How to Improve Caries Control in Patients With Dry Mouth

Dry mouth is a problem for both the patient and the dentist. There is the uncomfortable feeling for the patient, but more importantly, there is the risk of dental caries that ruins good teeth and previous dental work. The causes of dry mouth could be anything from aging to medications to radiation treatment, most of which cannot be changed.

Fortunately, there are strategies that can minimize the effects of dry mouth and resultant dental decay that have been helpful in some populations. Finding the right option for each case is a matter of trial and error in treating the symptoms and sequelae of dry mouth, as there is no “one size fits all” solution.

Use Sugarless Lozenges

Many people with dry mouth tend to use lozenges to alleviate the feelings of dryness, which, if not sugarless, will increase their caries risk. There are different sugarless lozenges, some containing pectin (which is best), and some containing menthol, which may be too strong for delicate tissues. However, the taste of many of these sugarless lozenges is very good.

Drink Water Frequently

Drinking water dilutes acids and helps cleans the teeth. It also means patients may have to go to the bathroom more often, though, so some patients avoid this approach.

Considering its popularity and variety, it is important to note that bottled water may not have the ideal amount of fluoride, if any. It all depends on the source of the water. Only certain bottled water, usually for infants, generally has the proper amount of fluoride, so one should check the label.

The pH of bottled water also varies greatly, ranging anywhere from 4 micro motor.7 to 6.5, with some highly flavored water being very acidic. In a compromised patient—one taking several prescription medications or post-radiation who is more susceptible to root caries and dry mouth—even the water pH can matter.

Another option using water and some oils is to have a “mouth spray” bottle to moisten the mouth with a mist.

Brush Before Bedtime

With dry mouth, some patients feel the need to brush in the morning, which is fine. However, the most critical time to brush is just before bedtime, since any bacteria and debris left on the teeth will have a bigger impact at night when saliva production, as well as talking and drinking, is significantly reduced or terminated.

Use Flossing and Brushing Aids

Some patients have limited manual dexterity or are missing teeth, so adequate oral hygiene is difficult to achieve. Large fluffy floss aids can help as well as floss holders and toothpicks. Using a 2×2 gauze to clean spaces as if you were drying your back with a towel or shining your shoes is the most effective method for cleaning teeth adjacent to spaces or where diastemas exist.

Use High-Fluoride Toothpaste

Patients should be advised that high-fluoride toothpaste, both to brush with and in a tray application, is very beneficial. The ADA code for a fluoride gel carrier is D5986, and the code for topical fluoride is D1208. The best tray design is a non-scalloped, no reservoir tray as used in bleaching. Then, the fluoride can be placed in the tray at night. Should I Brush At Work? for more information.

Use Carbamide Peroxide

Another technique for caries control is to elevate the pH in the mouth. A mouth with a basic pH (>7) will build up calculus, but not have caries. A mouth with an acidic pH (<7) will have caries but no calculus.

The caries process is an acidic process, where the dentin gets decay if the pH is below 6.8 and the enamel gets decay if the pH drops below 5.5. This difference in caries pH explains why people with dry mouth tend to have root caries in the dentin, but not smooth surface caries in the enamel: the pH is below 6.8 but above 5.5.

The bleaching material carbamide peroxide (CP) contains urea along with hydrogen peroxide, and the urea in the product will elevate the pH to above 8 within 5 minutes. As a result, another caries control option for patients with dry mouth is to sleep with the tray containing 10% CP, the concentration that is approved for use in the mouth as Generally Recognized as Safe (GRAS) by the Food and Drug Administration.

The 10% CP will remove the plaque, elevate the pH, and even kill some of the bacteria that cause tooth decay. The only bad side effect is that the teeth will turn white from bleaching. So, if the patient has crowns or composites that match the teeth, they may no longer match. However, that compromise may be a lesser problem than the cost and damage of continual root caries and replacement of restorations.

For cancer patients with dry mouth, it is best to avoid the mint flavors of 10% CP, which tend to create a burning sensation. A non-flavored material is best.

There are some over-the-counter 10% CP products, but many are too runny to remain in the tray dental curing light. Usually the bleaching material from the dental office is the best material. The codes for the tray would be the same as the fluoride gel carrier D5986, and the code for other drugs or medicaments is D9630.

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