Our expert is J. Max Goodson, DDS, PhD, Senior Member of the Staff, Department of Applied Oral Sciences at the Forsyth Institute and Associate Professor of Oral Medicine, Infection, and Immunity at the Harvard School of Dental Medicine.  


If there is a medical topic you would like to see explored here, please let me know!  And a quick thank you to Dr. Rick Dawson, DDS and Hilli Houdek, RDH, from Salisbury, MD for suggesting this blog post.


Very best,
Mitzi Perdue
mperdue@liebertpub.com

 

DRY MOUTH (XEROSTOMIA) IS A FREQUENT CAUSE OF TOOTH LOSS

The mouth needs saliva as a barrier against demineralizationof the teeth, which in turn can lead to tooth loss. If you put a tooth in a glass of water with even a small amount of acid, the tooth will start dissolving. However, a tooth won’t dissolve in an individual’s mouth when there’s adequate saliva even though bacteria are constantly producing acid, because saliva stabilizes the surface of the enamel so it doesn’t lose calcium and buffers the effects of intraoral acid. In the case of dry mouth, however, this protection is lost. Without adequate saliva, individuals may develop rampant caries and eventually lose all their teeth.

DRY MOUTH AFFECTS WOMEN MORE THAN MEN

Statistics on dry mouth are not firm. CHANGE TO DEFINITIVE?   A conservative estimate of prevalence of dry mouth is about 20% in the general population, with increased dry mouth prevalence in females (up to 30%) and the elderly (up to 50%). Sjögren’s disease, THE OFFICIAL NAME SEEMS TO BE SYNDROME BUT HE’S THE EXPERT….? an important cause of dry mouth, is an autoimmune disease in which white blood cells attack people’s salivary glands. In the case of the roughly 4 million Americans with Sjögren’s, nine out of ten are women.

MANY COMMON MEDICATIONS CAUSE DRY MOUTH

Of the 200 most frequently prescribed medications, 63% of them contribute to dry mouth. The problem is exacerbated when the individual is taking several of the medications that cause dry mouth. An individual who might not experience a strong dry mouth effect from ibuprofen alone, may have the effect exacerbated if she is taking an antihistamine or an anti-depressant, or a medication for arthritis, or maybe a blood pressure medicine. The big problem is that by the time a woman is in her 60s, she may be taking four or five medications, and these, when combined, can cause her to have a severe enough case of dry mouth that she’s at risk for losing all her teeth.

WOMEN MAY NOT COMPLAIN ABOUT DRY MOUTH

If you have reason to suspect dry mouth, ask your patient about it. Signs of xerostomia include cracked lips, mouth sores, and a dry, rough tongue.  Symptoms include trouble chewing or swallowing.  A simple xerostomia test is to ask the subject to spit into a test tube.  Patients with dry mouth will secrete 0.1 ml or less per minute.  Normal subjects will secret 0.3-0.4 ml/minute.  Even though dry mouth is an uncomfortable condition, especially given that dry eyes can accompany dry mouth, your patients may not bring it up. Dry mouth can come on so slowly that your patient may not recognize it, or she may simply associate dry mouth with aging. And further, she may not realize that her dry mouth is connected with dental extractions when she visits her dentist. Even after she’s lost all her teeth, dry mouth continues to be a problem because it takes saliva to create the suction needed to keep her dentures in place, yet she may be unaware that it is dry mouth  causing her problem.

TREATMENT FOR DRY MOUTH

There are many products marketed for use in dry mouth, but all fall short of their desired effects. The problem is that the effects are temporary. Using salivary substitutes will not prevent a person from becoming edentulous; that is, without teeth. The best treatment is removing or replacing the medication or medications that are causing the dry mouth. For a list of medications that cause dry mouth, go to: https://www.cliniciansreport.org/uploads/files/55/Meds%20Cause%20Xerostomia.pdf

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