A dry mouth, one without adequate saliva, has severe consequences for the teeth and gums. Technically called xerostomia, dry mouth can be caused by several things: damage to the saliva glands (from radiation treatment for head and neck cancer for example), or more commonly, side effects from medication. Saliva contains components of the immune system, enzymes that start to digest food, water for lubrication, minerals that help maintain tooth enamel and proteins that help to neutralize acid from the diet and acid produced by bacteria.
A dry mouth becomes more acidic and this increases the risk of tooth decay tremendously, especially on root surfaces because they decay at a lower acid level than enameled parts of the teeth. Teeth can become very sensitive. The lack of minerals and the high acidity open the “pores” on the root surface. The enamel of the teeth becomes more susceptible to acid erosion which results in an overall loss of tooth enamel on top of that which is lost to decay.
What can be done? The first thing is to try to reduce acidity in the diet. That means, especially, restricting the amount and frequency of fruit and fruit juices. To reduce the acid effect of the bacteria, limit the number of snacks per day and the sugars and simple carbohydrates in those snacks. These are readily used by bacteria to produce acid. Avoid sucking on candies to stimulate saliva, use chewing gum instead. Drink lots of water — without lemon flavouring. This is the only safe beverage to use for sipping. A toothpaste containing fluoride is essential and extra fluoride in the form of a rinse or therapeutic paste may be recommended. Replacing the lubricating effect of saliva is difficult. A number of saliva substitutes are on the market. One of the best, Biotene, is called Oral Balance Lubricating Gel. It assists people in speaking comfortably and prevents irritation under dentures. Replacing the mineral component that sustains the enamel is also a challenge. There are promising products on the market and we are in the process of trying a few of them.
Xerostomia is a challenge for those suffering from it to speak and eat comfortably and a challenge for the dental professionals to help maintain the health of the gums and the teeth. Together, we can partner to help alleviate symptoms and minimize damage to the dentition.
Products currently recommended: Colgate Prevident 5000 Plus toothpaste with 1.1% sodium fluoride, Optirinse 0.05% sodium fluoride mouthwash, Trident chewing gum with xylitol, any candy with xylitol only as sweetener (difficult to get in Canada, more available in the U.S.A). Biotene Oral Balance Lubrication Gel, MI Paste or Xremineralizing paste (only available through dental office at present).