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Xerostomia or Dry Mouth

Problems related to dryness in the mouth are known as xerostomia (pronounced "zero-stoh'-me-ah", from the latin word for dry mouth).

This condition is associated with decreased and insufficient quantities of saliva ("spit"), particularly when eating. Some of those affected with the condition may also have lower quality saliva characterized abnormally high viscosity (saliva which is thick and sticky instead of thin and watery)Xerostomia is not a disease in itself, but rather a symptom seen in a variety of diseases affecting both the mouth and the rest of the body.

Xerostomia is a significant health problem because it can affect nutrition and psychological well-being, while also contributing to tooth decay and other mouth infections. Dry mouth also may signal more serious problems in the body. If you have a dry mouth, you should be seen first by a dentist to determine the cause of the symptom.  Consultation with a physician may be recommended by your dentist.

Dr. Fox helps many patients with dry mouth problems (or associated oral discomforts). People afflicted with dry mouth often referred by their dentist or physician, but are also welcome to call our office directly to schedule an appointment.

If you answer "yes" to one or more of the following questions, then you may be one of the many people who suffer from xerostomia:

Do you have difficulty swallowing?

Does your mouth feel dry at mealtime?

Do you have less saliva than you once did?

Do you have pain in the lining of your mouth?

Do you feel the need to moisten your mouth frequently?

Do you have trouble eating dry foods such as crackers or toast?

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Does your mouth feel like a desert?

What happens when you have dry mouth?

Dry mouth caused by malfunctioning salivary glands is associated with changes in saliva. The flow of saliva can decrease, or the composition of saliva can change.

Patients with dry mouth have varying degrees of discomfort. Some people feel a dry or burning sensation in their mouths. Their mouth can feel as dry as a desert.  A dry mouth may affect their ability to chew, taste, swallow, and speak.

Changes in saliva also can affect oral and dental health. Cavities, tooth loss, and gum diseases are typically more aggressive in people with dry mouth.  Dry mouth also promotes or worsens bad breath (halitosis).  Oral yeast infections (candida albicans) may be an associated problem for those afflicted with dry mouth.

Severe cases of dry mouth can result in cracking of the lips, slits at the corners of the mouth, changes in the surface of the tongue, rampant tooth decay, ulceration of the mouth's linings, and infection.

Most cases of xerostomia are caused by failure of the salivary glands to function properly. But in some people, the sensation of a dry mouth occurs even though their salivary glands and output of saliva are normal. Dry mouth is a common side effect of many medications as well as some medical treatments.

Why is saliva important?

Saliva has many important functions in the body. It contains antibodies and special proteins which kill germs, start the process of food digestion, lubricate food for easier swallowing, and lubricate the mouth for proper speech, health and comfort.

Everyone needs adequate amounts of healthy saliva to:

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Limit the growth of bacteria that cause tooth decay and other oral infections.

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Preserve teeth by bathing them with protective minerals that allow small, early cavities to remineralize and heal

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Lubricate the soft tissues lining the mouth to keep them pliable and make speaking and chewing easier

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Dissolve foods and allow us to experience their sweet, sour, salty, and bitter tastes

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Assist digestion by providing enzymes that break down food

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Lubricate food so it can be swallowed easily

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Cleanse the teeth and mouth of food particles

What causes dry mouth?

Dry mouth can be due to changes in salivary gland function, brought on by:

Medications: Over 400 commonly used drugs can cause the sensation of dry mouth. The main culprits are the anti-hypertensives (for high blood pressure) and anti-depressants. Both are prescribed for millions of Americans. Painkillers, tranquilizers, diuretics, and over-the-counter antihistamines can also decrease saliva flow or quality.

Cancer treatments: Cancer is often treated with radiation or chemotherapeutic drugs. Radiation therapy can permanently damage salivary glands if they are in the field of radiation. Chemotherapy can change the composition of saliva, creating a sensation of dry mouth.

Of the 1.2 million Americans diagnosed with cancer each year, about one-third develop oral complications from their cancer treatment.  These complications can be so debilitating that doctors are forced to use lower, less effective doses of cancer curing drugs, to postpone scheduled treatments, or even discontinue cancer treatment entirely.  Oral complications or disease can also be a source of infections that interfere with cancer therapy or pose a serious threat to patient survival.

For these reasons, cancer patients need a dentist as part of their team of treating healthcare professionals.  Dr. Fox has experience and expertise in helping cancer patients with oral problems, while coordinating dental care with medical care through cooperation with treating oncologists and physicians.

Diseases: Sjögren's syndrome is an autoimmune disorder whose symptoms include dry mouth and dry eyes. Some Sjögren's patients also have a connective tissue disorder, most commonly Fibromyalgia, Rheumatoid Arthritis or Systemic Lupus Erythematosus (also called "Lupus" or "SLE").

Other Conditions: Bone marrow transplants, endocrine disorders, nutritional deficiencies, anxiety, mental stress, and depression can cause a dry mouth.

Dry mouth can be due to changes not related to salivary glands, such as:

Nerve damage: Trauma to the head and neck area from surgery or wounds can damage the nerves that supply sensation to the mouth. While the salivary glands may be left intact, they cannot function normally without the nerves that signal them to produce saliva.

Altered perception: Conditions like menopause, chronic oral yeast infections, Alzheimer's disease, or stroke may change the ability to perceive oral sensations.

Does aging cause dry mouth?

Until recently dry mouth was regarded as a normal part of aging. While the salivary glands that produce saliva do slow down a bit with age, researchers now know that most healthy older adults do not produce significantly less saliva than when they were younger. When older people do experience dry mouth, it is often because they suffer from diseases that cause the condition, or because they take medications that produce dry mouth as a side effect.

Relief for Dry Mouth

Desert Dunes Libya.jpg (24850 bytes)Yes, there is hope!  The first step is to consult a dentist with expertise in this area for a comprehensive oral examination.  There are both in office treatments and prescription medications that offer partial or even total relief.

Although there is no single way to treat dry mouth, there are a number of steps you can follow to keep teeth in good health and relieve the sense of dryness. These suggestions will not correct the underlying cause of xerostomia, but may help you feel more comfortable.

 

If you have xerostomia, these measures will help to preserve your teeth:

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Brush your teeth at least twice a day and use dental floss daily.

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Use a toothpaste with the American Dental Association Seal of Approval that contains fluoride.

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Avoid sticky, sugary foods or brush immediately after eating them.

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See your dentist at least three to four times a year for preventive care, professionally applied prescription fluoride treatments, periodontal maintenance care (if needed) and early treatment of cavities.

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Ask you dentist if you should use a remineralizing solution or prescription-strength topical fluoride preparation at home.

If you have xerostomia, these measures will help to relieve dryness and preserve soft mouth tissues:

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Take frequent sips of water or drinks without sugar. Pause often while speaking to sip some liquid. Avoid caffeine-containing coffee, tea, and soft drinks. Sucking on ice chips can also be helpful.

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Drink frequently while eating. This will make chewing and swallowing easier and may increase the taste of foods. Many patients find sipping skim milk (or other types of milk) a big help.

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Keep a glass of water by your bed for dryness during the night or upon awakening.

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Chew sugarless gum. The chewing may produce more saliva. This should not be regularly relied on, because sugarless gums can cause tooth decay.

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Eat sugarless mints or hard sugarless candies, but let them dissolve in your mouth. Cinnamon and mint are often most effective. But be cautious because sugarless candies or mints CAN cause tooth decay.

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Place a small piece of lemon rind or a cherry pit in your mouth. The sucking action helps stimulate saliva.

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Avoid tobacco and alcohol.  Also avoid commercial mouthwashes, which usually contain alcohol that will dry the mouth further.

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Avoid spicy, salty, and highly acidic foods that may irritate the mouth.

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Ask your dentist about using artificial salivas to help lubricate the mouth.

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Use a humidifier, particularly at night.  Keeping nasal passages and sinuses moist helps promote breathing through the nose.  If nasal passages get too dry and mouth breathing occurs, the mouth will get extremely dry very quickly.

Sjögren's Syndrome

As many as two million Americans may suffer from Sjögren's syndrome.  The syndrome is commonly misdiagnosed or enitrely undiagnosed.  Most afflicted patients don't get the correct diagnosis for 6 to 9 years after symptoms start.

Two prescription medications, Salagen (pilocarpine hydrochloride) and Evoxac (cevimeline), are available to treat the dry mouth associated with Sjögren's Syndrome.  These medications work by stimulating salivary gland nerve receptors (the M3 muscarinic receptors).  Depending on the nature and severity of symptoms, other medications include non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and immunosuppressive drugs.

Two voluntary organizations have chapters in major cities around the country that offer support for these patients. For further information, contact:

Sjögren's Syndrome Foundations, Inc.
366 North Broadway
Jericho,  New York  11753

Tel  (516) 933-6365
Fax  (516) 933-6368
Information Requests: (800) 475-6473

National Sjögren's Syndrome Association
3201 West Evans Drive
Phoenix, Arizona  85023

Links for More Information

Sjögren's Syndrome Foundation

Internet Resources for Sjögren's Syndrome

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David J. Fox, D.M.D., P.C.

Quality Dentistry for Discerning Adults ®

Telephone: (215) 481-0441

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