The Dry Mouth Epidemic

Talking to patients about how to manage dry mouth and it’s consequences has become something I do multiple times a day. Dry mouth is a common side effect of over 500 different routine medications. Antihistamines ( both prescription and OTC), blood pressure medications, decongestants, pain medications, diuretics and antidepressants just to name a few groups all cause dry mouth as a side effect. When I look at this list and think about the number of my patients that take one or more prescriptions everyday it is impressive that they don’t all have some form of Xerostomia. Dry mouth is also commonly associated with autoimmune disorders, diabetes and cancer therapy. There is also a relationship to age, but not the one we think. Research has shown that we do not produce less saliva as we age, the chemistry of the saliva will change however and it can become thicker and less able to protect the teeth and gums. The relationship we see between our older patients and the incidence in dry mouth is due to a higher percentage of these patients taking daily medications, and or having one of the underlying medical conditions. It is estimated that over 30% of the population over 65 years of age has dry mouth that requires management.

So how much saliva do we need? A healthy adult usually produces between a liter and a liter and a half of saliva every day. The lubricating effects make it easier to talk and swallow. It helps in the digestion of our food, contributes to the taste of our food and protects our teeth and oral tissues. A noticeable feeling of dryness is often the first symptom. Many patients try to manage it on their own by using hard candy, chewing gum or mints to stimulate saliva. The combination of the lack of saliva and added sugar held in the mouth for extended periods of time can be devastating to the health of the teeth. We are often the first person to diagnose and help patients with dry mouth. In our office we have started asking patients about a few of the key symptoms so we might make suggestions early before the onset of significant dental issues. For most of our patients making changes to their medication regimen is not appropriate, so we work with them to utilize salivary replacements, non-cariogenic mints and gum and sialogogues to treat the dry mouth. In addition we place these patients at higher risk for caries and recommend prescription toothpastes and chlorhexidine following the CAMBRA guidelines.