Severe General Health Consequences of Dry Mouth
The incidence of dry mouth is on the rise. As the population ages, the use of medication increases as the survival rate increases. A large side effect of medications is a dry mouth. Many respiratory and alimentary conditions can create a dry mouth. Of course, dental problems can lead to dry mouth, as well as social habits.
The mouth cops it from all directions, both internally and externally.
To make matters worse, the state of a dry mouth can exacerbate health conditions and even cause an even drier mouth! Vicious cycle!
A dry mouth leads to saliva to be less watery and more mucus. The mucus makes it harder to swallow and digest food. The thick gluggy mucus interferes with breathing making person cough continuously. This tires the person out.
The surface of the mouth and tongue become very sore and even have a burning sensation which can be unbearable. Any inflammation in the body produces chemicals that is attracted to other areas of the body that are inflamed. Hence the vicious cycle
The normal watery saliva acts like a buffer to neutralise acidity in the mouth and on the teeth. Dry mouth is prone to acid loving bacteria that cause decay and gum problems. The acid environment dissolves the surface of the enamel making it soft and worn easily. Another viscous cycle!
We need to break these viscous cycles.
- Increase saliva flow such as special chewing gum
- Buffer acidity with alkaline water
- Hydrate
- Use a saliva substitute
- Low sugar diet especially sticky forms
- Good oral hygiene
- Regular exam and clean visits and monitoring by the dentist
- Change medications, if possible, to reduce dry mouth side effect
- Clean tongue of any film or coating
Further, I recently had a patient die from a self-induced pneumonia. In other words, the patient inhaled organisms into her lungs. These microbes found themselves in a moist warm environment, the lungs.
Evidence is emerging for oral bacteria being a risk factor for aspiration pneumonia.
Some studies have found a link between the oral microbiome (the collection of all microbes, such as bacteria, fungi, viruses, and their genes), and respiratory diseases. Bacteria from the oral cavity are known to add to the population of the lung microbiome. There is growing evidence that microbial misbalance, such as in periodontitis, contributes to respiratory diseases.
Both periodontitis and respiratory illness are common diseases with COPD amongst the top 10 diseases inducing long term disability. In 2020, COPD was the fifth underlying cause of death in Australia.
Here is a scary number- periodontitis affects 45-50% of the global adult population.
Other factors that can lead to oral microbial imbalance that then affects lungs include tobacco use, diabetes and medicaments shown to decrease saliva flow.
Possible links between periodontitis and respiratory illness:
- Aspiration of oral bacteria exacerbating inflammation in the lungs and vascular cell dysfunction
- Indirect low-grade inflammation generated by periodontitis can lead to cytokines (small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells) impacting pulmonary epithelium.
Specific to COVID-19, studies have determined that the oral epithelium is highly susceptible to viral infection. High salivary viral loads, has been considered to lead to poor outcomes.
Aspiration pneumonia is common in patients with oral dysphagia (impaired swallowing which misdirects regurgitated gastric contents or mouth/back of throat secretions to the lungs. Studies have found increased levels of pathogenic bacteria in the mouth will increase the risk of transfer in susceptible individuals to the respiratory tract and cause aspiration pneumonia.
So, the message is, from my experience, aspiration pneumonia may be preventable, or at least the risk reduced. A healthy mouth, with the care outlined above, will improve the quality of life and improve the outcomes of medical treatment. Please have regular dental examinations and preventive care as it can be life changing.
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Next week
Medical Emergency in the Dental Surgery - Airway Management - Part 1