Day 19: Let It Flow

Barbara Tritz
· June 20, 2023 ·

6 minutes

Saliva- Liquid Gold

You brush, floss, and do all the homecare instructions you are told, yet, you still have cavities and gum disease. Let’s talk about the real key to oral health– your saliva. As I tell my patients, saliva is liquid gold. There is nothing more important to the health of the mouth than saliva.

Without a healthy flow of good quantity and quality of saliva, the mouth literally crumbles and decays.

Dry mouth contributes to tooth decay

Saliva has so many jobs to do. It lubricates the teeth, gums, and food. Keeps teeth clean. Neutralizes acids. Begins digestion. Aids in swallowing. Remineralizes teeth. Buffers the acids from the things we put in our mouth. Helps with taste and smell. speeds healing. Helps us keep the oral microbiome healthy in the mouth. Helps us speak. Keeps us disease free, and is part of our immune system. All that from a little spit. Yet, ask anyone with xerostomia (dry mouth) and they tell you the quality of their life is miserable without this flow.

Assess the Flow

pH testing

One of the first things I do with a new patient is test the pH of their mouth before we do anything else. The mouth wants to rest in neutral with a pH of 7.0. Normal saliva pH ranges from 6.2 to 7.7. and near neutrality is between 6.7 at the very lowest to 7.3.

Unfortunately, most of my patients seem to be in the 5.5 range – the acidic range of the pH scale. Teeth demineralize at a pH of 5.5. The minerals are flowing OUT of the tooth at that pH. Some people even demineralize at a pH of 6.7.

Testing pH is easy and anyone can purchase pH test strips for saliva and see what their range is throughout the day. I recommend they keep a pH diary for a few days to see how acidic their mouth is in the morning when they first wake up, then throughout the day both before and after meals and snacking. This helps us understand what is going on in the mouth. This will answer some important questions as to what is happening to cause tooth decay, gum disease, and possibly digestive issues.

Test the Flow

Blue plaque is acidic and causes tooth decay

During the appointment, I also test the pH of the plaque microbiome on the tooth with a special disclosing solution. The solution on the tooth shows up blue if the plaque biofilm is acidic. The “ah -ha” moment when my patients can actually see the reason they have cavities is an important learning tool for both of us. It helps guide my therapies and suggestions, and shows the patient/parents the root of the problem. Without testing, we are at best guessing, and very ineffective in a “hit or miss” way in our treatment.

In my exam, I am looking at the saliva. I assess if the mouth is dry and if the saliva is frothy, foamy, or thick. I take notes on the quality and quantity of the saliva. A thorough medical history is telling. If my patient has two or more medications, I know they probably have a reduction in their salivary flow. The side-effect of many medications is dry mouth. The real clincher is that most people do not realize their mouth is “dry” until the salivary flow is 60% reduced. That’s crisis level! I recommend the patient look up their medications and talk with their primary care doctors to see if there might be alternatives to their current medications if dry mouth and/or tooth decay are occurring.

Another critical test in assessing the health of the mouth is by looking at the health of the oral microbiome- the bacteria/fungi and other microbes that make their living in the mouth. We need a healthy mix of microbes but when there is decay or oral disease, we need to again test, so we don’t guess. We do this with salivary diagnostics. This test gives us a peek into the world of the microbiome. Does the patient have the right mix of the good guys or are the bad guys overpopulating and becoming pathogenic? Let’s prevent problems before disease sets in rather than wait until a cavity or gum disease occurs. Salivary diagnostic testing is our crystal ball into the future of what might occur in the mouth. This needs to be the standard of care in the dental world. Just as medical doctors do testing, so must we. Test, don’t guess.

The risk assessment score for this patient is 2968.16. The ideal score is <1.0

I tell my patients “the best predictor of future decay is current decay”. So, if we want to stop tooth decay we must get to the root of the problem. The pH of the saliva is one of those roots. A very important root.

Low Flow

Low flow- no go!

If they have no medications but still have dry mouth then we need to sleuth further. The next thing I suspect is mouth breathing. The mouth should only be used for breathing in an emergency. As I tell my patients: the nose is for breathing, and the mouth is for eating. Close your mouth and breathe only through the nose. When you mouth breathe it quickly affects the quantity, quality, and pH of the saliva. Dropping it to “cavity making” ranges.

Dry lips, open mouth= Mouth breather

Most folks think they nasal breathe when in reality their mouth is open ever so slightly. Open mouth, even slightly means mouth breathing. Then there is mouth breathing at night, and probably happening all night. That is when I recommend considering paper tape – yes taping the lips together while sleeping. BUT! Please try it first during the day. See if you can breathe through your nose. You’ll know within a few seconds if this is comfortable for you. If it is not, remove the tape and find an ear, nose and throat doctor or allergist to address your nasal congestion. Work with an orofacial myofunctional therapist to correct myofunctional disorders and help establish proper oral functions.

No Flow

No Flow? Dig Deep

How do we increase the flow of saliva? Address the source. Look at medications. Use your nose. Then, let’s chew food properly. Chewing pumps the parotid glands which stimulates the saliva flow.

Salivary stimulants and substitutes help aid swallowing, speaking, and coating the mouth. Here’s an older post with an updated list of saliva stimulants. Try them and see if any work for you.

Chronic diseases, Sjogren’s syndrome as well as other health problems contribute to salivary issues. A physical, testing and a consultation with your primary care provider is always a good idea. There are medications that can stimulate your salivary flow so discuss these with your medical providers.

Go with the Flow

If you need water to help you swallow, need a sip of water to unstick your tongue from the roof of your mouth in the middle of the night, or your mouth feels dry please let your dental professional know. This is a huge red flag and a predictor of dental disease. It won’t get better on its own. It should not be ignored.

Get Flowing!

Saliva bubbles are a great thing.

Saliva really is our secret weapon in the fight against tooth decay and gum disease. It is not just about the right toothbrush toothpaste or flossing. It is instead the very best tool to harness to cleanse the mouth, remineralize teeth, buffer acids, and keep the oral microbiome healthy. Testing the pH, looking at the salivary diagnostics, nasal breathing, proper chewing, and reviewing medical issues/medications and collaboration with other healthcare providers all help to get the flow to go!

Get Flowing,

Sincerely,

Barbara Tritz

Queen of Oral Health and Healthy Flowing Spit

Hello, I'm Barbara Tritz

Unveiling the Stories Behind Dental Hygiene

Loving science, especially biology, from an early age, Barbara is a registered dental hygienist, certified biological hygienist, and orofacial myofunctional therapist. In 2019, she received the Hu-Friedy/ADHA Master Clinician Award from the American Dental Hygienist Association.

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