,4,5,9–11 Dry mouth is increasingly likely to
dental caries and tooth loss.2 Additionally, impaired occur as the dose or the number of medicines a person
chewing and swallowing as a result of poor oral takes increases.4,12,13 Medicines that are associated
health can limit food choices and result in deficient with medicine-induced salivary gland dysfunction and
diet and accompanying weight loss.2 Despite recom- xerostomia have been systematically collated in a evi-
mendations for regular dental checks, more than half dence-based list compiled by the medicine-induced sali-
of Australian adults in the general population do not vary gland dysfunction group at the World Workshop
have an annual dental check-up.3 on Oral Medicine.1 A total of 56 medicines were iden-
There are a number of medicines that can have tified in this list as having strong evidence for interfer-
adverse effects on oral health.1,4,5 The most common ence with salivary gland function. Strong evidence was
effects from medicines are salivary gland hypofunction defined as evidence in studies dedicated to medicine-in-
(an objectively measured decrease in salivation) and duced salivary gland dysfunction or xerostomia where
xerostomia (a subjective feeling of dry mouth).1,5 the strength of the methodology of the study was high
Symptoms of dry mouth include an increased need to (typically meta-analyses, systematic reviews and ran-
keep the mouth moist with water, as well as difficulty domized-controlled trials). Each of the medicines in the
with speech, and chewing and swallowing dry foods, list with strong evidence for interference with salivary
the latter which can result in weight loss and malnu- gland dysfunction had evidence for either subjective or
trition.6,7 Prolonged dry mouth can also lead to objective oral dryness.

© 2020 Australian Dental Association 189

AK Moffat et al.

Management recommendations for dry mouth,

including medicine-induced dry mouth, recommend Box A
frequent dental evaluations and monitoring as the Evidence-based list of medicines with high evidence for
most important strategy.9,14 Though there are no affecting salivary gland function1
specific guidelines for frequency of dental check-ups Alendronate (M05BA04); Amitriptyline (N06AA09);
for dry mouth, Australian guidelines stipulate that all Aripiprazole (N05AX12); Atropine (A03BA01,
persons should have at least an annual dentist exami- S01FA01); Baclofen (M03BX01); Bevacizumab
nation.3 No previous studies have examined the fre- (L01XC07); Brimonidine (S01EA05); Buprenorphine
quency of dental visits among the population taking (N02AE01, N07BC01); Bupropion (N06AX12);
medicines that can cause dry mouth. We aimed to Chlorpromazine (N05AA01); Citalopram (N06AB04);
determine the prevalence of use of medicines that can Clonidine (C02AC01, N02CX02); Clozapine
cause dry mouth using the list compiled by the World (N05AH02); Duloxetine (N06AX21); Escitalopram
Workshop on Oral Medicines.1 Among this popula- (N06AB10); Fluoxetine (N06AB03); Furosemide
tion, we aimed to determine the frequency with which (C03CA01); Gabapentin (N03AX12); Imipramine
they visited the dentist as measured by claims for den- (N06AA02); Lisdexamfetamine (N06BA12); Lithium
tal services funded by DVA. (N05AN01); Methylphenidate (N06BA04); Nortriptyline
(N06AA10); Olanzapine (N05AH03); Oxybutynin
(G04BD04); Paliperidone (N05AX13); Paroxetine
MATERIALS AND METHODS (N06AB05); Phentermine (A08AA01); Propantheline
This study used retrospective health claims data from (A03AB05); Quetiapine (N05AH04); Reboxetine
the Australian Government Department of Veterans’ (N06AX18); Risperidone (N05AX08); Rotigotine
Affairs (DVA). This research was approved by the DVA (N04BC09); Scopolamine (A04AD01, N05CM05,
Human Research Ethics Committee and the University A 0 3 B B 0 1 ) ; S e r t r a l i n e ( N 0 6 A B 0 6 ) ; S o l i fe n a c i n
of South Australia Human Research Ethics Committee. (G04BD08); Timolol eye drops* (S01ED01); Tiotropium
The DVA claims database contains details of all pre- (R03BB04); Tolterodine (G04BD07); Venlafaxine
scription medicines, medical, dental and allied health (N06AX16); Verapamil (C08DA01); Ziprasidone
services and hospitalizations provided to veterans for (N05AE04); Zolpidem (N05CF02).
which DVA pay a subsidy. The data cover a treatment *We assessed timolol eye drops (ATC code S01ED001)
population of approximately 250 000 veterans. The rather than oral timolol (ATC code: C07AA06) which is
DVA also maintain a client file, which includes data on not available in Australia.
gender, date of birth, date of death and family status.
Medicines are coded in the dataset according to the
World Health Organization (WHO) anatomical and duration based on usual dosage. Persons were consid-
therapeutic chemical (ATC) classification15 and the ered to be using the medicine at the 1st September
Schedule of Pharmaceutical Benefits item codes.16 2016 if the duration estimated for the previous pre-
Veterans with a DVA gold card are entitled to full scription included that date. In the systematic review,
subsidy for all health services funded by DVA including medicines were defined as having strong evidence for
prescription medicines, medical, dental and allied causing dry mouth if results from meta-analyses, sys-
health services and hospitalisations. Veterans and their tematic reviews, or randomized-controlled trials in
dependents are eligible for a gold card if they have studies dedicated to dry mouth, or studies dedicated to
qualifying service in the Australian Defence Force or the adverse effects of medicines found a relationship.1
are a dependent (spouse or dependent child) of a previ- These medicines are listed in Box A.
ously serving veteran in certain circumstances.17 At The proportion of the population who used each
September 2017, there were 133 341 gold card veter- medicine and had a dental claim between study entry
ans in Australia, of which 79% were aged 70 years or and 31st August 2017 was determined. Dental claims
older, 52% were men and 47% were dependents.18 For were identified as any dentist or dental item claim
this study, we identified all gold cardholders who were from the DVA dental claims schedule.19
aged 18 years and older and exposed to any of the Results were stratified by gender, residence in the
medicines at 1st of September 2016 that were defined community or residential aged care facility (RACF),
in the evidence-based list of medicines that may affect and whether the person had complete dentures and chi-
oral health for which there was strong evidence (see square analyses were used to compare difference in the
Box A).1 The DVA dataset does not contain dosage proportion of people with claims in each group. We
information so we determined the duration for which a considered persons who were in continuous residential
patient is exposed to each medicine based on the time aged care facilities (RACF) at 1st September 2015 as
within which 75% of people return for a refill prescrip- living in RACF for the duration of the study. We identi-
tion, or, for medicines used for acute conditions, the fied persons who had complete denture sets as those
190 © 2020 Australian Dental Association
 Use of medicines associated with dry mouth

who had a claim for any of the following services at any Table 2. Percentage of the population that uses each
time prior to study entry: complete maxillary denture medicine that may cause dry mouth
(service item codes: D711, S711), complete mandibular
Medicine name Number who Percentage of the
denture (D712, S712), complete maxillary and use the cohort who use each
mandibular dentures (D719, S719), relining complete medicine medicine (%)
denture, processed (D743, S743), remodelling complete 1 Furosemide 16 253 32.1
denture (D745, S745), relining, complete denture, 2 Tiotropium 6200 12.2
direct, chair-side only (D751, S751), repairing broken 3 Escitalopram 4970 9.8
4 Amitriptyline 4738 9.4
base of a complete denture (D763, D484, S763, S484). 5 Sertraline 4678 9.2
6 Buprenorphine 4225 8.3
7 Venlafaxine 3563 7.0
RESULTS 8 Citalopram 3101 6.1
9 Verapamil 2150 4.2
There were 50 679 persons who met the criteria for 10 Oxybutynin 2070 4.1
inclusion in the study, which represents 40% of the 11 Duloxetine 1869 3.7
12 Quetiapine 1807 3.6
DVA population aged 18 years or older with full sub- 13 Fluoxetine 1694 3.3
sidy entitlement. The median age of the cohort was 14 Paroxetine 1510 3.0
80.3 years. Table 1 shows that just under half of the 15 Risperidone 1454 2.3
16 Gabapentin 1151 2.3
cohort was male (49.2%), one in five had complete 17 Solifenacin 1023 2.0
dentures (21.4%), and 16.0% resided in a RACF. 18 Timolol eye 994 2.0
Almost three-quarters of the cohort were taking one drops
19 Olanzapine 967 1.9
medicine that may cause dry mouth (72.6%), while 20 Brimonidine 909 1.8
just over one quarter were taking two or three 21 Alendronate 641 1.3
(21.6% and 4.8%, respectively). 22 Zolpidem 304 0.6
23 Nortriptyline 290 0.6
Table 2 shows the number and percentage of per- 24 Lithium 278 0.6
sons in the cohort who were using medicines that can 25 Baclofen 261 0.5
cause dry mouth. The most commonly used medicine 26 Clonidine 209 0.4
27 Chlorpromazine 118 0.2
was furosemide (32.1%), followed by tiotropium 28 Reboxetine 111 0.2
(12.2%) and escitalopram (9.8%). Of the top 20 most 29 Rotigotine 89 0.2
commonly used medicines, the percentage of the pop- 30 Aripiprazole 76 0.2
31 Atropine 69 0.1
ulation who had a dental claim ranged between 32 Bevacizumab 61 0.1
30.7% (risperidone) and 59.3% (fluoxetine). 33 Bupropion 38 0.1
Of those who were taking medicines that may cause 34 Paliperidone 33 0.1
35 Propantheline 31 0.1
dry mouth, 23 430 (46.2%) had a claim for a dental 36 Tolterodine 30 0.1
service. Table 3 provides a summary of dental claims 37 Imipramine 29 0.1
by demographic characteristics. A smaller proportion 38 Scopolamine 23 0.1
39 Methylphenidate 20 0.04
of women (35.9%) made claims than men (56.9%), 40 Phentermine 15 0.03
v2 = 2248.77, P < 0.0001. Residents of RACFs were 41 Ziprasidone 12 0.02
less likely than those in the community to have a 42 Clozapine 11 0.02
43 Lisdexamfetamine 2 0.00
claim for dental service (28.7% compared to 49.6%;

Table 1. Characteristics of veterans who are taking v2 = 1194.76, P < 0.0001). There was a significant
medicines that may cause dry mouth difference in the likelihood of a person making a dental
Number Percent of total cohort
claim when considered by the number of medicines
(N = 50 679) (%) that may cause dry mouth v2 = 86.90, P < 0.0001.
Persons who were taking one medicine were more
Gender
Male 24 933 49.2 likely to visit the dentist than those taking 2, 3, 4 or 5
Residential aged care facility medicines. Although the percentage of persons making
Yes 8092 16.0 a dental claim for the groups taking 6 or 7 medicines
Complete dentures
Yes 10 842 21.4 were high, the size of these groups was small.
Number of medicines
1 36 800 72.6
2 10 927 21.6 DISCUSSION
3 2452 4.8
4 440 0.9 Using point prevalence estimates, 40% of the eligible
5 54 0.1 cohort were taking medicines that may cause dry
6 5 0.01
7 1 0.00 mouth but less than half of these patients had a claim
for any dental service in the 12-month period after
© 2020 Australian Dental Association 191
AK Moffat et al.

Table 3. Number and proportion of veterans who are with fluoridated toothpaste and daily flossing, to pre-
taking medicines that may cause dry mouth and who vent dental caries.25 In addition, diet and lifestyle
have had any dental claim by demographic character- modifications can assist in maintaining good oral
istics health such as reducing consumption of drinks that
are acidic and high in sugar such as alcohol and
Any dentist or dental claim
sports drinks, and reducing caffeine.5,26,27 To reduce
Number Percent of demographic the symptoms of dry mouth, Australian guidelines rec-
group (%)
ommend non-pharmacological treatment such as
Total 23 430 46.2 proper hydration, use of a humidifier and use of
Gender sugar-free lollies or gum.8,28 Water-based lip mois-
Male 14 188 56.9
Female 9242 35.9 turiser may help prevent cracked lips8 and if non-
Residential aged care facility pharmacological treatments are not sufficient to
Yes 2320 28.7 reduce symptoms of dry mouth oral lubricants are
No 21 110 49.6
Complete dentures available, though these can be expensive and require
Yes 3542 32.7 frequent application.8 In rare cases where dry mouth
No 19 888 49.9 persists and impacts on patients’ speech and swallow-
Number of medicines
1 17 454 47.4 ing, support from speech pathologists may be appro-
2 4752 43.5 priate.29
3 1008 41.1 Our findings on the extent of dental visits in this
4 191 43.4
5 20 37.0 population are similar to previous work that has
6 4 80.0 shown approximately half of all Australian adults do
7 1 100.0 not have an annual dental check-up.3 Factors that
underlie low rates of dental care vary, but social fac-
tors do contribute, and inequalities in access to dental
using the medicine. While this study cannot determine care are reported at higher rates than access to other
the exact proportion of the population that experi- health care services.30 Because all persons in this study
enced medication-induced dry mouth, there is clearly were eligible for subsidised dental services, financial
a large percentage of veterans at risk of poor oral barriers to dental care that are widely reported both
health outcomes as a consequence of adverse medical in Australia31–33 and internationally30,34,35 are less
effects combined with infrequent consultation of den- likely to be responsible for the low rates of claims in
tal services.3,20 this population. However, lack of ease of access to
Treatment of patients with dry mouth is complex dentists due to location and the impact on family life
and first requires a diagnosis, which is likely to require for regional patients may all contribute to low rates
communication between a multidisciplinary team, of dental service claims31 in some patient groups. In
starting with a dental practitioner.11,21 Following con- addition, lack of awareness that medicines can cause
sultation with prescribing doctors and dental practi- dry mouth and contribute to dental problems may
tioners, dry mouth that has occurred as a result of also be a contributor.
medical use can often be reversed via changes in the Among those using medicines known to cause dry
time, dose or frequency of medicines used.5 For exam- mouth, a lower proportion of women than men
ple, giving the dose earlier in the day when saliva pro- received a dental examination. Dental anxiety is more
duction is highest can help,8,22 as can dividing the dose common in women than in men36,37 which may
to avoid the adverse effects of a large single dose.22,23 explain our results. Women may particularly benefit
Patients who are using inhaled medicines should be from education around dry mouth as a potential side
checked for proper technique and be advised of the effect of medicine. Women are more likely to experi-
benefits of using a spacer and rinsing their mouth with ence dry mouth10,38–40; a review of population-based
water immediately after use to reduce the effects of dry studies found estimates of xerostomia in men to range
mouth and associated oral health problems.14 In other between 9.7 and 25.8%, compared to a range of 10.3
cases, it may be possible to substitute a medicine for and 33.3% in women.39 Similar analyses have also
an alternative that is less xerogenic.4,5 reported prevalence in women as higher in all articles
If medicines have caused dry mouth and cannot be selected for review.38 Population studies where partic-
altered or ceased, patients require frequent monitoring ipants were not medicated found women to have
to ensure that dental complications related to low sali- higher rates of subjective dry mouth,41 however, this
vary output are addressed,24 and education related to difference was not replicated in non-medicated sub-
reducing the symptoms of dry mouth is provided. jects when saliva flow was measured objectively.42
Health professionals should advise patients of good Older people may particularly benefit from tar-
oral hygiene routines, including twice-daily brushing geted intervention to increase rates of dental visits.
192 © 2020 Australian Dental Association
 Use of medicines associated with dry mouth

Dry mouth increases with age,5,10,38 with the preva- the veteran population, particularly in those with
lence of dry mouth approximately 20% in the general recent service. For example, a report released by the
population38 increasing to approximately 30% of peo- Australian Institute of Health and Welfare in 2019
ple aged over 65 years.9,10 This is largely because age found that 20% of contemporary veterans with ser-
is associated with increasing polypharmacy and vice since 2001 were dispensed an antidepressant,
chronic illness over the life course1,9,43 rather than compared to 15% of civilian Australians.51 As a num-
ageing per se.5 Other causes of dry mouth including ber of antidepressant medications include dry mouth
systemic diseases such as Sjorgen’s Syndrome, and as a side effect, future research could investigate
radiotherapy,10 should also be considered as part of whether there are differences in use of medicines
monitoring and intervention for dry mouth. As both known to cause dry mouth, and oral health mainte-
objective and subjective dry mouth are associated nance in recently serving veterans and the general
with poorer quality of life,39 monitoring and treat- population.
ment of dry mouth conditions in older people is an This research has shown that many older persons
important part of dental, and particularly geriatric use medicines that can cause dry mouth and yet more
dental, care. than half do not see a dental practitioner. Interven-
We found that residents of RACFs were less tions raising awareness of the role that medicines can
likely than those in the community to have a claim play in causing dry mouth and dental problems along
for dental service (28.7% compared to 49.6%). with the importance of dental visits in this population
Poor access to dental services has been frequently appear warranted.
documented in residential aged care facilities.44–46
Residents in aged care are at high risk of dental
AUTHOR CONTRIBUTION
disease, particularly because more are ageing with
their teeth and often have difficulty with effective All authors made substantial contributions to (i) the
oral hygiene practices.45–48 Australian evidence conception and design of data, or analysis and inter-
shows that dentists have strong preferences for pro- pretation of data, (ii) drafting the article or revising it
viding treatment in their practices, resulting in barri- critically for important intellectual content and (iii)
ers to care for residents of aged care facilities.45,49 final approval of the version to be published.
The high rates of medicine use in the aged care
population50 increases the likelihood that patients in
ACKNOWLEDGEMENTS
this population will experience medicine-induced dry
mouth.10,13 Ensuring increased access to specialists This work was funded by the Australian Government
in geriatric dentistry as part of a multidisciplinary Department of Veterans’ Affairs (DVA) as part of the
team is required for this population to ensure that Veterans’ Medicines Advice and Therapeutics Educa-
good oral health is maintained,48 particularly where tion Services (Veterans’ MATES) program. DVA
patients are prescribed medicines known to cause reviewed this manuscript before submission but had
dry mouth. no role in the design of this research, the execution,
This study used administrative claims data, which analysis or interpretation of the data, or the writing
provides a number of advantages, including large sam- of the manuscript.
ple size and being unaffected by recall bias. However,
these data are limited in that we could not identify
ETHICS
whether the people taking the medicines experienced
dry mouth. Further, behavioural factors that may con- This research was approved by the DVA Human
tribute to dry mouth such as smoking, alcohol, and Research Ethics Committee and the University of
caffeine5 could not be examined, reducing our ability South Australia Human Research Ethics Committee.
to predict or infer persons most at risk of dry mouth.
Although persons included in this study were entitled
FUNDING
to fully subsidised dental care, it is possible that some
may still access privately funded care which was not This work was funded by the Australian Government
captured in our dataset. Department of Veterans’ Affairs (DVA) as part of the
It is unlikely that there are any systematic differ- Veterans’ Medicines Advice and Therapeutics Educa-
ences in how oral health is maintained in the study tion Services (Veterans’ MATES) program.
sample compared to the general population given that
the median age was over 80 years and consisted of
DISCLOSURE
both dependents and previously serving veterans.
However, prevalence of use of some medicines that DVA reviewed this manuscript before submission but
cause dry mouth may be higher in some sub-groups of had no role in the design of this research, the
© 2020 Australian Dental Association 193
AK Moffat et al.

execution, analysis or interpretation of the data, or 20. Murray J. Attendance patterns and oral health. Br Dent J
1996;181:339.
the writing of the manuscript.
21. Frydrych AM. Dry mouth: Xerostomia and salivary gland
hypofunction. Aust Fam Physician 2016;45:488.
REFERENCES
22. Rigby D. Medication in review: dry mouth and HMRs: A case
1. Wolff A, Joshi RK, Ekstr€ om J, et al. A guide to medications study. AJP. Aust J Pharm 2014;95:62.
inducing salivary gland dysfunction, xerostomia, and subjective
sialorrhea: a systematic review sponsored by the World Work- 23. Villa A, Wolff A, Aframian D, et al. World Workshop on Oral
shop on Oral Medicine VI. Drugs R D 2017;17:1–28. Medicine VI: a systematic review of medication-induced sali-
vary gland dysfunction: prevalence, diagnosis, and treatment.
2. Kossioni AE, Hajto-Bryk J, Maggi S, et al. An expert opinion Clin Oral Invest 2015;19:1563–1580.
from the European College of Gerodontology and the European
Geriatric Medicine Society: European policy recommendations 24. Chalmers J, Pearson A. Oral hygiene care for residents with
on oral health in older adults. J Am Geriatr Soc 2018;66:609– dementia: a literature review. J Adv Nurs 2005;52:410–419.
613. 25. Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia
3. Manton D, Foley M, Gikas A, et al. Australia’s Oral Health and salivary gland hypofunction: executive summary of a
Tracker: Technical paper. Melbourne: Australian Health Policy report from the American Dental Association Council on Scien-
Collaboration, Victoria University, 2018. tific Affairs. J Am Dent Assoc 2014;145:867–873.
4. Scully C. Drug effects on salivary glands: dry mouth. Oral Dis 26. Khairnar M, Wadgave U, Khairnar S. Effect of alcoholism on
2003;9:165–176. oral health: a review. J Alcohol Drug Depend 2017;5:1–4.
5. Han P, Suarez-Durall P, Mulligan R. Dry mouth: a critical topic 27. Erdemir U, Yildiz E, Saygi G, Altay NI, Eren MM, Yucel T.
for older adult patients. J Prosthodont Res 2015;59:6–19. Effects of energy and sports drinks on tooth structures and
restorative materials. World J Stomatol 2016;5:1–7.
6. Thomson W. Dry mouth and older people. Aust Dent J
2015;60(S1):54–63. 28. Australian Medicines Handbook. Adelaide: Australian Medici-
nes Handbook Pty Ltd, 2018.
7. Humphrey SP, Williamson RT. A review of saliva: normal com-
position, flow, and function. J Prosthet Dent 2001;85:162–169. 29. Gallagher L, Naidoo P. Prescription drugs and their effects on
swallowing. Dysphagia 2009;24:159–166.
8. Australian Medicines Handbook Aged Care Companion. Ade-
laide: Australian Medicines Handbook Pty Ltd, 2016. 30. Vujicic M, Buchmueller T, Klein R. Dental care presents the
highest level of financial barriers, compared to other types of
9. Ship JA, Pillemer SR, Baum BJ. Xerostomia and the geriatric health care services. Health Aff 2016;35:2176–2182.
patient. J Am Geriatr Soc 2002;50:535–543.
31. Curtis B, Evans R, Sbaraini A, Schwarz E. Geographic location
10. Turner MD, Ship JA. Dry mouth and its effects on the oral and indirect costs as a barrier to dental treatment: a patient
health of elderly people. J Am Dent Assoc 2007;138:S15–S20. perspective. Aust Dent J 2007;52:271–275.
11. Aliko A, Wolff A, Dawes C, et al. World workshop on oral 32. Sanders AE, Spencer AJ, Slade GD. Evaluating the role of den-
medicine VI: clinical implications of medication-induced sali- tal behaviour in oral health inequalities. Commun Dent Oral
vary gland dysfunction. Oral Surg Oral Med Oral Pathol Oral Epidemiol 2006;34:71–79.
Radiol 2015;120:185–206.
33. Roberts-Thomson K, Brennan DS, Spencer AJ. Social inequality
12. Ship J, McCutcheon J, Spivakovsky S, Kerr A. Safety and effec- in the use and comprehensiveness of dental services. Aust J
tiveness of topical dry mouth products containing olive oil, Public Health 1995;19:80–85.
betaine, and xylitol in reducing xerostomia for polypharmacy-
induced dry mouth. J Oral Rehabil 2007;34:724–732. 34. Thompson B, Cooney P, Lawrence H, Ravaghi V, Qui~ nonez C.
Cost as a barrier to accessing dental care: findings from a
13. Thomson WM, Chalmers JM, Spencer AJ, Slade GD. Medica- Canadian population-based study. J Public Health Dent
tion and dry mouth: findings from a cohort study of older peo- 2014;74:210–218.
ple. J Public Health Dent 2000;60:12–20.
35. Jatrana S, Crampton P. Primary health care in New Zealand:
14. Moses G. Supporting pharmacy practice: A pharmacist’s role in who has access? Health Policy 2009;93:1–10.
oral health in the community. Aust Pharm 2017;36:38–41.
36. Schuller AA, Willumsen T, Holst D. Are there differences in
15. Anatomical therapeutic chemical classification index with oral health and oral health behavior between individuals with
defined daily doses. Oslo: World Health Organisation Collabo- high and low dental fear? Commun Dent Oral Epidemiol
rating Centre for Drug Statistics Methodology, 2016. 2003;31:116–121.
16. The Australian Government Department of Health and Ageing. 37. Doerr PA, Lang WP, Nyquist LV, Ronis DL. Factors associ-
Schedule of pharmaceutical benefits. PBS for health profession- ated with dental anxiety. J Am Dent Assoc 1998;129:1111–
als. Available at: http://www.pbs.gov.au. Accessed 20 February 1119.
2016.
38. Orellana M, Lagravere M, Boychuk DG, Major P, Flores-Mir
17. The Australian Government Department of Veterans’ Affairs. C, Ortho C. Prevalence of xerostomia in population-based sam-
Eligibility for the DVA Health Card- All Conditions or Totally ples: a systematic review. J Public Health Dent 2006;66:152–
and Permanently Incapacitated (Gold Card). Available at: 158.
https://www.dva.gov.au/factsheet-hsv59-eligibility-dva-health-ca
rd-all-conditions-or-totally-permanently-incapacitated-gold. 39. Hopcraft M, Tan C. Xerostomia: an update for clinicians. Aust
Accessed 5 February 2020. Dent J 2010;55:238–244.
18. The Australian Government Department of Veterans’ Affairs. 40. Bergdahl M. Salivary flow and oral complaints in adult dental
Treatment population statistics, quarterly report—September, patients. Commun Dent Oral Epidemiol 2000;28:59–66.
2017. Available at: https://www.dva.gov.au/sites/default/files/f 41. Nederfors T, Isaksson R, M€ ornstad H, Dahl€
of C. Prevalence of
iles/publications/datastatistical/treatmentpop/TPopSep2017.pdf. perceived symptoms of dry mouth in an adult Swedish popula-
Accessed 5 January 2020. tion-relation to age, sex and pharmacotherapy. Commun Dent
19. The Australian Government Department of Veterans’ Affairs. Oral Epidemiol 1997;25:211–216.
Dental and Allied Health fee schedules. Available at: https:// 42. Smith CH, Boland B, Daureeawoo Y, Donaldson E, Small K,
www.dva.gov.au/providers/fee-schedules/dental-and-allied-hea Tuomainen J. Effect of aging on stimulated salivary flow in
lth-fee-schedules. Accessed 23 April 2018. adults. J Am Geriatr Soc 2013;61:805–808.

194 © 2020 Australian Dental Association

 Use of medicines associated with dry mouth

43. Gerdin EW, Einarson S, Jonsson M, Aronsson K, Johansson I. care provision for Adelaide nursing homes. Aust Dent J
Impact of dry mouth conditions on oral health-related quality 2001;46:277–283.
of life in older people. Gerodontology 2005;22:219–226. 50. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS.
44. Stubbs C, Riordan P. Dental screening of older adults living in Prevalence and factors associated with polypharmacy in long-
residential aged care facilities in Perth. Aust Dent J term care facilities: a systematic review. J Am Med Dir Assoc
2002;47:321–326. 2015;16: 535.e1–535.e12.
45. Hopcraft M, Morgan M, Satur J, Wright F. Dental service pro- 51. Australian Institute of Health and Welfare 2019. Medications
vision in Victorian residential aged care facilities. Aust Dent J dispensed to contemporary ex-serving Australian Defence Force
2008;53:239–245. members, 2017–18. Report no. PHE 264. Canberra: AIHW.
46. Saub R, Evans R. Dental needs of elderly hostel residents in Available at: https://www.aihw.gov.au/reports/veterans/medi
inner Melbourne. Aust Dent J 2001;46:198–202. cationsdispensed-contemporary-ex-adf. Accessed 22 January
2020
47. Slade GD, Spencer AJ, Roberts-Thomson KF. Australia’s dental
generations. The national survey of adult oral
health.2004;6:274. Address for correspondence:
48. Hopcraft M, Morgan M, Satur J, Wright F. Utilizing dental Dr Anna K Moffat
hygienists to undertake dental examination and referral in resi- Playford Building City East Campus
dential aged care facilities. Commun Dent Oral Epidemiol
2011;39:378–384.
University of South Australia, Adelaide, SA 5001
Australia
49. Chalmers J, Hodge C, Fuss J, Spencer A, Carter K, Mathew R.
Opinions of dentists and directors of nursing concerning dental Email: anna.moffat@unisa.edu.au

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