Q. I’m in my fifth year as a T8 para. I take Ditropan to control bladder spasms, which enables me to keep myself dry while managing my bladder with intermittent cathing. The one side effect I have from Ditropan is really bad dry mouth.

A friend of mine — also a para — said Ditropan also gives him dry mouth, and about a year after he started taking it, he developed a mouth full of serious cavities that cost him big bucks to fix, not to mention the pain of the dental work. His dentist said dry mouth caused by taking Ditropan probably led to the sudden outbreak of decay.

At his dentist’s suggestion he paid to have custom-made fluoride dental trays made (they look like clear upper and lower mouth guards that fit over his teeth). Each night he puts a prescription fluoride gel in them and wears them for 5 minutes. The idea is that  fluoride soaks in and makes his teeth stronger. This was two years ago and he hasn’t had any more cavities.

Is dental decay a common problem with dry mouth? What can I do to protect my teeth? His story has me nervous.
— Kim

A. Kim, according to the American Dental Association and WebMd, dry mouth can lead to serious oral health problems, including inflammation and infection of soft tissues of the mouth, such as the gums, and tooth decay. This is something I never heard about in rehab or from any physical medicine and rehab doc.

To find out more about SCI medications, dry mouth and tooth decay, I phoned the Craig Hospital SCI Nurse Advice Line with your question. Although they hadn’t received any specific questions about SCI and tooth decay, they did a Lexicomp search and pulled up the same information on dry mouth and tooth decay that I had found.

When I typed in “bad teeth” and also “dry mouth and bad teeth” in Rutgers CareCure Community Forums (see resources), I read page after page of people with SCI who have had rampant tooth decay requiring treatments ranging from multiple root canals and crowns to having teeth pulled — and the culprit was dry mouth caused by medications used to manage various conditions caused by SCI. I suspect the information gap about dry mouth and tooth decay in the rehab and PM&R community is because “dental issues” are treated by dentists, and the information doesn’t get back to rehab docs.

Dry mouth — also called “xerostomia” — happens when your salivary glands don’t produce enough saliva and is readily noticeable. According to the American Dental Association, the most common cause of dry mouth is medication, both prescription and over-the-counter. More than 400 medications list dry mouth as a potential side effect!

Saliva is an amazing substance, one we probably don’t think about until we don’t have enough of it. According to my research, a healthy adult produces about three pints of saliva each day, and it is vital for everything from making it easier to talk to aiding in swallowing and digesting food. From a dental perspective, saliva helps prevent tooth decay by breaking down and washing away food particles from the teeth and gums. It also neutralizes and washes away enamel-damaging acids that form when food is broken down by bacteria in plaque on your teeth and clears away cavity-causing bacteria that cling to our teeth and gums. And it carries minerals that build up and strengthen teeth and repair microscopic tooth decay.

The bottom line? Without sufficient saliva, tooth decay becomes much more common.

The main medications that cause dry mouth discussed on Care Cure were anticholinergics such as Ditropan, which are used to control bladder spasms. Other dry mouth culprits discussed were pain medications (opiates), baclofen and gabapentin (generic Neurontin).

In order to prevent tooth decay due to dry mouth, it is important to inform your doctor and dentist that you have it and ask about ways to protect your teeth. In some cases your doctor may be able to switch you to a medication that doesn’t cause dry mouth, or perhaps not as much. Paula Wagner, a urology nurse practitioner at U.C. Davis Medical Center in Sacramento, Calif., says there are other medication options you may want to discuss with your doctor. To control bladder spasms, Wagner says once-a-day timed-release medications are far less likely to dry out your mouth. They include VESIcare, Enablex, Detrol LA and Sanctura XR (by Allergan). Wagner adds two other options with similar results, Oxytrol, a patch that you apply to the hip, abdomen or buttock and change every four days, and Gelnique, a gel that is applied to the abdomen, or thigh or upper arm.

An SCI nurse moderator for CareCure suggests that people who are experiencing dry mouth as an effect of taking gabapentin may want to discuss switching to Lyrica with their doctor.

An important word of caution: Some medications can have serious side effects if you suddenly stop taking them. Always discuss this with your doctor.

What do you do if you are taking a medication that doesn’t have a “non-dry mouth” alternative or your dry mouth is caused by something else? Once again it is important to discuss dry mouth with your dentist and ask for his or her advice. One of the things your dentist may discuss with you is applying additional fluoride to your teeth. There are several options, including over-the-counter fluoride mouth rinse, prescription strength (1.1 percent fluoride) toothpastes like PreviDent 5000 Dry Mouth toothpaste by Colgate, and prescription fluoride trays that are worn four to five minutes before bed.

A vital defense for dry mouth is to follow good oral hygiene habits:
• Brush your teeth at least twice a day with a soft toothbrush — a firm brush can wear down enamel — in the morning and before bed. Even better, brush after every meal.
• Floss every day.
• Use an over-the-counter toothpaste that contains fluoride.
• Visit your dentist at least twice a year — more if they recommend it.
• Drink frequent sips of water.
• Suck on sugar-free hard candies, ice chips, or sugar-free popsicles. Chew sugarless gum — preferably one that contains Xylitol, a sweetener that inhibits one of the main bacteria involved in tooth decay.
• Avoid salty foods, as well as foods and beverages with high sugar content.
• Don’t smoke or use any tobacco products.
• Avoid commercial mouth rinses or mouth washes.
• Use a humidifier in your home, especially at night.
• Avoid mouth rinses that contain alcohol or peroxide — they will dry out your mouth even more.

The American Dental Association also says your dentist may recommend an artificial “saliva substitute” to keep your mouth moist — something that is sold in most pharmacies, as well as online. Wagner says Biotene makes a complete line of products along this line, including a dry mouth gum that stimulates saliva flow, an oral rinse and a mouth spray.

Kim, thanks for bringing awareness of this issue. It is a good reminder for all of us to follow good dental hygiene and get a check-up and teeth cleaning twice a year — after all, flossing and brushing is a lot less hassle and much less money than the cost and pain involved with root canals and crowns.

Resources
• Biotene, www.biotene.com
• Detrol LA, www.detrolla.com
• Enablex, www.enablex.com
• Gelnique, www.gelnique.com
• Oxytrol, www.oxytrol.com
• Colegate PreviDent 5000 Dry Mouth,  www.colgateprofessional.com/products/Colgate-PreviDent-5000-Dry-Mouth-Rx-only/details
• Rutgers CareCure Community Forums, sci.rutgers.edu/forum
• Sanctura XR, www.allergan.com/assets/pdf/sanctura_fact_sheet.pdf
• VESIcare, www.vesicare.com

Advice in this column is supported by Craig Hospital’s SCI Nurse Advice Line, a toll-free hotline for people living with SCI, a community service partially funded by grants from the PVA Education Foundation, Craig H. Nielsen Foundation and Caring for Colorado Foundation. For non-emergency nursing information about SCI health, call 800/247-0257 between 9 a.m. and 4 p.m. Mountain time. If you have a health question, contact Bob Vogel at rhvshark@mac.com.

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