Dr. Jones: Dry Mouth. Well, I have this problem and it makes me drink more and it's worse at night, so then I have to get up and go to the bathroom more.
What is this all about? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology here at the University of Utah Health Care and we're talking about dry mouth on The Scope. And boy is my mouth dry.
Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Today in the studio, we're going to be talking with Dr. Lea Erickson, who is the Associate Dean for Student Life at our dental school here. And she is an expert on the issue of the older mouth, and that doesn't tell you how old I am, but about dry mouth in specifics. Welcome to The Scope studio, Dr. Erickson.
Dr. Erickson: Thanks for the invitation.
Dr. Jones: Sure. So let's talk about women's mouths with respect to dry mouth. So is it frequent? How often does it happen for women?
Dr. Erickson: So dry mouth is really common among older people, not necessarily always older people, but see it much more commonly; it's usually associated with the use of medications. There are also some autoimmune diseases like Sjrogen's syndrome, again more common in women, that will have a dry mouth. A dry mouth can be really devastating for the patient having, or the individual having it. It's uncomfortable. One of the common complaints is I can't lick a stamp, I can't eat a cracker, I have to have liquids with my food, I have to have sauces on my food so it really can affect quality of life.
Dr. Jones: Does it affect your sense of taste as well or does it just dry mouth?
Dr. Erickson: Oh, it absolutely affects the sense of taste. Food needs to be in solution to be tasted and so if it isn't in solution then the taste buds don't affect it, don't get it, and so people with dry mouth have much less pleasure in eating as well as just not tasting it.
Dr. Jones: Well, we know that people when they get embarrassed or when people are giving a talk, there's always a glass of water for them. So dry mouth can be an acute response to nervousness or stress. And we know that there are some medications that make us get rid of fluid, like high blood pressure medications. So aside from diuretics, what other kinds of medications can lead to dry mouth?
Dr. Erickson: The list of medications, I think the last time I saw it, said 400 medications that cause dry mouth.
Dr. Jones: Oh, that many? Okay. Good.
Dr. Erickson: So any of the drugs that treat depression, again commonly used on adult patients. Pain medications are the worst so any of the narcotics.
Dr. Jones: Narcotic pain medications.
Dr. Erickson: Absolutely.
Dr. Jones: And then so if we have people that need their medications or need their blood pressure or their anti-depressants, what kinds of things do we do for people?
Dr. Erickson: So, what we need to do is either anything that will stimulate salivary flow, so you . . .
Dr. Jones: Ooh, thinking about pizza does that for me.
Dr. Erickson: Ahh, well, you know, thinking about food will
Dr. Jones: Or lemons
Dr. Erickson: . . . do it.
Dr. Jones: Thinking about lemons. I'm thinking about lemons right now and that's doing it for me.
Dr. Erickson: So, thinking is always a little bit useful, but most people are not going to walk around thinking about lemons and pizza. However, putting a sugar-free lemon candy in your mouth will stimulate salivary flow and keep it coming and not contribute to tooth decay.
Dr. Erickson: Putting some gum in your mouth. Cinnamon's my favorite. Cinnamon can be irritating in a dry mouth, but whatever flavor does it for you. The citrus flavored gums will do a wonderful job of stimulating salivary flow. And then you've got your natural saliva.
Dr. Jones: Is there some way of making . . . is there a medication that makes more saliva?
Dr. Erickson: There are two medications that are available. They both were tested on either patients who've had cancer therapy, radiation to the glands, or have Sjrogren's syndrome, but are often used for medication-induced dry mouth. Salogen, pilocarpine is one and cymatidine is the other one. They're not used terribly commonly because they also have side effects of making people sweat. So they're less convenient, but among the very, very dry mouth, they're very effective and very helpful.
Dr. Jones: So you have dry mouth, you say, "Well," you see everybody walking around with a bottle of water anyway. Now it's so acceptable to take your bottle of water with you. What are the side effects or what are the long-term risks of having a dry mouth?
Dr. Erickson: So the water puts the moisture in your mouth, helps your comfort, but does not have an effect on the health of the teeth.
Dr. Jones: Oh, so saliva has more in it than just water, huh?
Dr. Erickson: Absolutely.
Dr. Jones: Oh, tell us about that.
Dr. Erickson: It has anti-microbials, it has ions in it that remineralize the teeth. So the teeth are in a constant flow of losing calcium and phosphate and regaining it. So they demineralize and remineralize and it's a constant flow back and forth. Without saliva, it tends to be just a flow outwards and makes the teeth at very, very high risk for aggressive tooth decay that goes rapidly.
Dr. Jones: Oh. Well, that's something new for me because I figured that it was just dry and now I think of saliva as being really an important part of my mouth's health.
Dr. Erickson: It's absolutely a critical bodily fluid that has huge really therapeutic or functional benefits for the mouth.
Dr. Jones: So do you think the average family doc or nurse practitioner knows about treatment? Let's say . . . women might not even talk to their doctor about treatment cause they think it's common, but if they do . . . should women who's got this problem, should they go to their doctor? Should they talk to their dentist? Should they talk to everybody, their best friend?
Dr. Erickson: Well, they probably should at least talk to their physician and their dentist about it. The physician in terms of are there some alternatives to the medications that might have less of an effect, but absolutely talk to the dentist, get a prescription for a high concentrated fluoride dentifrice to use that will help to increase the remineralization.
Dr. Jones: Is that a toothpaste you're talking about, the dentifrice thing?
Dr. Erickson: Yes, toothpaste, sorry. Yes, it's a 1.1% neutral sodium fluoride, it requires a prescription, a number of brands. And really, most dentists manage to carry it in the office and have it available.
Dr. Jones: So and so brushing and flossing's more important in an effort to try to prevent tooth decay.
Dr. Erickson: Yes, and the patients that have good salivary flow can get away with doing less . . . well, get away with being a little more cavalier about their oral health care. Somebody with a dry mouth has to do such an excellent job of cleaning that they leave no plaque.
Dr. Jones: Okay. All you flossers and all you brushers who are of a certain age, if you have dry mouth, you should be talking with your clinician about causes that might be changeable if it's your prescriptions, about new therapies that might be helpful for you, but get your teeth checked out and keep them healthy and strong.
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