Dry mouth

Dry mouth is one of the most common issues that my patients have, most of whom are not aware of it, or they are but, don’t understand the implication of it on their oral health, and how to deal. From my experience the condition affects all ages. Young patients exhibit dry mouth mostly due to allergies and airway problems. Older patients have an added reasons for dry mouth, which quite often is a side effect of a lot of medications, and some medical conditions. I would like to share with you some important information from the American Academy of Oral Medicine about dry mouth.

The medical term for dry mouth is ‘Xerostomia’ (zeer-oh-stomia), a term derived from the Greek words xeros, meaning “dry” and stoma, meaning “mouth. It’s most often caused by a decrease in the amount of saliva or a change in the quality of saliva. The exact number of people affected by dry mouth is unknown but it appears to be a common condition. Estimates range from 1% to 65%, depending on the types of patient populations studied.

Saliva is an essential body fluid that contributes to the protection and preservation of the oral cavity and plays a major role in maintaining oral health and comfort. It is produced by the three pairs of major salivary glands and hundreds of minor salivary glands. Its value is seldom appreciated until there is not enough. Saliva is necessary to moisten the mouth, to lubricate food for easier swallowing, to protect oral hard and soft tissues, to modulate oral microbial populations, to provide initial digestive enzymes and to promote soft tissue repair and oral cleansing. Cleary, the lack of adequate saliva can lead to numerous clinical conditions affecting one’s oral and systemic health, comfort and quality of life. As a result, detecting the early signs of dry mouth is critical.

Role of Saliva:

• Protect, lubricate and cleanse the oral mucosa
• Aid chewing, swallowing and talking
• Protect the teeth against decay
• Protect the mouth, teeth, and throat from infection by bacteria, yeasts, and viruses
• Support and facilitate our sense of taste

Warning Signs and Symptoms of Dry Mouth

The dentist and dental hygienist are trained to detect dry mouth and can often identify its presence long before the patient becomes aware of its existence. One of the more common signs of a dry mouth is insufficient pooling of saliva under or around the tongue, a phenomenon easily noted by your dentist or hygienist. Other clues to the presence of a dry mouth are cavities affecting the necks of the teeth near the gum line9see below) or chewing edges of the teeth and a red parched or fissured tongue (see bellow). Common patient complaints or symptoms of dry mouth include difficulty swallowing food (especially dry food) without liquids, changes in the sense of taste, a burning sensation or pain in the mouth, and difficulty talking.

Causes of Dry Mouth

Dry mouth is typically caused by a multitude of factors including: medication side effects, various disease states, head & neck irradiation, dehydration, surgery, smoking, and mouth breathing.

Diseases Associated with Dry Mouth

• Allergies and airway problems
• Sjögren’s syndrome
• HIV / AIDS
• Diabetes
• Hypertension
• Hepatitis C
• Lymphoma

Diagnosing Dry Mouth

The diagnosis of dry mouth is usually made after your dentist or physician carefully assesses your medical history and the clinical findings. Your doctor will want to determine if your dry mouth is caused by a change in salivary function, its severity, and its cause. In some cases, they may need to order more specialized tests to assess your particular situation.

General Treatment Strategies

See your dentist regularly: Due to your increased risk for oral disease, your dentist may recommend you undergo more frequent check-ups, professional cleanings and in-office fluoride applications. It is important to have any necessary dental work done as soon as possible, since oral conditions such as caries, periodontal disease, and yeast infections may progress more rapidly in the patient with a dry mouth.

Perform oral hygiene as instructed: Your dentist or dental hygienist will reinforce the importance of regular brushing and flossing and may offer additional instructions regarding your daily oral hygiene. He or she may also recommend a prescription strength fluoride to be used in addition to your regular toothpaste. Your ability to consistently accomplish these daily oral hygiene measures, as instructed by your dentist, is one of the most important steps in successfully managing the complications of oral dryness.

Monitor your mouth for oral candidiasis (thrush): Patients with a dry mouth are at risk for oral candiasis, particularly the erythematous form.If you suspect you may have oral candidiasis, you should promptly see your dentist for an evaluation and management. Avoid sugary food and drinks: Decrease your fermentable carbohydrate intake, especially for sticky foods such as cookies, bread, potato chips, gums, candies. Avoid the frequent intake of acidic beverages (such as most carbonated and sports replenishment drinks) and lemon products.

Frequently sip fluids: Frequent sips of small amounts of fluids, especially water, can be quite helpful in diminishing the effects of oral dryness. Many patients keep a bottle of water handy to moisturize their tissues. However, excessive sipping of water can actually reduce the oral mucus film lining the mouth and worsen your symptoms. Letting chips of ice dissolve in the mouth may also be useful.

Use fluids while eating: Taking fluids while eating is an essential common sense strategy for dry mouth patients. A useful approach is to take a drink of water or beverage to hydrate the mouth, take a bite of food, and then wash it down with another sip.

Avoid caffeine: Caffeine is as a mild diuretic which promotes fluid loss and may worsen dry mouth. If possible, one should avoid or limit items which contain significant amounts of caffeine such as coffee, tea, and certain soft drinks.

Protect dry lips: Dry cracked lips contribute to the annoyance of oral dryness. The regular use of topically applied oil-based balms or lipsticks may provide soothing relief. The use of vitamin E-containing balm may also be helpful. These products should be replenished on regular basis to ensure their effectiveness.

Use a humidifier: The dry ambient air of most modern homes contributes to one’s sensation of dryness. The use of a humidifier, particularly at night, helps address this concern.

Use sugar-free salivary stimulants: To the extent that functional salivary tissue remains, the regular use of gums, mints, and candies can help stimulate salivary flow. Mints, lozenges, and candies should be allowed to dissolve slowly in the mouth. Dry mouth patients with natural teeth should avoid agents that contain sugar, due to their increased caries risk, and are encouraged to use products containing xylitol.