marny's notes

Marny's Notes

Xerostomia - What is It?

Xerostomia, also known as Dry Mouth is the condition of reduced saliva flow or changes in saliva condition. Xerostomia affects 3 out of 10 American adults.

What causes Dry Mouth?

The elderly population is at greatest risk for Xerostomia due to the following causes:

medications - including; ` antidepressives
antihypertensives
diuretics
antihistamines
Radiation Therapy - near the salivary glands in the head
Sjogren's Syndrome - an autoimmune disorder of salivary lands resulting in the destruction of the salivary glands
but other individuals also suffer from Dry Mouth such as those with:
- Diabetes
- Vitamin Deficiencies
- Stress and Depression

Why is saliva so important?

Saliva has a cleansing action which keeps food from sticking to the teeth and washing it away. It has antimicrobials such as enzymes and antibodies which fight bacteria and infections. It acts as a buffer against the bacterial acid attacks on the tooth enamel, keeping your mouth's pH above 5.5. Because saliva contains calcium and other minerals, it helps remineralize tooth structure throughout the day. And finally, saliva contains a blood coagulation factor that speeds wound healing in the mouth. It is surprising how important saliva is to oral health.

What are some of the problems associated with Dry Mouth?

Difficulty with swallowing, eating and speaking.
Increase in plaque levels - The saliva usually washes away the bacteria and plaque by diluting and rinsing it off the teeth. With reduced saliva you may notice thicker levels of that white sticky plaque on your teeth. This plaque is really billions of bacteria.
Increase in dental cavities - This is because the saliva clears the mouth of the acid that plaque (bacteria) makes. This acid eats holes into the enamel of the tooth allowing the bacteria in to cause cavities. This is especially true for cervical and root cavities if some of the tooth's root is showing.
Increase in oral infections - Reduced salivary flow means low amount of antibodies in the mouth, which allows for an increase in microbes in the mouth.
Oral Candidiasis is the most common infection. Its' most common symptoms are burning and soreness.

What are some treatments for Dry Mouth Symptoms?

Change medication - talk with your doctor and see if you can change your medication or dosage. Everyone responds uniquely to each individual drug.
Artificial Saliva - Oral Balance gel (Laclede) is very effective. Put a small pea sized amount on the tongue and use the tongue to push it around the mouth until the mouth is coated. This can also be used under dentures. Colgate also makes a saliva substitute in a small tube for carrying in your pocket or purse. These lubricants need to be replaced every 15 mins. to an hour, but users report much needed relief from their use.
Sialogues - stimulate saliva flow. Sugar Free lemon drops or cherry drops are very effective. Also, chewing sugar free gum will stimulate saliva flow.
Pilocarpine - is a prescription drug that increases saliva as well as other secretions such as sweat, tears, urine.
Topical Fluoride treatments - are essential to prevent cavities.
These can be topical Fluoride gels or foams applied in the dental office as well as daily Fluoride rinses (such as ACT or Fluroguard) or daily high Fluoride toothpaste (such as Prevident) which is not rinsed off.
Prescription antimicrobial mouth rinse (Peridex, Perisol etc.) can be effective against candidiasis. Be careful with this Chlorhexidene rinse as it has a high percentage of alcohol which can be even more drying to xerostomia patients.
Toothpaste that does not have Bio Laurel Sulfate in its ingredients. Bio Laurel Sulfate bothers some people with Dry Mouth. Some Bio Laurel Sulfate free toothpastes are Biotene, Rembrandt and Toms of Maine.
Limit sucrose in your diet to during your regular meals and then brush after each meal. Sugar feeds the bacteria in your mouth and results in high acidity that can cause cavities. Eat healthy snacks such as fruit, vegetables, nuts or cheese, rather than sugar snacks in between meals.
Vigilant home care such as brushing after every meal with a fluoride toothpaste is essential to oral health. Using an electric toothbrush such as Sonicare or Oral B have been proven to be very effective in keeping the plaque levels down.

If you suffer from Dry Mouth, it is critical that you consult with your dentist. Your symptoms can be alleviated and the future of your oral health can be preserved with your vigilance and the assistance of your health care provider.

Thanks to: Denis Lynch, DDS, PhD CDA 2000 Fall Scientific Session
Trudy Treschler, RDH, UCSF Spring 1998