Denise C. Gay, D.D.S., M.D.S.
Olde Naples Periodontics

The Importance of Saliva

Saliva is a part of our physical experience that we tend not to think much about, although we are constantly aware of it. Medically speak- ing, despite our indi!erence to it, saliva is a very important part of our physiology and plays a critical role in oral health.

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What Is Saliva?

Saliva is produced in the mouth, by three major salivary glands: the parotid, submandibular, and sublingual. In addition, there are several smaller glands that also produce about 10% of the total saliva in the mouth.

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On a daily basis, a healthy person produces from 500 milliliters to 1.5 liters of saliva, which is roughly two to six cups. Salivary production is highest in the afternoon and slows down while sleeping at night. Saliva production is increased with chewing. Saliva is composed primarily of water. In addition it is composed of many helpful substances that assist the body in breaking down food, protecting the teeth, and performing other important functions. 

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How Does Saliva Contribute To Oral Health?

Saliva plays an important role in maintaining healthy teeth and gums and performs several functions. Among other things, saliva:

• Washes away the bacteria that causes cavities, sugars that work with bacteria to create cavities, and the food that provides metabolic support for these germs.

• Contains elements that destroy bacteria.

• Helps digest food particles that support bacteria and cavities.

• Contains protein antibodies that can destroy oral bacteria.

• Calcium and phosphate in the saliva strengthen the enamel of the teeth (remineralization).

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Dry Mouth and Its Implications

The medical term for dry mouth is xerostomia. A lot of things start to go wrong when the glands in the mouth do not produce enough saliva. First of all, a dry mouth is uncomfortable. Without enzymes to break down and mucin to lubricate food, eating, drinking, and swallowing becomes di"cult and sometimes painful. Germs thrive in this dry, pasty environment. The food particles that serve as fuel for bacteria are not washed away and the teeth are not remineralized by the calcium and phosphate present with normal saliva production. As a result, cavities tend to become rampant, and periodontal disease progresses. Periodontal disease has been found to have a negative systemic ef- fect on general health and has been connected to serious diseases such as diabetes, heart disease, stroke, and other conditions. So, dry mouth is more than just an irritation. It is a condition that can become a health issue if not addressed. What Causes Xerostomia? Xerostomia is more prevalent in seniors. However, aging alone is rarely the cause. Dry mouth is a common side e!ect to many medica- tions, and people tend to start taking more medicines as they get old- er, in order to treat the common conditions that come with age. 

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Patients who are undergoing chemotherapy or radiation treatment for cancer, especially head and neck, commonly present with Xerostomia. When all goes well, patients with head and neck cancer can ex- pect to live for many years. Commonly dry mouth can persist long af- ter treatment is complete, along with the complications that result. Not drinking enough water and becoming dehydrated causes dry mouth. Anxiety can also contribute to reduced salivary output. Sleep- ing with an open mouth is another common cause. More rarely, autoimmune damage to the salivary glands can occur, in diseases such as Sjogren’s Syndrome.*

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Bad Habits Contribute

Bad habits such as the abuse of alcohol, smokeless tobacco, ciga- rettes, marijuana, and other drugs can cause damage to the salivary glands and cause xerostomia, as well as cancer.

 

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Primarily, Treatment Involves Rigorous Oral Hygiene and Prevention

If you are undergoing cancer treatment or have the symptoms of xe- rostomia for other reasons, I suggest you make an appointment with your periodontist, along with your primary care physician and ear, nose, and throat specialist. A visit to the periodontist is important to address the high levels of plaque, calculus, cavities, and bone loss that are a common result of long term dry mouth. It’s important to start preventative treatment, if possible, and to address any periodontal disease with appropriate periodontal procedures, as quickly as possible.

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Fluoride treatment is e!ective in adding protection to the enamel of teeth through remineralization and is especially indicated in patients who su!er from dry mouth, regardless of the cause. A periodontist can also discuss your situation with you and give you speci#c instructions on oral hygiene. For patients undergoing cancer treatment, it is important to establish good oral hygiene habits which should include routine exams and cleanings, even after completing cancer treatment. When you have xerostomia, meticulous oral care is critical.

 

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Other Treatment Options

In addition to periodontal procedures and proper hygiene, there are other treatments that can help address dry mouth symptoms. Saliva substitutes, topical agents, saliva stimulating lozenges, and sug- arless gum can provide transient relief of xerostomia. There are over the counter oral moisturizers that can provide relief, such as Opti- moist, Biotene, and Oral Balance.

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For cancer patients, there are other options. Pilocarpine is a stimulant that is known to cause salivary glands to produce more saliva. Please contact your ear, nose, and throat specialist for more information on pilocarpine. Of course, making sure you drink enough water is important. If you have any questions regarding xerostomia or any other oral health issues, please contact our office.

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