Dry Mouth/Xerostomia

What is xerostomia?

Dry mouth (xerostomia) is sometimes referred to as hyposalivation (hypo = less, salivation = secretion of saliva). If left untreated, rampant dental caries will start as soon as three months after the onset of xerostomia.
Factors that will influence or cause xerostomia

Biological ageing

With ageing, the probability of experiencing dental problems increases. The factors related to ageing, such as the consequence of diseases that the elderly are more likely to have, or the consequence of medications taken for these diseases are what can cause Xerostomia.
Certain diseases and conditions

• Rheumatoid conditions, e.g. Sjogren's Syndrome
  
• Dysfunction of the immune system, e.g. HIV/AIDS
  
• Hormonal disorders, e.g. Diabetes Mellitus
  
• Neurological disorders, e.g. Parkinson's disease
  
• Prolonged illnesses, e.g. Lupus, Multiple Sclerosis
  
• Anaemia
  
• Stress
  

Removal or tumours of the salivary glands

Conditions that necessitate the surgical removal of salivary glands will cause immediate xerostomia.
Tumours of the salivary glands might reduce the flow of saliva or block it altogether.

Functional problems

Persons with a decreased chewing ability will tend to eat softer and liquified foods. This tends to decrease the flow of saliva, since the need for saliva is less.

Radiation therapy

Head, neck and oral cancers are often treated with radiation, resulting in post-irradiation xerostomia, due to permanent damage to the salivary glands from the radiation.

Drugs or medications

This is the most common cause of diminished flow and is also most common in people older than 65. There are more than 400 drugs that have xerostomia as a side effect. Here is a list of the most common ones:

• Amphetamines
  
• Antianxiety drugs
  
• Antidepressants (tricyclics)
  
• Anticholinergics (atropine)
  
• Anticonvulsants
  
• Antihistamines
  
• Antihypertensives
  
• Antiparkinsonians
  
• Antipsychotics
  
• Antispasmodics
  
• Appetite suppressants
  
• Barbiturates
  
• Bronchodilators
  
• Decongestants
  
• Diuretics
  
• Hypnotics
  
• Muscle relaxants
  
• Opioid (narcotic) analgesics

Anorexia Nervosa and Bulimia Nervosa
Frequent vomiting and the use of laxatives can reduce the flow of unstimulated saliva (the saliva secreted without eating). The use of psychoactive medicines, especially antidepressants that are often prescribed for eating disorders, can contribute to dry mouth.

Menopause
Women who are going through menopause will occasionally experience a problem with gums that become dry and shiny, and that bleed easily (menopausal gingivostomatitis). Mouth dryness and a burning sensation in the mouth are common complaints.

Signs and Symptoms
The following are common signs and symptoms of xerostomia:

• Difficulty talking
  
• Halitosis (foul odour of the mouth)
  
• Frequent thirst
  
• Burning sensation of the tongue
  
• Difficulty in eating, especially dry foods
  
• Difficulty in wearing dentures, since the retention of dentures is dependent on saliva for adhesion
  
• Dry, cracked lips and corners of the mouth
  
• Impaired taste

What are the consequences of xerostomia?
Since saliva is the body's built-in cleansing mechanism and first line of defence against plaque, a reduction or lack of saliva will have definite effects on the oral environment as follows:

• Plaque accumulation
  
• Food accumulation
  
• Increased risk of dental caries, especially on the roots of teeth
  
• Difficulty in eating, swallowing and talking
  

What to do when you have xerostomia
The type of treatment will depend on the severity of the xerostomia. What works for one person might not work for another, and what works today might not work tomorrow. You should try various methods to alleviate dry mouth, and keep on using the most successful methods. Various methods are listed as follows:

• Medication: Xerostom is a product specifically developed for people with Dry Mouth or Burning Mouth Syndrome
  
• The following is available in the Xerostom range:
  - Xerostom Saliva Substitute
  - Xerostom Toothpaste
  - Xerostom Mouthwash
  - Xerostom Spray
  
• Frequently sip water, and keep water at your bedside during the night
  
• Sugarfree chewing-gum is a simple and effective method of increasing salivation, although it is only effective while you are chewing the gum. The use of xylitol (a sweetener that does not ferment) has been found to combat caries in people suffering from xerostomia.
  
• Use fluoride as often as possible to combat caries. The fluoride in toothpaste is a very low concentrate, and will be ineffective. Use a fluoride rinse such as 0.05% Sodium Fluoride (NaF) solution (an over-the-counter product) daily, or fluoride gels or varnishes which are routinely applied professionally
  
• Dietary adjustments include avoiding tobacco and smoking, alcoholic beverages, and foods high in sugar
  
• A thorough oral hygiene regime is very important. Heavy plaque accumulations will occur with dry mouth and this will lead to dental caries
  Dry mouth (xerostomia) can result in oral discomfort and can have serious consequences. If you feel you have this symptom, please see your dentist!
  

Teeth grinding - a sign of stress

It is estimated that about a third of the adult population suffers from clenching or grinding their teeth.
Even children as young as two years have been shown to grind their teeth during sleep.
How do I know if I am a bruxer?

Bruxing has been associated with:

• frequent headaches
  
• sore joints of the jaw
  
• sore and stiff jaw muscles
  
• a tired feeling in the jaws in the morning and locking of the jaws
  
• pain in the neck, throat, shoulders and face

Bruxing also results in various dental problems. These include:

• excessive wear of the teeth resulting in aesthetically unacceptable shortening of the length of the teeth
  
• sharp edges
  
• wearing down of the enamel on top of the teeth
  
• fractured teeth, fillings or crowns

Diet and healthy teeth

Mouth logistics

To understand what causes tooth decay, you need to keep in mind that we all have the following in our mouths:

• Teeth that is vulnerable to attack by acids.
  
• Saliva that circulates in the mouth and is capable of rinsing acid from the teeth.
  
• Microorganisms that ferment carbohydrates to form acids.
  The other important factor is time - how long and how often the teeth are exposed to acid will determine if decay can take place or not.

Factors that cause tooth decay

• Poor oral hygiene
  
• Lack of fluoride
  
• Long and frequent contact times (food & drink)
  
• Acid food and drinks

It is clear that tooth decay is not just caused by eating sugar, but by a complex set of factors that interact to cause damage to the teeth. The question is: “How can you prevent tooth decay in your children?”

How to prevent tooth decay

a) Baby bottle tooth decay
Do not allow your baby to suck on a bottle filled with milk or fruit juices or sweetened tea for long periods, especially at night. The practice of allowing your baby or toddler to use his bottle as a dummy allows the content to be in contact with the teeth for long periods of time and can promote decay. This is especially true at night when the production of saliva is less than during the day. Decay will set in rapidly!

b) On demand breastfeeding
Breastfeeding is one of the very best things you can do to ensure the health of your child, but it is not a good idea to let your baby sleep in bed with you and let her suck whenever she wants to. This creates a similar situation to baby bottle tooth decay.

c) Sticky food
Children should be taught to rinse their teeth with water after eating meals (especially after eating bread, fruit and candy) and to use dental floss to remove particles of food that get stuck between their teeth.

d) Acid food and drinks
Children and teenagers will also inevitably eat acid food and drink acid beverages, such as fruit, fruit juices and cola drinks. Teach them to rinse out their mouths if possible and ensure that their teeth are protected by fluoride (see below).

e) Fluoride
If you are lucky enough to live in an area where the water supply has a high fluoride content it is to your children's advantage because their teeth will be resistant to acid attack. However, many areas of South Africa have practically no fluoride in their water.
Children need to brush their teeth with fluoride toothpaste twice a day. In areas where there is no fluoride in the water supply, you can also consider giving your child a fluoride supplement (Zymafluor), but discuss this with your dentist, because overdosing on fluoride can leave brown marks on your child’s permanent teeth.
Fluoride mouthwashes are also an option to coat the teeth with a protective layer.

f) Oral hygiene
Brushing twice a day and flossing MUST be taught from an early age!

Oral health and pregnancy

During the gestation period enormous changes take place in the mother’s body, which involve the mouth and teeth – often overlooked by mothers and doctors during pregnancy.
The main oral health issues associated with pregnancy are:

Hormonal changes

Gums (gingivae) become inflamed at times of hormonal change. The terms puberty and pregnancy gingivitis are often heard but seldom understood. The inflammation causes swelling in the gums which makes cleaning the teeth and flossing more difficult.

Gingivitis may occur more frequently during the second trimester of pregnancy. This is due to a rise in the oestrogen levels, which increase the blood flow to the body tissues. It is not unusual for the gums to bleed when inflamed. It is imperative to realise that the bleeding is a sign that extra care must be taken when cleaning, and not, as so many mothers-to-be think, that the brush is hurting the gums and that brushing should be discontinued.
Also breastfeeding mothers should continue to monitor their oral hygiene, as hormonal fluctuations occur during lactation.

Diet

Primary tooth development has already started by the third month of pregnancy, and permanent teeth begin to form several months before birth. Vitamin A helps to develop the tooth enamel and Vitamin C is important in the formation of the inner tooth structure. Vitamin D aids in the absorption of calcium and phosphorus.
For optimum development of teeth (and bones) it is necessary that sufficient sources of Calcium are available in the diet, and that the body has the ability to absorb the calcium into the bloodstream.

Oral hygiene and dental treatment during pregnancy

As mentioned earlier, brushing is essential during pregnancy, but flossing is also important and in certain cases where plaque retention is a problem, your dentist or hygienist will be able to recommend special cleaning aids, to assist you in removing the harmful plaque.
It is advisable to visit your dentist as soon as possible after confirming your pregnancy in order that a more comprehensive list of do’s and don’ts can be provided.

Ideally, a dentist would prefer not to carry out extensive treatment during pregnancy, but in situations where treatment is essential, the next best option is to treat during the second trimester when foetal development is completed and the mother is not yet having to contend with a large abdominal distention.
Treatment during this period is very safe provided that all medicaments are “pregnancy” friendly. Radiographs during pregnancy are very safe these days but nonetheless lead protection should be used particularly over the baby in the first trimester.

Diabetes and oral health

Oral health is very important to a diabetic? If a bacterial infection is left untreated, it can lead to tooth loss. It will also cause elevated blood sugar levels. The infection of the bone and gums will be difficult to control. Diabetics, especially uncontrolled, may experience:

• delayed wound healing;
  
• decreased or diminished flow of saliva (Xerostomia);
  
• increased sugars in the saliva, which will increase the risk for dental caries.
  Diabetics should visit a dentist or oral hygienist regularly. They should schedule an appointment early in the morning, after breakfast, in
  order to stabilise and prevent a severe or sudden drop in blood sugar levels.
  

Smoking and Gum Disease

Smoking is one of the most significant risk factors in the development of periodontal disease.
Smokers are also more likely than non-smokers to form calculus on their teeth, have deeper pockets, and have more destruction of the gum and bone around the teeth.
Smoking increases the risk of:

• oral cancer
  
• bad breath
  
• stained teeth
  
• tooth loss
  
• bone loss
  
• loss of taste and smell
  
• less success with periodontal treatment
  
• less success with dental implants
  
• gum recession
  
• mouth sores

Oral Cancer is extremely difficult to cure and, because it spreads rapidly through the body, it is essential to take great precautions!
Quitting takes commitment. Join a tobacco-cessation programme, or talk to your dentist or physician.

Gum Disease could be a Health Risk

Studies have associated oral disease with potential heart disease, diabetes, pregnancy complications, and pancreatic cancer.

Over time, if we don't take good enough care of our mouths, bacteria can build up inside the gums. At first, the gums may simply bleed, or become inflamed. That condition is called gingivitis.

But eventually, if that early buildup of plaque and bacteria isn't cleared away, gaps can form between the gums and the teeth. As the body's immune system attempts to fight the infection that incubates in those gaps, it produces enzymes that attack not just the bacteria, but also the important tissue that actually holds the teeth in place.

By then, the condition has become periodontitis. The teeth can loosen, and fall out. Gum disease, in fact, is the leading cause of tooth loss in American adults.
Avoid tobacco. It doesn't just discolor teeth. Toxins from tobacco can accelerate the process that loosens teeth, while also raising the risk of oral cancer.

Another way to minimize your infection risk is to see your dentist for thorough cleanings twice a year.

How can infected gums lead to other health woes?

Inflammation: When the body's immune system gears up to fight large infections like the ones that contribute to severe gum disease, byproducts of that immune response can damage tissues throughout the body. And the result may well be more extensive illnesses.