By F. Neal Pylant, D.M.D., PC
Xerostomia is a condition affecting many patients these days. Defined as “a dry mouth caused by reduced or absent flow of saliva,” this condition is widespread and multi-factorial in causes.
Xerostomia is associated with difficulty in chewing, difficulty in speech, pain and discomfort, halitosis, poor oral hygiene, increased decay, and increased bacterial overgrowth. A disease of long-standing nature can also lead to oral fungal infections (candidiasis) and generalized tooth loss. According to “The Merck Manual of Diagnosis and Therapy,” about 20 percent of elderly people have some form of this disease.
The primary cause for xerostomia at this time is the use of different drugs. Anticholinergic drugs, antihistamines, anti-Parkinson’s drugs, cancer drugs and antidepressants cause dryness. Once the dryness occurs, the mouth can become sore. This condition is referred to as “stomatitis.”
Another cause of dry mouth in younger people is the use of methamphetamine. Meth vapors dry out the tissue, which increases disease activity, decay, tooth loss, etc.
Xerostomia can also be caused from the lack of salivary-gland tissue. This is mainly a side effect of cancer surgical treatment or radiation. The removal of the parotid gland (or any of the glands) due to cancer or tumor can significantly decrease the major salivary flow. Radiation will affect both major and minor salivary glands and decrease the amount of salivary production.
Still another cause for the lack of saliva is Sjögren’s syndrome. Sjögren’s not only affects the mouth, but various glands, the eyes and other soft tissues where there is a lack of moisture present. Normally, saliva keeps the tissues moist and helps with the chewing of food. Saliva makes an oral environment healthier by preventing decay. Saliva buffers the acid that decay-causing bacteria produce and, therefore, keeps your mouth and teeth healthier.
Diagnosis of Sjögren’s can be made by clinical examination. At times, a biopsy of the glandular tissue can be done to see if Sjögren’s or another systemic problem is the culprit behind the xerostomia.
Xerostomia can be diagnosed by your physician or dentist. There are ways to measure the volume of saliva that is produced. You may be suffering from this condition if you feel your “lips are sticking to your teeth,” you wake up with a very dry mouth and your tongue stuck to the roof of your mouth, or your lips stick to your teeth. Women particularly notice this if their lipstick has a tendency to stick to their teeth.
Current treatment methods for xerostomia include oral medications to stimulate salivary flow (i.e., pilocarpine or cevimeline) and sipping sugarless fluids throughout the day, particularly water or saliva substitutes. These can greatly reduce the symptoms of xerostomia. Air humidifiers, especially at night, will help people to not dehydrate.
Oral home care should be exquisite in people with dry mouth. Brushing and flossing regularly and using fluoride gels or rinses, or some of the newer toothpastes with toothlike components can help avoid severe decay. Increasing the frequency of preventative visits from twice a year to three or four times a year is also advised. If decay is found, your dentist may begin in-home fluoride treatments and/or bleaching treatments to help deter the bacteria, as well as decay.
It is necessary to avoid foods before bedtime, particularly sugary foods, and to be sure the teeth are thoroughly cleaned before going to sleep since the saliva glands automatically cut down their flow while we sleep.
If you are concerned about the possibility of having xerostomia, be sure to bring your concerns to the attention of your general dentist or physician. Although treatment of xerostomia can be a bother, it should be very manageable, and you should have many good years of eating and chewing with proper care.