FORT LAUDERDALE, FLA. — The chronic dry mouth that characterizes Sjögren's syndrome can accelerate dental decay in approximately 70% of patients with the disease, Steven J. Kusnick, D.D.S., said at a meeting sponsored by the Sjögren's Syndrome Foundation.
Patients who attempt to manage their dry mouth symptoms with gum or mints should be advised to use products that contain the natural sweetener xylitol instead of looking for ones that are merely sugar free because the latter won't prevent tooth decay, said Dr. Kusnick, a general dentist in private practice in Sunrise, Fla., and a specialist in cosmetic and reconstructive dentistry.
Over-the-counter products that contain xylitol include Smints, a brand of mints that stimulate saliva and have xylitol as the first ingredient, Koolerz gum in any flavor, and Starbucks gum.
Other tips include reminding patients to drink water throughout the day, use lip balm regularly, and avoid smoking and drinking alcohol. While some patients may realize they need to avoid acidic juices, such as orange and grape, many carbonated drinks, including diet sodas, also contain acid and should be avoided.
Two prescription salivary substitute medications—pilocarpine (Salagen) and cevimeline (Evoxac)—can be an effective adjunct to lifestyle modifications, but many patients are deterred by their side effects, which include flushing, sweating, and headaches.
Salivary substitutes can interact poorly with other medications, so physicians should inquire about all medications before prescribing them.
“The earlier we catch a problem, such as a cavity, the easier it is to treat,” so regular checkups are key. Dr. Kusnick also recommends that his Sjögren's patients use a standard, nonwhitening toothpaste. Whitening toothpastes have an ingredient that makes teeth more sensitive, irritates the soft tissues of the mouth, and they don't whiten your teeth that much.
Other rules for basic oral health apply and if patients snack, remind them to rinse their mouths with water afterwards to reduce dryness.
Fluoride varnish can be helpful to prevent decay in high-risk patients, Dr. Kusnick noted. In patients with gumline decay, power toothbrushes can be helpful in getting the fluoride into the gum area.