Few oral health conditions are as underestimated as dry mouth (xerostomia). It is the symptom of a dry mouth, due to a subjective or actual decrease in volume or an alteration in its composition. Dry mouth may be temporary and caused by medications, dehydration or infections (such as mumps). It may also be permanent and is typically due to advanced age, diseases or radiation therapy.

There is a significant difference between having brief, reversible episodes and the ongoing condition of dry mouth. If left untreated, the latter can lead to serious oral conditions.

This is because saliva has an important role in keeping the mouth lubricated, protected and healthy. So when levels decrease the potential for developing oral conditions and diseases significantly rises.

THE FUNCTIONS OF SALIVA

1. WETTING AND LUBRICATING

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• Moistens food to make it easier to chew and swallow
• Enhances taste
• Enhances enjoyment of eating food

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2. PROTECTIVE

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• Is an antimicrobial, lowering the risk of bacterial and fungal infections.
• Lubricates and protects the skin of the mouth.
• Irrigates the oral cavity preventing fungal and bacterial colonies from adhering to oral tissues and tooth structure .
• With a pH of 6.5, saliva has a buffering capacity, maintaining the mouth’s acidity levels at a healthy range.

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3. DIGESTION

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• Contains enzymes to initialize food digestion.

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4. DENTAL PROTECTION

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• Neutralizes acid in food reducing the risk of tooth decay and erosion.
• Contains calcium and phosphates which help re-mineralize teeth, protecting against decay and periodontal disease.

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Causes of Dry Mouth
The most common biological reasons for developing a dry mouth include talking, exercising, mouth-breathing, snoring, and increasing age. It often develops as a consequence of cancer treatment if the head and neck are exposed to radiation treatment. Smoking and dehydration also commonly cause dry mouth. As well, medical conditions including infection of the salivary glands or Sjögren’s syndrome often result in xerostomia.

Most cases of xerostomia however, are due to the side effects of medications. In fact, xerostomia is listed as a potential side effect of over 400 commonly prescribed medications and patients taking three or more medications are likely to suffer from xerostomia. 1

The most commonly used medications that have xerostomia as an adverse effect are:

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• Medications that treat over-active bladders
• Anti-histamines, such as benadryl
• Anti-depressants
• Blood Pressure medications
• Sleeping pills

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The Consequences of Dry Mouth
With the reduced cleansing in the dry mouth, food debris and, bacteria begin to adhere more effectively to teeth and oral soft tissues. As a direct consequence, patients become very susceptible to dental decay. Patients are also susceptible to fungal infections, such as candidiasis.

Other implications include disturbed taste sensation, burning sensations of the skin of the mouth, discomfort in speaking and swallowing, and for patients who wear dentures they have difficulty in managing them and decreased retention of these appliances.

Xerostomia can impact a patient’s quality of life. Since saliva is necessary for digestion, an inadequate amount can make swallowing and speaking difficult, making patients feel self-conscious, embarrassed and anxious. In severe cases, it can even lead to nutritional deficiencies.

 

Management of Xerostomia

Since the term xerostomia can describe both symptoms as well as the condition of reduced salvia flow, therapies for dry mouth are designed to improve one or all of the following areas:

• Alleviating the sensation of dry mouth;
• Replacing or supplementing the missing saliva in the form of artificial saliva; and
• Supplementing some of the natural salivary enzymes.

 

Management of xerostomia in general practice may include treating the following:

A. Infection– Treat the patient’s dental and mucosal infections with antifungals, antibiotics and prescription mouth-rinses. Dentists and hygienists should provide oral hygiene instruction. Decay and periodontal disease must be treated immediately with a more frequent periodontal maintenance schedule and an active preventive dental care regimen.
B. Symptoms – Provide recommendations to reduce the symptoms of dry mouth. These include: moisten foods during meals, drink water more frequently, reduce alcohol consumption, quit smoking, and eliminate caffeine from the diet.
Simple, practical measures can also help. These include: drinking frequent sips of water, sucking ice-chips and chewing sugar free gum to stimulate saliva flow. However, patients should also be advised that sipping water might not be enough to manage xerostomia. This is because water wets surfaces rather than lubricating them, therefore symptom relief may be transient.
C. Medications – If a medication is causing xerostomia as a side effect, dental practitioners can advise patients to consult their physicians about reducing the dosage or eliminating the xerostomic medication in order to relieve their symptoms. Alternatively, a prescription for a sialogogue, such as pilocarpine, may help stimulate the production of saliva if the salivary glands are functional and not damaged by disease.
D. Saliva substitutes and stimulants – These are designed to moisturize and lubricate the mouth, and increase salivary production. They are usually in the form of sugar-free gum, tablets, gels, mouthwashes, or toothpastes. They may contain sorbitol, xylitol, enzymes (e.g. lysozyme and glucose oxidase) and fluoride.

OTHER TIPS FOR EASING DRY MOUTH SYMPTOMS

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• Ensure adequate hydration by frequently sipping water
• Avoid things that dry the mouth such as hard or crunchy food like crackers
• Practice optimal oral homecare (plaque control)
• Use a cool air humidifier (clean daily)
• Chew sugar free gum to stimulate saliva flow
• A six-month recall examination is the standard for the healthy individual. For patients who are at a higher risk of developing oral conditions and diseases, a three-month preventative care and periodontal maintenance program is ideal

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Oral Herpes Simplex Viral (HSV) infections are commonly referred to as “Cold Sores”. The following is an article I had co-written for Canadian continuing education programs for Medical Doctors and Pharmacists.

Viral infections of the oral mucosa are frequently encountered in general practice. The clinical diagnosis of these lesions can sometimes be confusing due to similar clinical presentations as other oral conditions, such as ulcers, blisters, trauma or connective tissue disorders.

There are three types of oral herpetic infections: Acute Primary Herpetic Gingivostomatitis, Herpes Simlex Labialis and Recurrent Intra-Oral Herpes. The clinical presentation, diagnosis and appropriate management of these herpetic infections of the oral mucosa are discussed here.

Acute Primary Herpetic Gingivostomatitis
Approximately 1% of initial oral infections with Herpes Simplex Virus manifests as a very visible and acutely symptomatic primary infection. While this infection usually occurs in children, they also occur in adults . Mild forms look like multiple small punctuate shallow ulcers involving both the keratinizing (dorsal surface of the tongue, hard palate and gums) and non-keratinizing (buccal mucosa, ventral and lateral tongue and vestibule) oral mucosal surfaces. Severe forms may present as large diffuse whitish ulcers that have scalloped borders and erythematous halos. The patient often experiences fever and lymphadenopathy that lasts from 2 to 10 days. The painful ulcers and myalgia make masticating and swallowing difficult. In healthy individuals, these symptoms usually only last 2 to 4 days. However, in an immune-compromised patient an extended period of primary herpetic gingivostomatitis may develop. In these patients, the surface lesions are often larger and deeper than the lesions in healthier patients.

Herpes Simplex Labialis & Recurrent Intra-Oral Herpes
The two clinical types of recurrent oral herpes simplex infections, recurrent herpes labialis and recurrent intraoral herpes, are based on the location of the lesions. Recurrent herpes labialis affects the lips, whereas recurrent intraoral herpes involves the slope of the hard palate or maxillary gingiva. These recurrent lesions are commonly seen after the fragile lips have been manipulated during dental treatment. Lesions on the lips form fluid-filled vesicles that rupture, ulcerate and resolve as crusted brownish lesions. Intraoral lesions differ as they are punctuate with red or white bases. Herpes labialis is the most common form of recurrent herpes simplex infections, and occurs in 15-20% of those who have had a primary infection. As it often occurs following an upper respiratory tract infection, it is frequently referred to as a “cold sore”. The herpes simplex virus remains latent in the trigeminal ganglion but can be reactivated by prolonged exposure to sunlight, trauma and manipulation of the lips, fever, immune-suppression, menstruation, stress and anxiety. Patients often report a prodromal phase of tingling in the area in the days before an oral lesion appears. While patients are often uncomfortable from these infections, they usually do not experience concurrent fevers or lymphadenopathy. However, immune-suppressed patients usually experience larger and deeper lesions and have fevers and lymphadenopathy resembling a primary form of the disease.

When an outbreak starts, it usually goes through these phases:

1. Prodrome—This is often called the “tingle” stage, which is the first warning sign that an outbreak is coming on.
2. Blister—At this stage, swelling develops, with the blister filling with fluid that contains millions of virus particles.
3. Ulcer—At this point, the blister usually ruptures, leaving a painful, reddish ulceration. During this stage the cold sore is most contagious.
4. Scab/Crusting—When the ulcer dries, it leaves a scab or crust. Many find this stage painful because smiling, talking and eating can break the scab open. Severe itching and/or burning is also a problem.
5. Healing—At this stage, the scab starts to come off, leaving some dry flaking and residual swelling.

Patient Behavior

Patients may be uncomfortable talking to their health care professionals about their herpetic viral infections. Alternatively, they may attempt to self-medicate with various products including lip balms and “natural” remedies.

However, they may be more confused than ever, given the new category entrants that promise faster healing but lack sufficient supporting clinical research. Unfortunately, the overabundance of misinformation on the internet related to HSV treatments adds further confusion as the patient has no ability to separate fact from fiction.

Since dental practitioners encounter patients with HSV infections on a routine basis, they should use this opportunity to educate their patients.

Treatment of HSV Infections

Patients should be advised that HSV-1 is self-limiting and lesions will heal without treatment. Since oral herpetic infections can be physically and emotionally distressing to patients, treatment goals should include prevention, palliative measures to help minimize symptoms, and medications that may yield a faster healing process and shorter symptom duration.

Preventive measures must include lowering the risk of trauma to the oral mucosa such as the frequent use sunscreen-containing lip balms. If the manipulation of the lips during dental appointments leads to a manifestation of the infection, the dentist may want to consider prescribing an antiviral medication as a prophylactic.

There are several treatments available to help minimize symptoms. In the prodromal phase antiviral creams, such as Zovirax, can be used. For patients presenting with a lesion, pain control with analgesics and topical anaesthetics and prevention of lesion dryness and cracking with a petroleum-based moisturizer is beneficial. Recurrent herpes labialis and recurrent intraoral HSV infections can be treated with various classes of medications:

1. Over-The-Counter (OTC) Palliative Care Agents — This category of medications relieve symptoms only with no impact on the healing cycle. Examples include topical anesthetics and coating agents (diphenhydramine elixir 12.5mg mixed with kaopectate OTC or Maalox OTC mixed to a 50:50 ratio. Directions are rinse 1tsp for 2min BID and before each meal, and spit out)
2. OTC Cell-Entry Virus Blockers — This class of medications inhibits penetration of viral DNA into healthy oral mucosal cells. They are the only OTC class to have shown a clinically significant positive impact on shortening the healing cycle.
3. Prescription Antivirals — These medications inhibit DNA-polymerase in mucosal cells where viral penetration has already occurred. They shorten the healing period.
4. Healing Patches — These use hydrocolloid technology to form a protective barrier that contains the virus. Not only do they relieve symptoms and have a positive impact on the healing cycle, they also cover herpetic lesions, causing less social embarrassment.
5. Propolis-based NPH products — These indirectly act as an anti-viral agent by interfering with one of the steps of viral replication. They also help prevent the spread of infection through antibacterial and antifungal effects.

Understanding the differences in OTC products is important. Without the proper information, your patients may suffer in silence or use the wrong product, inadvertently prolonging their outbreak. Health practitioners should explain to their patients that OTC treatments such as lip balms may include moisturizers to prevent cracking and analgesics to relieve comfort, but they have not been proven to shorten the healing period.

The sooner treatment begins, the more effective a treatment will be. Unlike prescription products, a clinically proven OTC medication could allow patients to treat their cold sore immediately at the first tingle.

Throughout the course of an individual’s life, teeth are exposed to many physical and chemical insults, which can contribute to their deterioration. As lifestyles have changed through the decades, the amount and frequency of consumption of acidic foods and drinks have increased. Since more people are keeping their teeth longer, erosive wear is becoming increasingly significant in the management of the long-term health of the dentition and the overall well-being of those who suffer its effects.

Dental erosion is the progressive, irreversible loss of tooth structure caused by chemicals such as dietary, gastric, or environmental acids that are placed in prolonged contact with the teeth.

Erosion alters the appearance and anatomy of the tooth and can lead to extreme sensitivity and can compromise the esthetic appeal of one’s smile.

Diagnosing this condition and initiating treatment can be quite challenging to the dental professional. While preventive and restorative treatments have been successful, with significant erosive loss of tooth structure extensive dental treatment may be necessary.

The primary causes of dental erosion include:

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• Diet – acidic fruits, juices, carbonated beverages and sports drinks, herbal teas, vinegars and pickled foods, candies.
• Medications – chewable Vitamin C and Aspirin tablets, iron tonics, and saliva substitutes.
• Occupation – these are the result of the presence of certain atmospheric gases that become mixed with the saliva, producing acidic solutions.
• Sports – swimming in improperly chlorinated commercial pools.
• Overt vomiting or regurgitation of gastric fluids into the mouth.
• Consequences of anatomic defects, such as hiatus hernia, gastroesophageal reflux disease and esophageal diverticulosis.
• Psychological problems such as alcoholism, bulimia and anorexia nervosa.
• Medical conditions such as peptic ulcer and morning sickness during pregnancy.

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Preventive & Restorative Treatment Options

Early recognition, elimination of the causative habit and behaviour modification are the most effective treatments of dental erosion. However, once it has occurred, erosion is irreversible and can only be treated with preventive measures for early erosions and restorations for more advanced lesions.

Preventive measures include eliminating acids and improving the resistance of the teeth to acidic attacks. Using sugar-free chewing gum to increase saliva flow and drinking ample amounts of water for a greater cleansing effect also are beneficial. Fluoride mouth-rinses, gels and varnishes, as well as dental bonding can be applied to reduce hypersensitivity, stop tooth structure softening by dietary acids and encourage the rebuilding of enamel. Restorative treatments, such as fillings and crowns, or referral to specialists may be indicated for extensive tooth loss.

Effective Tips for Preventing Dental Erosion

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• Drink highly acidic drinks with a straw to keep acids away from your teeth.
• Do not swish highly acidic drinks in your mouth, such as colas and juices.
• Use a soft-bristled toothbrush with gentle strokes.

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Piercing the tongue, lip or cheeks has become a popular form of self-expression. People interested in this trend should be aware that it is not without health risks.

Risks Associated with the Procedure

• Infection – When the skin is penetrated for surgical or cosmetic procedures there is always a risk of infection developing, and the potential for infection is higher especially for treatment involving the oral tissues because the mouth is full of bacteria.
• Bleeding – Any procedure that involves piercing the oral tissues may result in prolonged bleeding due to the constant wet environment, which drastically slows the clotting process.
• Swelling – The risk of swelling and delayed healing is especially high for tongue piercing because the tongue is constantly in motion. Since the tongue can swell significantly, there is a risk of airway blockage.
• Nerve Damage – The tongue is filled with nerves that control movement (for speech and chewing) and taste. A piercing can damage these nerves permanently.
• Blood-borne disease transmission – It is no surprise that the process of getting a piercing always carries the risk of being exposed to bacteria, such as those that cause tetanus infections, or viruses, such as those responsible for Hepatitis B, C, and D.
• Endocarditis – The wound created during a piercing provides the opportunity for oral bacteria to enter the bloodstream, where they can easily travel to the heart. For people who have specific heart conditions, the bacteria can potentially cause inflammation and infection of the heart valves or tissues.

Complications Associated with the Jewelry

• Gum and Bone Loss – The risk of gum and bone loss around teeth is a significant concern for those with lip piercings. The fasteners used to hold a piercing in place continually rub and irritate the gums and bone, which always result in a localized thinning of these tissues. With extensive bone loss there is also the potential for tooth loss.
• Tooth Fracture – The risk of fracturing a tooth is always a concern for those with tongue piercings. Accidentally biting down onto the stud can result in chipping or severe fractures of tooth structure, and in some cases the tooth cannot be restored with a filling and would then require extraction and replacement.
• Interference with normal oral function – Oral jewellery can stimulate excessive saliva production, can interfere with the ability to pronounce words clearly, and may cause problems with chewing and swallowing food.
• Interference with oral health evaluation – Jewellery in the mouth can block the transmission of x-ray radiographs. Clear and unobstructed radiographs are essential to a complete oral health evaluation. Jewellery may prevent the x-ray from revealing conditions like cysts, abscesses, or tumours.
• Aspiration and Ingestion – There is always the possibility that the fasteners can loosen and become undone. These components are a choking hazard if they obstruct the airway, and they can lead to injury if they are aspirated into the lungs or ingested into the digestive tract.

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Bad Breath, or halitosis, is a sign that there may be a problem with your oral health.

 

 

Treating it may be as simple as improving your daily oral hygiene or it may indicate the presence of extensive tooth decay, gum disease or another medical problem.

According to dental studies, approximately 85% of people have persistent bad breath caused by dental conditions. Causes include gum disease, cavities, poor oral hygiene, dry mouth, certain health conditions and foods.

 

How to prevent bad breath?

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• visit the dentist regularly for periodontal maintenance and hygiene
• brush your teeth and tongue twice per day
• floss your teeth daily
• Rinse your mouth with non-alcoholic mouthwash
• avoid tobacco
• avoid alcohol and caffeine as they contribute to dry mouth

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Bad breath is a warning sign. Have a dentist take a look at your mouth!

Our office is conveniently located in the heart of Thornhill in Vaughan. In an effort to make dental care easy and convenient for all of our patients, we provide a complete range of specialized treatments, all under one roof. From paediatric dentistry to orthodontics, implants and preventive treatments, we minimize the need for outside referrals. Our office offers appointments throughout the week including evenings, Saturdays and Sundays. Call us today to schedule a free consultation or if you have a dental emergency.

If you wake up with a headache or a sore or stiff neck you may have been clenching or grinding your teeth while you have been sleeping.  Other signs may include sensitive teeth, notches in your teeth near the gums, worn down or chipped teeth.

       

We can fabricate a custom-fit soft appliance that is worn nightly to absorb the painful and damaging forces of grinding or clenching.