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    BAD BREATH

    What is Bad Breath?

    Normal breath is non-invasive and has been linked to scent of “blooming chestnuts”.  On the other hand, bad breath is unpleasant and offensive, a “sour, bitter, metallic” taste and can vary with the cause and can also be sulfurous.  The main components of bad breath are:  methyl disulfide, cadaverine and putrescine.  Bacteria is the most common cause of oral malodor.  Anaerobic bacteria are generally implicated and include: Porphyromonas gingivatis, treponema denticola, Prevotella species, Fusibacterium species, Peptostreptococcus species, and Capnocytophagia.  Fungus is also involved and produces a very unpleasant and somewhat sour odor.  When the mouth is dry, anaerobic bacteria are not flushed away and increase in concentration.  This leads to an increase in volatility, stronger malodor, and a dry pasty taste.  The reduction of flushing with saliva also leads to an increase in nutrients that are available to the bacteria.  Tongue saliva becomes more basic and this environment promotes the growth of even more anaerobes.  Breath odor and bad taste continue to increase.

     

    To form an odor, the bacteria require a substrate provided by amino acids.  The substrates are metabolized to form volatile substances.  Substrates are most commonly cysteine, cysteine methionine, trptophan, ornithine, and arginine.  The bacterial metabolic by products are hydrogen sulfide, methyl mercaptan, acetic acid, proprionic acid, putrescine and cadaverine.

    Methyl Mercaptan:

    Methyl Mercaptan is the most potent in oral malodor and is associated with periodontitis.  The best indicator for presence is bleeding on probing.  It can effectively penetrate oral mucosa through crevicular membranes.  Some of the celluar effects are inhibition of protein synthesis, degradation of collagen, alteration of cell shape and depression of white blood cell formation.

    Hydrogen Sulfide:

    Most Common. It is irritating to mucous membranes and to the respiratory tract. It can affect the nervous system and respiratory of present in air in substantial amounts so it possibly can account for taste and respiratory irritation in the amounts found in bad breath.

    Etiology

    1. Food Odors: garlic, onions, dairy, meats, fats, coffee, alcohol
    2. Hunger Odor: unpleasant; results from metabolic breakdown of proteins and fats when there is insufficient carbohydrate in the diet. Can also happen with strenuous exercise and fasting. Fruity odor of ketones.
    3. Smoker’s Breath: starving the mouth of oxygen and promoting overgrowth of anaerobic bacteria
    4. Women’s Menstrual Breath: mousy odor
    5. Medications: causes dryness
    6. Dental Conditions: periodontitis, gingivitis, caries, crowns with poor margins, overhangs in restorations
    7. Systemic Conditions: diabetes, renal failure, reflux, hiatus hernia
    8. Sinus, Throat, Tonsil Infections, Post Nasal Drip
    9. Carcinomas, Xerostomia, Candidiasis
    10. Bacteria: increase concentration, increase VSC production, increased volatility, anaerobic
    11. Mouth Breathing: most sulfur products produced

    Tongue Coating

    The tongue is composed of cellular debris, blood cells and bacteria.  Variation in mouth odor is related to the amount of coating that is present.  The amount of coating increases as mouth odor increases, but removal of the coating and flushing will decrease odors by 50%.  The pH on the tongue changes to a neutral or alkaline pH and this favors malodor production.  Increased with stress levels.  Tongue cleaning is an essential component of oral malodor treatment.

    Effects of Stress

    • Life dissatisfaction-respiratory illness
    • Personal failure-respiratory illness
    • Emotional distress anxiety-herpes simplex, mononucleosis
    • ANUG Lack of control-periodontal disease
    • High immune reactivity and high stress-high rate of disease
    • High immune reactivity and low stress-moderate rate of disease
    • Low immune reactivity and high stress-moderate rate of disease
    • Low immune reactivity and low stress-low rate of disease

    Treatment and Assessment of Halitosis

    Halimeter:

    An effective measuring tool, electrochemical sensor, and is efficient in assessing the amount of hydrogen sulfide that is present.  It measures the ppb of volatile sulfur compounds (VSC).  It does not measure Mercaptan well and will be compounded by alcohol, amount of saliva, and air pressure.

    Self-Assessment:

    Exhaling and smelling, smelling saliva, smelling a partially dry wrist

    Brushing and Cleaning the Tongue:

    Tongue cleaners (decreases to a low level for several hours), dental debridement and prophylaxis (decreases to a low level for several hours), toothbrush with toothpaste (returns within 2 hours)

    Antimicrobial Rinses:

    In general, 3-4 hour protection.  Research indicates that CHX and zinc ion are very effective.

    1. Chlorhexidine (CHX)- longer time of protection and can last up to 24 hours if bacterial loading is moderate.  Can come in strengths of 0.12% and 0.2% and come in combination with alcohol or zinc gluconate.  Some disadvantages are:  taste depression and staining.  Also available in non-alcohol rinse.  70% reduction of mouth odor and effectiveness depends on microbial load. (Available at our office)
    2. Breath Rx- Combination of zinc gluconate and cetylperidium chloride (CPC) along with some eucalyptus and thymol.  It can be effective for 3-4 hours and may be longer if bacterial loading is moderate.  PerioWorks- Has a rinse that contains 0.2% zinc chloride.
    3. Peroxide Rinses- Such as Peroxyl are effective, but can only be used for short periods of time.  Baking Soda- These products also reduce odors well and have a time effect of about 3 hours ( 40% reduction).
    4. Herbal Rinses-  Such as tooth and gum are a good alternative for those who wish a natural treatment.  The effect is about 3-4 hours for moderate cases.
    5. Chlorine Dioxide-  Rowpar products, Oxyfresh, Oxygene, Therabreath, Profresh.  Disadvantages are the lack of research to show efficacy as well as studies on long tem effects.
    6. Biotene- Very effective in reducing the dry mouth conditions and can be combined with another antimicrobial for comfort and reduction of bad breath
    7. TriOral-  New rinse popular in the US and works on the principal of active zinc ions changing bacterial metabolic processes from protein degradation to carbohydrate metabolism.  Since carbohydrate metabolism produces odor free by products, there is a substantial relief odor.

    Eating/Drinking Certain Foods:

    Eating foods like celery and carrots can stimulate salivary flow.

    Drinking plenty of water is needed to produce enough saliva.

    Chewing Gum:

    Sugar Free Gum or gum with Xylitol helps generate saliva.  This should only be done for short periods of time as chewing over long periods of time may encourage TMJ problems.

    Successful treatment is usually a combination of good oral hygiene along with the use of an antimicrobial mouthwash.  A problem to watch for is the loss of effect as the bacteria rebound or become resistant to the antimicrobial compound. 

    • What To Do
    • Measure odors
    • Locate Source
    • Analyze Presence of Microbes
    • Assess Nutrition
    • Treat Condition
    • Reassess Treatment

    This is a common problem that is easily eliminated in most cases.

    Causes and Cures:

    Certain foods such as onions and garlic can cause halitosis. Trapped in the lungs, the odor is mixed with the expelled air and may linger for quite some time. A temporary problem which can be improved with mouthwash.

    

Irregular oral hygiene, including absence of daily brushing and flossing will result in bad breath. When food and bacteria remains in the mouth, it decays. This process results in bad breath and can be eliminated with regular daily plaque and food removal.

    

Periodontal disease (gum disease) is a serious bacterial infection in which poisons are released into the gum tissues and bone. This infection results in inflammation which releases odors resulting in bad breath. Treatment of the infection along with regular bacteria removal, both professionally and at home, will help eliminate halitosis of this origin.

    

Xerostomia (dry mouth) which is a reduction of saliva can contribute to halitosis. A reduction in saliva may result from faulty salivary glands, medications, or mouth breathing. This reduces the natural cleansing of odor causing bacteria. Treatment may include frequent water and use of products which stimulate saliva. 


    Regular tobacco use can result in mouth malodor. Smoking results in a greater risk of developing bad breath, gum disease, and more seriously, oral cancer. Cessation of smoking is indicated.

    

Systematic diseases can also cause halitosis. Upper respiratory infections, diabetes, and gastrointestinal disease can all cause bad breath. Treatment may include specific oral care such as: tongue cleaning, use of prescription strength antibacterial, or fluoride mouth rinses.


    WOMEN’S ORAL HEALTH

    There are several ways in which changes to your body can affect your oral health:

    1. Puberty: The surge of hormones during puberty may increase blood circulation in the gums. Your mouth may become more sensitive to irritants such as plaque, and this can lead to gingivitis. Be sure to floss and brush regularly to ensure good oral health. Dental check-ups are also vital at this time.
    2. Menstration: Hormonal fluctuations associated with menstration may cause changes in the gum tissues of some women. These changes cause gums to swell and bleed during the days prior to menstration. You may also experience heightened sensitivity to pain, hot and cold fluctuations and pressure in the mouth during menses.
    3. Oral Contraceptives: If you are taking oral contraceptives, you may be susceptible to the same oral conditions that affect pregnant women. Oral contraceptives contain the hormones progesterone and/or estrogen; therefore, if you take oral contraceptives, you may experience a heightened sensitivity to plaque, which may result in gingivitis. You should advise your dentist if you are taking oral contraceptives as this may affect certain dental treatments.
    4. Menopause and Post-menopause: Oral symptoms experienced during this stage of a women’s life include red or inflamed gums eg. Gums that look dry or shiny, bleed easliy or range in color from abnormally pale to deep red. Other symptoms include: oral pain and discomfort, burning sensations, altered taste sensations (especially in relation to saltly, peppery and/or sour foods) and dry mouth.
    5. Osteoporosis: A number of studies have suggested a link between osteoporosis and bone loss in the jaw. Researchers suggest this may lead to tooth loss because the density of the bone that supports teeth may be decreased. When combined with gum disease, osteoporosis speeds up the process of bone loss around teeth. Studies have also indicated that panoramic x-rays those that show a picture of the upper and lower jaw and upper neck can detect lesions that have significant deposits of calcium within the soft tissues of the neck one of the many risk factors of stroke
    6. Reducing the Risk: Gum disease can be controlled. Regular hygiene appointments based on your periodontal assessment and customized oral hygiene programs appropriate for your needs are recommended to reduce systematic risks associated with gum disease.

    THE DENTURE PROCESS

    Dentures are false teeth that are made to replace teeth for a patient who has lost all of their teeth. If a patient goes with out any teeth in their mouth, there face can look shorter and their facial muscles begin to sag. Speech and mastication (chewing) can also become a challenge for a patient with no teeth.

    We make “Premium” quality dentures here at Harris Family Dentistry, which means they are made of the strongest and most esthetic materials available for denture fabrication. We do not offer “Economy” quality dentures.

    A denture can be made one of two ways. The traditional method is preferable. This is when the patient has had their teeth extracted and has healed for 4-6 weeks before the impressions are taken for the construction of the denture. This method involves having several “try-in” appointments. At these appointments, we take measurements, try in the teeth, and make as many changes necessary, until the patient is satisfied. We will make these changes, as many times as necessary for the patient to be happy before the denture is processed and delivered. With this method, anything can be changed before processing, including the shape, size, color, and placement of the teeth. The only negative aspect to this method is that the patient has to go without teeth for anywhere from 8 to 12 weeks (4 to 6 weeks of healing and 4 to 6 weeks to make the denture).

    Since most people are unable to go without teeth for the amount of time that it takes to make a traditional denture, we also offer “Immediate” dentures. With this method, impressions are made of the mouth, a few weeks before the teeth are extracted. The denture is processed at the lab and sent back to us to be delivered on the same day as the patient’s extractions. The negative aspect to this method is that we are unable to perform any “try-ins”, which means we cannot make any changes to the esthetics of the denture. The shape, size, color and placement of the teeth can not be changed, once the denture has been made. A reline is included in the price of an immediate denture, which we typically do six months to one year after it’s been delivered to the patient. When you have an immediate denture, your gums and bone will shrink over about 6 months to a year. As this happens, the fitting of the denture will become less and less ideal, possibly causing the denture to “rock” or become “loose” in the patient’s mouth. A soft reline is also included in the price of the immediate denture, to help get you through the transition time, while you are healing. The soft reline is rubbery and can tear easily and eventually will deteriorate and can be difficult to clean. It is not durable enough to be used long term.


    SIGNS AND SYMPTOMS OF ORAL CANCER

    • Sore that does not heal
    • White or red patch of tissue
    • Difficulty in swallowing
    • Lump or mass in the mouth or neck
    • Hoarseness that last for a long period
    • Pain or numbness in the oral/facial region
    • Pain in the ear of long duration
    • Change in voice

    SENSITIVITY OF TEETH

    Do you get a pain from hot, cold, eating, sweet, or sour foods, or maybe just by touching your teeth with a toothbrush? Does the pain come and go? It could be due to sensitive teeth. Make sure to tell us if you have this problem.

     

    Cause:

    Studies show the cause of sensitivity is when the dentin of the tooth is exposed. Dentin is in the porous part of the tooth under the enamel. Exposure can happen because:

    • Brushing too hard at the gum line
    • Recession of gums
    • Gum disease
    • Periodontal treatment
    • Fractured or chipped teeth
    • Tooth wear at the gum line
    • Clenching or grinding

    Once the dentin has become exposed, tiny fluid filled tubes that make the dentin porous become exposed too. The tubes are now exposed to the mouth, and connect back to the center of the tooth where the nerve is. Then, hot, cold, touch, sweets, or drinking can cause a pain.

    Treatment:

    We can show you a better brushing technique, and eating habits to help avoid triggering the sensitive spot. We may also suggest an in office treatment that can take some pain away. We may also recommend a sensitivity toothpaste. And in very severe cases, periodontal surgery can be effective.

    Sensitivity toothpaste can block the pain signal from the nerve to the brain or reduce the fluid in the tubes that trigger the nerve. Sensitivity toothpaste works over time – it is not fast acting relief. Once you stop brushing with this, the pain may return.

    Always tell us of any pain or sensitivity you are having. If it is sensitivity, we can help you in many ways so you are able to enjoy many types of food and drink.


    PREGNANCY AND YOUR ORAL HEALTH

    Many hormonal changes occur throughout pregnancy. Estrogen sites are found throughout the tissues and constant hormonal changes combined with increased levels of bacteria and plaque contribute to inflammation, and bleeding known as pregnancy gingivitis.

    Women with moderate to severe periodontal disease are at risk of having pre-term low birth weight babies. Low birth weight babies compared to normal birth weight babies are at greater risk of neurodevelopment, respiratory problems and demonstrate behavioral problems including attention deficient disorder. So controlling your periodontal condition is extremely import to a healthy baby.

     

    If you Plan to become Pregnant

    If you plan to become pregnant be sure to visit our dental office for a check-up and treat any existing oral problems prior to becoming pregnant. Have frequent dental cleanings to help control plaque and bacteria. A healthy diet during pregnancy will help to eliminate any dental problems, substituting healthy food such as fruits, vegetables and dairy for sweets.

    If you are pregnant

    First and foremost, advise the office prior to any treatment that you are pregnant, and of any history of complications during pregnancy. Avoid dental X-rays, antibiotics (especially tetracycline) and pain medications during the first trimester unless it is absolutely necessary!

    Schedule your dental visit during the fourth to sixth month of pregnancy. The first three months is a critical time for fetal development. During your last trimester, dental stress can induce labor and increase the incidence of prenatal complications.

    Teeth and gums need extra attention during pregnancy so brushing and flossing, balanced diet and frequent dental visits will help reduce any dental problems associated with pregnancy.

    Reducing the Risk

    Gum disease can be controlled. Regular hygiene appointments based on your periodontal assessment and customized oral hygiene programs appropriate for your needs are recommended to reduce systematic risks associated with gum disease.


    Overall Health and Your Gums

    Overall Health and Gum Disease:

    Recent studies have linked periodontal disease (gum and bone disease) with several serious health conditions: heart and stroke, respiratory diseases, diabetes, and premature and low birth weight babies. As with smoking, high cholesterol and obesity, gum disease may be a risk factor for these conditions. It is thought that the disease causing bacteria in periodontal disease travels through the blood stream contributing to or possibly causing health problems.

    Most adults have some form of gum disease. A bacterial infection which usually starts in the gums (gingivitis) and if untreated, spreads to the bone (periodontitis). Eventual tooth loss will occur if this disease process is not treated.

    The Heart and Gum Disease:

    Studies suggest that the gum disease causing bacteria may travel through the bloodstream and add to the formation of plaque that clog the arteries. One U.S. study found a higher incidence of heart and stroke disease in patients with moderate to severe gum disease than those with healthy mouths.

    The Lungs and Gum Disease:

    Scientists believe that gum disease may increase the risk of lung infections and worsen existing conditions such as emphysema and bronchitis. This can result when the disease causing bacteria from the oral cavity is inhaled into the lungs.


    Gum Disease

    Periodontal Disease (Gum Disease) is an inflammation and infection of the tissues and bone that support teeth. It is caused by bacteria, which is found in plaque that forms on the teeth. Gum disease affects about 70-75% of adults however, it can occur at any age. Early symptoms often go unnoticed and can lead to tooth loss if not treated. Periodontal disease presents as either gingivitis or periodontitis.

     

    Gingivitis:

    Gingivitis is first stage of gum disease. Infection in the tissue is caused by poison produced from bacteria in plaque. These toxins irritate the gum tissue causing swelling, redness and bleeding. This damage can be reversed if properly treated.

    Periodontitis:

    During this stage of gum disease, the infection breaks down the bone and fibers that surround the teeth. With proper dental and home care, the disease can be controlled but not cured. Most people are not aware that damage is occurring in the bone until the disease has reached an advanced stage. At that time the teeth may loosen, shift or abscess.

    Symptoms of Periodontal Disease:

    Since you can not see that your bone is being destroyed, it is hard for you to see that you have this disease. At the dental office, your gums are examined and assessments are made to determine the health of your mouth.

    Consult your dentist if you notice any of the following symptoms:

    • Red, swollen, and tender gums
    • Bleeding with brushing or flossing
    • Receding gums causing the teeth to look longer
    • Spaces, movement or a change in the way your teeth bite together
    • Pus coming from the tissues surrounding the teeth
    • Bad taste or breath

    Contributing Factors To Gum Disease:

    • Smoking
    • Stress
    • Poor Diet
    • Hormone Changes
    • Poor oral hygiene
    • Irregular/infrequent dental visits
    • Dry mouth
    • Faulty dental restorations
    • Diabetes Mellitus type 1 & 2
    • Hypertension
    • Other systemic diseases

    Can It Be Controlled?

    Periodontal disease can be controlled depending on the progress of the disease and how well the patient takes care of their teeth at home.

    Treatment:

    If treated in the early stages, gum disease can be reversed. Good oral hygiene can help control the bacteria causing the infection. A professional cleaning is also needed to remove mature and calcified deposits from the teeth. Your dentist and hygienist will make recommendations to help control the disease. This may include additional aids to help with daily plaque removal, more frequent professional debridement or referral to a Periodontist (gum specialist).

    Prevention:

    The best way to prevent periodontal disease is good oral health.

    Here are some tips:

    • Brush teeth at least twice a day to remove plaque
    • Floss everyday to remove plaque from between the teeth
    • Eat healthy foods
    • Visit the dentist regularly
    • Drink lots of water
    • Do not drink sodas

    Summary:

    Without treatment, periodontal disease will not cure itself. Generally, this disease, if left untreated, progressively gets worse, and can eventually lead to the loss of teeth and bone structure. Regular examinations and cleanings with a dental professional are vital to your oral health. Make time at home, to take care of your gums and teeth to keep them healthy.


    Diabetes

    What is Diabetes?

    Diabetes is an immune deficiency disease associated with six health complications including periodontal disease as well as effecting areas such as eyes, kidneys, heart, nerves and poor wound healing.

    Type II diabetes or non-insulin dependent diabetes was once thought to be a middle age disease but could present at any age! Diet, exercise and medications can control type II.

     

    Type I or insulin-dependant diabetes affects primarily young people and is caused by the total absence of beta cells. Beta cells secrete insulin; a hormone that is essential in the breakdown of sugars (glucose). The body must be assisted with injections of insulin.

    Did you know?

    2.25 million cases of diabetes have been reported in Canada, 85-90% has type II or non-insulin dependant diabetes. And there are many cases that are undiagnosed!

    How is Diabetes and Gum disease Related?

    Both diseases are controlled NOT cured. Cells require sugar for energy, and in diabetes, insulin is defective and does not allow glucose to enter cells efficiently thus slowing down the healing process or causes cell death if no insulin is provided.

    Uncontrolled diabetes can lead to boneloss, tissue break down and toothloss even when there is little plaque and calculus (tartar). There is a greater risk of more aggressive bacteria causing abscesses and increased periodontal disease. Periodontal disease is associated with heart and circulatory disease. Uncontrolled diabetes is 3 times at risk for heart and circulatory disease, making the patient high risk for periodontal disease.

    Controlled diabetes results in a decrease of oral inflammation. Diabetes should be controlled through proper diet and stable insulin levels. Well-controlled diabetics can have healthier gum tissues than non-diabetic patients due to lower sugar consumption.

    Other complications in the mouth with poor sugar control. (Too much sugar in saliva)

    • Dry mouth – relieved by chewing sugarless gum and lozenges
    • Burning mouth or tongue
    • Yeast infections/Thrush
    • Canker sores/Oral Ulcers
    • Poor taste/smell
    • Pain orally and facially
    • Lichen Planus

    What Can You Do?

    Control your diabetes. Check your blood sugar levels regularly. Wear a medi-alert bracelet. Let us know of any changes in medication and condition. Avoid smoking as it affects the immune response. Brush, floss, tongue debriment, sulk brush, interproximal aids and fluoride treatment for root exposure and visit Harris Family Dentistry frequently, every 3-6 months depending on your needs.

    What can we do?

    We will assess your periodontal condition and advise you of treatment that suits your individual needs. We will gladly educate you on the appropriate tools for your plaque and bacterial control with our informative self-care program.


    XEROSTOMIA

    Saliva Consistency

    Saliva consists of essential proteins, electrolytes, minerals, small organic molecules and water.

     

    Two Types of Saliva:

    Serous – water thin amylase (starch digestion) lipase (fat digestion) easy to replace stimulated by eating, smell, taste produced by the major salivary glands

    Mucous – thick, visous lubricating properties for the tissues difficult to replace causes the most problems when low, especially at rest 0.05 ml/min at rest (sleep, not eating), mostly mucous glands produced by the minor salivary glands

    With xerostomia, the salivary glands (parotid, sublingual and submandibular) produce about 90% of the saliva in the mouth. In a healthy individual, these three pairs of glands make about 3/4 teaspoon of saliva each minute. When chewing, the glands produce about 1 tablespoon per minute.

    Salivary Glands

    Major salivary glands (parotid, sublingual and submandibular) produce about 90% of the saliva in the mouth. In a healthy individual, these pairs of glands make about 3/4 teaspoon of saliva each minute. When chewing, the glands produce about 1 tablespoon per minute.

    What is the Function of Saliva?

    Lubrication: Keeps the mouth and throat moist to aid in chewing and swallowing food, Cleanses the mouth of food particles

    Protection: Limits bacterial, viral and fungal growth, the causes of mouth infections and tooth decay,  Bathes teeth with protective minerals to help prevent cavities, Helps to protect teeth from hot or cold temperatures, Coats soft tissues for phonation and food passage, Maintains ecological balance, Enhances soft tissue repair, Barrier for desication and environmental insults, Maintain neutral pH to maintain tooth integrity (Ca, F ions), pellicle

    Digestion: Breaks down food so in order to enhance taste (bitter, sweet, salty, sour), Through the actions of amylase, lipase, Serous saliva moistens food and solubilizes food for taste perception

    Communication: Keeps mouth moist, which makes speaking easier

    Taste: Facilitates taste, chemicals must be in solution, Alters taste, salivary chemicals influence taste

    What Causes Saliva Loss?

    Radiation Treatments: People who are going through or have completed radiation therapy for head and neck cancer may notice a big change in the amount and quality of saliva in their mouths. That is because radiation often damages healthy tissues that may include the salivary glands. When this happens, the salivary flow decreases. This loss of saliva leads to a condition known as xerostomia or dry mouth.

    Medication: More than 400 commonly prescribed drugs, such as pain relievers, antidepressants, high blood pressure medicines, and sinus and allergy medications can cause dry mouth to occur. These types of drugs interrupt the message the brain sends to the glands to produce more saliva needed. Alcohol, whether it is in mouthwash or beer, can also cause dry mouth and can lead to instant halitosis

    Disease: Decreases in salivary flow can be linked to a variety of diseases, such as Sjogern’s Syndrome which is an autoimmune disease that affects the many glands in the body. Other diseases like diabetes, cardiac failure, edema, dehydration, scleroderma, and graft vs. host disease can also cause saliva loss. Obstructions in salivary gland ducts, i.e. large stone trapped in duct of major salivary gland. Mucocele or sialolitiasis are small blockages and do not contribute to dry mouth.

    Deleterious Oral Sequelae

    As Saliva Levels Decrease, Symptoms of Dry Mouth May Increase: Decrease in Salivary Flow, Dry Mouth, Mucositis (inflamed mouth), Mouth Infection, Weight Loss, Tooth Decay

    As the saliva level drops, harmful bacteria begin to increase and helpful bacteria levels decrease. This decrease may lead to severe complications like mouth pain, difficulty chewing, swallowing and speaking, taste disturbances, weight loss, mouth infections and tooth decay. Other noticeable problems one may experience include a dry, cracked tongue, bleeding gums, cracks at the corners of the mouth, badly fitting dentures and frequent dryness in the eyes, nose, skin and throat.

    Tongue Changes:

    Slight tongue changes may occur at levels of 90% loss of mucous saliva. Some symptoms may be: reddening, deep fissuring, total papillary atrophy, severe lobulation, red/smooth atrophied tongue, loss of fungiform papillae.There also may be an overgrowth of yeast (hyphae) or Candida infection because of the loss of immunoglobulins. This Candida infection can cause median rhomboid glossitis producing red/white patches where the white wipes off leaving the red lesions. Median rhomboid glossitis may be difficult to distinguish between geographic tongue also check for dry/burning mouth to distinguish between the two. Contact lesions can also form on the palate from the tongue.

    Dentures:

    Dentures, in a dry mouth, are very susceptible to yeast infections. This can cause sore, red, denture stomatitis, intraorally, that need to have aggressive treatment to provide some relief. Some treatments include: moisturizing gel, oral balance (placed between the denture and the oral tissues). Extraorally, angular chelitis can also occur.

    Tooth Decay:

    Teeth do not dissolve in saliva when pH is neutral (ca, F ions). However, if there is a decrease in salivary flow, there is a decrease in pH and a decrease in the protective pellicle formation allowing demineralization of tooth structure (seen commonly first around the cervical margin of the tooth). Teeth are more susceptible to excessive and/ or unusual wear patterns. Chipping/fracturing is also common if the teeth are undermined with decay. Recurrent decay can also occur, as well as sensitivity from decay or excessive wear.

    Other Mouth Infections and Lesions:

    Herpetic ulcers, apthous ulcers.

    Sjogerns’s Syndrome Sjogern’s presents challenges both in diagnosis and therapy. It is chronic systemic inflammatory disorder of unknown etiology. Age and sex is not a factor. Common to have sjogern’s with another connective tissue disease such as Rheumatoid Arthritis, Lupus Erythematosus, Scleroderma, Cirrhosis. Symptoms: dry/red eyes (Keratoconjunctivitis Sicca) and other mucous membranes, digestive problems, dry skin, xerostomia (periodontal concerns, decay etc.), tongue changes, angular chelitis, swelling of the parotid gland.

    Dental implications include: dry mouth, difficulty swallowing/eating, candida infections, parotid gland enlargements, gingivitis and periodontitis is accelerated, caries at the cervical margin, root surface and incisal edge.

    Burning Mouth Syndrome

    About 1.3 million American adults, mostly postmenopausal women, are affected with burning mouth syndrome (BMS). There is no consensus on the cause or treatment. However, its onset can be related to a previous dental procedure or illness, upper respiratory infection. Multiple complaints: burning, dryness, taste changes. The spontaneous pain begins by late morning and usually reaches peak intensity by evening, which makes falling asleep difficult yet does not awaken the patient during the night. BMS patients can experience taste disturbances, usually a persistent bitter taste. Eating seems to relieve the pain. Tests to determine the difference between BMS and Xerostomia: check salivary flow rates, visual inspection for lesions, dryness assessment, taste (no decrease in taste buds) function assessment. Treatment: Clorazepam 0.25 mg/day (aform of benzodiazepine)

    Treatment Of Xerostomia

    Mild: artifical saliva (Mouth Kote), moisturizing agents (Biotene and Oral Balance-gel, toothpaste, rinses, denture grip), fluoride/remineralizing agents (Prevident, rinses, varnishes etc.), simple salivary stimulants (gum with Xylitol, sugarless lozenges), Sonicare and a good self care regimen, drinking plenty of water, avoid foods that are dry, spicy or acidic that may have an irritating effect on dry oral tissue, eat a healthy balanced diet, regular oral health care visits to detect and treat.

    Mild-Moderate: same as above, antibacterials (CHX), antifungals (Nystatin), pharmacological salivary stimulants (Salagen or pilocarpine), parasympathetic, cholinergic, salivary glands, git, sweet glands, exocrine glands, 5 mg/d, 10mg, patients feel better after 6-12 weeks, for maximum effect, must use for a minimun of 6 weeks

    Moderate-Severe: same as above, but more aggressive – pilocarpine up to 30mg/d