Dry Mouth Treatment (Xerostomia)
and Aggressive Cavities (Decay)

Note:

• Saliva washes acid from plaque/bacteria off the teeth. Saliva also buffers (neutralizes) these acids.
• Calcium and phosphate salts in saliva remineralize (rebuild) the tooth enamel.
• Too little saliva results in extreme decay (cavities) and severe periodontial (gum) disease.
• Fluoride helps saliva protect enamel; it builds stronger (more acid-resistant) enamel and inhibits bacteria.
• Age, medications, and conditions like diabetes may cause decreased salivation and dry mouth (xerostomia).
• Age, dry mouth, and acidic drinks (eg. sodas) can initiate root decay and tooth loss.

1. Practice meticulous homecare – Brush, Floss, Fluoride use + Tongue scraper!! Floss, then brush (not too forcefully), starting at a different position in the mouth (teeth) each time. Thoroughly clean/scrape the tongue as far back as possible. Have 3-month cleanings; ideally Peridex (chlorhexidine) rinse for 30 seconds twice daily for two weeks prior to each 3-month cleaning.
2. Use high-level fluoride toothpaste + fluoride rinse. Spit out; do not rinse. Most effective: Mouth trays with fluoride gel – 4 minutes per day. (Use while showering, dressing or some other regular daily activity) – spit out; do not rinse. 3-month fluoride varnish treatments are beneficial.

3. Use MI paste to remineralize the teeth: Brush the teeth with MI paste; do not rinse or spit. Place trays on teeth for five minutes: Remove trays and spit: Do not rinse. Alternate high-level fluoride therapy for 1 month, then MI paste for 1 month. Spit out; do not rinse. Alternate 1 month of each ongoingly.
   Do not use MI paste if dairy-allergic.
4. Drink plenty of water (large container sipped throughout the day) and/or suck on ice chips.
5. Use sugarless gum, candies, snacks with Xylitol (no citric acid) to stimulate saliva and inhibit oral bacteria. Chew Xylitol based gum (eg. Biotene) 5 times daily.
6. Salivary substitutes – Rinse/swish frequently: (Salivart, Xerolube, Biotene, Oasis, etc.)
   Salivary substitutes – small spray bottle: Spray frequently daily.
   Biotene and Oasis have good lines of rinse, oral gel, and xylitol-based gum.
7. Use a powered toothbrush to keep mouth cleaner; eg. Sonicare, Oral B or Ultreo.
8. Use of Salistat tablets or other xylitol-based tablets – as needed, to stimulate salivary flow.
9. Avoid carbonated drinks (sodas) and sports/energy drinks. All such drinks are extremely acidic and damaging. (Acidity is measured by pH: lower is more acidic: a pH of 6.5 dissolves dentin (root); a pH of 5.5 dissolves enamel. Carbonated drinks (sodas), Gatorade, and Red Bull have a pH of 3+: very damaging!) Drink sodas quickly: never sip slowly. Fruit juices must be calcium-fortified to minimize tooth damage.
10. Limit snacks (especially carbs and sugars) to 3 times daily and avoid these (#9) drinks. After snacks and drinks, rinse with water; if the drinks/snacks are acidic, rinse with an antacid liquid, do not brush the now–weakened enamel. Wait 1 hour to brush, gently, always beginning the tooth brushing in a different location.
11. Use an anti-microbial (germ-killing) rinse (Peridex-type vs. Crest Pro-Health Rinse) 2-3 X daily.
12. Be aware of your medications causing dry mouth. Ask your doctor about changing to a similar medication with fewer dry-mouth effects and/or Cevimeline or a similar medication to stimulate saliva production.
13. Know that this may be a long-term problem, requiring a long-term commitment on your part.