By Dr. Deborah Marynak
I’m not sure if I’m ranting, but I just need to say something about the problems we’re seeing in Dentistry with patients on mouth-drying medications. It’s clear that physicians don’t understand anything about the oral cavity, but really, it’s not all that difficult.
We all know what a lack of salivary flow looks like and how devastating it can be, so why don’t MD’s understand? Everyone looks to medical doctors to know all and see all, but clearly, they don’t. I work in a dental clinic where most patients are medically compromised. They present with such a lengthy list of medications I often spend my lunch hour researching for contraindications to Dentistry. In 95-98% of the time the most common side effect is dry-mouth.
So, let’s review: a decrease in salivary flow means an increase in oral disease. If you were to ask a physician the two most common diseases Dentists treat, I’d bet they wouldn’t know how to answer that question. I’d also be willing to bet that if you asked a physician the purpose of saliva, they wouldn’t be able to answer that question either.
Again, let’s review: saliva begins the of digestion of fats and carbohydrates. In fact, the beginning of the digestive tract is the mouth. I’m certain this is where their thinking stops. If we don’t have enough saliva, what does that mean for our digestion? Think about it. Further, saliva helps to neutralize the acid produced by cavity producing bacteria.
Saliva aids in the washing away of bacteria and food debris. With a decrease in saliva, opportunistic bugs are retained to a higher degree as well as the food debris they use to grow and colonize. Oral soft tissue is meant to be wet; when dry, it’s resistance to fight the effects of the bacteria are decreased. It’s really a simple concept.
So now we have less saliva, we don’t floss (as in much of our population) and we only brush in the AM (and quickly). This patient presents with root caries, caries under crowns, around older composites and alloys and a treatment plan that their fixed income cannot sustain. Honestly, it makes me very angry.
I understand the prescribed medications are necessary; it takes little effort to prescribe pilocarpine or recommend Biotene to help avert the ravages these medications take on the oral cavity. Little effort to also warn patients, encourage better home care and certainly recommend regular visits to their Dentist and Hygienist.
The job of the medical profession is to do no harm. When I ask patients what their MD’s told them about the ‘side effects’ of their meds, they report “they told me my mouth would get dry” or “they didn’t tell me anything”. I’m weary of seeing the elderly patient who presents with massive root caries and they’re on a fixed income. Their meds list includes six or seven mouth-drying medications that are contributing to their oral condition.
Or worse! Last week a twenty-six-year-old patient with Type I Diabetes presented as a new patient. He had a lengthy list of medications; a tooth ache brought him into our clinic. It was obvious he had a lot of oral problems just by talking to him as we went over his medical history. He reported he was having trouble controlling his A1C (which was 11), he couldn’t get rid of an infection in his foot and his MD had been treating it for several months.
On examination, the young man was found to have seven infected teeth, and active, moderately severe periodontal disease. His mouth was so dry the only moisture was the hemorrhage that exuded from his soft tissue when I explored several areas in question. Not only did his MD fail to recognize the tooth infection-diabetes relationship (so obvious just by speaking to him), he didn’t discuss the diabetes-periodontal disease relationship either.
I’m making it my goal this year to educate every patient with dry mouth no matter how long it takes to help them understand. Let’s start paying more attention to these lists of medications and be sure to educate our patients on how they can help themselves. Better home care (it’s not enough to say “you need to floss”…show them) and one of the several forms of Biotene will save them time, money and keep them out of our operatories more!!
“If you paint in your mind a picture of bright and happy expectations, you put yourself into a condition conducive to your goals.”
– Norman Vincent Peale
Dr. Deborah Marynak is the owner of DentalStaffing.org, a dentist with over 30 years experience, and is committed to helping Dental Professionals find the right fit for both employees and employers. She also works with Dental Offices to help them streamline their clinical systems and teach Dental Teams how to effectively document to avoid risk.