Clues in the dryness XEROSTOMIA

by Debra Seidel-Bittke, RDH, BS

The word xerostomia reflects its Greek origins from “xeros” (dry) + “stoma” (mouth). Everyone has a dry mouth once in a while when nervous, upset, or under stress. But if someone has a dry mouth all or most of the time, it can be uncomfortable and can lead to serious health problems.

Why do we need saliva and what does it protect us from?

Saliva helps us to digest our food. It helps protect the teeth from decay, and it prevents infection by controlling against an overabundance of bacteria and fungi in the mouth. If you don’t have enough saliva to chew your food, you may not get the proper nutrition you need, which, in turn, can contribute to other health concerns.

Saliva contains a clear, somewhat alkaline secretion from three major salivary glands of the mouth: the parotid, submaxillary, and sublingual. Saliva consists primarily of water, but it also contains enzymes and other proteins, small organic molecules, electrolytes, and constituents of nonsalivary origin.

Dry mouth can cause difficulties in tasting, chewing, swallowing, and speaking. If it goes untreated, severe dry mouth can also lead to increased levels of tooth decay and infections of the mouth such as thrush.

What causes dry mouth?

Severe dry mouth is not a normal part of aging. People get dry mouth when the glands that make saliva are not working properly. When these glands do not work properly, there may not be enough saliva to keep the mouth wet.

Symptoms of a dry mouth can be a clue to serious systemic diseases such as diabetes mellitus, Sjögren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, scleroderma, sarcoidosis, amyloidosis, and hypothyroidism. Below is a list of various reasons xerostomia can exist:

• Side effects of some medicines. More than 400 medicines can cause the salivary glands to make less saliva. Medicines for high blood pressure and depression often cause dry mouth.

• Disease. Some diseases affect the salivary glands. Sjögren’s syndrome, HIV/AIDS, diabetes, and Parkinson’s disease can all cause dry mouth.

• Radiation therapy. The salivary glands can be damaged if they are exposed to radiation during cancer treatment.

• Chemotherapy. Drugs used to treat cancer can make saliva thicker, causing the mouth to feel dry.

• Nerve damage. Injury to the head or neck can damage the nerves that tell salivary glands to make saliva.

Clinical signs and symptoms of xerostomia

The following signs and complications can be mild to severe:

• Difficulty wearing dentures

• Candidiasis: especially on the tongue and palate

• Increase in prevalence of dental caries, located at the sites generally not susceptible to decay

• Thicker, more stringy, whole saliva

• Difficulty with milking saliva from the ducts of salivary glands

• Loss of moist, glistening of the oral mucosa

• Dryness of oral mucous membranes

• Thin, pale oral mucosa

• Fissuring and lobulation, dorsum of the tongue

• Angular cheilitis/cheilosis

• Gingivitis

• Cracked, bleeding tissues

Nonoral symptoms of xerostomia

• Dry throat

• Dry nose

• Changes in sense of smell

• Heartburn

• Dry or burning eyes

• Constipation

• Dry skin/scalp

• Vaginal itching, dryness, history of fungal infections

• Breathes through the mouth

What can be done about dry mouth?

Dry mouth treatment will depend on what is causing the problem. As health-care professionals, we review medical histories on a regular basis each time we seat patients in the dental chair. Becoming aware of the diseases and medications that can cause dry mouth can be helpful in suggesting to our patients ways to prevent this disease condition and future root caries, which is seen frequently when patients experience xerostomia.

Click here to XEROSTOMIA table.

Recommendations for dry-mouth patients

• Sip water or sugarless drinks often.

• Avoid drinks with caffeine, such as coffee, tea, and some sodas. Caffeine can dry out the mouth.

• Sip water or a sugarless drink during meals. This will make chewing and swallowing easier. It may also improve the taste of food.

• Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow; citrus-, cinnamon-, or mint-flavored candies are good choices.

• Don’t use tobacco or alcohol; they dry out the mouth.

• Be aware that spicy or salty foods may cause pain in a dry mouth.

• Use a humidifier at night.

• Moisten the mouth each night prior to bedtime with Oral Balance™ (Biotene®).

Tips for oral hygiene care

• Gently brush teeth at least twice a day.

• Floss teeth every day.

• Use toothpaste with fluoride in it. Most toothpastes sold at grocery and drug stores contain fluoride.

• Avoid sticky, sugary foods. If you do eat them, brush immediately afterwards.

• Visit the dentist for a checkup at least twice a year. See the dental hygienist at frequent intervals depending upon a professional diagnosis.

• Apply a 1.1 percent sodium fluoride to teeth prior to bedtime.

• After applying the sodium fluoride, brush on or spray Oral Balance to prevent dry mouth at night.

Dry-mouth treatments that work

Biotene’s Oral Balance contains a lactoperoxidase enzyme system. When the amount of saliva is disrupted, the important antibacterial defense system is lost. Biotene is the only patented salivary enzyme product that is capable of protecting the mouth the same way our saliva does.

These lactoperoxidase enzymes work by employing the three enzymes and one protein that are able to replace the same enzymes naturally found in human saliva. Glucose oxidase and lactoperoxidase are two enzymes that work together as a system to generate a constant flow of hypothiocyanite, providing strong antibacterial and healing properties. The Biotene products contain lysozyme, an enzyme that splits the cell wall of pathogenic bacteria. Also included in the products is lactoferrin, an iron-binding protein that inhibits pathogenic bacteria by depriving the oral cavity of iron. The combination of these natural ingredients creates a salivary enzyme system that helps maintain a healthy balance of oral flora, reducing harmful bacteria while sustaining beneficial bacteria.

Research indicates that the use of xylitol can help generate the flow of saliva. Xylitol is very expensive to manufacture, so it can be difficult to find. One gum that contains xylitol is Carefree Coolerz®. Other dental products containing xylitol can be purchased through a company called Oxyfresh.

It is important that we make assessments at each dental appointment for each patient. Those of us who read dental journals and attend various continuing education courses can be a wealth of knowledge for our patients. We are able to educate patients with the latest evidence-based knowledge. When patients receive education from us, the health-care professionals, we can give them the knowledge to prevent disease.

Knowledge = Power. Therefore, Knowledge + Power = The Power To Prevent Disease!

Debra Seidel-Bittke is founder of Dental Practice Solutions, an evolutionary speaking and dental consulting business specializing in a team approach to prevention and nonsurgical treatment of periodontal disease. She may be reached for speaking, questions, or comments at (866) 206-6364 or [email protected]. Visit her Web site at www.dentalpracticesolutions.com.