Updated August 04, 2006

Disease, Treatment, and Oral Health

by Shirley Gutkowski, R.D.H., B.S.D.H.

Many people associate tooth decay and periodontal disease with too much candy and not enough brushing and flossing. If only it were that simple. While it’s true that food and personal oral hygiene have a role in oral health, there are many other things that can affect the health of the mouth, including medical conditions such as diabetes and, perhaps ironically, some medicines and medical therapies. This article describes some of the more common oral side effects of medical conditions, medicines, and treatments and what you can do to either head off such side effects or keep your mouth healthy and comfortable in spite of them.

Dryness
A common side effect of many prescription medicines is xerostomia, or dry mouth. Hundreds of drugs can cause dry mouth, although some are much more likely to than others. Drugs that commonly cause oral dryness include antihistamines, antidepressants (particularly the class known as tricyclic antidepressants), and medicines for high blood pressure. Other possible causes of dry mouth include prolonged high blood glucose, the medical condition Sjögren syndrome, radiation therapy (discussed later in this article), neurological disorders such as Parkinson disease, and dehydration.

Dry mouth is not just uncomfortable, but it can also make food taste funny, affect your ability to speak, and interfere with denture fit, leading to chafing and irritation where the denture touches the mouth tissues. Dry mouth also raises the risk of tooth decay, periodontal disease, and other oral infections, because the lack of saliva allows harmful bacteria to proliferate in the mouth.

Given the discomfort and possible consequences of dry mouth, it’s worth bringing this symptom to your doctor’s attention to determine the cause and whether anything can be done about it. There are also steps you can take on your own to keep your mouth moister and more comfortable and lower your risk of oral health problems. The following may help:

• Sip plain water throughout the day. Tap water is preferable to bottled water since it contains fluoride, which helps prevent against tooth decay.
• Experiment with dry mouth products such as saliva replacements or oral lubricating gel.
• Suck on ice chips or mints sweetened with xylitol, a type of low-carbohydrate sweetener known as a sugar alcohol that has been shown to help prevent cavities when used regularly.
• Choose foods that are moist and soft over foods with rough textures.
• Practice scrupulous oral hygiene: Brush your teeth with a soft toothbrush after meals and use a tongue scraper and floss at least once a day.
• Don’t use mouthwashes that contain alcohol.
• Avoid tobacco and alcohol. Both are drying to the mouth tissues.

Yeast infections
Yeast, or Candida albicans, is present in many people’s mouths, but its growth is normally held in check by “good” bacteria. A yeast infection, or uncontrolled growth, occurs when there is a change in mouth chemistry. Such a change can be the result of uncontrolled diabetes, infection with HIV, dry mouth (from any cause), or use of antibiotics, chemotherapy, or drugs that suppress the immune system. Pregnancy, use of birth control pills, and ill-fitting dentures have also been associated with oral yeast infections.

An oral yeast infection, sometimes called oral candidiasis or oral thrush, typically causes whitish or yellowish spots or a film in the mouth. If these spots are brushed or scraped off, they reveal bright red, tender tissue that may bleed slightly. A yeast infection may also be located in the corners of the mouth. It may cause the mouth to feel dry and may or may not be painful. If it is painful, it can be very difficult to maintain normal oral hygiene routines.

Treatment of an oral yeast infection generally requires antifungal medicine and correction of the underlying cause, if possible. In the case of diabetes, that means taking steps to bring blood sugar levels into target range. (Lowering blood sugar should also lower the amount of glucose in the saliva and effectively cut off the yeast’s food supply.) Antifungal medicine may be taken in the form of lozenges that are sucked or a liquid that is swished in the mouth then swallowed. Denture wearers may be instructed to remove their dentures at night and soak them in a cleansing solution overnight.

Shirley Gutkowski is a dental hygienist in private practice in southern Wisconsin. She writes a monthly column for the “Patients’ Corner” of www.dentistry.com, and she speaks to diabetes support groups throughout Wisconsin.

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