Dry Mouth
Anyone that has felt anxious or stressed while speaking in public knows that horrible feeling of having a dry mouth. The words stick in the mouth, and you look desperately around for a glass of water to sip. This is quite a normal acute anxiety response if you are unused to speaking in public, or under high pressure situations. However, although this type of mouth dryness is temporary, some people suffer more severe effects of dry mouth.
Dry Mouth (medically known as xerostomia) occurs as a result of a lack of saliva produced in the mouth. Saliva is one of those bodily secretions - it can be more than a litre a day - that is rarely thought about but greatly missed when there is a lack of it. A lack of saliva not only feels unpleasant but can also make swallowing difficult. Saliva is produced by the salivary glands to assist in the chewing and swallowing of food starting the digestive process. It will also establish the correct oral pH inhibiting the harmful effects of micro-flora and helps to protect teeth from decay and prevent infection by assisting in controlling mouth bacteria. With a dry mouth food debris is not cleared easily from the teeth there may be an increase in bacteria, leading to deterioration in oral health with the increased likelihood of extensive tooth decay. When the salivary glands do not work as they should, what can start as a minor aggravation can become a major problem. Eating dry foods becomes increasingly difficult and the taste of food and drink can be affected. Extreme dryness can cause cracked lips, bad breath, mouth sores and sore tongue and gums.
The causes of dry mouth are varied. Some diseases such as uncontrolled diabetes and Sjogren’s syndrome can be the cause of dry mouth. As can acute renal failure, stroke, thyroid dysfunction kidney dialysis and many other conditions. Radiotherapy to the head and neck or chemotherapy can also result in a lack of saliva production in the mouth.
Many different types of medication can cause dry mouth. There are over 400 commonly taken medications that have dry mouth listed as a possible side effect. These include drugs that are prescribed for gastro-intestinal problems, diuretics, some antihypertensives, bronchodilators, antihistamines, trycyclic antidepressants, analgesics, some drugs prescribed for Parkinson’s disease, and some drugs that are prescribed for urinary retention, frequency or the overactive bladder to name but a few.
Those people suffering with an overactive bladder (OB) have a problem with the muscle of the bladder contracting at an inappropriate time. Normally a bladder is controlled by a complex system of reflexes so that it is able to hold an increasing amount of urine (up to 4 -500 mls). During this filling phase a person becomes aware of a first feeling of wanting to empty their bladder but can put this off until the time that they really must go. In those without a problem, they can take themselves to the toilet in time without any leakage of urine. Bladder reflexes prepare the bladder to empty and then turn the storage mechanism of the bladder into an organ that contracts and acts as a pump to empty the urine. At the end of voiding further reflexes restore the bladder to its reservoir function. In the case of OB the signals of wanting to empty the bladder come in the form of a feeling of urgency and great need to empty quickly with often there not being enough time to get to the toilet with a resulting leakage of urine. This can become an increasing problem leading to great embarrassment socially. Bladder training and pelvic floor muscle exercises taught properly can be of great help in assisting in controlling the symptoms.
However, many people need to take medication to help to try and control the bladder contractions. The use of anti-cholinergic drugs, which have been developed to alleviate these bladder contractions, may have a side effect of dry mouth. Many people with OB have in the past put up with a dry mouth in order to keep up with their medication. Others have found the problem too uncomfortable and have been forced to choose between continuing with the medication or keeping their mouth dryness under control. Other medications have been developed with less severe dry mouth side effects, but nonetheless it has remained a problem for many.
So what can be done about it? The usual advice is to sip water, but this wets rather than lubricates. To avoid smoking, excessive alcohol intake, caffeine and foods high in sugar is sensible, and chewing sugar free gum may be helpful. A good oral hygiene routine is important. Regular daily flossing and twice a day brushing are essential together with bi-annual dental check ups.
The above will help in temporarily relieving the effects of dry mouth but may not bring essential lubricating comfort. For a longer lasting alternative to the problem there is a saliva substitute that has been found to be helpful. Biotène have a range of products developed specifically for dry mouth sufferers. It includes Biotene Oralbalance gel that can provide comfort for up to 4 to 5 hours at a time. There is also a non-alcoholic mouthwash that is gentle to sore teeth and gums, a toothpaste that does not contain the detergent Sodium Lauryl Sulphate (a detergent that is found in other toothpastes and can increase dryness), and a sugar free gum that stimulates salivary flow. All the products contain 3 enzymes and a protein that help to boost and maintain anti-bacterial protection and provide moisture to make the mouth feel more comfortable. These products may be of help and be worthwhile for those people that need to take any medication causing dry mouth. You can get the products from your local Lloyds Pharmacy and the gum and toothpaste are available at most branches of Waitrose. For more information on the products you can contact Anglian Pharma Sales & Marketing Ltd., telephone 01438 7403070 or visit the dry mouth information centre at www.drymouth.org.uk
Jeanette Haslam - Physiotherapy specialist in bladder and bowel dysfunction, Alston, Cumbria