Caring for your Dry Mouth

In Sjogrens Syndrome production and quality of saliva is markedly reduced causing problems with:
• Dry painful mouth; Burning tongue and gums; Mouth ulcers
• Recurrent Candida infection of mouth and oesophagus.
• Eating Problems/Choking including problems with Taste; Swallowing; Digestion; Acid build-up.
• Rampant tooth decay / difficulties with dentures
• Dry throat/cough/voice problems

There are many helpful products and self care ideas to help alleviate these problems. Understanding the functions of saliva is helpful to understand the problems lack of saliva causes. In this section there is information on Saliva and some useful hints and products for coping with your dry mouth and the problems it causes.   
                                
UNDERSTANDING  SALIVA

Saliva is important for :
• Lubrication and protection of the oral mucosa (i.e. the tissues in the mouth and throat/gums/tongue) preventing infection and ulceration. Oral candida and ulceration is common in Sjogren’s as is a burning painful tongue and gums.
• Taste

• Protection Against Tooth Decay                                
       Saliva prevents decay by:       
       1/ Maintaining the PH (acid/base balance) in the mouth;
       2/ Saliva contains substances which promote; remineralisation of teeth and protect against decay;  
       3/ Washing and cleaning the teeth and mouth, diluting   harmful bacteria and sugars;
       4/ Containing antibodies and proteins  which maintain a healthy balance  of organisms in the mouth so deter the harmful  decay promoting bacteria; harmful  decay promoting bacteria;

• Swallowing of Food – saliva helps form a slippery lump of food for normal swallowing- when saliva is lacking, as in Sjogren’s, food often sticks and causes choking and pain on swallowing

• Neutralising Stomach Acids (reducing acidity) / Aiding Digestion (saliva contains amylase, a digestive enzyme, which helps with initial stages of digestion of food)

USEFUL HINTS FOR COPING WITH DRY MOUTH

• Chew SUGAR-FREE chewing gum – particularly good are chewing gums specifically formulated for dry mouth containing xylitol and other protective ingredients.  Products available in NZ include :  Recaldent gum or Biotene gum.

• Sip water frequently to keep your mouth moist.
Water is pH neutral and contains no sugar so will not damage your teeth.  It is important to avoid drinks which contain sugar or are acidic (low pH) as these will rapidly promote tooth decay.  These drinks include  fizzy drinks, cordials/juices, and alcohol.  Drinks containing caffeine (coffee/tea/coke/energy drinks)  have a tendency to increase dryness of  the mouth and eyes. Tea has the lowest amount of caffeine out of these drinks. 

• Oral moisturising gels containing xylitol are soothing and protective of the oral mucosa and tongue. These are very useful for easing dryness and burning.
   Products available in NZ include: Biotene’s Oralbalance Mouth Moisturizing Gel and GC Dry Mouth Gel.

• Rinse and gargle with mouthwash regularly to rinse out food particles, decrease bacteria and promote healthy teeth. Products available in NZ specifically designed for use in a dry, sensitive mouth include:
  –  Biotene Mouthwash (contains Xylitil and Calcium and four Bio-active enzymes: Lysozyme, Lactoferrin, Glucose Oxidase and Lactoperoxidase:)  and
  –  Oral B Mouthwash (contains antiseptic, glycerine, fluoride). Both are alcohol free So will not sting and burn people with dry mouth.
 
You can mix your own mouth wash:
Mix:   1 teaspoon salt and
         1 teaspoon baking powder
         Dissolved in 1 litre of water.

Try small amount of sesame oil – some people with Sjogrens found this is a useful lubricant and its tasty!

• Mouth Ulcers/burning mouth and gums:
Orabase ointment can be applied to mouth ulcers. This is available in NZ on prescription but has a small part charge if this is not effective try Oracort which is a similar preparation with corticosteroid added. Oracort is fully funded on prescription.

If severe burning/ulceration of the mouth persists despite these measures GELCLAIR is a gel coating available from Australia which is very expensive but has been found to be  very helpful.

• Brush and Floss frequently to prevent tooth decay. Dental Hygiene is very important 

• Regular visits to your  dentist and dental hygienist every 6 months to keep an eye out for decay.  Try to preserve your own teeth at all expense as denture wearers who have dry mouth have difficulty with denture retention-dentures require saliva to create a suction to gums for good fit- some denture glues are helpful but in people with Sjogrens these often do not work very well leading to poor denture fit/discomfort and infection/ulceration of the gums causing difficulty chewing. (Study by David Hays Greenlane Dental Department, Auckland,NZ. 2002)

Dental costs are generally very high in NZ for people with Sjogrens as there is no government subsidy for dental care.

• Replace sugar with xylitol where able.(xylitol destroys bacteria in the mouth helping to prevent decay whereas normal sugar promotes growth of harmful bacteria)

• Use fluoride mouth washes and toothpaste.(Fluoride is proven to protect against tooth decay)

• Dry lips
Use lip balms/moisturisers with sunscreens

• Treat fungal infections- oral candida with Nystatin drops (available fully subsidised on prescription) and if persistent your doctor may need to prescribe oral anti-fungal capsules such as diflucan or sporonox.

• Humidifiers and steam inhalation and sipping warm drinks are useful for dry cough. Avoid air conditioning if possible as this is very drying.

• When eating…
          – Drink Plenty of Fluids to avoid food sticking
          – Eat Moist Food/avoid very dry foods unless you have moist copious amounts of water readily available as dry food may stick in the oesophagus causing pain and choking.

• Pilocarine is a medication that increases saliva and tear production – some people find it very useful. It is fully funded on prescription in NZ.  Try 2.5mls of solution 1mg/1ml Oral Solution (Chemists mix this oral solution from pilocarpine eye drops). There are some conditions where Pilocarpine should be avoided (uncontrolled high blood pressure/heartfailure)