Normal saliva formation in the mouth is vital to good oral health, keeping the mouth moist and clean. Reduced saliva flow in the mouth causes a common problem called xerostomia. Dry mouth can lead to tooth decay, gum infection, fungal growth, mucosal inflammation and bad breath. Many medications, certain diseases, stress, dehydration, and radiation therapy for head and neck cancer cause reduced salivary gland function leading to the dry mouth problems.
The importance of saliva
Saliva coats and lubricates tissues in the mouth. Saliva helps cleanse the mouth and begins the digestive process with chewing. A healthy mouth produces about three pints of saliva every day to begin the digestive process on the food that is eaten, to prevent fungal [candidiasis] growth, and to help prevent harmful bacterial growth, which can cause decay and gum disease. Saliva constantly bathes your teeth and washes away the sugars and food particles to help prevent tooth decay and gingivitis. Saliva also helps to replace minerals in the tooth enamel to strengthen the enamel against cavities.
Note: salivary flow stops during sleep otherwise, we would awake up in a pile of drool on our pillow, so it is particular important to brush and floss before bedtime to prevent decay. And sipping and swishing a little water during the night if awaken can help moisten and clean the mouth as well.
The term xerostomia (zero-sto-me-uh) comes from the Greek words “xeros” meaning dry and “stoma” meaning mouth. Dryness of the mouth results from an inadequate flow of saliva. Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection. Severe dry mouth can promote the growth of harmful organisms. Without the cleansing and shielding effects of adequate salivary flow, caries (tooth decay) and periodontal (gum) disease become much more common. Constant dryness and the lack of protection provided by saliva contribute to bad breath. Dry mouth also causes dentures to become less comfortable because there is no thin film of saliva to help them adhere properly to oral tissues.
It is a common misconception that xerostomia is an "old folks" disease. Dry mouth can occur at any age. It is true that many older adults have xerostomia, but it is not a normal part of the aging process, but rather related to certain diseases and certain medications. Dry mouth is found in anxiety disorders, diabetes, diet deficiencies, stroke, Parkinson's disease, Alzheimer's disease, Sjogren’s disease, HIV-disease, Hepatitis C infection and as a result of radiation therapy. Occurrence of dry mouth is also caused by stress, when an individual is excessively nervous or upset.
Xerostomia can also occur from dehydration, when not consuming enough water. Dehydration is a common problem with individuals who suffer from incontinence and drink too little water to try and manage the problem. Excessive use of caffeine or alcohol, which both act as diuretics, causes a net loss of fluid and can lead to dry mouth.
Mouth breathing can cause dehydration and dry mouth problems. It is best to breathe through one’s nose. Mouth breathing can lead to various health issues, including respiratory infections, snoring, bad breath and obstructive sleep apnea. A healthy adult normally breathes through the nose while resting or doing light exercise. Excessive mouth breathing can lead to tooth decay and gum disease..
Chronic mouth breathing is unhealthy, leading to hypertension (high blood pressure), increased heart rate, chronic snoring and obstructive sleep apnea.
The most common cause of xerostomia is medication use, both prescribed and over-the-counter. Those wonderful meds that are taken to ease allergies (systemic antihistamines), to relieve pain (NSAIDS, anti-inflammatory meds), to reduce obesity, to thin the blood (daily aspirin), or to lower blood pressure (antihypertensives and diuretics) are just a few of the many medications taken that cause dry mouth. Xerostomia is a side effect of over 400 known medications!
Symptoms of Xerostomia
Perhaps you are having trouble chewing, tasting and swallowing or difficulty speaking, a hoarse voice. You might have sores in your mouth, or a rough fissured tongue. Perhaps your denture is difficult to wear, or your mouth feels sticky from thick, stringy saliva. Your tissues could be dry to touch. You may have many recurring cavities, especially along the gumline with heavy accumulations of plaque and tartar. Halitosis (bad breath) is constant and strong.
What can be done?
There are numerous saliva substitutes on the market that can be prescribed, but artificial saliva is not a perfect substitute for natural saliva, which is complex physically and chemically. Most patients prefer sipping water to using a saliva substitute, since artificial saliva’s benefits are short lived. Not only is water sipping the most cost-effective means of improving oral moisture in the short-term, it has the added advantage of contributing to improved hydration.
The good news is that there are several easy things that can be done at home to improve a dry mouth, including:
* Sip water continually during the day. (Having a water bottle with a straw-type top is ideal).
* Avoid sugared drinks and eating sweets.
* Suck on ice chips.
* Chew sugar-free gum (Gum sweetened with xylitol has been shown to reduce cavities).
* Suck on sugar-free candy.
* Eat foods with a high liquid content.
* Avoid alcoholic beverages and drinks that contain caffeine.
* Avoid dental mouth rinses that contain alcohol.
* Use a mist humidifier while you sleep.
* Don't smoke or chew tobacco.
* Brush 2–4 times a day and floss once or twice each day.
*Use a fluoride rinse daily to prevent decay.
*Use fluoridated toothpaste that is free of sodium lauryl sulfate (a detergent used as a foaming agent in most commercial toothpastes).
*Use a prescription-strength topical fluoride (which may be delivered in custom fluoride trays or in a brush-on preparation).
Dry mouth is a common problem, but with early and ongoing treatment, serious dental and oral disease can be prevented. I have had many patients with severe xerostomia who have stayed in excellent oral health by using the above tips, particularly regular water sipping and good oral hygiene habits. The most important thing you can do for yourself is to get regular dental checkups and cleanings. The earlier dental problems are identified and intervened, the better for you, your overall health and your happiness.
ENJOY LIFE AND KEEP SMILING!
George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com