Archive for August, 2009

Dry Mouth Syndrome May be in Your Future

Thursday, August 27th, 2009

Xerostomia (fittingly pronounced zero-stomia) is a lack or deficiency in your production of saliva, more commonly called dry mouth syndrome (DMS).If you don’t have that condition, it doesn’t sound like such a serious thing, but if you are suffering from it, then suffering is an accurate description. Pain, swelling, difficulty in eating and even swallowing is a relentless curse. Also, if you don’t have xerostomia, this may be your only chance to avoid it, because the recovery rate is extremely low.

There are many factors that can cause or contribute to dry mouth, but let’s get to the heart of the matter and talk about the overwhelming winner, drugs. Illegal drugs certainly will dramatically increase the incidence of DMS, but if you’re using those, dry mouth would be the least of your problems. Typically, however, it is the elderly that have been taking medications for an extended period that suffer from DMS. Not that age is a factor, but the elderly have usually been taking medications the longest and their resistance to side effects is decreased. With expected medical advances, the percentage of the population over the age of 75 has been projected to rise to 12% in 2050, double what it was in 2005, and doubling the incidence of DMS. However, those figures were based on our current health care system. If congress passes their new health rationing bill, neglect will be the order of the day, not medicine, and you can just kiss those elderly people goodbye. Hey wait; you’ll probably be one of them!

Women are also much more likely to develop DMS. There has been very little research done on this subject, but again, we do know that women on the average take more medications than those stubborn men.

Most drugs cause DMS to some extent, but the ones that inhibit parasympathetic nerve impulses have the most effect. Those are classified as anticholinergic drugs, like atropine, and they are commonly used for dizziness, or to reduce spasms in smooth muscles, such as in the bladder, and oops, the salivary glands. Other drugs at the top of the DMS list are antidepressants, sedatives, antihistamines, blood pressure medications, drugs for epilepsy, Parkinson’s disease, and chemotherapy, and even nicotine, caffeine, and alcohol.

Although we have emphasized the role of drugs in xerostomia, there are of course other important considerations, systemic conditions being the most significant. Sjogren’s syndrome is the complete shutdown of salivary (and tear gland) excretions. This syndrome can appear without explanation, or as a secondary symptom of radiation treatment or other systemic problems. Those diseases that can cause DMS are rheumatoid arthritis, lupus, cirrhosis, HIV, depression, thyroiditis, pancreatitis, Down syndrome, kidney disease, anorexia, nutritional deficiency, dehydration, and many others.

Further health complications can then arise due to the lack of saliva. As the condition worsens, oral diseases can increase, going from cracking inside the mouth and on the tongue, to cavities, then gum infection, then pain, swelling, and secondary viral infections, until it becomes extremely difficult even to chew or swallow, resulting in poor nutrition.

In a recent study on xerostomia, Dr. Navazesh and Dr. Kumar developed a questionnaire to help clinicians diagnose dry mouth, which I’m sorry, you can summarize with one question, “Is your mouth usually dry?” They did however, offer a comprehensive protocol to help us determine the possible cause. It’s usually very difficult to reverse this condition, but sometimes discovering underlying causes can enable you to avoid an increase in the severity. For instance, if it is related to a medication, that drug can often be changed, reduced, or discontinued.

Therefore, your best chance to avoid DMS and many other diseases is to avoid drugs of all kinds. Unnecessary drugs, of course, legal and illegal, over-the-counter medications, and recreational drugs can be virtually eliminated. Don’t pop a pill every time you get a little symptom. These things add up over time. Your salivary glands are very fragile, and they’re one of the first things to reflect compromise to your endocrine, digestive, immune and nervous systems, which are the very targets of all drugs. Even with prescriptions, take control of your health. Become as knowledgeable about your medications as your physicians, and be prepared to challenge them about the side effects, interactions, necessity, efficacy, and alternatives. Especially scrutinize prescriptions that are given to possibly prevent conditions. A theoretical benefit is no match for an actual harmful effect.

If you are already getting dry mouth syndrome, besides having a dentist evaluate the possible causes and minimize the oral damages, there are drugs that can counteract those causes and stimulate saliva flow, as well as products to aid in cleansing and comforting. I have a local friend that has battled DMS for years, and has conducted his own trials of these products. His first choice is Optimoist spray by Colgate. It may be discontinued, so if you find it, please let us know. My friend has resigned to using his runner-up choice, which is the Salivasure Lozenge from www.scandinavianformulas.com. If you go the lozenge route, be sure they contain no sugar or even artificial sweeteners. Use Salivasure or Sparx by Xlear, which we carry. It contains Xylitol, which is a natural sweetener that actually prevents decay.

Dr. Moulton’s article was published in the Desert Valley Times on
8-11-09

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Brace Yourself

Thursday, August 27th, 2009

Summer is the season, usually, to start your braces. The kids are more available to drag in to the office at all hours for the initial appointments that are necessary, and they have time to work out a good oral hygiene regimen. They start to develop a real appreciation for the concept of serious plaque. Besides being uncomfortable and inconvenient, braces can pose a serious threat to the health of your gums and teeth. Chronic infections, decay, and discoloration can result from poor maintenance and hygiene.

Our office is certified for Invisalign orthodontic therapy, and if at all possible, I highly recommend Invisalign braces from the standpoint of oral hygiene. Since they are simply clear trays that you wear over your teeth, they can be removed in order to easily and thoroughly clean your teeth. However, they’re not always possible, so many end up with the challenges that braces bring. This article is just as important for the parents, so they might get clued in on what the orthodontist has already told the kids.

To properly care for braces, just remember the computer programmer’s motto, garbage in, garbage out. It’s important to mind what you put into your mouth as well as getting all the plaque out. On the diet side, avoid anything hard, sticky, or chewy. That about says it all, but here’s a partial list to give you an idea: No fingernails, pencils, jaw breakers, jolly ranchers, peanut brittle, lollipops, tic tacs, milk duds, sweet tarts, skittles, starbursts, good and plentys, licorice, dots, beef jerky, chunky peanut butter, hard taco shells, gummi bears, taffy, popcorn, corn chips, pizza crust, nuts, hard gum, ice, corn on the cob, meat on the bone, or carbonated drinks (diet is just as bad as sugared).
To get the garbage out, you must become a fanatic about cleaning your teeth, because I don’t want you to regret it later. I see too many sad kids with gum disease, decay, and decalcification spots from inadequate cleaning. Their teeth are nice and straight, but they’re all blotchy and discolored.

Your primary tool for cleaning is the toothbrush of course, but now you need to use it after every meal and snack, and for four minutes each time so you can get every surface and every bracket. The rotary brushes are OK, but they can’t work the bristles in between the hardware. I don’t usually recommend a Waterpik, but they have an orthodontic tip that is helpful as long as you point it away from the gums. The best brush for braces though, is the Rotadent with the orthodontic tip. Additional hygiene aids are important also. To floss, you will need something to help get the floss under the wires such as plastic floss threaders or special floss with plastic tips like Superfloss. Once the floss is between the teeth, wrap it against one tooth, then the other and then gently against the brackets as you clean back and forth. The Proxabrush is an excellent aid for cleaning around the wires and where the braces contact the teeth. To avoid the pain from having the wires periodically adjusted, get a bite wafer to chew on right away.

If you need any information on where to get any of the things I mentioned, please feel free to call our office at:
(888) 551-3371 toll free
(702) 346-3371

Dr. Moulton’s article was published in the Desert Valley Times, August 2007

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Something We Can Agree On

Friday, August 7th, 2009

On June 22, the government passed the Family Smoking Prevention and Tobacco Control Act. Public health organizations from all sides had nothing but praise for this measure. According to ADA President, Dr. John S. Findley, “Dentists are the first line of defense in the war against cancer and many other tobacco-related diseases. The American Dental Association heartily commends Congress for passing the FSPTC Act.”
Tobacco is responsible for a myriad of diseases, from emphysema, heart disease and severe peripheral artery disease, to lung cancer and probably the most fatal of all, oral cancer. One person dies every hour from oral cancer in the U.S. Other diseases manifested in the mouth, such as gum disease, decay, leukoplakia and diabetes are either aggravated or caused by smoking or chewing tobacco. Dr. Kathleen O’Loughlin, the ADA executive director, was invited to attend the signing of the bill, and had this to say: “The passing of this bill speaks to the power of broad-based support from very different and unique advocacy organizations coming together from different places and perspectives yet united by a common urgent public health issue.”
The mantle of the control of tobacco will now pass to the FDA from the Bureau of Alcohol Tobacco and Firearms, BATF ( I suppose now they will just be the BAF). So what will the FDA do with their new responsibilities? At least for now, they are inviting health agencies and even public opinion to help implement the new laws. It’s nice to see everyone on the same page. Of course, this will mean much higher tobacco taxes. I’m never in favor of higher taxes, but maybe we could just call this one “tough love.”

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