Dry Mouth

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications.  More than 500 medications contribute to oral dryness:  antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.

In its most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same.  Therefore, older adults are a significantly higher risk.

Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other functions that often go unnoticed.

Treatment options are available at our office.  Call for a consultation.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

ADA: Managing Dry Mouth

Xerostomia (dry mouth) is caused by salivary gland reduced function and results in less salivary flow.  It can be caused by chronic disease, medication use, and medical treatment, such as head and neck radiation or chemotherapy treatment.  Chronic dry mouth increases the risk of tooth sensitivity and decay, gum disease, oral fungal infections and detracts from a patient's quality of life.

The ADA recommends a systematic approach to the evaluation, diagnosis, and management of the condition.  This includes patient education, lifestyle changes, palliative measures, and pharmacological treatment with salivary stimulants, topical fluoride tooth treatments and the use of sugar-free chewing gum to relieve symptoms and improve the patient's quality of life.

Source:  JADA, 8/1/2014. vol. 145, no. 8, 867-873

Robert G. Tupac, DDS, FACP, Inc.,
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309

Age-Related Tooth Root Decay

A study comparing the prevalence of decay on tooth root surfaces in two groups--middle-aged adults (aged 45-64 years) and older adults (65 years and older)--shows differences between the two groups.  Middle-aged adults seemed to be prone to this type of decay if they were male, self-reported dry mouth, had exposed roots and increased frequency of eating or drinking between meals.  Older adults did not share the same associations.

Source: JADA, vol. 144, no. 5, 507-516

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Medications and Dry Mouth

Dry mouth (xerostomia) is a condition of reduced or no saliva in your mouth.  Because saliva enhances your ability to taste, aids in digestion and makes it easier to swallow, it affects your enjoyment of food.  In addition, saliva washes away food particles from tooth surfaces and limits the bacterial growth that can cause decay.  Hundreds of medications, including some over the counter drugs, produce dry mouth as a side effect.  They include those used to treat depression, anxiety, and antihistamines.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus Treatment: Oral and Dental Complications

Syndrome of Lupus

All Lupus patients suffer from some sort of oral involvement, and these complications often come about as a side effect of medical treatment. Certain forms of organ involvement carry dental warnings: with kidney involvement, certain antibiotics (tetracycline) or analgesics (aspirin, NSAIDS) adversely affect kidney function. Antibiotics need to be given prior to treatment for those with Liebman-Sacks Endocarditis (a form of heart involvement) or mitral valve prolapse. Nitrous Oxide (laughing gas) is contraindicated for those with lung problems. Caution should be taken with patients with abnormal bleeding. Those with Sjogren's Syndrome usually have severe dry mouth that may result in massive decay, dental infections, yeast infections and gum disease.

Oral Health 

Medications: Anti-convulsants can cause gum atrophy and bleeding. Anti-malarials (plaquenil) can cause intraoral rashes. Immunosuppressive agents (methotrexate) suppress the immune system and may result in bacterial or fungal infections. NSAIDS (advil, motrin, feldene, daypro) can cause oral ulcers. Steroids--prednisone and other corticosteroids increase the likelihood of bacterial and oral fungal infections. Any medications which cause dry mouth put the patient at risk for tooth decay and gum disease.

Lupus patients require frequent dental checkups and periodontal maintenance to optimize their oral health.

Source:  Lupus Guide to Dental Care, HeatherGalusha-Phillips

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Sjogren's Syndrome

Sjogren's Syndrome is a chronic autoimmune disorder in which the glands that produce tears and saliva do not function correctly.  As a result, poor salivary production causes dry mouth and lack of tears causes dry eyes.  When the symptoms become more severe, mouth dryness (xerostomia) may feel like a burning or cracking tongue, may result in an increased rate of dental decay, and difficulty swallowing.  It becomes necessary to sip fluids often both with and between meals.  The parotid glands (major salivary glands behind the jaw) may become swollen and painful.  Eye involvement is the other major manifestation.  The decreased tearing causes redness, itching, photosensitivity and a sandy or gritty feeling in the eyes.  There can also be a decrease in mucous gland secretion of the respiratory and gastrointestinal tracts.  One-third of patients can have symptoms outside the glands, effecting joints, muscles, lungs and kidneys.  Treatment attempts to relieve the effects of chronic dryness of the mouth and eyes by increasing the lubrication and moisturization of the affected tissues.  Artificial tears and saliva substitutes have been used.  Medications are prescribed for extraglandular symptoms.  The overall disease course of Sjogren's syndrome requires regular monitoring by a prosthodontist in conjunction with a physician. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Causes Of Bad Breath Other Than Needing Your Teeth Cleaned

Inflamed gums and tooth decay also produce odor.  Foods that contain oils, like onions and garlic, can cause bad breath.  After these foods are digested and the pungent oils are absorbed into the bloodstream, they're carried to the lungs and are given off while breathing until the foods are eliminated from the body.  Dry mouth, decreased salivary production, occurs during sleep and causes morning breath.  Mouth breathing does the same thing.   

Some medications can cause diminished salivary flow.  Nasal discharge in the back of the throat, from sinus or respiratory infection, is another source of bad breath.  Certain illnesses, some cancers and metabolic disorders can produce chemicals that cause distinctive breath odors.  If you have concerns, see your prosthodontist for an examination and consultation.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

My Broken Crown--How Long Did It Last?

I have a broken crown in my mouth.  One of the dentists in town did it, but it failed after just a few months.  For as much as it cost, I wanted it to last forever. It makes me appreciate the times patients ask: "How long will this last?"  Each meal, let's estimate I chew a bite of food 10 times.  With 20 bites per meal and three meals a day, that's 600 times a day that crown is used, not counting snacks, popcorn, ice, lifesavers, nuts, nibbling on bones, etc.  This is the environment of my mouth: temperature range from 150 ° F (hot coffee) to 30 ° F (ice cream), acid attacks (diet drinks are really bad), bacterial biofilm, clenching or grinding at night and holding a pencil.  So, I suppose my mouth is a tough place for a crown to survive.  Did I mention that many years ago, that tooth broke in the first place and that's why it needed a crown?  Did I mention that the first crown broke after many years and that's why I needed a second one.  What's a realistic estimate for a crown or filling to hold up?  The unsatisfying answer: it depends.  In a person who avoids sweets and sodas, regularly brushes and flosses, doesn't take any medication that causes dry mouth, doesn't grind at night and sees a dentist regularly in an effort to catch problems while they're small, that crown can last up to 15 years.  That's without gum disease or new decay. But regular wear and tear, even in "low risk" patients, will eventually do in any dental work because a prosthesis is never as good as nature. 

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Acupuncture Stimulates Saliva for Head and Neck Cancer Patients

Acupuncture reduces xerostomia (drymouth) in patients receiving radiation therapy for head and neck cancer, according to a study published online in Cancer.  A study of 86 patients with nasopharyngeal carcinoma was divided into two groups, one group receiving usual care and the other usual care plus acupuncture.  Patients responded to questionnaires regarding symptoms of dry mouth.  The researchers also measured unstimulated and stimulated salivary flow.  When questioned, the acupuncture group reported symptoms half as severe as the untreated group both one month and six months after radiotherapy.  Salivary flow rates were also greater in the acupuncture group, starting at week three of radiotherapy and continuing to the one- and six-month follow-up evaluations.  Because lack of saliva can result in increased microbial growth, possible bone infection and irreversible nutritional deficits, the implications of this study are profound in terms of quality of life.  Acupuncture can have a significant impact on improved sleeping, eating and speaking.  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Medication-Caused Dry Mouth (Xerostomia)

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications.  More than 500 medications contribute to oral dryness:  antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.  In the most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same. Therefore, older adults are at significantly higher risk.  "Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other important functions that often go unnoticed," notes Dr. Fares Elias, past president of the AGD.  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Age-Related Tooth Root Decay

 A study comparing the prevalence of decay on tooth root surfaces in two groups--middle-aged adults (aged 45-64 years) and older adults (65 years and older)--shows differences between the two groups.  Middle-aged adults seemed to be prone to this type of decay if they were male, self-reported dry mouth, had exposed roots and increased frequency of eating or drinking between meals.  Older adults did not share the same associations.

Source: JADA, vol. 144, no. 5, 507-516










Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Lupus Treatment: Oral and Dental Complications

All Lupus patients suffer from some sort of oral involvement, and these complications often come about as a side effect of medical treatment. Certain forms of organ involvement carry dental warnings: with kidney involvement, certain antibiotics (tetracycline) or analgesics (aspirin, NSAIDS) adversely affect kidney function. Antibiotics need to be given prior to treatment for those with Liebman-Sacks Endocarditis (a form of heart involvement) or mitral valve prolapse. Nitrous Oxide (laughing gas) is contraindicated for those with lung problems. Caution should be taken with patients with abnormal bleeding. Those with Sjogren's Syndrome usually have severe dry mouth that may result in massive decay, dental infections, yeast infections and gum disease.

Medications: Anti-convulsants can cause gum atrophy and bleeding. Anti-malarials (plaquenil) can cause intraoral rashes. Immunosuppressive agents (methotrexate) suppress the immune system and may result in bacterial or fungal infections. NSAIDS (advil, motrin, feldene, daypro) can cause oral ulcers. Steroids--prednisone and other corticosteroids increase the likelihood of bacterial and oral fungal infections. Any medications which cause dry mouth put the patient at risk for tooth decay and gum disease.

Lupus patients require frequent dental checkups and periodontal maintenance to optimize their oral health.

Source:  Lupus Guide to Dental Care, HeatherGalusha-Phillips

Robert G. Tupac, DDS, FACP, Inc., 
Diplomate, American Board of Prosthodontics
(661) 325-1275 | www.drtupac.com
5060 California Ave., #170, Bakersfield, CA 93309 (map)

Dry Mouth

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications. More than 500 medications contribute to oral dryness: antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.

In the most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same. Therefore, older adults are at significantly higher risk.

"Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other important functions that often go unnoticed," notes Dr. Fares Elias, past president of the AGD.

Treatment options are available at: 661-325-1275, 5060 California Ave #170, Bakersfield, CA 93309

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Dry Mouth

Causes of Dry Mouth

Dry mouth (xerostomia) can be caused by prescription or over-the-counter medications. More than 500 medications contribute to oral dryness: antihistamines (for allergy or asthma), antihypertensives (for blood pressure), decongestants, pain medications, diuretics and antidepressants.

Dry Mouth Can Lead to Decay

In the most severe form, dry mouth can lead to tooth decay, mouth sores and oral infections.  Half of all Americans take at least one prescription medication daily and more than 90% of adults over the age of 65 do the same. Therefore, older adults are at significantly higher risk.

"Each day, a healthy adult normally produces one and a half liters of saliva, making it easier to talk, swallow, taste, digest food, and perform other important functions that often go unnoticed," notes Dr. Fares Elias, past president of the AGD.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309