Step 3: Incorporate Additional Strategies for Patients with Special Considerations

Dry mouth (xerostomia): Patients with reduced salivary flow require extra care beyond standard hygiene, fluoride use, and dietary counseling. Encourage them to sip water regularly throughout the day and limit substances that further dry the mouth, such as caffeinated beverages and alcohol. Saliva substitutes available as sprays, lozenges, gels, or rinses can provide lubrication and, in some cases, added fluoride protection. These measures help maintain oral moisture and buffer acid attacks in the absence of sufficient natural saliva.^7,37

Patients with self-care limitations: Individuals who rely on others or are unable to perform oral hygiene themselves, such as older adults with illnesses or cognitive impairments, often require tailored preventive care. Their diets may lean toward soft, easily chewable foods, which can be high in carbohydrates; medications may be syrup-based and contain sugar; and they may not receive adequate nutrients that support oral health. A study found only 5% of elderly residents in assisted-living homes asked caregivers for oral cleaning assistance.³⁸ Providers should educate caregivers to help with daily oral care and prompt assistance when needed.

Other considerations include recommending toothpastes for sensitivity when dentin is exposed, and ensuring effective removal of hardened calculus (tartar) through professional cleaning or specialized tools. These individualized adaptations align with CAMBRA principles of minimizing disease progression and preserving oral health.³⁶