Dry Mouthand Related Oral Conditions

John T. Frey, D.D.S.

How To Dance in the Rain Conference

Grand Rapids, MI ◊ September 6, 2014

www.freydental.com

Xerostomia

The subjective feeling of oral dryness,associated with:

A change in saliva composition Reduced salivary flow No identifiable cause

Xerostomia

It is NOT a disease, but a symptom of various medical conditions, or a side effect of radiation or a medication.

Xerostomia

You can do some things to relieve dry mouth temporarily, but the best long term dry mouth

remedy needs to address the cause.

For many people, however, little can be done to alter the underlying cause of dry mouth.

Diagnosing Xerostomia

Sialometry – salivary flow measurement assessment- Clinical setting, done by a dentist

Complaint of dry mouth / frequent water intake- Especially at night

Difficulty eating dry foods like crackers or toast Tongue Depressor Test Lipstick sign

Diagnosing Xerostomia

Saliva is stringy, ropey, foamy, or absent

Tongue clicks during speech

Dental decay present along the gum line of

several teeth

Causes of Dry Mouth

DiseaseNerve DamageMedication side effectRadiation Therapy

Medications that causeDry Mouth

More than 500 commonly prescribed drugs cause dry mouth.

Medications that causeDry Mouth

Antihistamines

Antidepressants

Anorexiants AntihypertensivesAntipsychotics

Anti-Parkinson agentsDiuretics

Sedatives

AntiemeticsAntianxiety agents

Decongestants Analgesics

Antidiarrheals Bronchodilators

Skeletal Muscle Relaxants

Complications Associated withDry Mouth

Difficulties in tastingchewing swallowing

speaking Burning feeling in mouth Dry throat, hoarseness Cracked lips (chelitis)

Complications Associated withDry Mouth

Painful, rough, dry tongue (glossodynia) Mouth sores Mouth infections

Oral candidiasis is one of the most common oral infections seen in xerostomic patients Poor nutrition intake Increase risk of dental decay (caries) Increased risk of gum disease (periodontitis)

What’s Up With SALIVA?

Helps digest foodPtyalin and Amylase = digestive enzymes

Antimicrobial Helps control mouth pH Mechanical cleansing action Tooth remineralization Lubricates the oral cavity (taste chew swallow

speak) Helps retain dentures

These help decrease Tooth Decay.

Demineralizationvs.

Remineralization

Stephan CurvePlotting pH within Dental Plaque against Time

Critical pH

Bite or Sip

Bacteria ASLEEP

Bacteria ACTIVEDanger Zone

Just remember…

“When I eat, they eat.”

When I stop, they take 30 – 60 (75? 90??) minutes to turn off!

Stephan CurvePlotting pH within Dental Plaque against Time

Stephan CurvePlotting pH within Dental Plaque against Time

Let’s Talk About

DECAYCARIES

Bacteria

Diet

Susceptible Host

Caries

Time

Factors necessary for TOOTH DECAY

It doesn’t matter…

Cariogenic Foods Foods that promote formation of dental decay Fermentable carbohydrates, those that can be

broken down by salivary amylase and ptyalin Result in lower mouth pH Include crackers, chips, pretzels, cereals, breads,

fruits, sugars, sweets, desserts

Food Retentiveness

Cariostatic Foods

• Foods that do not contribute to decay• Do not cause a drop in salivary pH• Includes protein foods, eggs, fish, meat and

poultry; most vegetables, fats, sugarless gums

Anticariogenic Foods

• Prevent plaque from recognizing an acidogenic food when it is eaten first

• May increase salivation or have antimicrobial activity

• Includes xylitol(sweetener in sugarlessgum) and cheeses

Other Factors that Affect Diet Carogenicity

• Consistency: Liquids are cleared quickly while sticky foods remain on the teeth

• Meal frequency: frequent meals and snacks increase duration of exposure

• Food form: liquid, solid, slowly dissolving• Sequence of eating: cheese or milk at the end of the

meal decrease the likelihood of decay

The amount of sugar consumed is not as important as the eating behavior:

Frequency = Risk

Stickiness = Risk

Consumed betweenmeals = Risk

Factors affectingTOOTH DECAY

To Relieve Dry Mouth

1. Have meticulous oral hygiene (brush, floss, Fl toothpaste)2. Chew sugar-free gum (sugar-free candies, xylitol)3. Limit snacking, modify eating patterns4. Limit caffeine5. Limit sodas6. Stop tobacco7. Decrease alcohol intake8. Avoid alcohol-containing mouthwashes9. Use saliva substitutes (sialogogues)

To Relieve Dry Mouth

10. Sip water frequently, especially during meals11. Use mouthwashes designed for dry mouth12. Avoid antihistamines and decongestants13. Breathe through your nose, not your mouth14. Add moisture to your night air with a humidifier

To Protect Your Oral Environment

1. Avoid dry, spicy, acidic, or sugary foods2. Be vigilant on your brushing and flossing3. Brush with a fluoridated toothpaste4. Supplement with a fluoride rinse (dentist recommended)

- custom-made trays, Rx Fl gel5. Visit your dentist twice a year6. Remove your dentures before sleeping7. Soak and disinfect your dentures and partials properly

Relief from Dry MouthCaused by Medications

1. Stop the medication2. Substitute with a similarly-acting medication3. Alter the dosage of the medication4. Alter the dose schedule of the medication

Questions?