Few oral health conditions are as underestimated as dry mouth (xerostomia). It is the symptom of a dry mouth, due to a subjective or actual decrease in volume or an alteration in its composition. Dry mouth may be temporary and caused by medications, dehydration or infections (such as mumps). It may also be permanent and is typically due to advanced age, diseases or radiation therapy.
There is a significant difference between having brief, reversible episodes and the ongoing condition of dry mouth. If left untreated, the latter can lead to serious oral conditions.
This is because saliva has an important role in keeping the mouth lubricated, protected and healthy. So when levels decrease the potential for developing oral conditions and diseases significantly rises.
THE FUNCTIONS OF SALIVA
1. WETTING AND LUBRICATING
- Moistens food to make it easier to chew and swallow
- Enhances taste
- Enhances enjoyment of eating food
- Is an antimicrobial, lowering the risk of bacterial and fungal infections.
- Lubricates and protects the skin of the mouth.
- Irrigates the oral cavity preventing fungal and bacterial colonies from adhering to oral tissues and tooth structure .
- With a pH of 6.5, saliva has a buffering capacity, maintaining the mouth’s acidity levels at a healthy range.
- Contains enzymes to initialize food digestion.
4. DENTAL PROTECTION
- Neutralizes acid in food reducing the risk of tooth decay and erosion.
- Contains calcium and phosphates which help re-mineralize teeth, protecting against decay and periodontal disease.
The most common biological reasons for developing a dry mouth include talking, exercising, mouth-breathing, snoring, and increasing age. It often develops as a consequence of cancer treatment if the head and neck are exposed to radiation treatment. Smoking and dehydration also commonly cause dry mouth. As well, medical conditions including infection of the salivary glands or Sjögren’s syndrome often result in xerostomia.
Most cases of xerostomia however, are due to the side effects of medications. In fact, xerostomia is listed as a potential side effect of over 400 commonly prescribed medications and patients taking three or more medications are likely to suffer from xerostomia. 1
The most commonly used medications that have xerostomia as an adverse effect are:
- Medications that treat over-active bladders
- Anti-histamines, such as benadryl
- Blood Pressure medications
- Sleeping pills
The Consequences of Dry Mouth
With the reduced cleansing in the dry mouth, food debris and, bacteria begin to adhere more effectively to teeth and oral soft tissues. As a direct consequence, patients become very susceptible to dental decay. Patients are also susceptible to fungal infections, such as candidiasis.
Other implications include disturbed taste sensation, burning sensations of the skin of the mouth, discomfort in speaking and swallowing, and for patients who wear dentures they have difficulty in managing them and decreased retention of these appliances.
Xerostomia can impact a patient’s quality of life. Since saliva is necessary for digestion, an inadequate amount can make swallowing and speaking difficult, making patients feel self-conscious, embarrassed and anxious. In severe cases, it can even lead to nutritional deficiencies.
Management of Xerostomia
Since the term xerostomia can describe both symptoms as well as the condition of reduced salvia flow, therapies for dry mouth are designed to improve one or all of the following areas:
- Alleviating the sensation of dry mouth;
- Replacing or supplementing the missing saliva in the form of artificial saliva; and
- Supplementing some of the natural salivary enzymes.
Management of xerostomia in general practice may include treating the following:
A. Infection– Treat the patient’s dental and mucosal infections with antifungals, antibiotics and prescription mouth-rinses. Dentists and hygienists should provide oral hygiene instruction. Decay and periodontal disease must be treated immediately with a more frequent periodontal maintenance schedule and an active preventive dental care regimen.
B. Symptoms – Provide recommendations to reduce the symptoms of dry mouth. These include: moisten foods during meals, drink water more frequently, reduce alcohol consumption, quit smoking, and eliminate caffeine from the diet.
Simple, practical measures can also help. These include: drinking frequent sips of water, sucking ice-chips and chewing sugar free gum to stimulate saliva flow. However, patients should also be advised that sipping water might not be enough to manage xerostomia. This is because water wets surfaces rather than lubricating them, therefore symptom relief may be transient.
C. Medications – If a medication is causing xerostomia as a side effect, dental practitioners can advise patients to consult their physicians about reducing the dosage or eliminating the xerostomic medication in order to relieve their symptoms. Alternatively, a prescription for a sialogogue, such as pilocarpine, may help stimulate the production of saliva if the salivary glands are functional and not damaged by disease.
D. Saliva substitutes and stimulants – These are designed to moisturize and lubricate the mouth, and increase salivary production. They are usually in the form of sugar-free gum, tablets, gels, mouthwashes, or toothpastes. They may contain sorbitol, xylitol, enzymes (e.g. lysozyme and glucose oxidase) and fluoride.
OTHER TIPS FOR EASING DRY MOUTH SYMPTOMS
- Ensure adequate hydration by frequently sipping water
- Avoid things that dry the mouth such as hard or crunchy food like crackers
- Practice optimal oral homecare (plaque control)
- Use a cool air humidifier (clean daily)
- Chew sugar free gum to stimulate saliva flow
- A six-month recall examination is the standard for the healthy individual. For patients who are at a higher risk of developing oral conditions and diseases, a three-month preventative care and periodontal maintenance program is ideal