Long before toothbrushes, dental floss and oral rinses, evolution created protective mechanisms in the mouth as defense against the bacteria that cause decay. This defense is saliva.
The simplest way to explain the role of saliva is to describe what happens when it is in short supply. A patient may complain that his mouth or throat is dry, rough, sticky or sore. See accompanying article on dental health.
Dentists may hear complaints of “I’m hoarse—it’s so hard to talk,” or “I can’t wear my denture—my mouth is always sore,” or “My tongue is sticking to the roof of my mouth.” Eating may be difficult and, with certain foods, impossible. With too little saliva, a patient may not be able to tell the position of food in the mouth. Patients may complain that fillings are falling out, or that they’ve had an unusual number of new cavities.
Xerostomia (dry mouth) may result from a disease process, treatment of a disease, drug therapy side effects, or a generalized decrease in saliva associated with aging. In Parkinson’s, dry mouth is frequently the side effect of taking an anticholinergic medication (Cogentin, Artane, Akineton or Kemadrin).
It has been found that patients with dry mouth are not only more prone to cavities but may have tooth sensitivity. Additionally, the tissues in the mouth may become dry and painful.
These are just a few suggestions to help deal with dry mouth. Discuss these suggestions with your dentist, who can help you implement a program to maintain a healthy smile.
Note: Many people with Parkinson’s complain of an excess of saliva (causing drooling) and believe that Parkinson’s actually causes more saliva to be produced. There is not actually an excess of saliva in Parkinson’s. The cause is a reduction of the times per minute that the person swallows. In Parkinson’s, the involuntary act of swallowing is slowed as well as the number of swallows per minute, allowing more saliva to accumulate.
Medication can cause dry mouth
Some medicines can worsen dry mouth. Examples include:
Antihistamines such as Benedryl
Anticholinergic medicines used for tremor- Artane, Benztropine, Parsitan, Akineton
So why is xerostomia such a big concern? Saliva is part of the initial process of digestion. Prolonged periods of xerostomia can contribute to malnourishment. Secondly, xerostomia can lead to painful chewing, speaking, and swallowing. Patients with painful xerostomia may not chew their food properly, and when you combine this in a person with PD who may already have difficulty swallowing, there is an amplified risk for choking. Improper chewing can also add to malnutrition problems. Finally, saliva helps protect against tooth decay and periodontal (gum) disease. Saliva does this both by neutralizing the destructive acids produced by plaque, and by washing away the sugars on your teeth that can feed the plaque bacteria. Some people with PD who have long standing dry mouth require extensive dental work due to tooth decay caused by xerostomia.
Steps you can try to reduce dry mouth
- Avoid alcohol and tobocco that can dry mouth
- Talk to your doctor about your medicines
Chew gum or sugarless candies
For dry lips, try K-Y Jelly, Surgi- Lube or hydrous lanolin (ask your pharmacist). Avoid vaseline and products make your lips even dryer by pulling water out of the tissues.
Humidifying your sleeping area.
Add Papaine or papya to diet to thin thick secretions
Request a referral to a speech therapist if speech or swallowing is affected
See your dentist at least twice a year
An electric toothbrush improves dental hygiene over a standard toothbrush
substitutes like Xero- Lube, Salivart, Moi-Stir and Orex, or a solution of sodium carboxymethyl cellulose prepared by your pharmacist, can be used as an oral rinse several times a day.
For sensitive teeth, ask your dentist about a topical fluoride gel. Your dentist or his staff can teach you oral hygiene techniques (flossing, water pick, and special brushes) most effective in removing plaque, controlling cavities and keeping gums healthy.
Some people with PD report excellent relief of dry mouth with Myntz or Sqyntz, sorbitol based products available in the candy section of grocery stores. Click here
for more information on products used to improve dry mouth. Always remember that the best defenses against xerostomia and tooth decay are good oral hygiene and regular check-ups with your dentist.
Author: James DeLapp, DDS, This article is reprinted in part with the author’s permission. James DeLapp practices dentistry at the Cottonwood Dental Group in Highlands Ranch, CO.