By Dr. Jeff Shnall
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:- Does your mouth usually feel dry?
- When you are eating a meal do you have difficulty swallowing dry foods?
- Do you have to drink liquids in order to help swallow food?
- 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 MouthDry 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. 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:- Dry eyes requiring the application of eye drops or artificial tears at least 3 times a day,
- A dry mouth requiring frequent drinks or the need to constantly suck candy or chew gum to keep the mouth moist
- 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:
Let me mention I do not receive payment from any of the companies or products that I am about to mention.
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 Sonicare are the two brands of electric toothbrushes you may want to consider.
Flossing
Flossing thoroughly once a day will help prevent cavities from forming in between the teeth, especially under the gum line.
Fluoride
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 most 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.
Regular check ups & cleanings
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.
Reline Dentures
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.
Implants to help retain loose dentures
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.
Medicated mouth rinse
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. Note: Do not use coffee or tea to keep your mouth moist as they can be too acidic to the teeth and can cause erosion of the surface of the tooth, wearing it down or dissolving the tooth surface.
As well do not take sips of pop or fruit juice, or any beverage containing sugar including milk (which contains the sugar lactose) to keep your mouth moist throughout the day, for if you do you will be bathing your teeth in sugar.
This can lead can lead to severe tooth decay. As well 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.