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How to
Cope with a Dry Mouth
By Dr. Jeff Shnall
Introduction:
In this article we will be talking about the problems associated
with having a chronically dry mouth, as well as its treatment.
Having a chronically dry mouth is a fairly common disorder, and
will likely become more prevalent in the years ahead, for reasons
we will discuss.
As a dentist, I get to see first hand, the harmful
effects that having a chronically dry mouth can have on your teeth
and gums.
It can lead to a mouth full of cavities and gum disease,
but it can also have a negative effect on your overall health, your
enjoyment of food, your ability to speak and your
social life.
The feeling that one’s mouth is dry most of the time is
called Xerostomia, and about 30 percent of the adult
population in North America has this condition.
The most common reason why
people develop a chronically dry mouth is due to side effects of
medications they take for a variety of
problems.
There are more than 400 commonly prescribed drugs that
cause dry mouth as an unwanted side effect. One study reports that
80% of the most commonly prescribed medications can cause dry
mouth.
Some of the most common drugs that cause dry mouth
are antidepressants, some types of beta blockers, some blood
pressure medications, drugs used to prevent seizures and to treat
the symptoms of Parkinson’s disease. Even some types of
over the counter antihistamines can cause dry mouth.
As our population ages, a greater number of people are going to
be on medications for blood pressure, heart problems and the like,
so the number of people with dry mouth or xerostomia is only going
to increase.
When I see a patient in my dental chair who has an unusually
high number of cavities, one of the first things I check for is
signs of a dry mouth.
If you answer “yes” to one or more of the following questions,
then you likely have a chronically mouth:
1. Does your mouth usually feel dry?
2. When you are eating a meal do you have difficulty
swallowing dry foods?
3. Do you have to drink liquids in order to help swallow
food?
4. Does it usually seem like there is little saliva in your
mouth?
Facts about
Saliva:
To better understand the dry mouth problem let’s take a moment
to talk about saliva.
Saliva is a watery liquid that contains proteins that help us
digest starches, and it also contains an enzyme that helps
lubricate the tissues in our mouths to help keep them slippery.
Saliva also contains antibodies and other substances that fight
harmful bacteria that may enter our mouths. Saliva bathes our
teeth in a watery mixture that contains calcium and
phosphates. The calcium and phosphates that coat the teeth
help prevent cavities from forming. More on that later.
Saliva helps wash food particles from our teeth, gums and
cheeks.
Saliva plays a key role in keeping the lining of the
surfaces of our lips, mouth and throat healthy and lubricated.
Saliva is produced my three pairs of major glands and
hundreds of minor, tiny saliva glands in our mouth as well.
A healthy person will produce between one half to one full litre
of saliva a day. (That’s between 16 to 32 ounces for American
salivators).
When a person’s daily saliva flow reduces to less than one half
the amount they are accustomed, to they usually begin to complain
about having a dry mouth.
Dry mouth can be a result of either our saliva glands not
producing enough saliva due to a structural problem of the gland
itself. , or due to a signaling problem, that is, when
there is a problem with the messaging system that normally causes
our glands to produce saliva.
For example, if we see some mouth watering food
(pardon the pun), our brain sends signals to our saliva glands to
produce saliva, in anticipation of a meal. However, if you
have a chronically dry mouth, these nerve impulses from the brain
can be interrupted or reduced in number, so not as many nerves
impulse or signals reach the saliva glands, thus the saliva gland
is not stimulated to produce as much saliva as it normally
would.
Medications that some people take for blood pressure control or
other medical problems, as we said earlier, can interfere with
these signals from the brain to the salivary glands, causing dry
mouth.
Complications of Having a
Dry Mouth:
Now let’s discuss what happens if you don’t produce enough
saliva, and develop a chronic dry mouth:
Having a dry mouth can make it more difficult to chew and
swallow especially dry food like crackers. It can cause our
lips, inner cheeks, tongue, and floor of mouth to become dry,
cracked and/or red.
People with dry mouth cannot taste their food as well.
Talking becomes more difficult as the tongue can become stuck to
the roof of the mouth due to the dryness.
If the amount of saliva in our mouth decreases this can result
in an overgrowth of different types of bacteria other small
creatures that live in our mouth. Let’s explain why:
Our mouth is normally home to countless numbers of
bacteria and even healthy mouths can be home to the yeast Candida
albicans.
In fact, 80 % of all humans have Candida albicans either
on their skin, in their mouths, in their stomach or
intestines. Candida is actually a form of
fungus.
If we have a chronic dry mouth we will have
less saliva washing our mouths, and populations
of bacteria and Candida are that normally are washed off our
tongue, roof of the mouth and lips overgrow. An overgrowth of
Candida can cause red, thinning patches on the tongue and in the
tissues that line the mouth. We call this Candidiasis.
Dry lips can become cracked and painful at the corners and
can also become infected with Candida, a condition called
angular cheilitis.
We’ll discuss the effects of dry mouth on the teeth and gums in
a few minutes but first, let’s discuss a few other reasons that
people develop chronic dry mouth, besides the side effect of
medications.
Other Causes of Dry
Mouth
Dry mouth can also be caused by various medical conditions such
as: Alzheimer’s disease, diabetes, anemia, and rheumatoid
arthritis, to name a few.
The most common illness that causes dry mouth is Sjogren’s
syndrome (pronounced shoh-grinz).
Sjogren’s syndrome is one of the most common autoimmune
diseases, which means it is a disease in which our own immune
system attacks parts of our own body.
In this disease our immune cells are attacking our saliva glands
and the glands around our eyes which produce tears. This
results in dry mouth and dry eyes. It also causes
inflammation and sometimes swelling of the salivary glands and
ultimately damages a large portion of the salivary and tear glands,
seriously decreasing their function. I
Sjogren’s syndrome affects about 1 in 70 people.
That translates to about 430,000 Canadians and four million
Americans having the illness. 9 out every 10 people who
have it are women.
According to the Sjogren’s syndrome of Canada
Website the most typical symptoms of this illness are:
1. Dry eyes requiring the application of eye drops
or artificial tears at least 3 times a day,
2. a dry mouth requiring frequent drinks or the need to
constantly suck candy or chew gum to keep the mouth moist and…
3. And swollen saliva glands.
Severe dry mouth can be caused by the radiation treatment used
to treat head and neck cancers. Radiation that is applied to
eliminate the cancer cells unfortunately also destroys the cells in
the saliva glands and can cause severe and permanent dry
mouth.
On the other hand, Patients who have chemotherapy as opposed to
radiation treatment for cancer can develop dry mouth as a side
effect to the chemotherapeutic drugs during treatment but this
usually improves after treatment is finished.
As mentioned before, chronic dry mouth is most often due to a
side effect of the medications people take.
In fact, People who are on multiple medications are more
likely to develop chronic dry mouth, and dry mouth has been found
to affect about 30 percent of people over the age of 65.
However Dry mouth does not have to be an inevitable part of
aging. The trouble is, the older one gets, the more likely
one is going to have health issues that require the medications
that cause dry mouth.
How does having a chronic
dry mouth affect the health of your teeth?
In short, it can have devastating effect if not managed
properly.
Having a dry mouth increases the amount of bacteria or plaque
that grows on our teeth. In a normal mouth saliva washes
bacteria and food debris off our teeth. In a patient with dry
mouth, the decreased flow of saliva allows bacterial plaque to
remain on the teeth and multiply, especially along the gum
line.
When a person with dry mouth eats or drinks something
containing sugar, the coating of bacteria on the teeth are also
supplied with sugar. The bacteria uptake this sugar and then
produce acid, which starts to dissolve the surface of the
tooth.
In the dry mouth patient there is an insufficient supply
of saliva to wash the tooth, so if the patient doesn’t brush and
floss right after a sugary meal or snack the bacteria and acid will
remain on the tooth for long periods of time. The acid
continues to break down the tooth and causes a cavity to
form.
To add further insult to injury, a person with dry
mouth will have less calcium and other minerals bathing their teeth
as would occur in a normal mouth.
Whether a cavity starts on a tooth depends on the balance
between the amounts of acid the bacteria produces on a tooth, and
how long the tooth is exposed to the acid versus the amount of
calcium the tooth is bathed in to remineralize the tooth.
Teeth in the dry mouth patient are less likely to
remineralize and will have a higher chance of developing cavities.
Due to the lack of calcium bathing the
tooth.
Furthermore, dry mouth tends to affect older adults and this is
the age group who are more likely to have gum recession.
Patient with receding gums have longer looking teeth as their gums
shrink, exposing their roots. The roots of our teeth do not
have an enamel coating. Enamel is harder than bone and can
resist cavity formation much more than the softer root surfaces. So
the roots of the tooth, covered in plaque in a dry mouth patient
will be more likely to decay.
Ultimately, tooth
loss due to decay or cavities will be more likely if the cause of
the dry mouth can not be remedied or if the patient does not take
other steps to help their problem.
Gum disease is another risk in the dry mouth
patient. The build- up of bacteria at and under the gum line
in these patients can cause inflammation in the gums and ultimately
bone loss around the teeth. If untreated this can result in
tooth loss.
Dentures can become difficult to wear in the dry mouth
patient. Saliva normally helps to lubricate the
mouth….however if the mouth is dry, a denture is more likely to rub
and irritate gums and cheeks, causing denture sores.
The lack of saliva can also reduce the amount of suction between
the denture and the gums, causing dentures to become looser.
This is similar to the way that a dry suction cup doesn’t stick
well to a dry glass surface, where as a wet suction cup sticks
well.
How is dry mouth
treated?
The first step is to try to identify the underlying cause of the
dry mouth problem. I advise patients to discuss the matter
with their family doctor, who may help determine if the cause is
due to a side effect of a medication the patient is taking or to an
underlying medical problem.
It may be possible to change a patient’s medication to one that
is less likely to cause dry mouth, or to adjust the dosage of the
medication causing the dry mouth, but this is not often possible to
do as so many medications cause dry mouth.
So managing the symptoms of dry mouth often is the only
option.
How you can best cope with
a chronic dry mouth.
Here are some tips: and let me mention I do not receive
payment from any of the companies or products that I am about to
mention. As well, all the information on today’s
podcast can be found on my website or in today’s show notes.
More on this at the end of the article
Tip
1:
Maintain Good oral hygiene
The cleaner you are able to keep your teeth, the less coated
they will be with bacteria or plaque. This will reduce the
chance of developing cavities and/or gum disease. Good
thorough brushing at least twice a day is critical if you want to
minimize dental problems….3 times a day would be even better.
Be sure to use
a soft tooth brush and better yet, you should really consider
getting a good electric toothbrush. Oral B or Sonicaire
are the two brands of electric toothbrushes you may want to
consider.
Tip 2. Flossing
thoroughly once a day will help prevent cavities from
forming in between the teeth, especially under the gum
line.
Tip 3. .High amounts
of Fluoride delivered to the teeth in toothpaste,
mouthwashes and gels has been shown to strengthen the enamel and
exposed roots of our teeth and can help prevent or minimize
cavities.
Some good ways of ensuring you are exposing your teeth to an
optimum amount of fluoride are:
-using Prevident 5000 Dry Mouth Toothpaste by Colgate,
twice a day when you brush.
This toothpaste delivers far more fluoride to your teeth
than regular toothpastes and it does not irritate dry mouths the
way that some regular toothpastes do.
This is because Prevident 5000 dry mouth toothpaste does not
contain sodium laurylphoshate, an ingredient found in most
regular toothpastes. Sodium lauryl phosphate is added
to mosst toothpastes because it causes toothpastes to foam up in
your mouth, and it has been known to cause canker sores in some dry
mouth patients.
Biotene is a brand of fluoride containing tooth
paste for dry mouth patient and it does not contain sodium lauryl
phosphate but it does not have the high fluoride content of
Prevident, however, it can be used in patients who for any reason
don’t like Prevident.
Colgate’s Dry Mouth Relief Fluoride
Mouthwash can be swished around the teeth for one
minute twice daily to deliver an additional amount of
fluoride to the teeth of the dry mouth
patient.
If you are at high risk for
developing cavities the best way to reduce your risk is to
have your dentist make you special plastic fluoride trays
that fit over your teeth.
You fill the trays with a
special fluoride gel called Prevident 5000 fluoride gel by Colgate,
not to be confused with Prevident 5000 toothpaste mentioned
earlier. The fluoride gel can be placed in the
tray for 5 minutes, twice a
day.
Whether in a toothpaste,
mouth rinse or home fluoride tray, make sure you spit out the
fluoride after use and don’t eat or drink anything for thirty
minutes after use, so the fluoride has a chance to penetrate your
enamel and root surfaces.
Tip 4: The dry mouth
patient should have their teeth and gums checked and their teeth
cleaned at least every 6 months. In some patients
the teeth should be cleaned every 3 months, depending on the
severity of their dry mouth and plaque buildup.
At this checkup appointment a fluoride varnish can
be painted on the teeth, especially on any exposed roots , to
provide an additional fluoride boost to strengthen the teeth and
make them resistant to decay.
Tip 5: if a denture is
irritating the gums of the dry mouth patient,
the dentist can place a permanent soft reline in
the denture, which is more comfortable on tender gums than
the hard acrylic of a normal denture.
Denture adhesives can be used to help retain dentures that are
not sticking as well to dry gums.
Tip 6: Dental
implants can be of benefit to the dry mouth patient to
help retain loose dentures. Dental implants do not develop
cavities thus have a better chance of lasting in some cases than
the dry mouth patient’s own natural teeth.
A dry mouth patient however must keep their implants
clean with daily brushing. This is because if bacteria or
plaque is allowed to accumulate around an implant, this could
cause gum irritation and eventual bone loss around the implant, and
possible loss of the implant itself.
There have been scientific articles reporting that dental
implants can be placed in patients with Sjogren’s
Syndrome. These patients if you remember can have very
dry mouths due to destruction of their salivary glands, and
therefore can have a difficult time wearing conventional dentures
due to the dryness of their mouths. ‘’ So
patients may benefit greatly if they have implants
placed to support their denture, rather than have the denture get
all its support by sitting on dry fragile gums.
Tip 7: A chlorhexidine mouth wash can be
prescribed by your dentist to help prevent cavities, gum disease or
irritation around implants.. This rinse can be used
twice daily and helps kill bacteria in the mouth. of the dry mouth
patient..
How to keep your mouth
moist:
If your mouth is dry, Sucking on sugarless candies and
chewing sugarless gum can increase saliva production.
You can also take Sips of any beverage that does not
contain sugar throughout the day to keep the mouth
moist. Water is the best. Coffee without sugar or
tea without sugar would be fine as well.
But here is a crucial piece of advice for the dry mouth
patient:
Do not take sips of pop or fruit juice, or any beverage containing
sugar , such as
tea or coffee, to keep your mouth moist throughout the
day.
These drinks are fine with a meal, however, if you drink
even small amounts of sugar containing drinks, including fruit
juice, over long periods throughout during the day you
are bathing your teeth in sugar.
This can Lead can lead to severe tooth decay,. . if you take
frequent sips of pop you are bathing your teeth in acid.
Almost every brand of soft drink on the market contains either
citric acid or phosphoric acid, and this includes diet
pop. Little sips of pop throughout the day will
expose your teeth to acid for long periods of time and can cause
the gradual erosion of the surfaces of your teeth.
What are some Other dry
mouth remedies?
Believe it or not there is a product line on the market called
Artificial Saliva. As opposed to chewing sugarless gum
or sucking sugarless candies to stimulate saliva production,
artificial saliva delivers moisture directly to the mouth.
This product comes in several forms: liquid , sprays,
gels and lozenges.
Artificial saliva often contains calcium and fluoride to
help rebuild and strengthen teeth.
So for example, when your mouth feels dry, you can just give a
spray of a saliva substitute and your mouth is lubricated,
making speaking, chewing and swallowing easier.
Just to give you one example, there is a product called
“Entertainer’s Secret Throat Relief”, which is a
spray. From their website entertainers-secret.com,
they say the following:
“ Entertainer's
Secret Throat Relief is a spray formulated to resemble natural
mucosal secretions and designed to moisturize, humidify, and
lubricate the mucous membranes of the throat and larynx.” It
is marketed especially to actors and singers to prevent there
mouths from getting dry during performances, and I seriously may
just decide to order some myself to keep my voice going during
these podcasts.
You can buy this product off their website or you can ask your
neighbourhood pharmacist for other brands of artificial saliva.
Here are a few more:
Glandosane spray, Moi-Stir spray,
Optimoist spray, Saliva Substitute liquid, Salivart
preservative-free aerosol, Salix tablets, V. A. Oralube sodium-free
liquid, Xero-Lube® Artificial Saliva (Scherer) sodium-free spray,
MouthKote spray
There are two types of Prescription drugs for patients
with dry mouth as a result of either Sjogren’s Syndrome
or radiation treatment for head or neck
cancer, but these two medications will only work if the patient
still has some salivary gland function. These drugs are
Pilocarpine and Cevimeline.
Well, I have delivered quite a bit of information to you.
If I helped even person reading this article cope with this
problem or even save your teeth from a massive cavity attack,
then my time was well
spent.
If you have any questions please send me an email at Dr.Shnall@gmail.com
References:
I would like to
mention that a few reference Articles that I used to prepare this
article. they are:
1. Helping
patients with dry mouth, Cathy L. Bartels, assistant
professor of pharmacy practice, University of
Montana,
2. Treating
High Risk Caries Patients, April 2010 Issue of the Clinicians
Report - Clinical Research Foundation
3. Dry Mouth and Its Effects on the
Oral Health of Elderly
People
Written by Drs.
Michael D. Turner, and Jonathan A. Ship,
Journal of the
American Dental Association, September
2007.
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