When spit doesn’t happen: Dry mouth risks and remedies

CURE invited Dennis M. Abbott, DDS, founder and CEO of Dental OncologyProfessionals of North Texas, to explain the risks and management of dry mouth during cancer treatment."Sometimes my mouth gets so dry that I wake up with my tongue stuck to the roof of mymouth. It's been so bad that I've had to get a drink of water to get it unstuck!" - B.D., Mesquite, TXDry mouth. Xerostomia. Hyposalivation. Cotton mouth. Call it what you will...but veryfew people really understand what a severely dry mouth is all about better thansomeone battling cancer.Dry mouth is a common unwanted companion for many oncology treatments. For patients undergoing chemotherapy, xerostomia is a pharmacological side effect of the cytotoxic drugs used to combat the cancer. In head and neck radiation therapy, hyposalivation is a direct effect of ionizing radiation administration on the salivary glands. At best, dry mouth is annoying; but in severe cases, the potential effects of xerostomia on teeth and soft tissues of the mouth can be devastating for years.The story begins with spit, or saliva. Under normal conditions, the average humanproduces about one liter of saliva per day. Saliva functions as a protector of the oralcavity. It keeps the tissue moist. It neutralizes the acidic by-products of intraoralbacteria. It begins the digestion process, by moistening what we eat and breaking downstarchy foods. It lubricates the moving parts of the mouth allowing us to smile andspeak. In short, saliva is a big deal...and it is greatly missed when it's gone!A loss of saliva can lead to a host of problems: difficulty chewing or swallowing;changes in taste; nutritional compromise; intolerance to oral medications, such as pillsand capsules; increased susceptibility to dental decay; higher risk for oral infections;increased likelihood of injury to oral tissues; and an inability to wear dentures or partials.Often, patients find the consequences of dry mouth annoying; while sometimes, theycan be devastating. Some may even become emotionally depressed after not beingable to carry on with what had previously been daily routine activities such as eatingand tasting food.From a dental health perspective, severe dry mouth can be very damaging to the teethand increase the risk of intraoral infections. Teeth in a dry mouth are especiallysusceptible to decay at the gum line. A cavity at this location can be especiallyproblematic since decay does not have to travel far to infect the center of the tooth,leading to a dental abscess. Likewise, a patient with diminished saliva has anincreased risk for intraoral bacterial, viral or fungal infections that can become asystemic health problem if the patient has mouth sores, as in mucositis.The solution comes by first identifying the problem. Like many areas in medicine, thereare several ways to manage dry mouth. A dental oncologist, a dentist that specializes inoral medicine as it relates to cancer care, can help decide which is right. Treatment canrange from systemic medication to mouth rinses or topically applied intraoral gels. Aneutral rinse can be made by combining 1/4 teaspoon salt, 1/4 teaspoon baking sodaand 1 quart water. This simple mouth rinse can be used to moisturize the mouth byfollowing the directions to swish and spit. Again, a dental oncologist can determinewhich method of management is best for you.Fluoride is an essential element for management of dry mouth. Carrier trays forlocalized delivery of fluoride make it possible to get the tooth-strengthening gel rightwhere it needs to be. Patients with dry mouth must commit to meticulous oral hygieneincluding brushing and flossing two to three times a day, regular use of prescription-strength fluoride, and professional dental cleanings at least once every three months.When dental restorations are required, the dentist can even choose a fluoridecontainingfilling material.Food choices often change when dry mouth is a factor. Frequent consumption of highlyacidic foods should be avoided as this can be harmful to tooth enamel and increase therisk of decay. Foods that are high in sugar and sticky foods must also be controlled.When these foods are enjoyed, a proper dental hygiene regimen should immediatelyfollow to minimize the time these damaging foods have contact with the teeth.Understanding the risk and seeing dry mouth as more than just an inconvenience is abig part of the battle. Knowing there are healthcare professionals who understand thestruggle and can help manage not only the xerostomia but also the treat any infection orpain that might arise should encourage patients facing dry mouth to ask questions andseek help. So, when spit doesn't happen...call your dentist or dental oncologist.Dennis M. Abbott, DDS, is the founder and CEO of Dental Oncology Professionals of North Texas, an oral medicine practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. In addition to private practice, he is a member of the dental oncology medical staff at Baylor Charles A. Sammons Cancer Center and Baylor University Medical Center in Dallas. Dr. Abbott has conducted studies focusing on bisphosphonate-related osteonecrosis of the jaw and xerostomia in patients with cancer.