DRY MOUTH & SJOGREN'S SYNDROME

Every day, over a 24 hour period, the average person produces at least 500mL of saliva. In fact a normal person will make 5mL every minute when they are eating or chewing. This is not the case in patients with Dry Mouth Syndrome (Xerostomia) or Sjogren's Syndrome. These people suffer due to the inadequate saliva quality they produce and the inadequate saliva volumes they produce.

What are the Functions of Saliva
Saliva is a natural cleansing agent of teeth and gums. It helps to wash away accumulated food after eating, debris, bacteria and plaque. saliva lubricates the soft tissues of the mouth including gums, tongue, palate, floor of mouth, cheeks and lips, and throat. Saliva enables swallowing by lubricating the throat area.

Saliva also contains certain chemicals and compounds beneficial to us. Saliva contains proteins such as amylase (a digestive enzyme) to start break down of starch in food. saliva contains immunoglobulins which help counteract infections and the stickiness of bacteria adhering to teeth and soft tissue. Saliva contains calcium and phosphate, which help to remineralise teeth making them less susceptible to dental decay. Saliva contains buffering (acid soaking up) systems which neutralise and inhibit the effects of acid produced by oral bacteria or which are included in the diet.

What are the Symptoms of Dry Mouth
Although symptoms are very general in nature, patients tend to report the following symptoms. the lips may become dry sore and cracked, similar to wind burn. the tongue may also become dry and have a burning sensation. Saliva glands situated around the mouth, under the tongue and below the ear, may become swollen and tender.

Small sores or cracks can occur in the corners of the mouth. These are known as Angular Cheilitis. All the soft tissues of the oral cavity may be thinner and therefore more susceptible to damage. Taste sensation can be altered because of inadequate liquid to dissolve tastants in the food so that taste buds can be activated

Sufferers of Dry Mouth Syndrome and Sjogren's Syndrome show more secondary infections, such as yeast infections (thrush) caused by bacteria such as Candida Albicans. This thrush presents clinically as generalised inflammation of the skin surfaces of the mouth and tongue on which there are small superficial whitish patches. These patches may be removed leaving a red area underneath which often bleeds easily. The KFORCE Kit can help to remove thrush and prevent its reoccurence.

Patients report tender burning mouth sensations made worse by hot or spicy foods. Patients that wear dentures find that wearing and fit of the dentures is worse. This is because lack of saliva means that the dentures do not get an adequate seal. Finally patients present with increased decay levels.

Patients may report a metallic taste in the mouth and thin frothy saliva. They also may report increased bad breath. The more dry your mouth, the more chance you will have bad breath. It has to do with the amount of oxygen available in your saliva. The bacteria that cause bad breath, thrive in an anaerobic (no oxygen) environment. When your mouth gets dry, your saliva disappears or gets thicker, representing the reduction of Oxygen. When the bacteria senses this difference, they start to produce Volatile sulphur Compounds.

How do we Manage Dry Mouth
Fluid Replacement and Mouth Moistening. This is necessary to diminish soreness in the mouth and oral discomfort. Also to to aid speech and swallowing.

It is recommended to chew chewing gum to stimulate saliva glands. This gum should ideally have Xylitol added to it and also be sugar free to avoid decay. We recommend Recaldent Chewing Gum which comes in both Mint and Tropical flavours. One stick or two pellets can be chewed for 20 minutes after meals.

Glandular massage. Massaging the salivary glands can reduce tenderness. this tenderness is due to thickened viscous saliva secretions that become retained in the salivary ductal system.

Saliva substitutes. This is especially important if there is no saliva gland function, or the saliva tissue has been removed.

Substitute saliva with water. This is probably the simplest thing we can do. We recommend two glasses of water after meals or sipping as necessary during the day. Other oral lubricants such as Breeze Morning Fresh Oral Gel are also excellent. This gel has many ingredients which not only aid in soothing damaged tissue but also lubricate tissue extremely well.

Use Anticariogenic Aids such as Recaldent Mousse to cover the teeth at night and help stop decay. Recaldent Mousse contains the same active ingredients as Recaldent Gum. It aids in remineralising tooth structure whilst also aiding in stopping adhesion of plaque film to the tooth surface. Plaque film contains bacteria, sugars and acids that damage teeth.

Pilocarpine. This drug appears to be a useful salivary stimulant but has side effects. The patient needs to be screened for heart disease and diabetes and other medications first. These side effects can make this drug unacceptable in most cases. But we mention it here for completeness.

Avoid acid juices and carbonated drinks. Most commercial soft drinks, processed juices or fluid replacement drinks are acid in nature. This is done to keep them stable. Due to lack of saliva buffering abilities these drinks should be avoided.

Avoid oral swabs such as Lemon and Glycerine Mouth Swabs designed to "freshen the mouth"

Avoid difficult to eat foods such as bread and chicken

Avoid in between meal snacks which are high in carbohydrate as these contain sugars which encourages dental plaque and decay.

Continued speaking during the day, causes your saliva to thicken representing the onset of more dry mouth. This eventually leads to bad breath production. By the way, from the age of 25 on, we all begin producing less saliva. It goes downhill from that point on, so there is always a greater chance to produce more bad breath as we all get older.

Smoking is a major factor in dry mouth. When you smoke you are effectively starving the mouth of oxygen, thus promoting the overgrowth of anaerobic bacteria that create the smelly sulphur products. Unfortunately smoking is addictive and therefore not easy to cut down or quit. Smoking effectively decreases the ph level of your mouth and dries your oral tissues. Consider that if you smoke you need to be paranoid about your breath. It is therefore essential that all smokers use some form of breath system as well as chewing gum during the day to help keep adequate supply of saliva and oxygen to the mouth.

Alcohol causes dry mouth. Alcohol can turn occasional bad breath into horrible bad breath and lousy taste. It doesn't matter if the alcohol is wine or beer, or even in mouthwash, that can be bought over the counter. Alcohol makes the mouth extremely dry very rapidly, and this can lead to instant halitosis. Did you know that some commercial mouth rinse contain up to 26% alcohol whereas wine only contains 11%

If you snore, or mouth breath, you are making your mouth, tongue and throat very dry during the evening. This is when most sulphur compounds are produced. Because mouth breathing dries off the tongue, it can also be a serious initiator of bad breath.