X is for Xerostomia

Ever get the feeling that your tongue is stuck to the roof of your mouth and your lip is sticking to your teeth?  These are just a couple of the annoying things we find when our mouths go dry. It may be that you are about to do some public speaking- the most common most stressful situation or that you are just a bit dehydrated. 

Xerostomia is the name given for the description  of a condition which manifests itself  with symptoms including a dry mouth, cough and difficulty in chewing and swallowing. 

 

 

Saliva is your mouths best friend and some of the functions it fulfils are lubrication, digestion, helps you swallow, neutralises acid, contains antibacterials, antivirals, antifungals and the minerals in your saliva help to repair the tooth surface when acid has been present. It is an amazing substance and there can be many dental problems when your saliva rate is reduced. 

There are several medical conditions which can affect our saliva production and Sjogrens syndrome is one of these. It is an auto immune condition and some patients find that they have other auto immune conditions such as rheumatoid arthritis as well. 

Over the last few years we have seen a gradual increase in dry mouth as certain medications reduce the production of saliva some more than other. These include:

Levothyroxine - used to treat thyroid conditions

Bendroflumethiazide - this is a diuretic drug which helps to reduce excess fluid

Furosemide-also diuretic and helps to  improve hypertension

Citalopram - used to treat depression and also some muscle pains

What do we notice?

Apart from asking you directly about your health, there are some signs which tell us if your mouth is dry and these include our dental mirror sticking to the inside of your cheek, frothy saliva with lots of bubbles in it, low flow rate and perhaps even bits of food debris which your saliva would normally have cleared away. 

What can you do about it and what can we do to help.

The most important thing it to have fantastic oral hygiene! Don't give plaque the opportunity to settle on the surfaces of your teeth and we will find the best products and techniques to help you do this. 

Check your diet. You may be more prone to decay so avoid having anything between meals that is sweet or may contain hidden sugars.

Use a high fluoride toothpaste such as Colgate's Duraphat 5000 which can be recommended by your dentist. 

Biotene gel and toothpaste are also very effective against dry mouth. 

Consider using a fluoride mouthwash after lunchtime so it will help repair any acid damage on the surfaces of your teeth more effectively.

Consider using products which contain Xylitol. This is a fantastic product which helps stop plaque building up on your teeth and we can find this in sugar free chewing gum, mouthwashes and lozenges.

We can also apply high fluoride varnish to any vulnerable surfaces on your teeth.

There are several great  artificial saliva replacement products for dry mouth on the market and they include Salivary Orthana which can be prescribed and comes in the form of an oral spray, which is a pump  dispenser, mouthwash and lozenges.  

Keep well hydrated!  but aim for longer drinks of water as you want to keep what saliva there is in the mouth- dont drink it away!

Let our Absolute team know if you feel that your mouth is dry so we can help!!

Whcih toothpaste should I use?!

There are so many toothpastes on the market surely they can’t be that different?

I thought I’d give you a brief run down on the most popular paste from well-known brands, but if you have any questions about your toothpaste just ask one of the team and I’m sure we can help!

Oral B Pro Expert – all around protection, marketed as 5 specialist toothpastes in one tube to protect enamel, gums, sensitivity, tartar, whitening.

This paste is unique in its flavour and more of a gel that a paste, it has polishing “active clean crystals” and boasts an antibacterial fluoride.

Most patients (and my husband!) says it leaves his teeth feeling really clean, different from many on the market, it has a different texture and taste, my husband says it makes his teeth really clean!

Colgate Sensitive Pro Relief  has Pro-Argin™ Technology which is an insoluble calcium compound and also has 1450ppm fluoride. Marketed has giving instant relief to sensitive teeth when rubbed directly to sensitive areas.  Also with daily use it claims significant relief from sensitivity compared to other pastes.

This is my favourite and find it really helps with sensitivity but like all sensitive pastes if you stop using it the sensitivity will return, but remember to get the most benefit spit out the excess paste after brushing don’t rinse with water or mouthwash

Colgate Maximum Cavity Protection plus Sugar Acid Neutraliser

Fluoride helps by promoting remineralisation and decreasing demineralisation.  Sugar Acid Neutralise Technology creates a healthy environment that allows fluoride to effectively help remineralise the tooth enamel it also has 1450ppm fluoride.  It doesn’t mean that you can have more sugar in your diet though!

 

Sensodyne Repair & Protect

Sensodyne Repair & Protect contains patented NovaMin® technology, which seeks out and forms a tooth-like layer over vulnerable areas of the tooth where dentine is exposed. Use twice a day, every day, to continuously help repair, strengthen and protect your teeth from sensitivity.

Contains 1450ppm fluoride.

Sensodyne pronamel

This is a great paste for those with a more acidic diet, or people suffering with acid reflux, or regular sickness (morning sickness).

It is designed to help protect against the effects of acid wear.  It helps to re-harden the acid softened enamel, and has a neutral pH, and is a low abrasive with the optimum fluoride content of 1450ppm.

It doesn’t foam a great deal with brushing but this is because it is SLS free.  Also to brush around and spit out and not rinse, and remember not to brush straight after eating or drinking, leave 1 hour.

I hope this has taken some of the mystery out of the choices found in your chemists and supermarkets!

Effects of Medical Conditions on Oral Health

A key part of Absolute's safe dental practice is knowing and understanding  the medical conditions patients will present with, and how these conditions and their medical management may impact on proposed dental treatment. 

 

We know that there are links between plaque bacteria and heart disease, diabetes, obesity, low birthweight babies and kidney disease and this list is not exhaustive. One of the most important aspects of your dental care are not just the conditions themselves but the medication you take for them. This is one of the reasons we ask you to help us keep up to date with any conditions or changes in medication as this could play a significant part in your oral health.

 

These following drugs are among the 20 most commonly prescribed drugs in 2013. Do you recognise any that you are taking? Were you aware of these side effects?

 

1. Simvastatin and Atorvastatin

These are prescribed to reduce serum cholesterol and this reflects the fact that many patients through diet and lack of exercise  are at risk of atheroma and narrowing of the arteries can occur. These drugs can react with some anti fungals and complications of the need for statins can manifest as stroke, thrombosis or angina and even myocardial infarction.  The team at Absolute take part in  regular extensive training to familiarise ourselves with the most up to date procedures to keep you safe whilst in our care.

 

2. Levothyroxine

This is given as a replacement for those patients  who either have an underactive thyroid or who have had  a gland removed because of its over-activity. Much of thyroid disease is autoimmune and autoimmune diseases can manifest themselves in multiple sites in a patient e.g rheumatoid arthritis and sjogrens syndrome. This is hugely important to us as Sjogrens syndrome will mean that the patient has a dry mouth and the role of saliva is crucial including  neutralising plaque and food acids, controlling the growth of plaque, lubricating the mouth and helping us swallow. 

 

3. Amlodipine

This is a calcium channel blocker and used to treat hypertension. Its side effects can manifest as an overgrowth of gum tissue which can be particularly fibrous or tough and can make cleaning very challenging and also very  difficult for some dental treatment to be carried out. 

 

4.Citalopram and Amitryptyline

These are both antidepressant drugs but are also used in the management of chronic pain such as bone and joint pain and some facial pain such as trigeminal neuralgia. The principal relationship to dental disease is the reduction in saliva similar to the effects of Levothyroxine but with added complications  of difficulty in cleaning  due to pain. 

 

5. Warfarin

This is an anticoagulant drug which has been around for  many years and it is used on patients who may have had a stroke, Myocardial Infarction, deep vein thrombosis or may have head a heart valve replacement.. The anticoagulant effect of Warfarin is measured using the international normalised ratio or INR. For simple dental procedures  the current guidelines state that this must be 4 or less. It helps us if you can bring your yellow card with your reading on it to your appointment so that we can update our records and keep you safe. 

 

Please tell our Absolute team if there have been any changes to your general health so we can help your oral health.

How do we diagnose if you need a filling?

We encourage regular visits to see our dental team here at Absolute, because we know that not all dental problems or tooth decay give rise to symptoms or pain. In fact the early stages or tooth decay and gum disease are painless, and if picked up early can often be rectified with preventative treatment rather than complex dental treatment.

We check if a filling is needed by visually examining your teeth and sometimes taking x-rays. X-rays allow us to see below the surface of a tooth to check the health of the tooth tissues below.

During a Dental Health Assessment, each tooth is looked at individually and its health recorded. The reason a tooth may not be healthy can be due to tooth decay or a problem with an existing filling. Older fillings can wear over time, they can become broken due to hard biting forces or their seal can begin to "leak" allowing the bacteria that cause tooth decay to extend beyond the margins of the filling.

The most common places for tooth decay to start is in the fissures on the biting surfaces of the teeth, or in the spaces between teeth - where plaque can stagnate and this will allow tooth decay to begin. We check these areas very carefully and record our findings. Some of these areas are more prone to staining, and although this looks suspicious, our diagnosis methods rule out active tooth decay, but we will always keep these areas under observation each time we see you. In some circumstances where an area looks particularly vulnerable, fluoride may be applied or a sealant restoration placed. If the area shows active decay, we discuss with you the available treatment options.

Tooth decay needs to be addressed quickly, and not allowed to progress through the tissues of the teeth as this can lead to more extensive treatment being required to restore the tooth to good health.

As it is the bacteria in plaque that cause tooth decay, it is so important to remove plaque from every surface of every tooth, every day; this includes those surfaces that you can't see, so flossing and Tepeing between all teeth is vital! In this respect, the health of your teeth is in your hands, so we will always encourage you, and ensure you have the right "tools", to keep your teeth and gums as healthy as possible.

If you are concerned that you need a filling, here are some of the symptoms that you might experience:

• Sensitivity: to hot, to cold, to pressure, to sweet things

• Toothache

• A sharp or throbbing pain

• Pain on biting or chewing.

And here are some of the changes that you might be able to see:

• A hole that you can see (dark spot) or a hole that you can feel

• Floss that keeps catching in a particular spot

• Food trapping continually between certain teeth

• A rough tooth

• A broken filling

• Chipped or broken tooth

• Lost filling.

If you have any concerns, or to book an appointment, please call one of the team on 01548 852165 or email info@absolute-dental.co.uk