Saliva: more important than you think!

Saliva may not have ‘the drama of blood, the integrity of sweat and the emotional appearance of tears’, as one dental expert is often quoted as saying[1], but as a lubricant of life, it’s more important than you may realise.

Our saliva helps us eat, smile, talk and swallow, which are all essential in themselves. However, these actions also influence how comfortable we are when socialising or interacting with others.

That’s why having good saliva function is not only beneficial for our oral health, it’s also central to our sense of comfort, happiness, wellbeing and self-worth. And when we feel good about ourselves and our lives, we are better equipped to safeguard our rights and protect ourselves against elder abuse.

Healthy saliva – healthy us

Loss of, or change in, saliva is called xerostomia or ‘dry mouth’. While it might sound insignificant, xerostomia is actually a major threat to both our oral health and our general health.

Why? Saliva is one of the body’s first lines of immune defence. It’s full of antibodies, immune cells and protective molecules, and it flushes and cleans the mouth, carrying away food waste, buffering and neutralising acids, and coating our teeth in protective proteins.

Saliva also facilitates effective chewing and swallowing by lubricating the eating process and protecting the teeth. This improves our ability to eat well maintaining general health and enabling better quality of life.

What damage can xerostomia do?

If our saliva is unhealthy or diminished, our oral health and general health suffers. We are more likely to experience:

• tooth decay

• oral infection

• friction trauma and ulcerations (which increase the risk of oral cancer)

• speech issues

• swallowing issues

• general oral discomfort comfort and loss of function.

Tooth decay is by far the most common, obvious and detrimental effect of xerostomia. Bacteria on our teeth consume dietary sugar to produce acid that dissolves the surface of the tooth, but saliva quickly neutralises the acid and reduces the damage. Without enough healthy saliva, the production of acid can become uncontrolled and rapidly cause breakdown of the teeth.

What causes saliva loss and change?

There are many causes of xerostomia, and several factors contribute to the likelihood of it developing.

• The risk increases with age: up to one in four people over 65 develop the condition.

• Having xerostomia often reflects a person’s general health, and people with more health issues have a greater chance of salivary dysfunction.

• In Australia income- and location-related factors are also an influence, which suggests that access to management and care is a significant issue.

The most common causes of xerostomia are:

• medication side effects (this is by far the largest cause; saliva loss and severity increases with the number of medications being taken)

• dehydration (see our article, The ABCs of dehydration)

• salivary gland disease

• systemic, autoimmune and inflammatory diseases (for example, rheumatoid arthritis, coeliac disease and psoriasis)

• ageing of salivary glands (while the amount of saliva may not decrease, the fluid itself often becomes a little thinner, weaker and less protective)

• alcohol, smoking and recreational drug use.

How do I know if my saliva is unhealthy?

Early saliva changes can show no symptoms and hide the potential problems that are developing. However, usually there are warning signs, and the common ones are:

• the mouth feeling itchy, dry and or mildly uncomfortable

• a change in oral health, with increasing dental decay in a previously stable mouth

• more difficulty in eating, speaking or swallowing

• regular mouth ulcers or red, swollen, uncomfortable oral skin tissues.

If you experience any of these, you should visit a dental professional. They can:

• undertake effective saliva analysis to measure changes in volume, quality and function

• work with your medical practitioners to diagnose the likely causes

• implement preventive and corrective treatments.

Top tips for managing dry mouth

• Clean your teeth regularly and thoroughly at home to remove plaque (invest in an electric toothbrush—they do the job twice as well).

• Eat a well-balanced, low-sugar diet to avoid the high risk of acid decay – for advice on age-appropriate diets, read Eating well in your 60s, 70s and Beyond

• Stimulate your saliva flow with sugar-free chewing gum/sweets after eating or drinking (hint: xylitol, a sugar substitute, can help prevent decay).

• Manage dehydration; regular sips of water help – see The ABCs of dehydration

• Use a high fluoride (5000 ppm) toothpaste such as Colgate ‘Neutrafluor’ and remineralising pastes (for example, Tooth Mousse) every day.

• Rinse your mouth daily with bicarbonate of soda mouth rinses to reduce the acidity;  A simple, cheap, and effective management.

• Visit your dentist, dental hygienist or oral health therapist regularly for professional preventive care.

• In severe cases, consider seeing a specialist, who can administer medications that increase saliva flow.

A combined medical and dental problem

Given that saliva loss, general health and oral health are closely related, it’s important that their management is combined and coordinated by both your doctor and dentist.

Changes in saliva can be a sign of systemic illness (conditions that affect a related set of organs or the whole body). Diagnosis and management of these conditions, along with the side effects of the associated medications, may affect your saliva.

To avoid any harmful effects of systemic illness treatments, your dentist, medical practitioner and specialist should all be involved as a team in working out your care plan.

It’s so important to manage saliva changes

Salivary changes are one of the highest risk factors for deteriorating oral health, and they can cascade to have a significant impact on general health and quality of life. Xerostomia is common and its effects can be devastating, but early diagnosis and intervention is effective and essential.

Saliva: a lubricant of life, good for our oral health and general health, and central to our sense of comfort, happiness, wellbeing and self-worth. It truly is more important than you think!

Fun facts: words to dazzle your Scrabble opponents!

• Sialagogue – ‘something that stimulates saliva flow’

• Xerostomia – ‘loss of saliva’

• Dysphagia – ‘difficulty in swallowing’

Dr Wayne Sherson [BDS with Distinction Otago MSc (Dent) Sydney] is a registered dentist with 40 years’ experience. His practice interests include oral health and systemic health, periodontics and complex restorative care. Wayne retired from clinical practice in 2023 but continues to provide continuing education to the profession through the Australian Dental Association NSW Centre for Professional Development.

Disclaimer: The information provided on this website is not a substitute for individual health advice from your doctor, dentist or dentist.