A DOCS Education member writes:
I have a patient with extremely high dental anxiety and severe Fibromyalgia. She presented with a chief complaint of thick, ropey saliva. She noted that it often makes dental procedures very uncomfortable for her and can lead to gagging.
She is a 52-year-old Caucasian female. Her medical and drug history includes taking 15mg of morphine sulfate for long standing Fibromyalgia. She is also on Rhinocort® and Optivar®. She is a non-smoker and only “socially†consumes alcohol. She has seen numerous doctors for her Fibromyalgia problem including a neurologist, and has discussed the salivary problem with these doctors to no avail. Her chief complaints to me were tooth sensitivity, her saliva, and the need for bridgework. She is currently missing #’s 19, 20, 29, and 30. She has had three different removable partials, which she could not wear. I am planning on doing two fixed bridges from #18-21 and #28-31. There are no other dental concerns at this time. Could you please give me any differential diagnosis you may have regarding this case and the proposed treatment?
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
Thick, ropey saliva is often a side effect of medication. Saliva usually comes in two forms, serous (thick) and the thin watery kind. Anticholinergic agents, smoking, alcohol, and many other medications often dry the patient up resulting in the serous form predominating. In the patient you describe, both the Rhinocort® and the Optivar® are likely the cause of her saliva issue. This can be a challenging problem to solve since these medications and others used to control her allergy symptoms will all cause the problem she presents with to one degree or another. The morphine can also add to the problem. I suggest you recommend a medical consultation for her to explore other medication alternatives.
If you are asking about her possible candidacy for sedation, these chronic pain patients on potent opiates often hyporespond. A test sedation appointment is appropriate if you plan sedation as part of your treatment regimen. This will further define the type of sedation (oral or IV) that is most appropriate for this patient.
This blog post should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece.
