Xerostomia – when the flow of saliva decreases

Dry mouth – also known as xerostomia – is a common phenomenon. It is caused by a decrease in salivary flow. Read on to find out more and get some practical advice.

Author: Dr Gabriele David, Ivoclar Vivadent AG, Schaan/Liechtenstein

Older people at higher risk

Especially older people are affected by xerostomia. The most common cause is the intake of certain medications. Dryness in the mouth is a side effect of the medication in these cases. Many common medications such as analgesics, antihistamines, antihypertensives, antidepressants and diuretics can lead to a reduced salivary flow. This effect worsens if several medications causing dryness in the mouth are taken together.

Saliva fulfils a variety of roles

At this point, it becomes clear how important saliva - and therefore a sufficient flow of saliva – is. Saliva fulfils numerous functions in:

• speaking,
• tasting,
• chewing and swallowing,
• cleansing the oral cavity,
• protecting the oral soft and hard tissues from physical and microbial injury,
• digesting,
• transporting important compounds such as proteins, buffers, ions,
• keeping a neutral pH and preventing demineralization,
• retaining removable dentures and making them comfortable to wear.
  

Reduced salivary flow carries many risks

People affected by a dry mouth often feel that their well-being is impaired. However, this is not the only consequence: their oral health and thus general health may also be affected:

• As the cleansing action is diminished, bacterial biofilm begins to settle. Proteins that can prevent the adherence and growth of microorganisms are not present in sufficient amounts if salivary secretion is reduced.
• Buffers that neutralize the acids and can protect the teeth against their attacks are not present. The delivery of remineralizing calcium and phosphate ions comes to a standstill. The risk for developing tooth decay and erosions increases considerably. Exposed root surfaces are particularly at risk.
• Inflammatory processes such as gingivitis and mucositis can progress more quickly.
• Traumatic oral lesions occur more frequently and do not heal as well as with a normal salivary flow.
• Removable dentures do not fit properly any more.
• Bad breath can impact well-being.
• Problems with chewing and swallowing as well as an altered sense of taste often lead to a change in dietary habits. If eating is not accompanied with adequate amounts of fluid, the situation is often exacerbated. Those affected eat less and/or prefer soft-boiled or liquid food. This leads to a weakening of the masticatory musculature and to nutritional deficiencies, which can have an adverse effect on general health.

How can you protect yourself?

Patients suffering from reduced salivary flow can protect themselves from negative effects. There are essentially two options:

1. Fluoride application in the dental practice

The treatment of patients with dry mouth includes the application of fluoride as part of the recommended basic protective care program against caries and/or erosions. Various delivery forms are available for this purpose. Fluoride-containing protective varnishes have been proven to provide an effective professional care measure. A flowable formulation such as Fluor Protector S wets complex surface structures and penetrates to hidden risk sites. In this way, the root cementum and the porous dentin of exposed tooth necks are given effective protection. The fluoride source consisting of ammonium fluoride with 7700ppm fluoride is completely dissolved and the varnish is therefore immediately ready for use. Once the varnish has been applied, the fluorides are immediately released and the tooth structure is effectively supplied with fluorides.

2. Oral care gel for use at home

Xerostomia patients require special oral and dental care products designed for their particular oral condition. One such product is the special care gel Fluor Protector Gel. In addition to calcium and phosphate, the gel contains 1450 ppm fluoride and is therefore suitable for daily dental care and can even be used in lieu of toothpaste. The gel also contains xylitol, which hampers the metabolism of cariogenic bacteria, and provitamin D-panthenol, which soothes the dry gums and stressed oral mucous membrane. The gel features a natural pH value, which is particularly advantageous if exposed tooth necks are present. In addition, the gel does not contain any abrasive particles and, as a result, is particularly gently to the less resistant root cementum and susceptible dentin. The mild flavour leaves patients with a pleasant feeling in the mouth. This is an important criterion, particularly in conjunction with a sensitive mucous membrane, and contributes to user compliance.

See here how Fluor Protector S is applied