"Combo" and Dry Mouth
Some people taking combination therapy (interferon and ribavirin) experience dry mouth and nasal passages. Dry mouth (xerostomia) occurs when the amount or quality of saliva decreases. Saliva plays an important role in keeping the teeth, gums, inside of the mouth, and throat healthy.
Healthy saliva is necessary to:
- cleanse the mouth of food;
- bathe the teeth with protective minerals that harden teeth and reverse early cavities;
- lubricate the food and start the digestive process;
- moisten the soft tissue in the mouth; and
- limit the growth of bacteria that cause tooth decay and gum disease.
An absence or decrease of saliva produces an uncomfortable feeling in the mouth, makes the oral cavity more prone to diseases and can lead to swallowing problems that affect nutrition. Possible causes of dry mouth may include medication side effects, low fluid intake, mouth breathing and/or lack of daily oral hygiene procedures. A small percentage of people on treatment will also experience vomiting because of the nausea caused by treatment. Lack of saliva and vomiting both can change the acid levels in the mouth, which can lead to de-mineralization and tooth decay.
The drugs can also inhibit the body’s ability to fight infections. The mouth is constantly bombarded with germs; therefore common infections can get out of hand very quickly.
Warning signs of dry mouth are:
- difficulty in swallowing food;
- persistent sore throat;
- new decay especially on root surfaces of teeth
- denture discomfort;
- dry lips; and corners of the mouth that crack or bleed.
- Drink water frequently,(avoid tea, coffee and soft drinks, they cause dehydration).
- Suck on ice chips, popsicles, frozen grapes, sugarless hard candy or chew sugarless gum. The best gums have xylitol, which helps fight cavities(Trident)
- Moisten dry foods with butter, margarine, gravy, sauces or broth.
- Use topical fluoride, apply moisturizing gels inside the mouth, rinsing with a recommended mouth rinse, or moisten the mouth with artificial saliva.
- Clean your teeth after every meal. Use a soft toothbrush (a hard toothbrush is less effective in cleaning). Hot water will help to soften the bristles even more.
- If your gums are too sensitive for even a soft toothbrush, use a gauze or clean wash cloth. Use a nonabrasive fluoridated toothpaste or fluoride rinse.
- Rinse your toothbrush well after each use and store in a dry place.
- To disinfect toothbrushes, run them through the dishwasher (yes, it works) or soak in Listerine for 20 minutes and rinse thoroughly. (Listerine is not recommended as a mouthwash as it contains alcohol which can dry the mouth and may affect the liver)
- Use lip lubrication (e.g., lanolin, crème, etc.)
- Do not eat foods that irritate the mouth (e.g., spicy, salty or highly acidic).
- Some people have found that swishing their mouth with a small amount of sulcrate (a prescription ulcer medication) helps with mouth sores
Re-mineralizing gels and rinses can protect your teeth from decay. Using a daily product is better than a weekly product. There are re-mineralizing gels and rinses as well as fluoride gels and rinses; both help stop decay. The gels can be brushed on or put into custom trays. Gels applied in a custom tray made by your registered dental hygienist and left on for four minutes a day in the shower are the most beneficial way to re-mineralize the teeth. However, some people have difficulty with the trays, as they trigger their gag reflex, particularly the "one size fits all" type of tray. For them, brushing on the gel or using a rinse is better. Germiphene makes remineralizing gels and rinses that contain .05% Calcium, Phosphorous and Fluoride.
Oral B makes Fluoride rinses. Colgate makes a toothpaste called Prevident 5000.
Minor oral infections can be treated or prevented with antibacterial mouth rinses that contain 0.12% chlorhexidine. Proctor and Gamble make Peridex. Colgate makes Perioguard and Germiphene makes Oroclens.
Saliva substitutes are recommended for easing the discomfort of dry mouth. Some people recommend Mouthkote, which is sold in heath-food stores. Biotene Mouthwash and Oralbalance Gel are also recommended. These contain two key enzymes found in saliva that are important in maintaining the oral flora. Vaseline and all other petroleum products are not recommended as they increase the drying out of oral tissues.
Dry nasal passages can be treated with Secaris ointment.
Some people experience changes to their sense of taste, appetite and food preferences while on treatment. Make allowances for these changes and try to eat a healthy, well balanced diet.
It is a good idea to get your dental care up to date before starting treatment and to advise your dentist when you are on treatment. Your dentist may suggest that you have more frequent checkups during treatment in order to maintain good oral health.
If you experience sudden pain, swelling, fever or other unusual occurrence, contact your physician or dentist promptly.
For further information, please contact Dental Health Services at your local health centre.
IHA – Dental Health Services
Nelson: (250) 354-6728
Trail: (250) 364-0511
Our thanks to the following sources:
Mara Sand, RDH, Community Dental Hygienist, Interior Health Authority
Ginny Cathcart B.A., Dip. D.H., I.D., M. Ed.
Registered Residential Care Dental Hygienist
Dental Hygiene Department Head, Vancouver Community College
Peppermint Patti’s FAQ/HepCBC
The many members of the Hepatitis C community who shared their experience.