Xerostomia is the medical term for “dry mouth”. I’ll
use the terms xerostomia and dry mouth interchangeably throughout this video.
Dry mouth means you don’t have enough saliva in your mouth to properly protect your teeth
and gums. It’s usually a result of a decrease in saliva production.
In this video I will explain why dry mouth is bad for your teeth and gums,
what causes dry mouth, and what you and your dentist and medical doctor can do about it.
Hello, I’m Dr. Rich Piotrowski, a general dentist with over twenty five years of experience. I’m
teaching you about dentistry and teeth so that you can have a very nice smile.
The average person produces between two and six cups of saliva per day. For my
viewers outside of the United States, that’s between half a liter and one and
a half liters per day. And yes, they do teach the metric system here in the USA.
Saliva is mostly water with enzymes, proteins, and minerals. The enzymes help to start digesting
your food as you chew it. The water and proteins help to lubricate your tongue,
teeth, gums, roof of your mouth, and the inside of your cheeks to prevent food
from sticking while you chew. The minerals will help protect your teeth from cavities.
Cavities are caused by the bacteria that live in your mouth that produce acids which will remove
minerals from your teeth. The minerals in your saliva will help your teeth remineralize. The
neutral pH of your saliva will help buffer the acid that is produced by the bacteria.
Without a healthy amount of saliva, your teeth will start to demineralize and become
sensitive and it will eventually lead to cavities. People with dry mouths tend to
get many cavities very quickly. Several years ago I had a patient who experienced dry mouth
and he ended up getting so many cavities that he needed to get all his upper teeth removed.
Having a dry mouth will lead to an increase in dental plaque buildup, which will cause
gingivitis and periodontal disease. Dry mouth can also contribute to mucositis,
which is inflammation of the soft tissues in your mouth. This can make it painful to eat,
swallow, and speak. It can also affect your sense of taste.
If you are a full or partial denture wearer, dry mouth can make it painful to wear your denture.
Dry mouth may cause full dentures to not stay in place well.
The amount of xerostomia you experience can also vary. Some patients may only get it temporarily,
for instance if you have a cold and have to breathe through your mouth for a few
days until you get over the cold, while other patients have severe cases of xerostomia that
are permanent. Even temporary xerostomia can lead to an increase in cavities,
the more frequently you get dry mouth, the greater the chances of getting cavities.
So now that you know why saliva is important for mouth health,
next I’ll talk about what causes xerostomia.
Xerostomia can be caused by many different factors, the most common cause being a side
effect of certain medications. Medications such as allergy meds, high blood pressure meds,
nasal decongestants, water pills (also called diuretics), muscle relaxants,
antidepressants, and seizure medications may cause dry mouth to varying degrees.
As you get older, you are more likely to get dry mouth,
usually because most people take more medications as they get older.
Another big cause of xerostomia is cancer treatment. Both chemotherapy and radiation
therapy can cause dry mouth. After chemotherapy, the xerostomia usually goes away but for people
who need radiation therapy of the head and neck, the xerostomia may be permanent.
The radiation therapy will destroy any salivary glands that are in the path of the radiation beam.
Xerostomia can also be a symptom of various medical conditions as well. Issues such as
diabetes, Alzheimers, Parkinson's disease, and Sjogren’s syndrome can cause xerostomia.
For Sjogren’s syndrome, dry mouth and dry eyes are the two most common symptoms.
Other causes of xerostomia are anxiety, mouth breathing,
and excessive use of alcohol, caffeine, and tobacco. Some of my patients with
sleep apnea report that using their CPAP machines everynight gives them dry mouth.
So we know that there are a lot of things that can cause xerostomia. But what can we do about it?
First step is to try to fix the underlying issue that is causing the xerostomia. If
it’s due to a medication, talk to your physician to see if they can switch you
to a different medication or adjust the dose of your medication to try to minimize the xerostomia.
If you are getting dry mouth due to alcohol, tobacco, or caffeine use, try to cut back on
the amount of alcohol, tobacco, or caffeine. If you are someone who breathes through their mouths
while they sleep, a simple solution may be to use some surgical tape to tape your mouth closed while
you sleep. This will only work if you can breathe through your nose easily. If you can’t breathe
through your nose, consult with an ear, nose, and throat specialist to see if surgery could help.
Also make sure that you are well hydrated and that you drink enough water throughout the day.
Dehydration can cause xerostomia as well.
If none of that helps, there are prescription medications and
over the counter medications and products that may help.
Which medications and products you use will depend on the severity of your xerostomia.
For mild cases, drinking extra water and using dry mouth lozenges may be enough. Dry mouth
lozenges are sweetened with xylitol, an artificial sweetener. The sweet flavor and having a lozenge
in your mouth will stimulate saliva production. The xylitol is good for your teeth, since it
helps to prevent cavities. Don’t over do it with the lozenges since the xylitol can cause gas and
diarrhea in some people. Stay away from lozenges that contain sugar. The combination of dry mouth
and sugar will cause rampant decay very quickly. The patient of mine that I mentioned earlier lost
his upper teeth due to decay caused by sucking on hard candy to try and help his dry mouth symptoms.
One popular brand of xylitol candy is called “Ice Chips”. I've been hearing a lot about
it in various dental facebook groups as being very helpful for patients with dry mouth. It
comes in twenty different flavors and you can buy it directly on their website or on Amazon.
I’ll leave links to it down in the description.
The next level of treatment are products that are designed to replace the missing saliva.
These artificial saliva products don’t cure the xerostomia, but they will relieve it temporarily.
These products include prescription medications such as Neutrasal and Bocasal,
as well as over the counter products such as Biotene Mouthwash and ACT dry mouth rinse.
Some medical doctors will prescribe “Magic Mouthwash” to their patients who are undergoing
chemotherapy or radiation therapy for cancer treatment. Magic mouthwash is a combination
of medications that are mixed by a compounding pharmacy and used to help treat the symptoms
of mucositis and xerostomia. It’s usually a combination of a topical anesthetic to
help numb the inflamed areas of the mouth, some topical steroids or antihistamines to help reduce
inflammation, some anti-fungals or antibiotics, and an antacid to help coat the mouth.
Neutrasal and Bocasal are both a supersaturated calcium phosphate rinse. They are a powder
which gets mixed with water, then is swished around your mouth, then spit out.
It will help sooth the gums and mucosa in your mouth and the minerals will help
keep your teeth mineralized. Neutrasal and Bocasal are prescription products and you
can get them from a pharmacy and some dental offices. They can be used several times a day.
Biotene mouthwash and ACT dry mouth rinse are available over the counter at most pharmacies
or grocery stores. There are numerous other brands of mouthwashes for dry mouth that are available,
but these two seem to be the two that my patients tend to use the most.
With all the saliva substitute products, you may need to try a few out to see which one works the
best for your situation. And always consult with your dentist and medical doctor before using them.
There are two pill medications available by prescriptions that will help increase saliva
production. They are pilocarpine also known by the trade name Salagen and cevimeline also known
by the trade name Evoxac. Both medications work by increasing the amount of saliva your salivary
glands produce. Both medications have quite a few side effects and other drug interactions so
please consult with both your dentist and medical doctor to see if either medication may be helpful.
I hope this video gives you a good overview of what xerostomia is, what causes it,
why it can have serious consequences for your mouth, and what you can do about it.
As always, thank you very much for watching, and please let me know if you have any questions.