O Saliva, where art thou? (aka the subject of dry mouth)

the subject of dry mouth

Have you ever felt like your mouth is as dry as the Sahara Desert itself? You can’t swallow properly, your lips are chapped and your tongue sticks to your palate. You become distracted and can’t rest until you had a sip of water (or ten).

Many of us suffer from dry mouth time to time for various reasons, but there are people for whom this becomes a chronic condition.

This article considers the causes of permanently dry mouth with some hints and tips on how to relieve its symptoms.

the role of saliva

Having enough saliva in the mouth isn’t only significant for comfort but also for various health reasons.

As I have mentioned in one of my previous articles, saliva plays an integral part in the prevention of oral diseases. Saliva has an important role in the mouth’s defence mechanism. 

It has a cleansing and neutralising effect against the bacteria which can cause decay and gum problems. It also helps the tooth in remineralisation after an acid attack (see article: Is chocolate really bad for your teeth?). 

Furthermore, saliva contains an enzyme, which controls bacterial growth, therefore protecting the mouth. Various other functions: speech, mastication, taste, digestion. (1)

important facts about saliva:

The average amount produced daily is between 0.5 and 1 litre.

Certain medical conditions can cause overproduction of saliva, which results in dribbling or drooling (for example Parkinson’s disease). (1)

On the other hand, there are factors which can cause a reduction in the saliva flow.

For instance, saliva is barely produced during sleep, which is important to know. (2)

If after the last tooth brushing anything other than water consumed the bacteria has the chance to cause damage throughout sleep, as the saliva isn’t there to protect the teeth.

There are other reasons and medical conditions that can cause a significant reduction in the saliva flow. Xerostomia is the term which is used for excessive dryness of the mouth.

what are the causes of xerostomia

Causes of dry mouth can be (but not limited to):

  • Medication: certain prescription drugs (there are hundreds of them), prescribed for example for asthma, diabetes, high blood pressure, HIV, allergies, depression and so on. It is worth noting that quite a few of these medications are prescribed characteristically to elderly people. (2,3)
  • Dehydration: sweating, diarrhoea and vomiting can cause reduction of saliva flow. (4)
  • Mouth breathing: occurs mostly at night or in people with sinus problems. (4)
  • Sjögren’s syndrome: it is an autoimmune disorder where the immune system attacks the glands which produce fluids such as tears and saliva. (3)
  • Radiotherapy (for cancer): treatment to the head and neck. (3)
  • Burning mouth syndrome: the cause of this isn’t always identifiable; sometimes underlying conditions can trigger it (e.g. medication, allergies, hormonal changes). Notably, burning mouth syndrome can cause dry mouth, but it can be caused by dry mouth as well. (2)
  • Anxiety: can cause lower saliva flow. (4)

implications of permanently dry mouth

Increased risk of tooth decay and gingivitis, fungal and yeast infections, ulcers, burning mouth sensation, tongue sticking to the roof of the mouth (especially at night), difficulty in eating and speaking and denture sticking to the mouth. (3)

dry mouth syndrome

how to manage xerostomia

It can be advised to people who have chronic illnesses and taking medication causing dry mouth to consult with their doctor if there is a possibility to modify the medication to help to relieve the symptoms. (5)

People who suffer from xerostomia will have to maintain excellent oral hygiene, with using fluoride toothpaste, thorough removal of plaque and use of mouthwash (use it at a different time than toothbrushing).

which toothpaste to chose

If necessary, a high concentration of fluoride toothpaste is available in the United Kingdom (by prescription only). It is also helpful to use a fluoride toothpaste which doesn’t contain the foaming agent called Sodium Lauryl Sulphate (SLS) as this tends to dry the mouth (a few examples of toothpaste not containing SLS: many Sensodyne products, Biotene or Kingfisher). There are moisturising gels and sprays also available to relieve the dryness. (5)

fruits and vegetables to help

Eating fresh fruit and vegetables can stimulate the saliva flow (however you need to be careful with the frequency of consuming those). Sipping water frequently or sucking on ice chips can also help. Chewing sugar-free gum stimulates the production of saliva, however, the downside is that people with dentures find that difficult and some people can find the habit of chewing gum ill-mannered. Using saliva substitutes and lubricating the mouth with non-virgin olive oil or sesame seed oil could help as well. (5)

Permanently dry mouth can have serious implications on oral health and it can also harm the overall wellbeing. The discomfort (sometimes even aches and pains due to e.g. burning mouth syndrome) can make a person socially withdrawn, interacting less with friends and family. Xerostomia can also alter one’s diet (it is likely that some foods will be avoided as they will be hard to chew and swallow), which can lead to inadequate nutrition. (6)

It is important to consult your dentist/doctor if you notice that your mouth gets dry easily or stays dry permanently and this is something you haven’t had before (it is also worth mentioning it to your doctor if you suspect that the change is brought on by a medication you have been prescribed), furthermore if you can’t pinpoint why you are experiencing it. The dentist will give you advice; they might prescribe you a higher concentration of fluoride toothpaste and alter (most likely shorten) your recall interval if they find that you have a higher risk of developing oral diseases due to the dry mouth.

To put it in a nutshell xerostomia is a very uncomfortable condition with potentially serious implications on your oral and general health. 

If you have dry mouth you have to make sure you let a professional know about it to get the right advice, probable further investigation and treatment if needed. 

You will have to look after your oral health by developing a strict routine and sticking to it.

Keep hydrated, keep happy and keep healthy (remember: water is a tooth-friendly liquid, which means that you can have plenty of it and as often as you like without damaging your teeth).

By Hajnalka Takacs (qualified dental nurse and oral health educator).
N.B.: The author confirms that the content of this article is created solely for educational purposes. The content is for non-commercial use only, and in no ways the author has gained any financial benefit from the platform it has been uploaded to or from any of the companies mentioned in the text of the article.

References

  1. Miller, M. and Scully, C. (2015) Mosby’s Textbook of Dental Nursing. 2nd edn. London: Elsevier Ltd.
  2. Iorgulescu, G. (2009) ‘Saliva between normal and pathological. Important factors in determining systemic and oral health’, Journal of Medicine and Life, 2(3), pp. 303-307.
  3. Greenwood, M., Seymour, R.A. and Meechan J.G. (2009) Textbook of Human Disease in Dentistry. Chichester: John Wiley & Sons Ltd.
  4. National Health Service (2018) Dry mouth. (Accessed: 28 July 2020).
  5. Felton, A., Chapman, A. and Felton, S. (2014) Basic Guide to Oral Health Education and Promotion. 2nd edn. Chichester: John Wiley and Sons Ltd.
  6. Mayo Clinic (2018) Dry mouth. (Accessed: 28 July 2020).
O Saliva, where art thou? (aka the subject of dry mouth)

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