Dry Mouth

Dry mouth is the condition of not having enough saliva to keep your mouth wet. It is know as xerostomia

Saliva is the "workhorse of the mouth"***. Saliva is necessary to help protect the teeth in these important ways:

	Saliva is 98% water and includes antibodies, enzymes and mucoproteins which provide the slimy feeling of saliva.
	There are three sets of saliva glands, each producing different proportions of mucous and serous saliva.
	Saliva constantly flushes the mouth to clear food debris that may act as a food supply for the bacteria in plaque.
	It reduces the pH (acidity) of the waste products produced by plaque which helps to limit tooth decay by these acid attacks.
	Saliva is the source of systemic fluorides and minerals needed for the remineralization of damaged dental enamel.
	It helps digest food
	It prevents infection by controlling bacteria and fungi in the mouth through its antimicrobial action.
	It makes it possible for you to chew and swallow. Amylase in saliva begins the digestion of simple starches. Saliva does not flow evenly through the mouth. There are saliva "highways", such as the tongue side of the lower molars, where the flow is greater and faster. There are saliva "byways" such as the check side of the upper incisors where to flow is less and slower. The result is that plaque will be more cavity causing on the byways than the highways of the mouth.* Saliva covers the teeth and gums with a protein film. Stimulated saliva offers more buffering protection than non-stimulated saliva. This is why chewing sugarless gum can often help prevent caries.* Without enough saliva you can develop tooth day or other infections in your mouth and you would limit your nutritional intake if you could not chew or swallow certain foods. Dry mouth can:

	Cause difficulties in tasting, chewing, swallowing, and speaking
	Increase your chance of developing dental decay and other infections in the mouth
	Be a sign of certain diseases and conditions
	Be caused by certain medications or medical treatments

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Symptoms include:

	A sticky, dry feeling in the mouth
	Trouble chewing, swallowing, tasting, or speaking
	A burning feeling in the mouth
	A dry feeling in the throat
	Cracked lips
	A dry, tough tongue
	Mouth sores
	An infection in the mouth
	Decay, when there is not an adequate supply of saliva, the rate of tooth decay increases rapidly

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Most often, chronic dry mouth is caused by:

	Side effect of drug therapy. More than 400 medicines can cause the salivary glands to make less saliva. Medications used to treat hypertension, anxiety, depression or psychosis cause the most difficulty. Antihistamines, antispasmodics, cancer-chemotherapy drugs, decongestants, and muscle relaxants often cause dry mouth.
	Health conditions such as extensive radiation therapy to the face and neck and undergoing hemodialysis can cause severe dry mouth.
	Many disease effect saliva flow: Sjogren's syndrome*, bacterial and viral infections, poorly controlled diabetes, salivary-gland stones, tumors, Alzheimer's disease, diabetes, anxiety, HIV/AIDS, depression, Bell's palsy, and Parkinson's disease. Alzheimer's and stroke can not feel the wetness in their mouth.
	Chemotherapy drugs that are used to treat cancer can make saliva thicker causing the mouth to feel dry.
	Poorly controlled diabetes may result in a neuropathy to these glands and a subsequent decrease in secretions leading to dry mouth.
	Nerve damage from an injury to the head or neck that tell salivary glands not to make saliva.
	Attachment loss from periodontal disease or who have had root caries are especially vulnerable to the adverse effects of xerostomia.

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Dry mouth is not a normal part of aging. So if you think you have dry mouth, see your dentist or physician.

The average person creates around 1 Liter of saliva a day.

If saliva production is reduced, an individual's oral bacteria levels can increase 10 times over normal levels.

Medications that can cause dry mouth. Most common drugs are: pilocarpine (Salagen®). Starting with 5 mg three times per day. Proventil, Ventolin, Xanax, Elavil, Valium, Claritan, Paxil, Darvon and Zoloft. It is important to consult with your physician to discuss the possibility of altering the dosages of the drugs being prescribed that could be causing the dry mouth. Many physicians are aware of the increased risk of dental disease in patients with dry mouth but fail to take any steps to prevent cavity development. Pilocarpine is safe for most patients but will be ineffective where there is no salivary function. This medication is contraindicated for patients with glaucoma, asthma and certain cardiovascular conditions.**

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Benefits of Treatment:

These treatments contributes prevention of:

	decay
	perio disease
	mouth irritation
	brittle teeth so remember to drink more water

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Understanding the complexity of Sjogren's syndrome

This syndrome is a chronic disease with no known cure or treatment. It has many manifestations in the oral cavity, and dental professionals may be among the first health-care workers to identify symptoms. Sjogren's syndrome, an autoimmune disorder in which the body attacks its own moisture-producing glands, affects more than 1 million Americans. This disease typically affects white women, often near the menopausal age. The cause of Sjogren's syndrome is unknown. Theories have linked it to hormone levels due to menopause; however, viruses and genetics also have been studied.

This syndrome and its symptoms are known to be misdiagnosed with diseases such as diabetes, lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, and multiple sclerosis. It usually takes the health-care provider approximately six years to diagnose this disease from the time of onset. Specialists who treat Sjogren's syndrome are rheumatologists, ophthalmologists, dentists, and other specialists. People who are diagnosed with Sjogren's syndrome experience an array of the following symptoms: - Dry mouth - Dry eyes - Difficulty with chewing, swallowing, or talking - A sore or cracked tongue - Dry or burning throat - Change in the sense of taste or smell - Dental cavities - Fatigue - Low-grade fever - Enlarged parotid glands (located behind the jaw in front of the ears) - Joint pain - Oral yeast infections - Nosebleeds - Bruising - Skin rashes or dry skin - Vaginal dryness - Shortness of breath.

There are actions that can be taken to relieve the annoying symptoms of Sjogren’s.

	a high-fluoride toothpaste like Fluoridex or Colgate’s Provident 5000+ to help reduce decay.
	extreme, uncomfortable dry mouth at night? Try Biotene relief of dry mouth, including an artificial saliva spray that you can keep next to your bed on your night table. If you awaken during the night with dry mouth, give your mouth a couple of quick spritzes of Biotene’s product and go back to sleep.
	Salagen ( Pilocarpine). Taken four times a day, Salagen pills have been shown to provide significantly increased saliva flow and relief of dry mouth. Saliva flow can start to increase as soon as 20 minutes after you take Salagen and the increase can last for 3 to 5 hours. Peak effectiveness is about an hour after you take Salagen. Since it’s difficult to eat when your mouth is very dry, many people time their Salagen dose to be taken an hour before mealtimes. Since Salagen may cause fluctuations in blood pressure or heart rate, you should be closely supervised by an M.D.
	chew gum or sour candy. If your candy or gum contains sugar you can set yourself up for rapidly-spreading tooth decay. Look for sugarless candy with Xylitol. If you chew this gum for five minutes after every meal, studies show that you can reduce the incidence of tooth decay up to 62%.
	Sjogren’s, go to www.sjogrens.org. They put out a monthly newsletter called “The Moisture Seekers.”
	Getting a lot of dry mouth, particularly when it gets cold and air is dry in the house...try Prevident and Biotene to moisten your mouth.

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Cigarette smoke undermines protective properties of saliva

Once exposed to cigarette smoke, our normally healthy saliva not only loses its beneficial qualities but it turns traitor and actually aids in destroying the cells of the mouth and oral cavity. Cigarette smoke is not only damaging on its own, it can turn the body against itself. Cigarette smoke can destroy the antioxidants found in saliva, leaving behind a mixture of compounds that can accelerate the development of oropharyngeal cancer [www.ada.org News Today June 2004]

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Source Dentistry Today April 2001 pg 44.

Next section: Recommendation for what to do for dry mouth

*Sjögren's Syndrome is a major cause of dry mouth. You can get information about dry mouth related to Sjögren's Syndrome from:

Sjögren's Syndrome Clinic
National Institute of Dental and Craniofacial Research

Some of this material came from:

National Oral Health Information Clearinghouse

**Dental News , Safeco 1999

Where are your salivary glands

*** Understanding the Saliva, Fluoride and diet Axis, Dr. Ronald Goldstein, Contemporary Esthetics and Restorative Practice July 2001 pg 8.

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February 06, 2008
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