Bromhexine

Complaints of a dry, sore or "burning mouth" are common among the elderly, especially women -- sometimes due to the many medications taken. The incidence of xerostomia, to give dry mouth its medical name, is unknown. In recent surveys, 45-60 per cent of the elderly in institutions and 20 per cent of seniors at home complained of occasional xerostomia. Dry mouth can be a mere annoyance, but besides the discomfort it can also cause pain when eating and talking, and may lead to dental decay, periodontal (gum) and denture problems and an increase in fungal (yeast) infections. The condition should never be ignored. Good oral hygiene and brushing teeth three times daily, are a must. Smoking and excess alcohol consumption aggravate the disorder.

Lack of saliva is the main problem

Normally, the salivary glands produce about 500 ml to 1 litre of saliva per day -- vital for preserving and protecting the teeth, gums and oral tissues and to combat infections. Saliva lubricates the mucous membranes (lining tissues) so the mouth feels comfortable; it helps soften food, so you can taste what you eat; it provides the liquid needed for chewing, swallowing and talking; it's an adhesive that helps keep dentures in place; it contains enzymes that begin the process of digestion and antimicrobials that limit bacterial growth. Saliva is also a "buffering agent" that reduces tooth erosion due to acids produced from carbohydrates (starches and sugars), and it also helps "remineralize" teeth with calcium.

Symptoms of dry mouth -- very uncomfortable

* An irritated, sore, dehydrated mouth;

* Difficulty swallowing food;

* Raw, red tongue;

* Flaking or dry, cracked lips;

* Food sticking to teeth or dentures; loose dentures;

* "Fruit burn" (on eating fruit or acidic foods);

* Unexpectedly frequent dental cavities and gum problems

(despite good oral hygiene);

* Recurrent yeast infections (candidiasis).

Diagnosis: Pinpointing the cause

Careful diagnosis by a physician or dentist can help to tell whether dry mouth is due to something that can be reversed, and how much salivary function is left. But identifying the cause can be challenging. Diagnostic procedures include taking a thorough medical history; evaluating eating, drinking and oral hygiene habits; looking for signs of mouth sores, checking the teeth and dental work. Blood and biochemical tests may be done, also perhaps salivary flow measurements. A patch test can be useful to identify an allergy.

Treatment of dry mouth

Management aims to reduce discomfort and prevent mouth infections, tooth decay and gum disease. Frequent dental check-ups and meticulous attention to oral hygiene are a must. Intrinsic therapy tries to stimulate any remaining salivary gland function with saliva-stimulators such as citric acid, bromhexine and pilocarpine. Extrinsic therapy, uses products to relieve the dryness such as sugarless gums, saliva replacements, alcohol-free rinses, special toothpastes and fluoride application.

Management strategies include:

Good dental care with regular visits to the dentist and brushing teeth three times a day for 2-3 minutes.

Frequent sips of water or aerosol water sprays to remedy the discomfort.

Sucking sugarless gums containing sorbitol, xylitol or mannitol, or sugarless citrus (lemon) candy. (Xylitol is thought to inhibit tooth decay.) Since even some sugarless gums or candy might harm teeth, check which to use with a dentist.

Use of rinses, sprays and toothpastes, containing mouth-wetting agents such as citric acid to help keep the mouth moist. Some products, (such as Biotene and Orobalance), also contain antibacterials; chlorhexidine (prescription) rinses have both antifungal and antibacterial properties.

Artificial saliva substitutes that contain thickening agents such as methylcellulose (e.g., in Moistir and Salivart sprays) or mucins, which seem especially effective. Trial and error will show which formulation works best for each person. Unfortunately, saliva substitutes don't stay in the mouth long and need to be used often.

Saliva-stimulators may help to increase flow in those whose salivary glands still work - such as anetholetrithione and bromhexine. Recently approved for use by the U.S. Food and Drug Administration, pilocarpine is especially helpful for radiation-induced dry mouth. Side effects include sweating, flushing, dizziness and increased urine output; it is unsuitable for anyone with asthma.

Fluoride application as a prescription gel or rinse can reduce plaque formation and help remineralize teeth (To maximize usefulness, eating and drinking should be avoided for half an hour after application of some products).

For dry, chapped lips try water-based lubricants (not petroleum jelly products, which worsen the irritation).

For oral candidiasis (yeast infections) antifungal rinses, drops or tablets may be prescribed, such as ketoconazole, nystatin (or clotrimazole); sugar-free antifungal (vaginal) tablets that dissolve in the mouth can be useful. Chlorhexidine (prescription) rinses can help, but may temporarily stain the teeth.

For drug-induced dry mouth, whenever possible, try alternative medications. For example, blood pressure medicines (e.g., clonidine or methyldopa) known to suppress saliva output might be replaced by less drying agents (e.g., beta blockers or calcium-channel blockers).

Dehydrating beverages such as caffeine and alcohol, alcohol-containing rinses and acidic foods (that irritate mucous membranes) are best avoided.

Sugary foods and drink should be kept to a minimum to reduce tooth decay.

For more information, read "The Moisture Seekers," a newsletter of the Sjogren's Syndrome Foundation, Tel. (516) 767-2866; FAX (516) 767-7156; or consult your dentist.

RELATED ARTICLE: Many possible causes of dry mouth

Medications -- a common, but reversible reason for dry mouth. More than 400 drugs list dry mouth as "possible side effect," including:

* sedatives (e.g., barbiturates) * anesthetics

* blood pressure and heart drugs * antihistamines

* diuretics ("water pills") * antidepressants

* antipsychotics (traquillizers);

Radiation therapy for cancer of the head and neck;

Obstruction of salivary glands from injury, mucus plugs stones or certain diseases;

Aging, emotional stress;

Viral infections, such as mumps, that affect the parotid glands (special salivary glands);

Systemic diseases, such as diabetes, anemia, uremia (bladder infection), lupus erythematosus (a skin disorder) and cystic fibrosis;

Sjogren's syndrome (SS) -- an autoimmune disorder in which the body's antibodies attack its own salivary and lacrimal glands -- often causing a dry mouth, dry eyes and dry vagina. SS is sometimes associated with other diseases such as rheumatoid arthritis, scleroderma and lupus erythematosus. It affects about one per 2,500 people, women more than men, usually starting in middle age.

Brush your teeth the right way

Teeth should be brushed for 2-3 minutes at least three times a day, suing a soft toothbrush that's replaced as soon as the bristles begin to fray (usually every 3-4 months). Consult a dentist or dental hygienist about the proper brushing technique. Brushing teeth right after eating removes some food residues, but it is the flouride in toothpaste that really fights caries. Studies show greater benefits in rinsing with a palmful than a cupful of water. (There is no anti-caries benefit in swallowing all the fluoride in toothpaste.) The toothbrush carries fluoride from toothpaste or prescription gel to areas between the teeth (where decay usually starts). Toothbrushing, even without toothpaste, inhibits gingivitis (gum inflammation) if done diligently, with a good technique.

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