I’m driving to Yuma (it’s a long story) and always marvel at the diversity of Arizona’s topography. The mountains and spectacular hundred mile views, the distinct ecological zones dictated by elevation, temperature and rainfall all proudly wear their own style of beauty, often stark, always magnificent. The Sonoran zone below 1,200 feet is remarkable for creosote bushes, paloverde and ironwood trees, cholla and other xerophiles which survive and even thrive in extremely dry conditions. The same is not true for our teeth, however.
Teeth need a very wet environment to stay healthy. Saliva serves multiple functions in oral health aiding in chewing, swallowing, digestion, and it also acts as a chemical buffer to neutralize acid and provides a source of calcium ions to re-mineralize your teeth. In dry mouth conditions called xerostomia, your mouth becomes very acidic which dramatically increases your susceptibility to tooth decay, especially on the root surfaces. No saliva: No resistance to cavities. Desert-like dry mouth will rapidly turn your teeth from ironwood trees into dying saguaro cacti eaten out around the base and irreversibly damaged.
Xerostomia is quite prevalent in aging populations and can be caused by many things including radiation therapy or surgery for cancer treatment, as well as medications such as antidepressants, high blood pressure pills, antihistamines and many other categories of drugs. Mouth breathing due to nasal obstruction or chronic allergy is a common source of dry mouth and so is the use of CPAP machines and oral appliance therapy for sleep apnea. Even just getting older can result in decreased salivary gland function. Regardless of the reason, if you notice that your mouth is becoming drier than normal, especially at night, talk to your dentist. You need aggressive preventive intervention.
Preventive techniques may involve wetting agents available over the counter such as Biotene, Orazyme, or DR Fresh used frequently during the daytime, concentrated fluoride gels, xylitol containing sugar free gum and candies and special toothpastes such as MI paste to facilitate re-mineralization. A new prescription rinse and paste kit called CariFree is designed to actually raise the pH of your mouth which pushes calcium into the tooth and promotes re-mineralization. Changing the acid/base balance of your mouth is a different philosophy than past treatment techniques.
Rampant root cavities are a growing epidemic in our senior population and are not easily managed. Enough so that a treatment option gaining favor is the use of dental implants and crowns or implant-supported dentures to replace teeth for individuals for whom conventional prevention methods have not been successful. Obviously, this challenges dentists to consider changing paradigms when virtually all of our training revolves around saving and repairing teeth, not electively extracting them. However, titanium won’t decay and some of our patients may be spared years of frustration if we are able to consider the big picture when creating treatment plans for people suffering with dry mouth.
I sincerely hope you never have to experience chronic xerostomia and if you do that you are able to get relief by changing medication, treating your allergies or some other benign therapy. Otherwise, don’t ignore it. Fight it hard and we’re here to help. No cactus mouth!
Man it’s a long way to Yuma! Dr. JC Goodwin is a member of the AADSM and the ACSDD. He holds a Diplomate credential in the ACSDD and practices dental sleep medicine, the management of sleep apnea with oral appliance therapy, full time in several locations around Arizona.