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

CURE invited Dennis M. Abbott, DDS, founder and CEO of Dental Oncology

Professionals 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 my

mouth. It's been so bad that I've had to get a drink of water to get it unstuck!"
- B.D., Mesquite, TX

Dry mouth. Xerostomia. Hyposalivation. Cotton mouth. Call it what you will...but very

few people really understand what a severely dry mouth is all about better than

someone 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 human

produces about one liter of saliva per day. Saliva functions as a protector of the oral

cavity. It keeps the tissue moist. It neutralizes the acidic by-products of intraoral

bacteria. It begins the digestion process, by moistening what we eat and breaking down

starchy foods. It lubricates the moving parts of the mouth allowing us to smile and

speak. 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 pills

and 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, they

can be devastating. Some may even become emotionally depressed after not being

able to carry on with what had previously been daily routine activities such as eating

and tasting food.

From a dental health perspective, severe dry mouth can be very damaging to the teeth

and increase the risk of intraoral infections. Teeth in a dry mouth are especially

susceptible to decay at the gum line. A cavity at this location can be especially

problematic 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 an

increased risk for intraoral bacterial, viral or fungal infections that can become a

systemic health problem if the patient has mouth sores, as in mucositis.

The solution comes by first identifying the problem. Like many areas in medicine, there

are several ways to manage dry mouth. A dental oncologist, a dentist that specializes in

oral medicine as it relates to cancer care, can help decide which is right. Treatment can

range from systemic medication to mouth rinses or topically applied intraoral gels. A

neutral rinse can be made by combining 1/4 teaspoon salt, 1/4 teaspoon baking soda

and 1 quart water. This simple mouth rinse can be used to moisturize the mouth by

following the directions to swish and spit. Again, a dental oncologist can determine

which method of management is best for you.

Fluoride is an essential element for management of dry mouth. Carrier trays for

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