Q&A: Saliva and Brushing with Dr. V Kim Kutsch

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.