Transcript Dry Mouth and Related Oral Conditions John T. Frey, D.D.S. How To

Dry Mouth
and Related Oral Conditions
John T. Frey, D.D.S.
How To Dance in the Rain Conference
Grand Rapids, MI ◊ September 6, 2014
www.freydental.com
Xerostomia
The subjective feeling of oral dryness,
associated with:
 A change in saliva composition
 Reduced salivary flow
 No identifiable cause
Xerostomia
It is NOT a disease, but a
symptom of various
medical conditions, or a
side effect of radiation or
a medication.
Xerostomia
You can do some things to relieve dry mouth
temporarily, but the best long term dry mouth
remedy needs to address the cause.
For many people, however, little can be done to
alter the underlying cause of dry mouth.
Diagnosing Xerostomia
 Sialometry – salivary flow measurement assessment
- Clinical setting, done by a dentist
 Complaint of dry mouth / frequent water intake
- Especially at night
 Difficulty eating dry foods like crackers or toast
 Tongue Depressor Test
 Lipstick sign
Diagnosing Xerostomia
 Saliva is stringy, ropey, foamy, or absent
 Tongue clicks during speech
 Dental decay present along the gum line of
several teeth
Causes of Dry Mouth
Disease
Nerve Damage
Medication side effect
Radiation Therapy
Medications that cause
Dry Mouth
More than 500 commonly
prescribed drugs cause dry
mouth.
Medications that cause
Dry Mouth
Antihistamines
Antipsychotics
Anorexiants
Diuretics
Antihypertensives
Antidepressants
Anti-Parkinson agents
Antiemetics
Antianxiety agents
Decongestants
Antidiarrheals
Sedatives
Analgesics
Bronchodilators
Skeletal Muscle Relaxants
Complications Associated with
Dry Mouth
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Difficulties in tasting
chewing
swallowing
speaking
Burning feeling in mouth
Dry throat, hoarseness
Cracked lips (chelitis)
Complications Associated with
Dry Mouth
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Painful, rough, dry tongue (glossodynia)
Mouth sores
Mouth infections
Oral candidiasis is one of the most
common
oral infections seen in xerostomic
patients
 Poor nutrition intake
 Increase risk of dental decay (caries)
 Increased risk of gum disease (periodontitis)
What’s Up With SALIVA?
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Helps digest food
Ptyalin and Amylase = digestive enzymes
Antimicrobial
Helps control mouth pH
Mechanical cleansing action
Tooth remineralization
Lubricates the oral cavity (taste chew swallow
speak)
Helps retain dentures
These help decrease Tooth Decay.
Demineralization
vs.
Remineralization
Stephan Curve
Plotting pH within Dental Plaque against Time
Bite or Sip
Bacteria ASLEEP
Critical pH
Danger Zone
Bacteria ACTIVE
Just remember…
“When I eat, they eat.”
When I stop, they take 30 – 60 (75? 90??) minutes to turn off!
Stephan Curve
Plotting pH within Dental Plaque against Time
Stephan Curve
Plotting pH within Dental Plaque against Time
Let’s Talk About
DECAY
CARIES
Factors necessary for TOOTH DECAY
Susceptible
Host
Bacteria
Caries
Diet
Time
It doesn’t matter…
Cariogenic Foods
 Foods that promote formation of dental decay
 Fermentable carbohydrates, those that can be
broken down by salivary amylase and ptyalin
 Result in lower mouth pH
 Include crackers, chips, pretzels, cereals,
breads, fruits, sugars, sweets, desserts
Food Retentiveness
Cariostatic Foods
• Foods that do not contribute to decay
• Do not cause a drop in salivary pH
• Includes protein foods, eggs, fish, meat and
poultry; most vegetables, fats, sugarless
gums
Anticariogenic Foods
• Prevent plaque from recognizing an
acidogenic food when it is eaten first
• May increase salivation or have
antimicrobial activity
• Includes xylitol
(sweetener in sugarless
gum) and cheeses
Other Factors that Affect Diet
Carogenicity
• Consistency: Liquids are cleared quickly while sticky
foods remain on the teeth
• Meal frequency: frequent meals and snacks increase
duration of exposure
• Food form: liquid, solid, slowly dissolving
• Sequence of eating: cheese or milk at the end of the
meal decrease the likelihood of decay
Factors affectingTOOTH DECAY
The amount of sugar consumed is not as
important as the eating behavior:
  Frequency =  Risk
  Stickiness =  Risk
  Consumed between
meals =  Risk
To Relieve Dry Mouth
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9.
Have meticulous oral hygiene (brush, floss, Fl toothpaste)
Chew sugar-free gum (sugar-free candies, xylitol)
Limit snacking, modify eating patterns
Limit caffeine
Limit sodas
Stop tobacco
Decrease alcohol intake
Avoid alcohol-containing mouthwashes
Use saliva substitutes (sialogogues)
To Relieve Dry Mouth
10. Sip water frequently, especially during meals
11. Use mouthwashes designed for dry mouth
12. Avoid antihistamines and decongestants
13. Breathe through your nose, not your mouth
14. Add moisture to your night air with a humidifier
To Protect Your Oral Environment
1.
2.
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Avoid dry, spicy, acidic, or sugary foods
Be vigilant on your brushing and flossing
Brush with a fluoridated toothpaste
Supplement with a fluoride rinse (dentist recommended)
- custom-made trays, Rx Fl gel
5. Visit your dentist twice a year
6. Remove your dentures before sleeping
7. Soak and disinfect your dentures and partials properly
Relief from Dry Mouth
Caused by Medications
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Stop the medication
Substitute with a similarly-acting medication
Alter the dosage of the medication
Alter the dose schedule of the medication