Q&A With Dr. Kim Kutsch: Saliva and Brushing

written by CariFree

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Here are some questions posed recently to Dr. Kutsch and his responses:


Q: What is your baseline approach to a saliva compromised patient?

For the patient with reduced salivary flow, which may be a result of age and or medication use, my approach is to make sure they understand the importance of keeping the mouth hydrated and the impact of snacking throughout the day. They need to understand how snacking compromises their saliva flow and pH. I would discuss changing dietary habits to achieve the least amount of negative impact. Also, it would benefit them to replace their saliva with a pH neutral or elevated pH product in order to protect and buffer their pH. I would have them on the CTx4 Gel 5000 for life. Also, after they eat, I tell them to rinse with tap water.

Now, for the patient that is completely saliva compromised, like a radiation patient or one that has Sjogren’s syndrome, it is a whole different approach. If their bacteria levels are high, I would put them on an antimicrobial for 3 months-2 years. I may use SDF to arrest any root surface caries while we figure out a treatment plan. I have put many Sjogren’s patients into trays with the CTx4 Gel 5000 to wear during the day or at night. You need to do everything for this patient and know that it is a lifetime treatment as their saliva is forever compromised.


Q: Do you approach a saliva compromised patient differently based on their ‘why’? (i.e Sjogren’s vs. medication or radiation induced xerostomia)

With exception of the radiation patient, the patient who has Sjogren’s or is on many medications I use the approach above. Now, for the radiation patient, short term they lose a lot of saliva, but long term it can go from totally dry to just a hyposalivation situation. You can prescribe Pilocarpine, and it will help with secreting saliva, but it will also produce more tears and sweat. There is a lollipop and sucker version that is an OK short-term solution for some patients.


Q: Are there any benefits of brushing with a toothpaste that do not contain remineralization agents?

A: Yes, even dry brushing is better than not brushing at all. Disrupting the biofilm on the teeth and cleaning it off the teeth everyday is beneficial. Do you get as good a benefit as using a gel with nano-hydroxyapatite or fluoride? Probably not. But, brushing every day will be helpful. The simple answer is: yes. However, in my mind, if you are going to do it anyway, use something alkaline (like saliva or CTx4 Gel 5000 with Nano HA) to reap additional benefits.


Have a question for Dr. Kutsch? Leave it in the comments below and you may be featured on a future blog post!


2 Responses to “Q&A With Dr. Kim Kutsch: Saliva and Brushing”

  1. Janet Yellowitz

    Hi –
    Two concerns:Perhaps you can help me understand.

    1)What is the evidence that there is a significant reduction in salivary flow in older adults.

    2) Xerostomia is the subjective feeling of having a dry mouth vs. hyposalivation which is a reduced salivary flow – Although xerostomia is the term most often used to describe “dry mouth” – there is a significant difference. How can we help correct this error.

  2. Dr. M

    PUBMED Format: Abstract

    J Am Geriatr Soc. 2015 Oct;63(10):2142-51. doi: 10.1111/jgs.13652. Epub 2015 Oct 12.
    Meta-Analysis of Salivary Flow Rates in Young and Older Adults.
    Affoo RH1, Foley N2, Garrick R3, Siqueira WL4, Martin RE1,5,6,7.
    Author information

    To determine whether salivary flow decreases as a function of aging.


    Literature review.

    Individuals aged 18 and older reported to be free of major systemic disease.

    Relevant studies were identified through a literature search of several databases, from their inception to June 2013. Studies were included if saliva had been collected on at least one occasion in subjects aged 18 and older and if the data were presented in a manner that enabled comparisons of younger and older participants. Differences in salivary flow rates between age groups were calculated for each salivary source and condition and reported as standardized mean differences (SMDs), standard errors (SEs) and 95% confidence intervals (CIs). The results were pooled using a random effects model. A separate analysis examining medication use was also conducted.

    Forty-seven studies were included. Whole (SMD = 0.551, SE = 0.056, 95% CI = 0.423-0.678, P < .001) and submandibular and sublingual (SMSL) (SMD = 0.582, SE = 0.123, 95% CI = 0.341-0.823, P < .001) salivary flow rates were reduced significantly in older participants and in unstimulated and stimulated conditions. In contrast, parotid and minor gland salivary flow rates were not significantly reduced with increasing age. Additionally, unstimulated and stimulated SMSL, and unstimulated whole salivary flow rates were significantly lower in older adults, regardless of medication usage.

    The aging process is associated with reduced salivary flow in a salivary-gland-specific manner; this reduction in salivary flow cannot be explained on the basis of medications. These findings have important clinical implications for maintaining optimal oral health in older adults.

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