Being a dentist in Florida, I treat an older patient population. Recently, I’ve noticed a number of patients in my practice exhibiting dental decay and a common complaint of having a dry mouth. With age often comes a deterioration in general health resulting in the use of multiple prescription medications. Some of these medications, unfortunately, are a double-edge sword. On the one hand, these medications are necessary to keep the patient alive and functioning. Conversely, these medications can cause a dry mouth condition known as xerostomia. And xerostomia is a big problem.

A healthy mouth requires the production of saliva. Saliva plays many protective roles in the mouth. It maintains antimicrobial activity, provides enzymes involved in the breakdown of food, and physically rinses the teeth to remove bacterial plaque. Without saliva the mouth is dry. It looses it’s immune fighting function as well as the ability to wash plaque away from the teeth. As dry mouth syndrome continues, more bacterial plaque can build up on the teeth. The result is tooth decay at the gum line on susceptible soft root surfaces. Quite often an older patient will have had quite a few dental restorations like fillings and crowns in their mouth. These restorations do NOT make a tooth any less susceptible to decay. In fact, they may make decay MORE likely! Older fillings and crowns might have defective edges that often trap plaque eventually decaying the tooth. Decay of this type can be very difficult to detect. If the decay occurs below the gum line it is tough to visibly locate. Decay occurring under a filling or crown is harder to see even on an X-ray. So what can you do to prevent this from happening to you?

If you suffer from dry mouth the first thing you need to do is increase your water intake. Have a water bottle with you at all times and regularly rinse or sip. There are prescription and over the counter products that can be used in addition to water. For information on these you should ask your dentist.

In addition to water, try reducing carbohydrates in your diet. Bacteria use carbohydrates, especially sugar, to produce an acid that dissolves tooth structure. By reducing the food sources that these bacteria consume, you can reduce the acid they produce and thereby decrease the amount of decay on your teeth.

Another way to manage your risk is to make sure to see your dentist on a regular basis. It may be in your best interest to see the dentist more than twice a year if decay is constantly occurring. This will allow early detection of decay that can often be treated before you need expensive dental care or a tooth extraction. Even if you already see your general dentist regularly, there are a few extra things they can help you add to your daily routine.

Lastly, it may be worth consulting with your physician. It might be possible that alternative medications can be prescribed which do not cause dry mouth. Perhaps you and your physician can develop a plan to reduce the overall number of medications you need. I want to be clear that I am not advocating that patients cease completely their prescription medications. I am only suggesting that all methods to maintain or increase salivary flow are explored. Try having a conversation with your physician prior to making any decisions on your own.

To wrap things up let’s highlight the most important facts to take away:

1) Dry mouth is often caused by the use of prescription medications.
2) Dry mouth can lead to rapid decay and tooth loss.
3) Non-restorable decay and tooth loss can be decreased on your own by keeping your mouth wet and by altering your diet consuming fewer carbohydrates.
4) Early decay can be restored and expensive treatment or tooth loss can be prevented by seeing your dentist more frequently.
5) Dry mouth may be decreased with help from your physician by changing or reducing your prescription medication use.

With patients living longer due to increasingly effective medications, dry mouth is a problem that is here to stay. Therefore, we need to do all we can to protect our teeth.

 

Dr. John