Sjögren’s Syndrome with Dry mouth?
Xerostomia from medication?
Sjögren’s Syndrome and medications are a major cause of xerostomia (dry mouth). This post is for patients that are suffering from severe dry mouth. Many of my patients that have dry mouth are over the age of 45 and are on medications that limit their saliva production (partial list of meds). The main medications that I see cause this are anti-depressants/anti-anxiety medication, allergy medication, and/or blood pressure medication. The individuals that suffer the most though are those with Sjögren’s Syndrome, nearly 2% of the population has this condition. Sjögren’s comes with a 44x increased risk of lymphoma. If you have that you don’t need me telling you much about the disease side of it but I think the Sjögren’s Syndrome website is nice.
Major Dental Issues from dry mouth and Sjögren’s Syndrome
- With the loss or decrease of your bodies natural cleaning effects of saliva you are open to all the problems that mouth pathogens bring, the worst for your teeth is decay. The worst part about the decay is that it tends to be along the gum line and often ruins expensive existing dental work like crowns and bridges. Solutions 1-12
- Besides just cavities there is also an increase in gum disease, which over time causes teeth to lose bone and become loose and fall out. Solutions 3-12
- Without the protective coating of saliva some people will get mouth sores more easily also. Solutions 3-14
- Pain inflicted because of the general dryness and cracking of the skin, especially in the corners of your lips. Solutions 3-15
- Difficulty eating and swallowing due to the dryness. Solutions 3-13
- Increase chance of fungal infections, especially in corner of lips. Solutions 3-14
- A burning or itching tongue, many times also related to fungal infection. Solutions 3-14
- Bad breath, resulting from excess bacteria and skin cells not being washed away with the saliva. Solutions 1-14
How can we combat xerostomia issues: Our Solutions to dry mouth!!
- Ask physician about medication like pilocarpine and cevimeline. Doctors that treat Sjögren’s will be the best bet. These have side-effects are not to be taken lightly.
- 5000ppm Fl gel at night and a fluoride tray to wear all night. I have seen better results with fluoride trays than everything else combine for individuals with severe xerostomia and issues with decay. So if you are getting cavities from your severe dry mouth and do just one thing, please get a custom fluoride tray made to wear at night. It is just like a bleaching tray and if you already have one than that will work fine. We supply you with professional strength fluoride gel to place in the tray every night.
- Diet – Avoid frequent sugar intake, especially candy and mints with sugar
- Chew xylitol gum or get the xylitol mints!!! This is also a HUGE deal. This will increase what saliva you are producing due to the chewing motion and also releases small doses of xylitol, which inhibit the bacteria that form cavities. I like to tell patients to leave this in the car console and pop a piece whenever you go somewhere.
- Alcohol free CHX rinse 2-3 times a day. Another prescription. NO ALCOHOL in the mouthwash!!
- Carry a bottle of water in your purse or in your car.
- Teeth should be professionally cleaned, with a fluoride varnish, every 8-12 weeks depending on severity and how many cavities you are getting. Using an electric tooth brush at home is recommended. Get a dentist and hygienist that you like because you will be spending some time with them.
- Use of synthetic saliva replacement products (many listed in this article) like Biotene oral balance or oral lubricants like vitamin E oil. NeutraSal is another similar product. Especially helpful for those wearing dentures or partials.
More xerostomia solutions
- There are prescription drugs to increase saliva production also, but for long term use it would be best to consult your MD or rheumatologist about that. The main ones are Salagen, Evoxac, and bethanechol. Like all drugs these have side-effects of their own, but the last two should have fewer side effects. A new 1% malic acid spray should be available soon.
- Sleep with a humidifier running
- Try to breath through your nose as much as possible. No mouth breathing.
- Take mutli-vitamin, eat lots omega-3, drink tea for the polyphenols, and increase low fat dairy products.
- Avoid tobacco, alcohol, and caffeine.
- Diet – Eat a soft bland diet; avoiding hot (temperature), acidic, spicy, course, and dry foods.
- Anti-fungals if fungal infection starts, usually in the dry mouth this looks bright red and is painful. Often either in the corner of the lips or on the tongue.
- Vitamin E oil containing balm for lips
Mouth sores or generalized mouth soreness from a dry mouth or Sjögren’s Syndrome??
- Individuals with sores should avoid tobacco, alcohol, and caffeine.
- Eat a soft bland diet; avoiding hot (temperature), acidic, spicy, course, and dry foods.
- Fungal infections often occur on top of the mucositis and will require taking both oral and topical antifungal medication.
- Finally a “Magic Mouthwash” or mucositis cocktail can be used. These are made by specially trained pharmacists. Different pharmacists use different drugs, but almost all have a combination of an anesthetic to numb the mouth, a coating agent to soothe the tissue, an antifungal, and occasionally a topical steroid. Caphosol is another rinse that is used. We often use Rincinol and have had patients say they prefer this to the Magic Mouthwash. OraMagic RX is similar.
If your dry mouth is the results of chemo check here.
Good Luck and stay positive! If there is ever anything we can do to help ease your pain and suffering please let us know.
Bryan Bauer, DDS, FAGD