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Dry
Mouth and Diabetes
Frank
Varon, DDS
1 December 2006
We often take our teeth for
granted, but the mouth is the first part of the digestive process. It’s
amazing how what we put into it and what comes out of it can get us in
so much trouble.
Most of us don’t realize that the
health of our mouths affects our diabetes control, and that our diabetes
control affects our oral health.
We should avoid saying “dental
health” and say instead “oral health,” since there is a two-way street
between systemic health and oral health.
Dry Mouth
One of the most common oral health
problems for diabetics is dry mouth or altered salivary flow (or
xerostomia, if you like medical terms). The teeth and muscles in the
mouth, face and jaw chew the food into smaller pieces to facilitate
digestion in the stomach and intestine. The saliva has several
functions. It prevents infection by controlling bacteria in the mouth.
It moistens and cleanses the mouth by neutralizing acids produced by
dental plaque, and it washes away the dead skin cells that accumulate on
the gums, tongue and cheeks. It helps with the digestion, making it
possible to chew, taste and swallow food. Dry mouth occurs when there is
not enough saliva (real or perceived) to keep your mouth moist, which is
important for health, comfort and for speaking. Diagnosis of dry mouth
is difficult due to the subjective nature of this condition.
In most cases, dry mouth is due to
side effects of medications. There are over 500 prescription and
nonprescription medications that have been found to cause dry mouth.
Medications that treat high blood pressure or other heart problems are
used by many patients to manage complications of diabetes. Other drug
groups that cause dry mouth are those used for depression, anxiety and
allergies, as well as diuretics, anti-psychotics, muscle relaxants,
sedatives and anti-inflammatory medications. Caffeinated beverages also
cause dry mouth, and these should be limited.
Precautions
Ask your pharmacist about side
effects of your medications in order to avoid any possible problems. It
is important that diabetes patients drink water frequently while on
these medications, as well as for their general health. Also, be sure to
see your dentist and dental hygienist for an oral examination and dental
prophylaxis at least every six months to minimize or prevent the
development of oral health problems. Optimal oral health will improve
your diabetes control and your quality of life.
Dental Care for Dry Mouth
Patients
The diabetes patient with dry mouth
along with his or her oral health team will have to develop a routine
for optimal oral health. Here are some simple ways to accomplish that
goal:
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Perform oral hygiene at least four times daily, after each meal and
before bedtime
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Rinse and wipe the mouth immediately after meals.
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Brush and rinse removable dental appliances after meals.
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Use only toothpaste with fluoride. Some toothpastes (such as Biotene)
are formulated for dry mouth.
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Keep water handy to moisten the mouth at all times.
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Apply prescription-strength fluoride at bedtime as prescribed.
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Avoid liquids and foods with high sugar content.
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Avoid overly salty foods.
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Limit citrus juices (orange, grapefruit, tomato), as well as diet
sodas.
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Avoid rinses containing alcohol. Several nonalcoholic mouthwashes
are now available on the market.
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Use a lip balm or moisturizer regularly.
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Try salivary substitutes, gels or artificial saliva preparations.
These may relieve discomfort by temporarily wetting the mouth and
replacing some of the saliva constituents.
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In severe cases, use of pilocarpine might be used under a
physician’s care.
The most common reasons for a
dry mouth in a diabetes patient are
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Side effects of medication
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Neuropathy (autonomic)
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Lack of hydration
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Kidney dialysis
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Hyperglycemia
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Mouth breathing
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Smoking
Some clinical signs of dry mouth
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Loss of moisture, glistening of the oral mucosa
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Dryness of the oral membranes
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Irritated corners of the mouth (cheilitis)
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Gingivitis
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Difficulty wearing dentures
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Mucositis
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Mouth sores
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Yeast infection (Candidiasis), especially on the tongue and palate
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Dental cavities: increased prevalence and located in sites generally
not susceptible to decay
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