Dry mouth, also called xerostomia, is a common oral health problem. Unfortunately, for some patients it becomes a “silent” condition that often goes undiagnosed and untreated. While there are many potential reasons for this condition, one of the most frequent contributing factors is the use of medications. Over four hundred commonly prescribed drugs list dry mouth as a potential side effect.
While this condition is fairly common in the general population, the prevalence increases with age. This is likely because many older adults take medications for one or a number of co-existing medical conditions.
Though some people may consider dry mouth an inconsequential medical or dental concern, it can be a troublesome symptom also associated with systemic diseases and health conditions. Things that most people take for granted, such as being able to chew their food – or even to taste it – result in a reduced quality of life for the patient with xerostomia.
Negative effects of dry mouth can include:
• Increased dental decay
• Oral infections
• Cracks and fissures in the tissues of the mouth
• Denture sores and ulcerations
• A decreased willingness or ability to speak easily
Keep in mind that almost everyone has experienced dry mouth at some time in their lives. Dehydration following excessive perspiration, diarrhea, or alcohol consumption are experiences many people have experienced at one time or another. These situations are generally transient and easily identified. It should be noted here that not only alcohol consumption, but simply rinsing with alcohol-containing mouthwashes can result in a dry mouth. Many patients hold these rinses in their mouths for much longer than the recommended 30 second period. This can produce a type of tissue burn called sloughing; however, even regular use can cause a drying effect for many individuals.
If, however, you find any of the following problems to be daily events, you should raise the issue with your dentist or physician:
• Do you consistently need to sip liquids to help you to swallow your food?
• Does your mouth feel dry whenever you eat?
• Do you have any difficulty swallowing?
• Does the amount of saliva in your mouth seem to be much less than you remember, or do you not notice the difference?
There are several simple things your health practitioner can do to evaluate your condition. A medical history will also provide clues. For example, certain conditions such as diabetes, cancer treatments, and Sjögren’s syndrome have also been connected with dry mouth. (Sjögren’s syndrome is a chronic autoimmune disease in which a person’s white blood cells attack their moisture-producing glands.)
Keep in mind that dry mouth symptoms may not appear until saliva production has been reduced to approximately half the normal flow.
While it is always best to identify the source of the problem to seek a long-term resolution, sometimes it is necessary to provide symptomatic relief. A number of products have been developed that can help the dry-mouth patient who so often has extra sensitive mouth tissues. These include stimulation products such as chewing gums, specially formulated toothpastes and mouthwashes that are free of irritating ingredients, and moisturizing gels or sprays.
The important thing is that you do not ignore dry mouth symptoms if they exist. Talk to your dentist or doctor. Day-to-day symptoms and their complications can be managed. If you and your doctor correctly identify the source, perhaps those problems can even be eliminated over time. The simple pleasures of life – eating comfortably, tasting an enjoyable meal, laughing freely – shouldn’t be just a memory.
Do you suffer from a loose lower denture or have a family member who is having a rough time wearing their denture?
Unfortunately, this is a common problem. When all of the lower teeth are missing, little remains to stabilize or retain the denture.
An upper denture actually creates some suction on the roof of the mouth and will generally hold well. Not so, with the lower denture. First of all, the tongue has a tendency to displace it and because the surface area that the denture rests upon is generally narrow – there is little surface tension to hold it in place.
Many denture wearers have to rely on adhesives to keep their dentures from flopping around while they speak or eat. In a number of cases, even these adhesives fall short of their objective. Not to mention the fact that many patients find the adhesives unpalatable and some concerns have been recently raised about zinc sensitivities and copper de
ficiencies associated with these products.
Eating with full lower dentures can become difficult or even painful. Patients often opt not to wear their lower dentures at all out of frustration or embarrassment. Unfortunately, this can make it difficult to eat certain foods that are needed for good nutrition and health.
Numerous remedies have been forwarded to solve the problem in addition to adhesives. For example, relines can create an improved fit but they still don’t overcome the inherent problems described above. Then, there are dentures that are designed to look like they have octopus suction cups on the bottom, dentures with valves to suck out the air that gets under them, and dentures that have little “wings” on them that hold the denture down by the weight of the tongue.
Probably the greatest advance in denture stability, however, has been the development of dental implants. If a person has enough bone that is of good quality (not too soft) to accept implants, little comes close to these to provide both retention and stability for a loose lower denture. Also, much of the pain associated with dentures moving around and creating sore gums is eliminated because the denture is actually supported by the implants.
But what if you have been told you are not a candidate for conventional implants because of insufficient bone? Countless patients have still been able to benefit from mini-implants.
These are extremely small (1.8 mm diameter) implants that can be used for critically needed support purposes. Mini-implants can and do serve as long-term devices. In fact, some have been successfully functioning in patients for decades.
Because they are so narrow, they can typically be inserted directly through the overlying gum tissue into the bone underneath. This means that the procedure is generally much more comfortable for the patient because (in most cases) there is no need to surgically cut open the gum tissue – routinely required for standard implant cases. As a result, post-operative patient irritation and soreness is significantly reduced.
It should be mentioned that no implant system is fool-proof or has any guarantee of longevity. Such factors as poor oral hygiene, poor health, stress-inducing habits such as tooth grinding and clenching, smoking, poor health, osteoporosis, medications, and lack of follow-up care can all lead to potential failure of the implants. Compared to conventional implants, however, the cost of replacement is generally much smaller and with less bone loss and gum deterioration. Failures involving mini-implants are not unheard of, but are generally quite rare.
As you might expect fees vary from doctor to doctor and by geographic location. Generally, though, the fees tend to be a lot lower than for conventional implants – with similar results, less discomfort and much shorter waiting times. The best way to address the cost issue is to have an open and honest discussion about what fees may arise with the dentist of your choice.
Many dentists now consider an implant-stabilized lower denture the new “standard of care.” By choosing this option you are deciding upon an improved way of life that is free of so many of the heartaches and discomforts associated with loose, painful and ill-fitting dentures. Because people need to use their teeth each and every day of their lives, that’s worth a great deal.
If you require that a cosmetic dental crown be placed, it is a good idea to evaluate how you feel about the color of your existing teeth before the process is initiated. If you like the color of your teeth, the dentist will then find a crown shade that matches them.
On the other hand, if you feel that you would like your teeth to be lighter, bleaching may be an option for you. If you know you would like to whiten or lighten the shade of your teeth, it is a good idea to communicate this to the doctor beforehand. Once the final crown or cosmetic restorations are made, it will not be possible to change their color without re-doing them.
While bleaching is generally predictable, the results do not last forever. You may have to touch them up every one to three years. Teeth will re-darken. (This tends to occur more slowly with Power Bleaching.) The rate at which it happens, though, depends upon your habits. The good news is that your teeth can be brightened once again. Just remember, crowns and fillings do not change their color with bleaching — only your natural teeth will lighten.
When many people think of a dentist, one of the first associations they make has to do with filling cavities. While this has traditionally been one thing dentists are known for, it is far from the complete picture.
Nevertheless, tooth decay is one of the most common diseases world-wide and, if neglected, can become one of the most expensive to treat. Our practice philosphy is that it is far better to prevent a problem from occurring than it is to treat it. For that reason, we feel it is important for you to understand your condition so that you can make informed decisions.
If knowledge is power, then we want you to be able to take control of your dental health with useful and practical information.
After over twenty years of practice I have learned that many patients feel a cavity should hurt before you treat it.. Unfortunately, that can be a formula for disaster. Some time ago, I prepared this short video to explain just why that is.
Consider this article a public service announcement. I really dislike it when patients lose their teeth unnecessarily. My practice philosophy is that if a person has a dental problem, the goal is to handle that difficulty first, but then empower the patient with the correct knowledge that will keep him out of trouble from there on out. Ideally, my hope is that most future visits to my office will only be for routine maintenance.
Unfortunately, and all too often, I encounter new patients with teeth that are so badly decayed there is little hope of salvage. Possibly just as frequently, I find these patients scheduling a checkup – usually after a long absence from dental care – who are surprised to learn that they have any cavities at all. Sometimes they will think they lost a filling when, in fact, a piece of their enamel has broken away.
Why are they surprised? The common denominator seems to be the idea that cavities are supposed to hurt.
Well, sometimes they do hurt. But most of the time – especially in the early stage – they don’t.
In fact, by the time a tooth does start to hurt you it’s usually pretty bad. More often than not, it is so bad that a dentist is evaluating whether it can be treated with endodontic (root canal) therapy or whether it needs to be extracted. A little understanding of basic dental anatomy is helpful here.
Take a look at the illustration below:
The outer layer of the tooth is comprised of enamel. This is the hardest substance in your body. It breaks up your food and is designed to last you a lifetime.
And now, here is the important part for you to understand: it doesn’t contain any nerves.
It is more than ninety-five percent mineral. Water and organic materials make up the balance. And because it doesn’t have nerves, it doesn’t have feeling. This is actually quite practical since it wouldn’t do to have pain every time you bit into something. On the other hand, it also means that it can be decayed without giving you a warning.
In fact, decay can also travel into the supporting layer – the dentin – and still not cause you pain. It usually has to travel pretty close to the inner layer that contains the blood vessels and nerves – the pulp – before you feel it. Of course, by then, the tooth has generally undergone considerable destruction.
Another factor that makes spotting decay difficult is the way it spreads. I have drawn two black triangles into the enamel above. Notice that the narrow point is on the outside of the enamel. The broader base faces the inside of the tooth. This is how decay usually travels. Sometimes, it will undermine the interior of the tooth while the outer, harder enamel still maintains its form . . . until it eventually crumbles because the underlying supporting dentin has been eaten away by decay.
Many cavities also form at the contact point between two teeth. These are areas that you simply cannot see. Even the dentist needs an x-ray to spot these cavities in most cases.
So what does all this really mean? Spotting decay is not always that easy. As dentists, we use visual examination, but we also rely on probes, x-rays, and even laser detection devices to locate cavities. Even then, it can be difficult to find cavities under existing fillings.
Don’t rely on pain to tell you if you have a cavity in your tooth. If you do, you can be assured that your treatment is likely to be more uncomfortable, expensive, and may even result in the loss of a tooth that could have been treated much more easily earlier in the game.
If you have a loved one, who still has their teeth and hasn’t seen a dentist in a while, have them read this article. You may be saving them from quite a bit of discomfort – not to mention time and money – if they catch potential problems before they are hopeless.
Some of you may be thinking, “No big deal. If it’s that bad, I’ll just pull it.” OK, sometimes that is necessary, but therein lies a lesson for another day.
Dr. Richard Walicki is a dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.
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