Dry Mouth Syndrome or Zerostomia

Saliva is our natural protection for our teeth and oral tissues. It helps keep various bacteria, viruses and fungi in check and at the same time cushions and buffers our tissues against damage from the hard, sharp, dry, spicy, acidic, basic, hot, cold things we put in our mouths. It also helps re-mineralize and repair broken down (decalcified and decayed) areas of our teeth. If we have to wear removable prosthetics such as dentures, it helps retain them by creating suction but also acts as a lubricant to protect the underlying tissues. The reduction or loss of saliva for most patients is very uncomfortable and irritating and at the same time the major cause of tooth loss and degradation of the entire stomagnathic system (oral cavity).

There are many causes for Dry Mouth Syndrome (Loss of Saliva). It may be due to medications used for any of the following; high blood pressure, muscle relaxation, Parkinson’s, as antihistamines, to treat depression, bipolar disorders, anxiety, as antacids, as anti-diarrheals, as analgesics for pain relief, just to name a few. There are over 450 medications today that list dry mouth or zerostomia as a potential side effect.

It may also be due to cancer therapy, nerve damage, diabetes, inflammation, Sjogren’s, Lupus, Sclerosis, Sarcoidosis, Lung Disease, Metabolic Bone disease, Alzheimer’s, stroke, alcohol and drug abuse, any number of auto-immune diseases, immune suppressed patients or AIDS just to list the most common conditions. There are many more. It is normal as we age, to loose some of our saliva flow and it is always worse at night.

Dry mouth, (Zerostomia), may be transient or permanent. Regardless, the potential damage to your teeth and oral tissues may be very grave and result in the loss of some or all of your natural teeth, make removable prostheses impossible to wear, destroy extensive crown and bridge work and even cause peri-implantitis (infections of the support tissues) around implants and their potential premature loss.

If the cause of the Dry Mouth cannot be found or corrected we have to manage as best we can. It is critical the teeth are cleaned every 2 months and the tissues examined for secondary opportunistic infections. When the tissues are dry, normally controlled bacterial, viral and fungal infections tend to flourish. Bacterial infections of Streptococcus mutans, various spirochaetal and chlostridial bacteria should be treated, along with fungal infections such as Candida(Thrush) and various viral infections herpetic in nature. All require different treatments from antibiotics to disenfectant rinses such as Peridex, Tantum to antifungal rinses and lozengers such as Nystatin for fungal infections, to steroidal rinses and antiviral drugs.

It is mandatory that you maintain impeccable oral hygiene, brushing, interdental cleaning( flossing, stimudents, floss piks, etc.) proxy brush, sulcus brushing, interdental stimulation and massage. All sugars have to be removed from the diet and carbohydrate intake reduced. Only neutral toothpastes such as Biotene, Orajel Moisturizing must be used. Remineralizing toothpastes such as Prevadent 5000, Clinpro 5000, Recaltrate, and MI paste show some benefit. Use of a water flosser such as the one made by Water Pik, are comforting but should not be relied upon as
an adequate cleaning tool. A daily fluoride rinse of .2% or higher have to be added to the mix(eg. ACT or Phos-Flur by Colgate.)

For moisture relief chewing gums and mints sweetened with Xylitol work best to stimulate some saliva flow(eg. Spray, EPC chewing gums). There are some drugs such as Pilocarpine but the side effects usually out weigh the benefits. Saliva substitutes are numerous but all offer a limited and brief benefit. ( eg Biotene Saliva substitute).

Treating this condition(Dry Mouth) is very difficult and frustrating for both the patient and dentist. Perseverance and diligence remain the key watch words in treatment of this affliction.

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