Saliva plays a fundamental role in maintaining oral health. Besides keeping your mouth moist and clean by washing away any food debris left in your mouth, it also helps with the sense of taste, swallowing and speaking. Saliva is mainly produced and secreted by the three pairs of major salivary glands located just in front of the ears (parotid glands), under the tongue (sublingual glands) and below the jaw (submandibular glands). It helps to re-mineralise and toughen tooth enamel. Saliva also contains bicarbonate which contributes to the neutralisation of acidity in the oral cavity. When the salivary glands do not produce and secrete a sufficient volume of saliva, your oral health will be adversely affected. You may experience mouth dryness or ‘dry mouth’, also known as xerostomia.
Dry mouth occurs frequently, especially among older adults, with the risk increasing with age. About one-fifth of the elderly experience dry mouth, with women having a higher prevalence than men. Dry mouth symptoms may include a dry, sticky, burning or tingling sensation in the mouth, difficulty chewing or swallowing, especially dry foods, and an altered sense of taste. The physical findings are thick saliva, a dry tongue and loose dentures where applicable. Affected individuals may describe their mouth textures as "like sandpaper" or "like a desert."
If you persistently experience the above symptoms, it is worthwhile to see your dentist for the cause of your dry mouth.
What causes dry mouth?
Several factors can give rise to dry mouth, ranging from local to systemic causes. Local factors such as dehydration, tobacco use, alcohol and caffeine consumption, medications and head and neck radiotherapy, can all cause dry mouth, with dehydration being the most common. When you don’t drink enough water, the salivary glands cannot produce adequate saliva, leading to mouth dryness. Fluid shifts due to body responses to stress and anxiety can also cause a dry mouth. Medication, especially multiple medications (polypharmacy), is the most common cause of dry mouth, particularly among adults over 60. Hundreds of medications, such as antihistamines, anti-hypertensives, anti-depressants, anti-anxiety drugs and diuretics (water pills), can cause or worsen dry mouth. In addition, radiotherapy-induced dry mouth is one of the most frequently observed complications of conventional head and neck radiotherapy, as the irradiated field includes the major salivary glands. Recent advanced radiation techniques such as intensity-modulated radiotherapy (IMRT) help prevent salivary gland irradiation damage and preserve salivary gland function, which reduces the risk of developing dry mouth. In addition, dry mouth can be an integral element in several systemic diseases, including diabetes mellitus, thyroid diseases, Sjogren’s syndrome, and rheumatoid arthritis, with salivary gland cellular damage.
What are the consequences of dry mouth?
A dry mouth can give rise to several significant oral health problems that can impair patients’ quality of life. These problems include tooth decay, gum disease, increased risk of fungal infection of the mouth (i.e. oral thrush), speaking problems, poor nutrition as a consequence of chewing and swallowing difficulties, and taste changes.
Dental plaque can build up very quickly for people with dry mouth, especially those not brushing or flossing their teeth properly, causing susceptibility to bad breath, tooth decay and gum diseases. For an oral fungal infection or oral candidiasis, the affected individuals may develop soreness or a burning sensation in the mouth when eating spicy or hot food. These symptoms may be accompanied by creamy white spots that can be found on the tongue, inside the cheek and occasionally on the roof of the mouth. If you have a dry mouth, it is incumbent upon you to see your dentist for early detection of oral problems related to dry mouth.
What can you do to manage dry mouth and prevent its consequences?
It is crucial to pinpoint the cause of dry mouth before settling on a course of treatment. For example, if medication is suspected to be the culprit, your doctor may reduce the dosage or switch to an alternative with fewer side effects. Several measures are available to help relieve symptoms of dry mouth, including sipping water, sucking on sugar-free sweets, chewing sugar-free gum, keeping ice chips in the mouth, avoiding caffeinated drinks and quitting smoking and drinking alcohol if you can.
Moreover, a wide range of over-the-counter salivary substitutes and oral mucosal lubricants to keep your mouth moist are available on the market. They come in different forms, such as oral gel, spray and medicated lozenges, which you can use as often as needed to suit your lifestyle.
Most importantly, to prevent oral health problems due to dry mouth, individuals with dry mouth should see their dentists regularly, preferably every six months for proper professional dental care. Moreover, tooth decay and gum disease prevention through regular brushing with fluoride toothpaste and flossing are highly encouraged.
Author: Dr. Kununya Pimolbutr, MD, DDS, Higher Grad Dip (Oral Med), MSc (Oral Med), PhD (Oral Med), Oral Medicine specialist, MedPark Hospital. Tel. 662-023 3333.
Series Editor: Katalya Bruton, Healthcare Content Editor and Director, Dataconsult Ltd. Dataconsult’s Thailand Regional Forum at Sasin provides seminars and extensive documentation to update business on future trends in Thailand and the Mekong Region. Email: info@dataconsult.co.th Tel: 662-233-5606/7.
