Salvia: The multi-talent in the oral cavity
Humans have three large salivary glands, each located on both sides of the mouth. In addition, a large number of smaller salivary glands are embedded in the oral mucosa. All of them secrete between approx. 700 and 1000 ml of saliva into the oral cavity every day. The saliva wets the tooth surfaces and mucous membranes with an adherent thin film.
The composition of saliva is complex; the main components are water, organic components such as mucins, proteins, immunoglobulins and inorganic components such as calcium and phosphate.
Salivary flow is subject to large fluctuations during the day; chewing movements and the sensation of taste, even the idea of delicious food, stimulate salivary flow, while it is greatly reduced during the night.
You can't eat without salvia
Saliva performs a lot of important functions in the oral cavity. Chewing or swallowing is hardly possible without the moistening of the mucous membranes by saliva and its rinsing function. Saliva has an antibacterial effect, enzymes contained in it begin to digest food.
The mineral balance of the teeth is maintained and acids are buffered (neutralized). In addition, saliva plays an important role in taste perception.
Dry mouth can significantly reduce the quality of life and increase the risk of many oral diseases
The stimulated salivary flow rate, e.g. during chewing of a chewing gum, is about 1 ml of saliva per minute. Below 0.3 ml of stimulated saliva flow (hyposalivation) per minute is called dry mouth (xerostomia). People affected by this often suffer greatly. The tongue sticks to the roof of the mouth, speaking is difficult, swallowing can become a torture, there is unpleasant bad breath and burning of the mouth and tongue. The spread of bacterial infections in the mouth is favored and the risk of oral fungal infections increases. The lack of a cleaning function and remineralization of the teeth leads to rapidly progressing caries as well as inflammation of the gums, periodontium and oral mucosa. Taste sensation is also very limited, even to the point of misperceptions such as the salty perception of sweet foods (dysgeusia).
The causes of temporary dry mouth can be varied
In the short term, dry mouth can occur as a result of a lack of fluids, mouth breathing, snoring, dry ambient air (e.g. in winter), in connection with flu-like infections or hoarseness. Stress, excitement, nervousness, but also depression and stimulants, especially smoking and alcohol abuse, can lead to dry mouth.
Hormonal changes (pregnancy, menopause, hormone preparations) also correlate not infrequently with a dry mouth. Older people are often affected, but up to 10% of young adults also seem to suffer from dry mouth to a greater or lesser extent.
Dry mouth as a (severe) disease
Persistent dry mouth is not infrequently a consequence of radiation or chemotherapy, a concomitant of a disease of the salivary glands, a consequence of salivary gland tumors or diabetes.
In Sjögren's syndrome, an autoimmune disease, a chronic inflammatory reaction leads to the destruction of the salivary and lacrimal glands. Postmenopausal women in particular can be affected.
Many medications can lead to dry mouth as an undesirable side effect
Last but not least, dry mouth often occurs as a result of medication side effects:
In particular, antihypertensives (blood pressure-lowering drugs), beta blockers, antidepressants, psychotropic drugs, antihistamines (anti-allergic drugs), antiepileptic drugs, drugs for Parkinson's disease, muscle relaxants, painkillers from the opiate group, sedatives and sleeping pills, diuretics (diuretic drugs), but also antiemetics (drugs for nausea, motion sickness) can lead to (greatly) reduced salivation.
Home remedy for dry mouth
The obligatory glass of water on the lectern is supposed to alleviate the dry mouth of the often agitated speaker, facilitate the flow of speech and prevent hoarseness. Otherwise, it also helps to drink enough regularly throughout the day, preferably water or unsweetened tea. In general, food should be chewed intensively. Stimulants such as excessive consumption of coffee or alcohol should be avoided and smoking reduced, better stopped. Salty, spicy and highly seasoned foods should also be avoided.
Especially in winter, care should be taken to ensure that rooms, especially bedrooms, are adequately humidified and regularly ventilated.
Regular chewing of sugar-free chewing gum (e.g. ApaGum) or lozenges (e.g. Xerodent) stimulates the flow of saliva.
Professional help for dry mouth
The special suppleness of the oral mucosa as well as its ability to store water and glide for food is achieved primarily through naturally formed hyaluronic acid in the connective tissue. This natural substance promotes wound healing and inhibits inflammation.
Regular use of high-molecular-weight hyaluronic acid preparations 3-5 times a day, especially sprays containing hyaluronic acid (Cumdente GengiGel® Spray) or mouth rinsing solutions (Cumdente GengiGel® Mouth Rinsing Solution), can significantly improve this ability, especially in dry mouth. The reduced amount of saliva is again bound to the mucosal surface in an increased and more sustainable manner.
Dental and oral care for dry mouth
Healthy teeth require a balanced mineral balance. After each meal, lactic acid formation by plaque bacteria (biofilm) causes demineralization of the tooth surface. Especially calcium and phosphate ions are dissolved out. The buffer systems in saliva slow down this natural process. The minerals from the saliva are then reintegrated into the tooth surface (remineralization). With sufficient saliva, de- and remineralization are in balance. Fluorides also require sufficient saliva to build up the protective calcium fluoride layer on the tooth surface, for example during tooth brushing with a fluoridated toothpaste. Here, too, the calcium comes from saliva. Without saliva, the protective function of the fluoride is thus also considerably limited. Especially in the case of dry mouth, it is therefore necessary to supply the dental minerals such as calcium phosphate and hydroxyapatite with the dental care products. The best way to do this is with a toothpaste that contains hydroxyapatite as well as fluoride (e.g. ApaCare® Remineralizing Toothpaste).
Prevention of caries and periodontitis
Enamel minerals such as hydroxyapatite from ApaCare® toothpaste are deposited on the tooth surface as a further protective layer during tooth brushing, thus reinforcing or proportionally replacing the function of saliva on the tooth surface. If dry mouth persists for a long time, so-called tooth repair pastes should be used in addition to brushing with fluoridated toothpaste containing hydroxylapatite (e.g. ApaCare® Repair). These are highly enriched with tooth minerals such as hydroxyapatite and are applied with a toothbrush or finger after brushing.
In severe cases of dry mouth or after consuming highly acidic meals or drinks, it is advisable to apply these repair pastes (ApaCare® Repair) several times a day or even overnight, for example by means of carrier trays made by the dentist, in order to achieve sufficient remineralization of the tooth surface irrespective of the insufficient saliva flow.
When should a doctor be consulted?
Do not hesitate to consult your general practitioner, ear, nose and throat specialist or dentist if the dry mouth persists over a longer period of time, you have increasing problems with a fluent flow of speech or even swallowing difficulties.
Important indications of general medical causes also exist if not only the mouth is dry, but also regularly the nose or the eyes, taste impairments exist or the salivary glands become palpable or swell.
What else can be done
After a detailed anamnesis (questioning the patient about the state of health, medications, general diseases, course of symptoms, etc.) and thorough examination of the patient with special focus on the oral cavity and salivary glands, the stimulated salivary flow rate is usually determined. If the suspicion is confirmed, further examinations such as laboratory diagnostics, blood tests, a sonography (ultrasound examination) of the salivary glands, endoscopic examinations of the salivary excretory ducts, X-rays, magnetic resonance imaging, scintigraphy, possibly with contrast medium, can be performed to narrow down the cause. In rare cases, a sample is taken from the salivary gland (biopsy). In addition, interdisciplinary diagnostics or therapy may be required, involving hormone specialists, endocrinologists, rheumatologists or psychologists.
Saliva substitutes are often the last resort in very severe cases of dry mouth to form a film on the oral and pharyngeal mucosa to facilitate speaking, eating and swallowing.
Living with dry mouth
Saliva substitutes consist of sodium carboxymethylcellulose (Na-CMC), carboxyethylcellulose (CEC), hydroxyethylcellulose (HEC), animal mucin, flaxseed oil, sorbitol or polyethylene oxide (PEO), among others. Many saliva substitutes also have added enzymes and substances to adjust pH and viscosity. In dentate patients, pH-neutral saliva substitutes containing fluorides and supersaturated with calcium and phosphate should be recommended whenever possible for caries prevention. Butter and wetting the mucous membranes with edible oils are also helpful. Despite all these substances, to date no substitute preparation has been found that can substitute for human saliva. Unfortunately, many forms of dry mouth still cannot be treated in a truly cause-oriented manner, and the affected patient has to live with dry mouth.
Since the relief of the symptoms with the above-mentioned therapeutic approaches is perceived differently in each individual, it is recommended that the affected person tries out different measures to find out which is best for him individually.