Dry Mouth and Related Oral Conditions John T. Frey, D.D.S. How To Dance in the Rain Conference Grand Rapids, MI ◊ September 6, 2014

Xerostomia The subjective feeling of oral dryness, associated with: AA change in saliva composition RReduced salivary flow NNo identifiable cause

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 Disease Nerve Damage Medication side effect Radiation Therapy

Medications that cause Dry Mouth More than 500 commonly prescribed drugs cause dry mouth.

Medications that cause Dry Mouth Antihistamines Antidepressants Anorexiants Antihypertensives Antipsychotics Anti-Parkinson agents Diuretics Sedatives Antiemetics Antianxiety agents Decongestants Analgesics Antidiarrheals Bronchodilators Skeletal Muscle Relaxants

Complications Associated with Dry Mouth  Difficulties in tasting chewing swallowing speaking  Burning feeling in mouth  Dry throat, hoarseness  Cracked lips (chelitis)

Complications Associated with Dry 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 food Ptyalin 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.

Demineralization vs. Remineralization

Stephan Curve Plotting pH within Dental Plaque against Time Critical pH Bite or Sip Danger Zone

Just remember… “When I eat, they eat.” When I stop, they take 30 – 60 (75? 90??) minutes to turn off!

Stephan Curve Plotting pH within Dental Plaque against Time

Let’s Talk About DECAY CARIES

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 sugarless gum) 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 between meals =  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 patterns 4.Limit caffeine 5.Limit sodas 6.Stop tobacco 7.Decrease alcohol intake 8.Avoid alcohol-containing mouthwashes 9.Use saliva substitutes (sialogogues)

To Relieve Dry Mouth 10.Sip water frequently, especially during meals 11.Use mouthwashes designed for dry mouth 12.Avoid antihistamines and decongestants 13.Breathe through your nose, not your mouth 14.Add moisture to your night air with a humidifier

To Protect Your Oral Environment 1.Avoid dry, spicy, acidic, or sugary foods 2.Be vigilant on your brushing and flossing 3.Brush with a fluoridated toothpaste 4.Supplement with a fluoride rinse (dentist recommended) - custom-made trays, Rx Fl gel 5.Visit your dentist twice a year 6.Remove your dentures before sleeping 7.Soak and disinfect your dentures and partials properly

Relief from Dry Mouth Caused by Medications 1.Stop the medication 2.Substitute with a similarly-acting medication 3.Alter the dosage of the medication 4.Alter the dose schedule of the medication