Over the past several months we have noticed an increase in the number of patients complaining of dry mouth and the devastating effects this condition is having on their oral health. Dentists call the condition “xerostomia,” which literally means “dry mouth.” Its causes are many and its consequences can include rampant decay and gum disease.
What Concerns Us
Recently, several patients have come into the office with rampant decay and gum disease. With one of our patients, the decay was so significant that extracting many teeth was our only option. In another, new patient, decay had worked its way down the root surface and under a crown that was only a few years old. In a third patient who wears dentures, sore spots and poorly fitting dentures had become very bothersome. Xerostomia is not new; it is a problem that every dentist understands, but patients may or may not be aware of the devastating effects on oral health. Dentists see it as a problem that is worsening as patients in general are keeping their natural teeth for a much longer period of time and also are living longer. As we will discuss later, age and prescriptions can be the two main culprits for xerostomia.
From the dentist’s perspective, the treatment of dry mouth depends on identifying the most likely cause and understanding that several risk factors may be responsible. Often it is a side effect of medications, and even more frequently, it is a sign of aging. There is not a whole lot we can do about the aging, but prescriptions can sometimes be changed or the dosage altered. Obviously, any decisions regarding your medicines or dosages should only be made by your physician. Your dentist can help treat the decay and gum disease that can occur as a result of xerostomia, educate you about its consequences, and suggest ways of mitigating the effects of dry mouth.
What Saliva Does
Most of us produce upwards of three pints of saliva a day. This volume of “watery” (not thick) saliva helps us in the following ways:
- A large volume of watery saliva helps to wash away food particles and plaque from your teeth (analogous to your garden hose cleaning off your outdoor patio).
- Saliva can act as a buffer and can help to neutralize the acids that are responsible for tooth decay.
- Saliva contains an enzyme, which begins in the digestion of starches and sugars.
- Calcium and other minerals found in saliva can help re-mineralize the tooth and decrease the progression of cavities.
Symptoms of Xerostomia
- Increases in plaque, cavities and/or gum disease
- Saliva that appears thick and stringy
- Sore throat that appears to be dry
- Cracked lips or sores or at the corners of your mouth
- Bad breath
- Difficulty chewing or swallowing
- Food does not taste as good as it used to
Effects of Age and Medicines
As we get older and as we take more and more medicines (both prescription and over-the-counter), our salivary glands begin to secrete less “watery” saliva. When dentists see a sudden onset of the symptoms of dry mouth, our first thought is to investigate which “new” prescriptions you are taking. If we see a gradual onset of symptoms, we are more inclined to suspect that it may be related to the aging process. In reality it is likely from both.
Hundreds of medications, many available over the counter, produce dry mouth as a side effect. These include broad diseases or medicine categories such as:
- Antihistamines (allergies)
- Drugs used to treat anxiety and/or depression
- Parkinson’s Disease medications
- High blood pressure medications
- Drugs used to treat autoimmune diseases
- Sjogren’s syndrome medications
- Diabetes medications
- Alzheimer’s drugs
- Chemical or radiation treatments for cancer (talk to your doctor about how to reduce the risks of xerostomia)
- Alcohol ingestion
- Snoring or chronic mouth breathers
- Sinus problems (unable to breathe effectively out of your nose)
How to Reduce Dental Problems and Symptoms of Xerostomia
- Sucking on sugar-free hard candy or chewing sugar-free gum. If you use regular candy, you can expect it to produce cavities very quickly! It acts like putting napalm on your teeth!
- Quit smoking. Smoking worsens your symptoms!
- Avoid alcohol and alcohol mouth rinses, as the alcohol dries out your mouth.
- To protect your teeth, brush with a fluoride toothpaste and maintain regular dental visits. Your dentist may recommend more frequent cleaning (every 2- 4 months as an example).
- Breathe through your nose, not your mouth. If you can’t, consider making an appointment with your physician to see how they can address this.
- Dentists frequently write a prescription for fluoride rinses or tooth paste that can be used at night before you go to bed.
- Consider using or purchasing an electric/sonic toothbrush. These can make a great difference.
- Sip water frequently. We recommend having water available bedside at night.
- Discuss your problems with your pharmacist. They may be able to help with over-the-counter medications or rinses too numerous to mention. These productions frequently contain xylitol as an ingredient.
- There are a limited number of saliva substitutes that may provide relief for a short period of time.
- Your physician may consider other medications (parasympathetic stimulating agents) but these should be avoided in patients to have heart disease, narrow-angle glaucoma and uncontrolled asthma.
As our society ages, and as the number of people using prescription medications increases, dry mouth (xerostomia) is causing more and more of dental problems. Devastating dental decay is one of the many side effects that can occur over a very short period of time.
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