Chapter 11- Saliva.

Saliva is one of those things in life that you never really appreciate ‘till it’s not there anymore.

Saliva has a function [the human body doesn’t usually waste its resources on producing things that have no use] and is essential to oral health.

These are its functions;-

Lubrication, you need it to talk and eat comfortably, It lubricates your food to make it easier to swallow and coats your teeth and the skin inside your mouth [oral mucosa] with a protective layer.

Taste, as some of your food needs to partially dissolve in saliva in order for you to be able to taste it.

Immunity, it contains antibodies and other anti microbials to help you fight infection and disease.

Digestion, it has enzymes in it [alpha amylase often called ptyalin] so it starts digesting your food [the carbohydrate] as it embarks on its journey from one end to the other and cleans up the bits a little.

Mineralisation, helps remineralise the outside of your teeth.

Buffering the acid in your food and drink back to neutral to stop it dissolving the enamel of your teeth.

Saliva is truly magical stuff!

Where does it come from?

It is not made anywhere else in the body.

You have 3 pairs of major salivary glands [one on either side]-

Parotid in front of your ears these are what swells up when you get mumps,

Submandibular in the floor of your mouth near the angle of your jaw [where your jaw turns a right angle below your ears].

Sublingual underneath your tongue.

Then on your lips, soft palate and dotted all over the inside of your mouth you have lots of little minor salivary glands [a bit like the sebaceous glands in your hair].

All these glands big and little together produce a combination of serous [watery] and mucous [thicker] saliva depending on what type of secretory calls they have in them and what type of saliva is needed in that particular place.

These salivary glands are called exocrine glands. So a gland, any gland in your body, makes whatever it makes and then it either discharges it straight into your blood system [endocrine glands] to carry it to where it’s needed [for example cells in your pancreas discharging insulin] or as in the case of salivary glands it has a bit of pipe work, a duct, to carry it to where it’s needed.

Your mouth is like a little sluice, you are constantly producing saliva which washes stuff down your throat- old dead cells, bits of food etc. It is constantly cleaning your mouth and helping to keep it healthy. If you are not producing enough your mouth will become unhealthy.

DRY MOUTH.

The real name for this condition is Xerostomia.

All of us suffer from a dry mouth occasionally- taking exams, got to make a speech, difficult customer, job interview etc. This is normal, but some people [and indeed all of us as we get older] will have dry mouths for other reasons.

Lack of saliva depending on the severity can make life very difficult for the sufferer, causing difficulty in eating, swallowing and talking comfortably, unpleasant and altered taste sensation and if oral hygiene is not diligent, rampant tooth decay [caries] with eventual tooth loss.

Main causes of dry mouth.

Uncommon causes.

Blockage in a major salivary duct. Stones can form in salivary ducts just like in your kidneys they are called sialiths. Even rarer, a growth in a major gland will cause it not to function properly.

There are also some auto immune type diseases which cause the salivary glands to stop working. The most well-known of these is Sjogren’s syndrome where the salivary glands and the tear [lacrimal] glands stop working.

Patients who have had radiotherapy to the head and neck region for cancer will have malfunctioning salivary glands.

Patients with these problems are special cases and require tailor made management.

Commonest causes-

1 Advancing years.

2 Drugs.

Advancing years– as we all get older our salivary glands like other bits of us become a little less efficient!  Approximately 30% of people over 65 suffer from a dry mouth.

Drugs– as we are all living longer many of us are on drugs for various things [polypharmacy]. Many of the drugs for the commonest things also cause a dry mouth. They include- antihypertensives [high blood pressure], antihistamines, some antidepressants and many more.

A dry mouth is difficult to quantify. Some patients are unaware of a problem and some appear to have sufficient saliva but constantly feel their mouths are dry.

There is a way of measuring it called the Challacombe scale [invented by Prof Challacombe, professor of Oral Medicine at King‘s College Hospital London]. This looks for various things in the mouth and depending on how many of them present, puts the patient into 1 of 3 management categories.

The beauty of this scale is that anyone can use it, it’s very simple and straight forward, doesn’t require any specialised medical or dental knowledge, any health professional or member of the public can use it.

Most people fall into category 1.

THIS IS THE MANAGEMENT;-

Scrupulous oral hygiene [how did you guess].

Reduce/ remove as far as possible any sugar in the diet.

Rinse the mouth with water after eating.

Use an alcohol free fluoride rinse after lunch for one minute [ask your dentist which one which one].

Drink at least 8 glasses of fluid a day of which no more than ½ should be tea or coffee as they are diuretics. Sip water throughout the day and keep a glass at your bedside at night.

Always drink water with meals, eat slowly and eat ‘wet’ or moistened foods;- Soup , melon , grapes, casseroles, yoghurt, salad dressing etc

Chew sugar free chewing gum after a meal [containing xylitol towards the front of the list of ingredients] or a little cube of hard cheese [if you haven’t got high cholesterol]. These both stimulate salivary flow and cheese also tops up the calcium on the outside of your teeth.

You can look up the Challacombe scale yourself-

If you type The Challacombe Scale in to google or similar it will give you hopefully top of the list fgdpscotland.org.uk [Federation of General Dental Practioners in Scotland] and you can download a printable copy of the scale. If you look a bit further down the list you will find the link to the relevant entry in Wikipedia which gives you further information.

Things that will make the dryness worse are;-

Alcohol.

Drugs as mentioned.

Smoking.

Caffeine in coffee, tea and some soft drinks such as colas.

Mouth breathing, keep your lips moist by using a lip salve.

Hot dry environments, sleep with your windows open, perhaps a humidifier in your bedroom, even a wet towel sitting on top of your radiator when its on in in cooler months will help.

A bit of a dry mouth is manageable by yourself using the above information. However if it is a real problem it is very important that you seek professional advice. The above is just a rough overview. There are lots of medical causes of dry mouth and as with all medical problems the diagnosis is the most important thing. Go and see your dentist and your GP.