When Spit Doesn’t Happen: Dry Mouth Risks and Remedies

Dennis M. Abbott, D.D.S.

“Sometimes my mouth gets so dry that I wake up with my tongue stuck to the roof of my mouth.  It’s been so bad that I’ve had to get a drink of water to get it unstuck!” - B.D., Mesquite, TX

Dry mouth.  Xerostomia.  Hyposalivation.  Cotton mouth.  Call it what you will...but very few people really understand what a severely dry mouth is all about better than someone battling cancer.

Dry mouth is a common unwanted companion for many oncology treatments.  For patients undergoing chemotherapy, xerostomia is a pharmacological side effect of the cytotoxic drugs used to combat the cancer.  In head and neck radiation therapy, hyposalivation is a direct effect of ionizing radiation administration on the salivary glands.  At best, dry mouth is annoying; but in severe cases, the potential effects of xerostomia on teeth and soft tissues of the mouth can be devastating for years.  

The story begins with spit, or saliva.  Under normal conditions, the average human produces about one liter of saliva per day.  Saliva functions as a protector of the oral cavity.  It keeps the tissue moist.  It neutralizes the acidic by-products of intraoral bacteria.  It begins the digestion process, by moistening what we eat and breaking down starchy foods.  It lubricates the moving parts of the mouth allowing us to smile and speak.  In short, saliva is a big deal...and it is greatly missed when it’s gone!

A loss of saliva can lead to a host of problems:  difficulty chewing or swallowing; changes in taste; nutritional compromise; intolerance to oral medications, such as pills and capsules; increased susceptibility to dental decay; higher risk for oral infections; increased likelihood of injury to oral tissues; and an inability to wear dentures or partials.  Often, patients find the consequences of dry mouth annoying; while sometimes, they can be devastating.  Some may even become emotionally depressed after not being able to carry on with what had previously been daily routine activities such as eating and tasting food.

From a dental health perspective, severe dry mouth can be very damaging to the teeth and increase the risk of intraoral infections.  Teeth in a dry mouth are especially susceptible to decay at the gum line.  A cavity at this location can be especially problematic since decay does not have to travel far to infect the center of the tooth, leading to a dental abscess.  Likewise, a patient with diminished saliva has an increased risk for intraoral bacterial, viral, or fungal infections that can become a systemic health problem if the patient has mouth sores, as in mucositis.

The solution comes by first identifying the problem.  Like many areas in medicine, there are several ways to manage dry mouth.  A dental oncologist, a dentist that specializes in oral medicine as it relates to cancer care, can help decide which is right.  Treatment can range from systemic medication to mouth rinses or topically applied intraoral gels.  A neutral rinse can be made by combining 1/4 teaspoon salt, 1/4 teaspoon baking soda and 1 quart water.  This simple mouth rinse can be used to moisturize the mouth by following the directions to swish and spit.  Again, a dental oncologist can determine which method of management is best for you.

Fluoride is an essential element for management of dry mouth.  Carrier trays for localized delivery of fluoride make it possible to get the tooth-strengthening gel right where it needs to be.  Patients with dry mouth must commit to meticulous oral hygiene including brushing and flossing two to three times a day, regular use of prescription-strength fluoride, and professional dental cleanings at least once every three months.  When dental restorations are required, the dentist can even choose a fluoride-containing filling material.

Food choices often change when dry mouth is a factor.  Frequent consumption of highly acidic foods should be avoided as this can be harmful to tooth enamel and increase the risk of decay.  Foods that are high in sugar and sticky foods must also be controlled.  When these foods are enjoyed, a proper dental hygiene regimen should immediately follow to minimize the time these damaging foods have contact with the teeth.

Understanding the risk and seeing dry mouth as more than just an inconvenience is a big part of the battle.  Knowing there are healthcare professionals who understand the struggle and can help manage not only the xerostomia but also the treat any infection or pain that might arise should encourage patients facing dry mouth to ask questions and seek help.  So, when spit doesn’t happen...call your dentist or dental oncologist.

Dennis M. Abbott, D.D.S. is the founder and CEO of Dental Oncology Professionals of North Texas, an oral medicine practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. He holds a Bachelor of Arts in biology from Rice University in Houston, and is an honor graduate of Baylor College of Dentistry. After dental school, Dr. Abbott studied immunology, microbiology, and oral medicine at the School of Dental Medicine, State University of New York at Buffalo. In addition to private practice, he is a member of the dental oncology medical staff at Baylor Charles A. Sammons Cancer Center and Baylor University Medical Center in Dallas. 

Dr. Abbott has most recently conducted studies focusing on bisphosphonate-related osteonecrosis of the jaw and xerostomia in patients with cancer. He is the previous recipient of the Dentist Scientist Award and the National Research Service Award, both granted by the National Institutes of Health. Dr. Abbott has been a visiting faculty lecturer for the University at Buffalo School of Dental Medicine continuing education program and has lectured throughout the United States.