Not enough saliva? Here’s how to manage a dry mouth

A dry mouth is a topic I’ve written about previously.

Surprisingly common, and affecting people of all ages, a dry mouth can cause people anxiety. It can also be a challenge to manage.

Although there’s no one-size-fits-all approach to manage a dry mouth, there are some guidelines a dentist might prescribe to a patient who does not have enough saliva.

It’s all very well to provide a ‘to do’ list for conditions like dry mouth, but I find there’s nothing like real life examples to show what works and what doesn’t. This can be tricky given a dentist’s obligation is to maintain patient confidentiality. However, I have managed to obtain the permission of a couple of patients who I’ve worked with for many years.

It just so happens both my mum and dad experience a dry mouth and they’ve kindly agreed to let me share their experience here.

Both have a dry mouth, however the causes for each are different, and as you’ll see, we manage them in slightly different ways.

I also relate the experience of many cancer sufferers who have a dry mouth. Maybe you, or someone you know, has this issue, and I feel it’s important for these people to understand, a dentist should be part of the team to help manage this condition.

Meet my father: he has a dry mouth caused by medication

As we age, our body starts to experience wear and tear.

Depending on our health, we might be prescribed medications to help us stay on top of things. It’s certainly the case for my father.

Like many people his age, Dad is on medications for his heart. As a result of these medications, he experiences medication-induced dry mouth, or xerostomia. The particular medication is a diuretic, which removes excess fluid from the body. While that’s great for my father’s heart condition, it’s not so great for his oral health.

My approach to Dad’s condition has been one that involves working with his doctor and coming to a solution that is sensible – and works for him.

When we discovered my father’s dry mouth issue, we talked to his doctor and asked:

Is this the right medication for him?

Is there a substitute?

Do the benefits of the medication outweigh the effects?

Once we’ve established the answers to these questions, we can move to the next step, which is about management and prevention. In Dad’s case, the answers to these questions meant it was best for him to stay on the medication.

How do you manage a dry mouth caused by medication?

With patients like my father, I typically recommend an approach that is both practical and manageable. It incorporates any or all of the following elements:

1. Drink the right amount of water.

• • Notice I didn’t say drink more water? Well, there’s a reason for that. Medications like those my father is taking help eliminate excess fluid in the body, so it may not be appropriate for my father to just ‘drink more water’. It was essential we consulted with his heart specialist to confirm what would work. To help manage the dry mouth, my father can also rinse before swallowing when he does drink water, as this will promote the desired effect, without necessarily having to drink more water.

2. Conduct a diet review.

• • Regardless of what causes a dry mouth, a diet review is essential. Why? Because it’s important to eliminate as many simple carbohydrates and sugary foods from your diet as possible. This is because these are major contributors to tooth decay and gum disease. So when saliva is in short supply, or of poor quality, the balance is tipped in favour of unhealthy bacteria growth, which can lead to decay and gum disease.

3. Increase the frequency of oral health checks.

• • Instead of a six monthly check, I encourage patients like my father to attend the clinic for an oral hygiene check every three to four months. More frequent visits mean we can stay on top of things and take remedial action sooner.

4. Use a stronger toothpaste and a supplement it with professional strength fluoride.

• • When Dad comes to the clinic, we will always apply some fluoride treatment in either a gel or varnish form. This helps strengthen and toughen the teeth, making them more resistant to tooth decay.

5. Use a tooth mousse.

• A tooth mousse, or minimum intervention paste (MIP), helps remineralise teeth and provides a reservoir of minerals to help buffer against acids. This also forms part of Dad’s oral care at home, together with the strong toothpaste mentioned in the point above.

A question I’m asked a lot is how do I use a tooth mousse and a toothpaste? My father knows not to use the stronger toothpaste and tooth mousse at the same time. Rather, he uses the toothpaste in the morning and the tooth mousse at night. The tooth mousse helps mineralise the teeth, making them ‘complete’ (think of it as ’improving their integrity”), while the fluoride ‘seals’ the tooth surface and locks the minerals in.

What if your dry mouth due to an issue with the salivary glands?

I mentioned earlier that my mum experiences a dry mouth too.

Unlike my father, she has had an issue with one of her major salivary glands, which reduced her capacity to produce saliva. This is complicated by the medication Mum is taking, which also contributes to her dry mouth.

Unfortunately for my mother, because of these combined factors, she’s exposed to an even greater risk of tooth decay because her condition is not as easily remedied as Dad’s. The lower volume of saliva and its reduced quality, means Mum’s teeth are at an increased chance of erosion.

How do you fix tooth erosion from dry mouth?

The strategy to remedy this is very similar to the one I take with my father. We increase the water intake, rinse before swallowing, and modify diet. We increase the frequency of checkups, use a high fluoride toothpaste and apply a tooth mousse.

One additional element we include in my mother’s preventive protocol is rinsing with sodium bicarbonate mouthwashes. A weak solution of sodium bicarbonate (or baking soda) counteracts the effects of acids and helps buffer them, improving the pH of her oral environment. Other treatments that might also be considered, and offered in the clinic, include protective varnishes. These allow for a sustained release of higher fluoride concentration, even after Mum has left the clinic. They also help reverse or ’heal’ any newly cavities that form.

What does a patient with cancer do when they have a dry mouth?

It’s an unfortunate reality that many patients receiving radiation therapy as part of their cancer treatment find their salivary glands no longer work.

More so the case for patients who have had surgery for oral cancer, these people almost always experience a higher rate of tooth decay.

We would typically apply the same preventive treatments outlined above, only we might increase the frequency of them, depending on the individual. For example, if the patient could manage it, we might ask that they visit for an oral hygiene check every three months (or less, but certainly no more). We might also suggest they use the tooth mousse or stronger toothpaste after every meal, rather than just twice daily.

And in tandem with of the sodium bicarbonate solution I mentioned above, I may also prescribe two additional mouthwashes, with antibacterial properties and/or remineralising capabilities. However, I would only prescribe these under certain circumstances and with specific instructions which are outside the scope of this blog. which is only available.

A good rule of thumb when trying to manage a dry mouth, or not enough saliva, is the worse the dry mouth, the more significant and severe the complications, and the more intervention and management is required.

I’ve only mentioned a couple of dry mouth examples here, but there are many other ways it can present. For example, people who have dentures find that a dry mouth makes it hard to keep the dentures in place, which in turn can create sore spots in the mouth or promote fungal infections. These would need to be managed another way. Although this can be helped with dry mouth gels, which help with lubrication, it’s vital the true cause of the dry mouth is assessed by a dentist. Taking a considered approach in this regard means nothing gets missed.

Are you concerned about not having enough saliva or a dry mouth? Book an appointment today at Define Dental to understand the cause and learn practical and effective steps to manage this condition.

Owned by Dr Les Jabbour, Define Dental is located in Benowa. As the Gold Coast’s premier dental practice providing quality dental care to local residents longer than any other, Define Dental has decades of experience of providing exceptional dental care for the local Gold Coast community. The team at Define Dental is experienced at working with patients to treat conditions such as dry mouth, and would love to help you achieve your best oral health.