Steps for good dental hygiene

Know your own oral health needs.

Commit to a daily oral health routine.

Limit snacks high in sugar and eat a balanced diet.

Do not use tobacco in any form.

Visit your dentist regularly for professional cleaning and oral exams. Examine your own mouth regularly.

Replace your toothbrush every three to four months.

Brush your teeth twice a day with an ADA-accepted fluoride toothpaste. Floss daily.

Use antimicrobial or fluoride toothpastes and mouth rinses to reduce risk of gum disease.

 

experiencing symptoms. The ADA recommends the use of visual or numerical analogue scales to assess the severity of dry mouth. These scales aid the practitioner in determining the benefits of the chosen therapy based upon follow-up scores. A thorough medical history should also take place allowing for the identification of any known risk factors, such as medications, medical conditions, diet, lifestyle and oral hygiene habits. Diagnosis continues with an examination of the oral cavity, including the salivary glands, lips, mucosa, tongue, teeth and gums. The final step in the evaluation process is determining salivary gland function through salivary flow measurement, also known as sialometry. This test involves collection of whole saliva under unstimulated and stimulated conditions. Flow rates of 0.1 ml per minute to 0.2 ml per minute for unstimulated saliva and 0.7 ml per minute for stimulated saliva are considered abnormal and diagnostic of xerostomia. ⁴ Rates of less than 0.1 ml per minute of unstimulated saliva are considered diagnostic of Sjögren’s syndrome. ⁵ Since dry mouth is a subjective complaint, most cases will require saliva flow rate measurement as objective evidence. Biopsy of the salivary glands and blood tests related to causative medical conditions might be required in certain cases.

 

TREATMENT

Goals for individuals with dry mouth are aimed at relief of discomfort, prevention and treatment of oral infections and gum disease, and reduction of risk of development of dental caries. Treatment of dry mouth should focus on improving one’s quality of life, such as increased dental appliance wearing time and reduced need to sip liquids when eating or talking. Long-term goals include preventing permanent tooth loss, oral mucosa ulceration and the need for

oral surgery. Management of dry mouth involves lifestyle changes, basic oral care to prevent dental complications, use of salivary stimulants, oral moisturizers or salivary substitutes and pharmacologic stimulants.

 

LIFESTYLE CHANGES

Behavioral modification can help relieve some of the symptoms for patients who are experiencing dry mouth caused by a medication or medical condition. These include sipping water throughout the day, use of ice chips, avoidance of alcohol,

 

Treatment of dry mouth

should focus on improving

one’s quality of life, such as

increased dental appliance

wearing time and reduced

need to sip liquids when

eating or talking

 

smoking cessation, restriction on caffeinated beverages, use of a humidifier in the bedroom at night and avoiding breathing through the mouth during sleep. ^{3, 13, 14} Choosing appropriate foods is also important in the management of dry mouth. Patients should avoid foods that irritate the mouth, such as spicy, salty or acidic foods. Chewing moist foods and such hard-textured foods as carrots, celery, hard breads and meats also can stimulate salivary flow.

In the case of a medication-induced dry mouth, resolution of symptoms may be observed upon discontinuation of the drug. Unfortunately, in many cases the causative drug cannot be discontinued. Pharmacists should, however, discuss alternative medications that may have a lower incidence

TABLE 5

Alcohol content of common mouthwash products

Product

ACT Restoring Anticavity Fluoride Mouthwash, cool splash spearmint

Alcohol content

11%

Biotene Mouthwash with Calcium

0

Cepacol Antibacterial Mouthwash Gold

14

Crest Pro-Health CPC

antigingivitis/antiplaque oral rinse cool wintergreen alcohol-free

0

Listerine Cool Mint Antiseptic Mouthwash

21

Oasis Moisturizing Mouthwash, mild mint

0

Scope Mouthwash, original mint

15

Tom’s of Maine Natural Care Anticavity Fluoride Mouthwash for a dry mouth, lemon lime

0

of dry mouth. A change in the dosing regimen may be helpful. For example, taking a medication that causes dry mouth one hour prior to meals may help because chewing during the meal will stimulate salivary flow. ^{3, 4} If available, liquid or sublingual formulations of a medication may provide easier administration for people suffering from dry mouth than tablets or capsules. Pharmacists should counsel patients on the importance of drinking plenty of water prior to and after taking a tablet or capsule in swallowing of the medication.

 

ORAL HYGIENE

Table 4 reviews appropriate oral hygiene practices that patients should follow. ^14-16 These guidelines do not just apply to those with dry mouth but all patients. However, they are especially important for those at risk of dental complications associated with medical conditions, such as patients with diabetes. Patients should be advised to consult with their dentist or dental hygienist about their individualized oral health care, which products may be more suitable for them and how often to have a professional oral exam. Patients with dry mouth need to focus on preventing dental complications and oral infections. This can be accomplished by following correct toothbrushing and flossing techniques. Using a soft bristled toothbrush, one should brush twice daily with a mildly flavored, low-abrasive, fluoride-con-

taining toothpaste. Fluoride found in toothpastes helps strengthen teeth and is indicated for both preventing and treating tooth decay in individuals 12 years and older. ¹⁷

Toothpaste products containing sodium lauryl sulfate (SLS), a foaming agent, should be avoided in patients with dry mouth as they can be irritating to the mouth. ² Gently flossing or using an interdental cleaner in between the teeth and gum line daily will help to remove bacteria, plaque and food debris not reached with a toothbrush. The benefits of using a fluoride mouth rinse as an adjunct to toothbrushing and flossing should be discussed with a dentist prior to use.

When selecting a mouthwash, patients with dry mouth should real labels carefully. Many commonly available mouthwashes contain alcohol, an ingredient that can be irritating and worsen dry mouth. Individuals with or at risk for dry mouth should take care to avoid mouthwash products containing alcohol (Table 5).

Due to the risk of swallowing the rinse, children under the age of 6 should not use these products. ¹⁷ In addition to visiting the dentist regularly for professional cleanings, patients at risk of developing complications of dry mouth should discuss appropriate brushing and flossing techniques with their dentist or hygienist. Patients should be encouraged to examine their mouth daily for ulcers, tooth decay or white patches on the tongue, cheeks or palate.