Barrie clinical dentistry: dry mouth, acid reflux and your teeth

We’ve written about the dental diagnosis, which identifies the threats to the individual teeth themselves (as opposed to threats to the gums, bite and joints, or to the appearance of the smile).
One of the major risks to teeth is the presence of a dry mouth (xerostomia) or one that has been exposed to a prolonged acidic environment.

In 100% of all dental decay, the cause is acid of some sort.  We’ve written here about what a cavity is, and how it develops.
In a normal oral environment, the surfaces of teeth are not just sitting there unchanged – there is a dynamic process of demineralization (dissolving) and remineralization (what’s the opposite of dissolving – solving?) at a molecular level in response to the acidity or basicity of the surrounding fluid.  Normally, acids dissolve a little bit of teeth, while saliva neutralizes those acids and the minerals found in saliva rebuild what has been lost.  It’s a back-and-forth change that overall results in no net loss of tooth mass when things are going well.  The importance of saliva’s buffering capacity (though the bicarbonate in the saliva) cannot be overstated.

When the balance is tipped in favour of acidity, however, the exposed tooth surfaces become softer, and ultimately collapse to become the classic cavity.  This can happen at a single site, such as an area of food trapping between teeth that does not get flossed out well, or it can be at all tooth surfaces in the entire mouth.  When dry mouth is present, or for some reason there is chronic acidity, all tooth surfaces are at risk.

Causes of Dry Mouth

The causes of dry mouth are many, but the more common reasons behind lack of saliva would include medications (and with people on more and more medications, this is becoming more prevalent), working in dry or hot environments, exposure to head and neck radiation for cancer treatments that damage saliva glands, and systemic diseases such as Sjögren’s syndrome, Systemic Lupus Erythematosis, and rheumatoid arthritis.  (Notably, aging is not a cause of dry mouth).  For some reason, the quantity or possibly the quality of saliva is insufficient to counteract the effects of the acid, and decay can result quickly and aggressively.

Acidic Oral Environments

In an acidic mouth, the saliva may not be problematic – the problem is simply too much acid entering the mouth. This can be due to acid reflux (heartburn) that makes its way into the mouth, bulemia or other causes of frequent vomiting, or just the simple act of consuming acidic beverages (we’re looking at you, soft drink fanatics and oenophiles).

What You Can Do

In both dry mouth and especially acid-exposed mouths, if the problem is not managed aggressively, there is almost no hope for the teeth.  Here are things that one can do:

For dry mouth:

No matter the cause, fluoride fluoride fluoride!  There is no way that there can be too much fluoride exposure to the teeth.  Fluoride works best when exposed to the teeth over longer periods of time, so in addition to using high-fluoride toothpastes, we recommend keeping it in your mouth.  This can be done by brushing your teeth for longer periods, and not rinsing out your mouth after you spit out the toothpaste.

A great new product now available is X-Pur rinse with fluoride and 10% xylitol by OralScience, available at pharmacies by request.

If medication is the cause of your dry mouth, speaking to your physician about acceptable alternatives may yield some good results.

Finally, if you have some sort of systemic disease or some other reason that your mouth cannot produce adequate saliva, there are:
1) rinses – saliva-mimicking rinses are never as good as the real thing, but they can help. Widely available is Biotene rinse, available at pharmacies.
2) medications – ask your physician about medications that can increase saliva flow.  Commonly, pilocarpine can be prescribed if there is some residual salivary gland function.
3) drinking lots of water – the simplest solution; just make sure it is uncarbonated and without things added to it for flavour.  Often those additives are quite acidic.

For acidic oral environments

Management of acidic mouths is targeted at (obviously) the source of the acidity.

Gastric reflux or vomiting that makes its way into the mouth needs to be controlled , often with medication.  Ask your physician for advice.

If the acidity is coming from food and drink, simply ensure that what you are consuming is not bathing your teeth for long periods of time, or frequently throughout the day.  Ask you dentist if you need help identifying those foods.

If the acidity is coming from poor quality saliva or oral hygiene measures, you should definitely see a dentist for advice on management.  This is a tough situation that calls for many different measures to address appropriately.  Your dentist will recommend specific products, home hygiene advice, and dietary counselling, possibly in conjunction with your physician .

If you have dry mouth or are getting cavities but do not know why, please contact us and we can help you get to the bottom of the situation. This does not have to be an exercise in frustration!  Contact us for an opinion; we’d love to be your dentist in Barrie.