The amount of saliva we produce varies naturally during the day. Our natural "resting" saliva flow even has a biorhythm! We make least saliva during the night and most during the afternoon. When we eat, we make more saliva, to help digest food - and the make up of the saliva changes. Saliva stimulated by chewing is higher in bicarbonate, which helps to neutralise acidic food and also mops up the acid produced in plaque when eating sugary foods.
Frustratingly for some, a dry mouth is a regular problem, or even a permanent one. There are all kinds of reasons for developing a dry mouth -
General health problems - thirsty all the time? Get checked for diabetes, particularly if your breath smells of "pear drops".
Radiation - used for treatment of head and neck cancers. Salivary glands are very sensitive to radiation. If the area treated with radiation covers the salivary glands, the glands will often stop making saliva. Radiation will often leave the skin inside the mouth inflamed (mucositis) - take away the saliva and the skin isn't lubricated. Result - a horribly sore mouth.
In 27 years in General Dental Practice, combined with five years working with psychiatric patients (who ALL took medication that caused dry mouth), I tried everything. There are all kinds of remedies for dry mouth - here's a critique from my experience -
Sipping water - OK if you want to carry a gallon of water and spend half your day in the toilet!
Sipping water with lemon added - acid in a mouth with no saliva is bad news. Saliva is our way of repairing teeth. Dissolve the surface of the tooth with acid and if you've no mechanism of repair .............!
Chewing - something like gum. The idea is to create stimulated saliva. I personally have a problem with chewing gum since I had to chew raw, unflavoured gum or a lump of wax for three hours every Wednesday morning for a whole academic year. All in the name of saliva research. If using gum is socially acceptable to you, then give it a go. Use a sugar free version, and if you wear a denture make sure it's not one of the types that stick to a denture. Personally, I've not touched it since 1980 because of those damned experiments.
Artificial saliva - the poor ones are as good as sipping water and the good ones feel "like somebody else's saliva"! The good ones are more slippery than water, so they don't disappear immediately. The usual format is a small pocket/handbag sized spray bottle topped up from a large depot bottle. Watch out for the contents of the artificial saliva - our experience has been that the best one's contain "porcine mucus" - pig stomach mucus - not great if you're squeamish, vegetarian or don't do pig based products on religious grounds.
Pilocarpine - this drug stimulates saliva production. It seems to be very rarely used, so I wouldn't like to give it an honest critique.
So what does that leave us?
Clever stuff. It basically works by coating the inside of your mouth with a pleasantly slippery layer that gives the impression that it's wet. We've been using it with patients since about 1997 (at a guess), and with all kinds of patients. We've met just one that didn't get on with it. It comes as a system of a mouthwash, toothpaste, gum and so on. Much of it is available from your GP as an NHS prescription - but can also be bought "Over The Counter" (OTC). Many GPs (and dentists) are unaware of it - educate them if needs be! We have the knowledge, let's get it out there!
Best place to buy Biotene around us - Hessle Pharmacy. 256, Boothferry Road, Hessle. They keep it in stock and the service is exceptional.
As an addendum - we have a patient with very severe Sjogrens who's been treated in a specialist centre with one of the cutting edge anti-rheumatoid drugs. As a side effect, her saliva flow has been dramatically improved. We've reported this back to the centre and we're informed that a national trial is underway - watch this space!
© Hesslewood Lodge Dental Practice, 16 Nov 2015