Xerostomia

People do not usually go to the dentist complaining that their mouth is dry or that they are always thirsty. However, many patients note the sudden appearance of stains, cavities or even thrush, a fungal infection, that herald the development of xerostomia or dry mouth.

Xerostomia is the lessening or lack of saliva. It may be the side effect of medication, radiation treatment or the autoimmune disease Sjögren's syndrome. Smoking and alcohol make the effects of dryness much worse. While easy to diagnose, xerostomia is not easy to correct. Usually, the best treatment a patient can get is advice from your dentist or hygienist on how to decrease the serious and irritating side effects of dry mouth.

The absence of saliva is the primary cause of the deleterious effects of xerostomia. Saliva is a complex solution of water, proteins and buffering agents that work together to fight disease and maintain the health of teeth and gums. Saliva contains components of the immune system that fight bacteria. Other proteins clean teeth and make bacteria less able to adhere to teeth. Calcium in saliva hardens teeth that are weak due to exposure to acid from food, drink and decay causing bacteria. There are even enzymes and lubricants in saliva that begin digestion of food before swallowing. Saliva does so many things; loss of saliva is very hard to treat.

Often, the first noticeable symptom of xerostomia is difficulty swallowing. This is due to the loss of saliva as a lubricant. Many people naturally adjust to this problem by drinking more fluids with meals. Their complaint to their physician or dentist might be that they are thirstier than usual or that they find that food does not have as much flavor or go down easily.

Those who suffer from xerostomia should always consult their physicians. Some causes of xerostomia can be treated or lessened. For example, controlling diabetes may reduce accompanying dryness. Taking a xerostomia causing medication after meals rather than before may allow for a better flow of saliva at mealtime.

There is a pattern of tooth decay caused by xerostomia. Early, teeth will appear chalky white due to the effect of acid from food, drink and bacteria not washed away or deactivated by saliva. The chalky spots stain easily; patients often comment on brown or black stains that will not go away. The chalky areas are the same places where dental plaque builds up - the surfaces of the teeth closest to the gum line and between the teeth. Later, the chalky areas break down revealing large areas of orange or yellow decay. The decay may ring the entire tooth.

Dentists can introduce their patients to many tools to help this problem. Medications, sugarless gum and hard candy may stimulate saliva to flow. Daily fluoride treatments and antimicrobial mouth rinses reduce the onslaught of tooth decay. Other mouth rinses, water and artificial saliva freshen and lubricate the mouth and throat. Saliva may never flow as well as it should, so these preparations and applications may always be necessary.

Many people will complain of a burning sensation in their mouth or tongue. The burning sensation is due to candidiasis, also known as thrush or yeast infection. Flowing saliva helps to reduce the level of yeast in the mouth. When yeast builds up, it creates an uncomfortable condition. Dentists and physicians treat candidiasis by prescribing antifungal medications. Professionals may recommend a low yeast diet when a yeast infection returns or becomes unrelenting.

Denture wearers have special problems caused by dryness. Upper dentures rely on saliva to maintain suction. Imagine a toy suction cup adhered to a wall. If the suction cup is moist, it adheres better than if it is dry. The same principal affects upper dentures. Also, saliva lubricates the denture bearing surface of the gums and protects the gums and cheek lining from abrasions caused by the denture rubbing against the soft tissue.

Denture wearers can benefit from many of the same treatments used by others. Medications, gum and candy may improve flow of saliva. Drink plenty of water. Additionally, try using cream denture adhesives. Powder adhesives and Sea Bond rely on saliva to provide moisture. Cream adhesives such as Polident and Fixodent do not require added moisture to be effective.

Candidiasis may be more irritating to denture wearers, because yeast may cause painful denture sores. Keep dentures very clean by brushing them twice a day and soaking them at night in a denture cleanser to reduce the presence of yeast.

When suffering with xerostomia, consult your dentist and your physician. It is best for you if they can work as a team to treat the causes and symptoms of xerostomia.

(Dr. David Leader has practiced in Malden since 1989. He is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs. Dr. Leader is a member of the department of general dentistry at Tufts University School of Dental Medicine.)