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BackTable / ENT / Podcast / Transcript #103
Podcast Transcript: Xerostomia: The Dentist's Perspective
with Dr. Anushka Gaglani and Dr. Abhishek Nagaraj
In this episode of BackTable ENT, Dr. Shah and Dr. Agan invite two comprehensive dentists, Dr. Abhishek Nagaraj and Dr. Anushka Gaglani, back to the show to discuss diagnosis and treatment of xerostomia. You can read the full transcript below and listen to this episode here on BackTable.com.
Table of Contents
(1) Patient Presentation of Xerostomia
(2) History-Taking for Xerostomia
(3) Causes of Xerostomia
(4) Treating Xerostomia
(5) Labs & Imaging for Xerostomia
(6) Using Artificial Saliva & Mouthwashes to Treat Xerostomia
(7) Xerostomia vs Reduced Salivary Flow
(8) When to Consult an Oral Pathologist
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[Dr. Gopi Shah]
This week on The BackTable Podcast.
[Dr. Abhishek Nagaraj]
One of the things research is showing, like putting a little surgical tape right across your mouth at night, just freeing up a little bit on the side, changes the way we breathe into nasal breathing. Nasal breathing changes immediately. Almost within 5 to 10 days, you'll see shifts in a dry mouth going into a more lubricated mouth and also reducing chances of sleep apnea because of that because the tongue sits at a higher position now.
[Dr. Gopi Shah]
Hello, everybody, and welcome back to The BackTable ENT Podcast. My name is Gopi Shah. I'm a pediatric ENT, and I am here today with my favorite general ENT and partner in crime, Dr. Ashley Agan. How are you today, Ash?
[Dr. Ashley Agan]
Hey, there. Good morning, Gopi. I'm wonderful and always happy to be doing a podcast with you on a Sunday morning.
[Dr. Gopi Shah]
On a Sunday morning, that's how we get our week started.
[Dr. Ashley Agan]
That's right. Let's do it.
[Dr. Gopi Shah]
We are back with our dynamic dental duo. We have Dr. Abhishek Nagaraj and Dr. Anushka Gaglani. Both are practicing general dentists with a focus on comprehensive dentistry, from dental implants to cosmetic dentistry. They are also co-CEOs and co-founders of Areo Dental Group, which is a multi-practice dental partnership organization that focuses on providing stellar patient experience through same-day comprehensive care and education, as well as improving care, collaboration, and practice efficiency on the doctor side.
They were on the BackTable ENT Podcast for an episode on the role of dentistry in head-neck cancer patients. Please, check that out. They are here to talk to us today about xerostomia and the role of the dentist. Welcome back to the show, guys.
[Dr. Anushka Gaglani]
Thank you, guys. Very happy to be here.
[Dr. Abhishek Nagaraj]
Thanks for having us back.
[Dr. Ashley Agan]
For listeners who haven't already listened to our last podcast, maybe it'd be good to still give us a brief description of yourselves and your practice, just to set the stage and give us a little background.
[Dr. Abhishek Nagaraj]
We are the co-founders of Areo Dental Group. Areo Dental Group is a group practice, dental partnership organization. We partner with doctors. We ramp them up. We hire new grad doctors and create badass GPs, general practice dentists, over a three to five-year time frame. Our core focus is stellar same-day comprehensive care through education. This is seventh year in a row for us. We've gone on to open six dental practices, and we plan on expanding our footprint a little bit further. We're in two states, Illinois and Indiana. Anushka, if you want to add something to that.
[Dr. Anushka Gaglani]
We've been on the Inc. 5000 a couple of times, if that can help. Look us up. Aside from that, our passion just lies in helping dentists be autonomous and keep dentistry in the hands of dentists.
[Dr. Ashley Agan]
That's awesome. I feel like we need more of that as well on the medical physician side of it too.
(1) Patient Presentation of Xerostomia
[Dr. Gopi Shah]
Today, we're going to talk about xerostomia, dry mouth. How do these patients present to you? Is there a common age or risk factor that you've noticed in your practice?
[Dr. Anushka Gaglani]
Yes. There's so many ways that they can present to us. We have patients who come in at any age really. More likely, it's patients who are older. I think the statistic is that 30% of patients over the age of 65 and 40% of patients over the age of 80 usually have xerostomia. It's usually due to medications. Usually, it's for more medications that really increase that risk, but also comorbid conditions like diabetes, Alzheimer's, Parkinson's, et cetera.
There's such limited data on xerostomia. It's anywhere between 0.9% to 64.8% of the population who suffers from it, which is such a wide range. In our experience, it's definitely though, again, those older patients or lifestyle factors, which we'll obviously dig deeper into.
[Dr. Abhishek Nagaraj]
Some of the non-medication, to Anushka’s point, is things like people who are mouth breathers, or they don't hydrate enough, obviously don't drink enough fluids. Those are some of the more common non-medication-related.
[Dr. Anushka Gaglani]
Alcohol, smoking, caffeine.
(2) History-Taking for Xerostomia
[Dr. Ashley Agan]
When you're doing your initial intake, and a patient's like, "Oh, yes, I just have terrible dry mouth. Can you help me out with this?" Are there specific questions like screening that you're asking about? Can you take us through what their initial history-taking looks like before we talk about physical exam?
[Dr. Anushka Gaglani]
Yes. We'll talk about their lifestyle factors like we mentioned earlier. Are they staying hydrated? Are they keeping their oral hygiene up to par? Are they alcohol users? Do they smoke? Do they drink a lot of caffeine? All of these are going to be lifestyle factors. We also will look at any medications. I mentioned earlier, comorbid factors. Medications like antihistamines, antihypertensive, decongestants, pain meds, diuretics, antidepressants, these are going to be those bigger risk factors. We'll look for those things first.
A lot of people will think that they have dry mouth, but really they don't. What we do is we check for any salivary pooling on the floor of the mouth. There is a salivary flow rate test that can be done as well. What we check for is either reduced unstimulated flow, which has to be, I believe it's 0.1 milliliters per minute of flow. That's measured over a 5 to 15-minute period. In chewing, it has to be at least 0.7 milliliters per minute or more to not have reduced salivary flow. That's checked over five minutes.
The last thing we would do really, if we see that someone is not pulling saliva or if they have reduced salivary flow, we can actually also do a minor salivary gland biopsy. By we, I don't mean the general dentists. We would refer out to an oral surgeon, oral medicine practitioner, or an ENT in that case.
[Dr. Abhishek Nagaraj]
Those are great points. Generally, people with dry mouth or xerostomia will present with thick, stringy saliva. That's usually generally a really good sign. That's where we start to decipher whether it's really lifestyle-related or dig deeper. They will also present with a lot of dental caries, rampant caries. We could be doing a bunch of work on them. Six months later, they have this whole mouth full of new cavities as though we never saw them.
[Dr. Anushka Gaglani]
Especially root caries. When their gums are receded, they have it at the root or the cervical portion, which is where the root and the coronal portion of the tooth meet is where we'll usually see it.
[Dr. Abhishek Nagaraj]
Right.
[Dr. Ashley Agan]
Backing up a little bit, so you've got patients who you're trying to decipher, do they truly have dry mouth and an issue with either producing their saliva or the amount, or do they have the sensation of dry mouth because those are going to lead you down to different pathways. Then with looking at your lifestyle types of contributions, when you talk about staying hydrated, how much is appropriate?
I think people will quickly say like, "I drink plenty of water," or they are quick to say, "Oh, yes, I'm in with oral hygiene. What is the appropriate oral hygiene?" "Yes, I brush my teeth. It's fine." Do you get into like, okay, but are you doing it to this extent? What level is that threshold where it's like, this is the amount of water you need to drink every day?
[Dr. Abhishek Nagaraj]
Generally, I want to say I can totally relate with that because I used to be one of those guys. I was like, yes, I drink enough water. Why do I wake up with a little bit of a dry mouth? I'm also a little bit of a mouth breather. Generally, I want to say minimally 60 to 65 ounces a day. You want to be hydrating with that. Anything less than that is not enough. Also, I think from an oral hygiene perspective, I think at least brushing at the minimum morning and night.
Generally, now, the ADA, the American Association of Periodontics is saying three times a day because plaque builds up as soon as we brush, immediately. It starts to build right away. Twice a day with some good, at least flossing regimen, four to five times a week. Those are the things that we can control.
[Dr. Anushka Gaglani]
As far as staying hydrated too, I do have patients say, "But I drink a lot of, X, whatever the process can drink of choices." I'm like, "No, you have to really have water." Then also, things with caffeine and sugar, obviously are not going to help the problem. We want to stay away from those kinds of things. That brushing, like Abhishek said, that oral hygiene is going to be key as well. If there truly is dry mouth, there are some other pallet of things that can be done, but those are a couple of the bigger ones.
[Dr. Abhishek Nagaraj]
We could certainly hit on those palliative things later down this podcast.
(3) Causes of Xerostomia
[Dr. Gopi Shah]
In terms of medications, initially, you had mentioned four or more medications. Is it four or more of the medications that have the side effects of dry mouth or is that what you had meant with that?
[Dr. Anushka Gaglani]
It's a combination of medications of really any four medications that can cause that, but it's obviously intensified with those particular ones that are related to dry mouth.
[Dr. Abhishek Nagaraj]
I think standalone can do it too. A standalone Lisinopril for hypertensives has one of the side effects as dry mouth. Just combination drug therapy just exacerbates that condition.
[Dr. Ashley Agan]
You ask about the different lifestyle things, are you drinking enough water, are you a mouth breather, are you drinking a lot of coffee, those types of things. Then you're looking at their medication lists, and then let's say you mark off, okay, this could be causing it, this could be causing it. You're going down. Then any other types of screening questions when it comes to the other types of things that can cause dry mouth. Thinking of things like Sjogren's or history of radiation or other types of things that don't fit into the other boxes.
[Dr. Anushka Gaglani]
Yes, for sure. We're looking at chemo as well. We're looking at radiation. We're looking at autoimmune diseases. You mentioned Sjogren's disease, that definitely plays a big role. Lacrimal ducts as well. Then radioactive iodine. If anyone's gone through thyroid treatment, that's something else we would ask about because that does affect it. Especially the parotid gland is where it would affect it. That's going to be the major salivary producer.
[Dr. Abhishek Nagaraj]
Right. Ashley, I'm glad you bring that up because I think the first two lines of questioning with the lifestyle and the medication stuff, most people will fall in those two. It's that third line of questioning, which is then like, hey, have any recent history of radiation treatment or Sjogren's, because generally, that has some dry eyes type symptoms too. That would be our third line of questioning for sure.
[Dr. Ashley Agan]
Then just moving on, on your physical exam, you mentioned a little bit that these patients might have more dental caries more often because of not having that saliva to protect against that. Then you also mentioned about salivary pooling and the testing for the flow rate. Can you talk a little bit about other things you see on exam, and then how is that flow rate test done?
[Dr. Gopi Shah]
You're talking about 0.1 ml and 0.7 ml. How do you measure that volume? Is there a litmus paper or something?
[Dr. Abhishek Nagaraj]
Generally, you have them suck on some type of a lozenge, could be a lemon. Then it literally-- you're going to spit into a pipette or something over a five-minute period. It's a very physical test, but it's also the easiest way to test salivary fluoride.
[Dr. Ashley Agan]
Interesting.
[Dr. Gopi Shah]
If they can spit out 0.1 ml in a pipette, they probably have a little bit more than that that they're able to produce. That's probably a good sign.
[Dr. Abhishek Nagaraj]
Yes.
[Dr. Anushka Gaglani]
Correct.
[Dr. Abhishek Nagaraj]
Generally, people with all the existing conditions that we talked about are going to be in that 0.1 to 0.2. That's generally a good sign that they suffer from xerostomia.
[Dr. Ashley Agan]
How often are you using that test? Is that a more academic research-y thing to give you some objective measures or is that something that you actually use frequently in your workup?
[Dr. Anushka Gaglani]
To be honest, we don't really use it. It is more on the academic side, but that's just basically what the numbers come down to.
[Dr. Ashley Agan]
Anything else that you're seeing on the physical exam that tips you off to what could be going on?
[Dr. Anushka Gaglani]
Yes. Just how it presents, it's dry mouth, difficulty chewing, difficulty swallowing.
[Dr. Abhishek Nagaraj]
Burning, soreness.
[Dr. Anushka Gaglani]
Burning dry mouth, halitosis, angular cheilitis, which is the cracking on the corners of the lips, a dry, rough fissure tongue.
[Dr. Abhishek Nagaraj]
Candidiasis.
[Dr. Anushka Gaglani]
Hoarseness, halitosis. Then another thing, patients that wear dentures or partial dentures, if it's ill-fitting or if they have difficulty retaining it, because it requires some level of suction, that's how we would know too that they're struggling with that as well.
[Dr. Abhishek Nagaraj]
One of the things I would say is just people when they wear dentures, they come with a lot of expectations. You add dry mouth xerostomia to that, oh my God, it is a really challenging thing because every other day, patients will present to us saying, "It hurts me here, or it hurts me here," and there's a lot of sores in their mouth. As a clinician, it can be super challenging to deal with patients that have both dry mouth and a denture wearer at the same time.
[Dr. Gopi Shah]
Are they higher risk to sores as well and irritation and rubbing and all that?
[Dr. Abhishek Nagaraj]
Absolutely. You get a completely red palette and then lots of sores. They're really miserable.
(4) Treating Xerostomia
[Dr. Gopi Shah]
In terms of those medications, how do you prescribe them? On the pedi side, this is something I don't always see very often and I've never prescribed pilocarpine before.
[Dr. Anushka Gaglani]
The pilocarpine, usually we would do five milligrams a day, three times a day. That would be for about three months. Then the cevimeline hydrochloride would be about 30 milligrams a day and also for three months.
[Dr. Ashley Agan]
Would that theoretically work for any of these dry-mouth patients? Depending on what their pathophysiology, is it possible that that would not work as well?
[Dr. Anushka Gaglani]
Yes, I would say, obviously in cases with something like radiation therapy which can cause permanent damage to the salivary glands, I would imagine it would be a little bit tougher for that to work because it has to stimulate the saliva and they're already damaged. Also, we'd want to look at any other medication that the patient is taking because these do have their own side effects, sweating, dilation of the vessels, hypotension, bradycardia, bronchoconstriction, things like that. Theoretically, yes, in most cases where there's not damage of the glands, it should work.
[Dr. Ashley Agan]
Maybe for your patient who's had radiation or your patient with Sjogren's, you might counsel them like, the underlying issue is that the salivary glands are not actually able to make the saliva. If we stimulate them, this may be low yield to try this, but maybe you could try it, but it may not work very well.
[Dr. Anushka Gaglani]
Exactly. Correct.
[Dr. Abhishek Nagaraj]
Correct.
[Dr. Anushka Gaglani]
For those patients, unfortunately, it's going to be mostly palliative.
[Dr. Abhishek Nagaraj]
It generally works well for chemo patients because there isn't a whole lot of irreversible tissue damage. It's more the tissues that are able to heal themselves over time. Chemo patients will react well to these medications.
(5) Labs & Imaging for Xerostomia
[Dr. Ashley Agan]
Going back to the workup, we skipped over. I meant to ask, is there any other lab work or imaging or anything else that's done after a physical exam and before treatment?
[Dr. Abhishek Nagaraj]
That's a good question. Generally, when they come to the dentist, we're sticking to a panoramic x-ray, a pantomograph, and a full set of x-rays that includes bite wings. Generally, they don't give a whole lot of information on salivary glands, unfortunately. We're not generally doing any more x-rays or scans of that nature for these patients. Generally, it's that lifestyle questioning and then medication-related questioning in order for us to probe that further.
A lot of times, when we think as general dentists, we can't handle the severity or the complexity of that condition, we are generally going to refer them to an oral surgeon or an oral pathologist who could probably do some biopsy, to Anushka’s point earlier.
[Dr. Anushka Gaglani]
They might be able to do an MRI or something that would show the soft tissue as well to see if there's any damage.
[Dr. Gopi Shah]
Ash, do you ever get labs or anything like that for these patients?
[Dr. Ashley Agan]
I wouldn't say that I routinely get labs for everybody. Sometimes if we're thinking about Sjogren's, I might get some labs to check for those antibodies, but not always. A lot of the time, patients will be sent to me for that lip biopsy. Maybe they're seeing somebody else for it. Part of that workup, someone has said, "Well, maybe it would be helpful to get that lip biopsy to solidify whether this is or is not Sjogren's." I would say that's probably the most common thing.
[Dr. Gopi Shah]
It reminds me of our kids with hearing loss. We don't just get a set of labs anymore. You want it targeted. It sounds like for xerostomia, you want to have an idea of what you're looking for, as opposed to just, we check for diabetes, for Sjogren's through lab work, because what are you going to do with that? You still might miss what's actually going on.
(6) Using Artificial Saliva & Mouthwashes to Treat Xerostomia
[Dr. Ashley Agan]
Yes, I think it can be really challenging, especially because some patients will have multiple reasons to have dry mouth. You're going through the list and they check off some of the boxes for the lifestyle, they check off some of the boxes for the medication. You're thinking, well, what angle are we going to use to try to treat this and make it better? I think we, at least in my world with general ENT, sometimes I forget about the complications when it comes to dental hygiene with having dry mouth because when patients are using these lubricants to help with the symptoms, I assume that doesn't actually help with the prevention of caries though, does it, because it's not actually saliva? How does that work out?
[Dr. Anushka Gaglani]
To some extent, it may because it does have calcium phosphate ions in it and that helps remineralize. To some extent, yes, it will. It will act as a buffer as well. Again, it's more topical. It's unfortunately not going to be systemic.
[Dr. Abhishek Nagaraj]
The Biotène mouthwashes have some fluoride in them. They're sodium fluorides. Those are really-- I wouldn't say they're really effective. They're somewhat effective.
[Dr. Anushka Gaglani]
Yes. I was going to say the fluoride is really a big piece to that. A lot of these artificial salivas don't have that. If it's possible, I would definitely recommend that along with a fluoride gel, just going back to the importance of fluoride, fluoride gel and even making sure we're getting that systemic fluoride through fluoridated tap water.
[Dr. Abhishek Nagaraj]
I also think it's a great idea for people suffering from dry mouth to come get their cleanings four times a year. Six months, again, is not enough because we could detect a lot more caries earlier on. They can come in more frequently.
[Dr. Anushka Gaglani]
Yes, because it does progress quickly.
[Dr. Gopi Shah]
Does dental insurance cover that for the patients that are higher risk for caries? The radiated patients, the patients that have Sjogren's and xerostomia, once you've had that condition, does the dental insurance cover an extra cleaning?
[Dr. Anushka Gaglani]
It depends on the insurance company, unfortunately. It depends on the plan that they have. We have seen a lot of plans allow three to four cleanings a year, but it really depends on their plan. They'd have to check on that.
[Dr. Gopi Shah]
In terms of fluoride, are mouthwashes like the over-the-counter ACT, are those enough? Are those as helpful as the gel? Is that all over-the-counter as well?
[Dr. Anushka Gaglani]
The gel, no. The gel and the prescription toothpaste like PreviDent 5000 as an example, those are going to have a much higher part per million of fluoride. Those would be more recommended. The over-the-counter is just going to be a lot lower. That's more for your healthy patient. We would definitely want to talk about prescription level at that point.
[Dr. Abhishek Nagaraj]
I think to your point, mild xerostomia cases will be okay with ACT and Biotène. Over time, they'll learn to live with that and make that work for them. The more severe cases, I think, need a little more intervention, for sure.
[Dr. Ashley Agan]
It sounds like it's really important to make sure these patients are following with their dentist regularly. That may be something that I haven't been as good about in the past, to make sure the patients are aware of the possible dental repercussions of having xerostomia.
I think a lot of them come in and it's the discomfort and the symptoms that they're experiencing that we are focused on, but it sounds like it's also just important from a dental health long-term to make sure that I'm asking, okay, do you have a dentist? When was the last time you saw them? Let's make sure that you're staying on top of this because now that we know this, you are at higher risk of having long-term complications from not having enough saliva, basically.
[Dr. Abhishek Nagaraj]
I think that would be super helpful. The other piece of this is psychological. If patients came in six months ago and they were diagnosed with seven cavities, they come back six months later, we tell them, "Hey, you have seven more cavities." Patients are like, "What the hell? We just got all these fillings done. You're telling me I have seven more?" Yes, that would be super helpful just from a medical-dental perspective.
(7) Xerostomia vs Reduced Salivary Flow
[Dr. Gopi Shah]
I think as we discussed last time, for some reason, people still tend to think that the mouth is not part of the body. We want them to relate that you are going to have these other issues. Of course, the main things that can affect the body too are going to be the dysphagia and dysgeusia. I don't know if this is a good time to ask, but you all had touched upon the sensation of dry mouth versus really having xerostomia or decreased salivary flow. Can we dig into that a little? Would this be a good point to dig into?
[Dr. Abhishek Nagaraj]
Sure.
[Dr. Anushka Gaglani]
Yes.
[Dr. Gopi Shah]
Who are the patients that just present with the sensation and how does that happen? Is the treatment or the way in which you counsel those patients similar?
[Dr. Abhishek Nagaraj]
Those patients, generally, our first line of questioning to reiterate would be lifestyle. How much coffee are they drinking? How much tobacco are they chewing or smoking? What does their hydration look like on a daily basis?
[Dr. Anushka Gaglani]
Do they drink alcohol pretty frequently? Is it more infrequent?
[Dr. Abhishek Nagaraj]
Correct.
[Dr. Anushka Gaglani]
Then do they stay hydrated as well during that time?
[Dr. Abhishek Nagaraj]
Right. Depending on these answers, if their answer is yes to every one of these, it's generally like counseling and saying, "Hey, if you don't do these things, you potentially have a chance in the future to have reduced salivary flow, which can turn to dental caries and you spending a lot of time and money at the dentist." That's the educational piece. The second line would be, obviously, the medication-induced, what medications they're on, what medical conditions and comorbidities they have.
Depending on that, then we would try to work with their physician to see if tweaks can be made with their medication regimen, whether can they go on a standalone drug as opposed to multiple drugs for the same condition. Those are things that we get involved in if the dry mouth is much more severe.
The third line is when patients present to us after a chemo or radiation. The chemo and the radiation, those are more complex cases, and especially, it gets more intensified when patients have prosthesis in their mouth, like dentures and partials. Now they're really struggling to keep them in because they get sores all over the place. They need a lot more care in those cases. In these cases, we will then work with their physician and/or the oral surgeon and the oral pathologist to see if there is drugs that patient can be prescribed to actually induce salivary flow like pilocarpine and drugs of that nature.
[Dr. Gopi Shah]
The sensation of dry mouth, whether the patient actually has decreased salivary flow or not, to me, it sounds like it doesn't really matter the fact that they have the sensation of dry mouth, it's the same workup questioning treatment options.
[Dr. Anushka Gaglani]
I think I would say the treatment options may differ obviously. if there's something medication-related or chemo, et cetera, that would be a totally different set of treatment than it would be if it's the sensation. The sensation is going to be stop smoking or stop drinking alcohol or reduce your caffeine. Let's use artificial saliva or lubricant. Another thing is with the mouth breathing, let's check for sleep apnea, let's figure out why you're mouth breathing, things of that nature. It's going to be more, again, palliative versus someone that's actually got an underlying condition.
[Dr. Abhishek Nagaraj]
A point about mouth breathing, I'm passionate about this because I've been a mouth breather myself for quite a few years. I was always waking up with a little bit of a dry mouth. One of the things research is showing, like putting a little surgical tape right across your mouth at night, just freeing up a little bit on the side, changes the way we breathe into nasal breathing. Nasal breathing changes immediately. Almost within 5 to 10 days, you'll see shifts in a dry mouth going into a more lubricated mouth, and also reducing chances of sleep apnea because of that, because the tongue sits at a higher position now. It's crazy how interconnected all these things are.
[Dr. Ashley Agan]
It all goes back to the unfortunate circumstances of medical and dental being separate instead of us all being under one-- After you guys, let's say you have the patient-- this happens every once in a while where you have just a difficult case and the patient has come back, and they're like, "I quit smoking. I don't drink alcohol. I don't drink any caffeine. I've done all the things," and they're still having problems with dry mouth. You've ruled out Sjogren's.
At that point, is there a particular specialist that you like to refer these patients to pick it up from there because things have just gotten complicated, or maybe there's some rare zebra condition that you're not sure about?
[Dr. Anushka Gaglani]
Honestly, my specialist of choice at that point would be an oral medicine specialist. They can really dig deep into what else is going on.
[Dr. Abhishek Nagaraj]
Oral pathologist is also my number one go-to, medicine or oral pathologist.
(8) When to Consult an Oral Pathologist
[Dr. Ashley Agan]
For those of us who just aren't as familiar with that realm, can you tell us more about what is the difference between dentistry and oral medicine, oral pathologist? What does that training pathway look like? Is that like a fellowship out of dentistry, like they've done dental school and then more, or what is their area of expertise?
[Dr. Anushka Gaglani]
That's exactly it. They go to a couple more years of school. Some of them may receive a PhD, so it's going to take a little bit longer than that. That's all they do is they focus on these, as you mentioned, these conditions and zebra conditions that we may not have as much training on.
[Dr. Abhishek Nagaraj]
Correct.
[Dr. Ashley Agan]
If you are an ENT and you're looking for someone to help with maybe an oral pathologist or oral medicine doctor to refer to, are these doctors usually associated with a dental school or how would you find somebody if you didn't already have that relationship?
[Dr. Abhishek Nagaraj]
Absolutely. You nailed it. It's generally, you want to pick the biggest dental school that's in your vicinity. Usually, dental schools have a full-blown department for oral medicine, radiology, and pathology. That is generally where we refer these patients to because they can receive the multidisciplinary care that they deserve at that point.
[Dr. Ashley Agan]
Perfect. I think that's really helpful because sometimes, you just get to the end of the line and you say, "We've tested for everything I know to test for, and I don't know what I can do." We need to get another set of eyes on you and get a different perspective at this point.
[Dr. Abhishek Nagaraj]
Yes.
[Dr. Gopi Shah]
How do you guys follow these patients? What's your follow-up?
[Dr. Abhishek Nagaraj]
Generally, our follow-ups are when people are presenting with more than mild dry mouth, we want to see them every three months. It's not as frequent as two weeks, especially if they have pre-cancerous condition. It's not as bad. Generally, we want to get them back in three months to see how they feel. By making these lifestyle changes, one of the simplest things that people can do is hydrate more. 60 to 70 ounces of water a day will really start to make them feel better.
[Dr. Anushka Gaglani]
As far as follow-up, that's exactly it. It's not going to be super frequent, but we do want to see them more regularly than we would someone with a healthy salivary flow. I think the main thing, again, when it comes down to dentistry is catching that caries before it starts to cause major issues. That's going to require more frequent follow-up.
[Dr. Gopi Shah]
I think we could all drink more water. Thank you guys so much for taking the time today. We appreciate you coming on. It was great to see you again and chat with you again. For those who haven't listened to our previous podcast, I want to make sure and give you a chance to tell our listeners about where they can find you, where you are on social media, your website for your dental practice.
[Dr. Abhishek Nagaraj]
Our website is www.areodental.com. That's the parent organization. Then all our portfolio practices are listed under that. TrueBlueDentistry.com, BlueIslandSmiles.com, StJohnSmiles.com, StagerSmiles.com, and BlueIslandSmiles.com. We're in the south suburbs of Illinois in northwest Indiana. We also have a LinkedIn page with Areo Dental Group, where we try to post meaningful content for listeners and viewers. We also have an Instagram page on Areo Dental. We also have personal Instagram handles. I'm Dr. Dentagram.
[Dr. Anushka Gaglani]
I'm Dr. Ontoothpreneur. Then we're also on LinkedIn.
[Dr. Ashley Agan]
I love those. It's just so cool.
[Dr. Gopi Shah]
Thank you guys so much. For a dry topic, it was actually very interesting. I learned a ton. Thank you for taking the time. Thank you guys.
Podcast Contributors
Dr. Anushka Gaglani
Dr. Anushka Gaglani is a practicing dentist in Chicago and the co-founder and co-CEO of Areo Dental Group..
Dr. Ashley Agan
Dr. Ashley Agan is an otolaryngologist in Dallas, TX.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Cite This Podcast
BackTable, LLC (Producer). (2023, April 6). Ep. 103 – Xerostomia: The Dentist's Perspective [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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