With the increase in the elderly population comes an increase in the prevalence of chronic conditions such as hypertension, arthritis and cancer. We are blessed today to have many treatment options that help us combat these conditions; however, some of the available options cause dry mouth, a serious side effect that cannot be managed simply by drinking more water.
Dry mouth occurs as a result of the abnormal reduction of saliva most commonly due to medications, in addition to radiation therapy in the head and neck region and some diseases. There are approximately 400 medications that cause dry mouth and almost each older adult is being treated with at least one of these medications.
According to a publication in the Journal of the American Geriatric Society, an estimated 30 percent of the population older than 65 has dry mouth. This lack of adequate saliva impacts the quality of life. It causes sudden and severe dental decay, bad breath, burning sensation, and difficulty in chewing, swallowing and talking.
Although the side effect of medications is reversible, it is not possible for most patients to change their medications. Additionally, the damage caused by radiation therapy is permanent. Managing dry mouth then becomes more palliative — relieving the symptoms — and focuses on preventing potential complications rather than curing the condition.
Saliva has many benefits to our mouth. It is the most important natural defense of teeth. It neutralizes acid produced by plaque and introduced by food and contains minerals that repair teeth after acid attacks. It also contains enzymes that fight bacteria, washes food debris, and lubricates the mouth during chewing, swallowing and talking. Substituting saliva thus requires using multiple products.
Over-the-counter Biotene products are the most commonly recommended saliva substitutes; they are formulated to moisturize the mouth. They are alcohol-free and also free of sodium lauryl sulfate, a detergent that irritates dry mouth and found in regular toothpaste.
Biotene Oral Balance Gel has the longest moisturizing effect and is recommended for nighttime use, while Biotene mouthrinse is recommended for daytime use. Some Biotene products have bio-active enzymes that fight bacteria; however, they are not potent antimicrobials. Other non-alcoholic antimicrobial rinses such as Crest Pro-Health Multi-Protection and the Natural Dentist should also be used.
Additionally, using prescription fluoride gel strengthens teeth against cavities and chewing sugarless gum can stimulate salivary flow. Due to the lack of natural immunity, a strict regimen of regular brushing and flossing and good dietary habits are also as important as ever.
— Samer Alassaad is in private dental practice in Davis. Contact him at [email protected]