Water Water Everywhere

......and still feel as though you are parched?

A rheumatologist once told me that it was easy for him to spot the Sjogren's patients in his waiting room. They were those lugging around the extra large water bottles, he said. 

Lack of normal production of saliva leads most Sjoggies to seek moisture continually. The most obvious choice for relief of dryness would seem to be water. And though drinking water certainly tastes good and is necessary for overall good health, it lacks the other vital components of normal secretions. 

Saliva is secreted at the rate of two to four pints per day in normal individuals, from salivary glands located inside each cheek, on the bottom of the mouth, and under the jaw. 

In Sjogren's Syndrome, autoimmunity triggers destruction of cells which secrete fluids. This cell destruction, which also occurs elsewhere in the body, can create a multitude of problems, one of which is the significant decrease of saliva produced. 

If you have Sjogren's, and don't have a copy of The New Sjogren's Syndrome Handbook edited by Steven Carsons, MD, and Elaine K. Harris, consider picking up a copy. It contains detailed information about decreased saliva production and all the other effects that SjS may have on your body. This post will focus on the dry mouth issues from Sjogren's. 

The following information has been paraphrased from the Handbook:

Normal saliva has five major functions:

1. Coating and lubricating the mucous membranes inside the mouth.
2. Act as a cleansing mechanism to remove food remnants and potentially harmful bacteria from the teeth and soft tissues.
3. Maintaining a chemically neutral pH balance in the oral cavity.
4. Balance the calcium and phosphate in the teeth and decrease susceptibility of tooth decay and erosion. 
5. Protect oral cavity from bacterial infections and yeast (Candida) infections by utilizing salivary proteins which inhibit bacterial, yeast, and viral growth.

What seems to be the quickest and easiest solution when faced with decreased saliva production - to guzzle large amounts of water - isn't the best choice.

Plain water lacks components such as mucins (lubricating agents), buffering substances, calcium and phosphate salts, antibodies (secretory IgA), and salivary proteins. 

Besides lacking important components, water, when drunk in large amounts, will not overcome mouth dryness, and may remove any remaining mucous on the lining of the mouth and further increase the symptoms of dryness. Frequent small sips of water during the day is more beneficial, and reduces the need to make trips to the bathroom during the night. 

There are other treatment options for Sjogren's dry mouth.

Medications are available which stimulate salivary flow, but only in those patients who have some function remaining in their salivary glands. These drugs must be prescribed by your doctor, and may have side effects. Pilocarpine  and cevimeline HCL are examples of these types of medications.

Saliva substitutes are also available, and are especially useful for those who wear dentures. These work best when used at bedtime, while talking, or traveling. They work for a limited amount of time because eventually they are swallowed, and take their beneficial properties with them. 

Some patients benefit from chewing sugarless gums or letting sugarless hard candies dissolve in their mouth. Care should be taken to avoid candy and gum containing sugar, however, since sugar will promote tooth decay, a significant problem when facing a decrease in saliva. 

Which brings up an important issue - prevention of caries, or cavities. For all the reasons described above, meticulous care of your teeth is vital. Good oral hygiene (there's that word again - see a previous post) such as twice daily tooth brushing with a flouride-containing toothpaste, daily use of dental floss, and avoiding sugar in the diet is a good place to start. 

Hmmm....wonder if moisturizing my mouth with pina coladas would be beneficial? 

I'll let you know.