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Our 53rd Year

Saliva’s Role In Disease By Jamie Talan

A dry mouth, which can be caused by many medications, is more vulnerable to cavities…

The clear substance that lubricates the mouth may be one of the most ignored factors in the prevention of tooth and gum decay.

That’s what Israel Kleinberg thinks. Kleinberg, an oral biologist at the State University of New York at Stony Brook has spent the last 20 years studying saliva. He believes that the substances that make up saliva are the key to understanding dental disease.

Studies have shown that up to 30 percent of the adult population lack normal saliva levels, according to Leo Sreebny, another oral biologist at Stony Brook. People who lack saliva, Kleinberg and Sreebny agree, are at increased risk of developing cavities. Saliva is vital to the health of the mouth. Researchers say that it only takes a few months for teeth to rot away in a saliva-free environment. The less saliva, the more cavities.

The Stony Brook researchers have figured out precisely why saliva, which starts the digestive process, is so protective. Apparently, the liquid contains two substances, urea and arginine which are both used by the bacteria of the mouth to produce ammonia, which in turn neutralizes acids formed from sugars.

“A person can have their cake and eat it too, if they have enough saliva,” Kleinberg muses.

Indeed, saliva helps prevent decay by controlling the bacteria that cause cavities, and it also helps to mineralize teeth, said Philip Fox, chief of the clinical investigations section of the National Institute of Dental Research. Saliva also makes it possible to wear dentures. And the mouth needs to be moist for talking and eating.

Saliva problems are caused by a variety of reasons. Dentists have found that there are some 400 medications, such as beta blockers, diuretics, tranquilizers and diet pills, that decrease saliva flow. “Most doctors are not aware of this,”Kleinberg said.

Sreebny and Dr. Anthony Valdini just completed a study that found that the more medications a person takes, the less saliva flow he will have.

Cancer patients who receive radiation to the head or neck are also at risk for saliva problems. People with an autoimmune disorder called Sjogren’s syndrome also suffer from dry eyes and mouth.

“The mouth can become so dry that a tongue can literally stick to the palate,” Kleinberg added.

Experts in dry mouth agree that people with saliva problems should take special precautions to protect their teeth. Dentists recommend having the teeth cleaned and scaled at least three times a year and brushing and flossing after every meal.

Patients with dry mouth also complain of a burning sensation of the tongue and difficulty in swallowing or talking. A lack of saliva can also cause gum disease, which loosens the teeth, and an impaired sense of taste. These people are also more susceptible to fungal and bacterial infections.

Sreebny says that by the time someone feels dry mouth syndrome that person will have lost 50 percent of their normal salivary flow rate. He adds that people will also have dryness elsewhere, the eyes, the nose and the throat, for example, and women will also have dryness in the vaginal region. “These people are terribly unhappy and uncomfortable,”Sreebny said.

Dentists can determine saliva problems by performing a two-part test: Patients spit into a tube so that a dentist can measure saliva flow during a resting state; then, the salivary glands are stimulated to see whether they are working properly.

People with dry mouth should ask their doctor if it is possible to reduce the number of medications they are taking. Many deal with the problem by drinking a lot of juices and sodas or sucking on candies. Unfortunately, sugar and acid from these substances can become an added burden to the teeth and gums.

Dentists recommend water. Also, people should avoid alcohol, tobacco, and caffeine because of their drying effects, Fox said.