Dry mouth treatment: Tips for controlling dry mouth

Answer

from Alan Carr, D.M.D.

The best way to treat your dry mouth depends on what's causing it. There are some things you can do that will relieve dry mouth temporarily, but the best long-term remedy for dry mouth is to address its cause.

The medical term for dry mouth is xerostomia (zeer-o-STO-me-uh). To relieve your dry mouth:

• Chew sugar-free gum or suck on sugar-free hard candies.
• Limit your caffeine intake. Caffeine can make your mouth drier.
• Don't use mouthwashes that contain alcohol because they can be drying.
• Stop all tobacco use if you smoke or chew tobacco.
• Sip water regularly.
• Try over-the-counter saliva substitutes. Look for ones containing carboxymethylcellulose or hydroxyethyl cellulose, such as Biotene Oral Balance.
• Avoid using over-the-counter antihistamines and decongestantsbecause they can make your symptoms worse.
• Breathe through your nose, not your mouth.
• Add moisture to the air at night with a room humidifier.

Saliva is important to maintaining the health of your teeth and mouth. If you frequently have a dry mouth, steps to protect your oral health may also help your condition.

• Avoid sugary or acidic foods and candies because they increase the risk of tooth decay.
• Brush with a fluoride toothpaste. Ask your dentist if you might benefit from prescription fluoride toothpaste.
• Use a fluoride rinse or brush-on fluoride gel before bedtime.

If these steps don't improve your dry mouth, talk to your doctor or dentist. It could be that medications or another condition is the cause. Medications are one of the most common causes of dry mouth. Long-term relief from your dry mouth may mean stopping or changing your medication or its dosage, or addressing underlying health issues.

Does it impair calcium absorption?

Answer

from Katherine Zeratsky, R.D., L.D.

Chocolate contains oxalate — a naturally occurring compound in cocoa beans — which can inhibit the absorption of calcium. Calcium binds to oxalate in your intestines, limiting its absorption into your bloodstream. People with oxalate kidney stones, which could occur when there is too much oxalate in the urine, should limit the amount of oxalate in their diets.

The jury is still out, however, on whether chocolate causes problems for healthy people who eat calcium-rich diets. A 2008 study suggests there might be reason for concern. The study found that elderly women who ate one or more servings of chocolate a day had lower bone density and strength than did women who ate fewer servings of chocolate. Researchers believe this may be due to oxalate inhibiting calcium absorption — but it could also be due to the chocolate's sugar content, which may increase calcium excretion. In addition, chocolate also contains flavonoids, which are thought to be beneficial to health. Further research is needed to fully determine the role chocolate plays in calcium balance and bone strength.

In the meantime, if you get the daily recommended amounts of calcium and vitamin D from food or supplements, and practice weight-bearing exercise, eating chocolate in moderation is unlikely to adversely affect your bone health.

Don't forget vitamin D with your calcium

At the same time that the Institute of Medicine released its recommendations for calcium intake, they also released new recommendations for vitamin D. Vitamin D is also important for bone health and helps your body absorb calcium. Some calcium supplements contain vitamin D. A few foods naturally contain small mounts of vitamin D, such as canned salmon with bones, and egg yolks. You can also get vitamin D through fortified foods or even sun exposure.

Recommended Dietary Allowance (RDA) for vitamin D for adults
Men, age in years	RDA each day, in international units (IU)	Upper limit each day, in international units (IU)
19-70	600	4,000
71 and older	800	4,000
Women, age in years
19-70	600	4,000
71 and older	800	4,000

Source: Institute of Medicine, 2010

Too much calcium has risks

Dietary calcium is generally safe, but more isn't necessarily better, and excessive calcium doesn't provide extra bone protection. In fact, if the calcium in your diet and from supplements exceeds the upper limit set by the Institute of Medicine, you could increase your risk of such health problems as:

• Kidney stones
• Prostate cancer
• Constipation
• Calcium buildup in your blood vessels
• Impaired absorption of iron and zinc

If you take calcium supplements and eat calcium-fortified foods, you may be consuming more calcium than you realize. Check your calcium supplement to see how much it contains and read food labels to help monitor your total calcium intake.

Timing matters: When to take calcium supplements

In general, you can take calcium supplements at any time of day. But there are special circumstances that may affect when you should take calcium supplements.

• Dosage. Calcium is absorbed most efficiently when it's taken in amounts of 500 or 600 mg or less at one time. So if you take 1,000 mg of calcium a day, split it into two or more doses over the course of the day.
• Other supplements. Calcium can affect or be affected by other supplements. If you also take an iron supplement, for instance, don't take it at the same time as you take calcium. Check with your doctor, pharmacist or dietitian about other interactions.
• Medications. If you take prescription medications, ask your doctor or pharmacist about possible interactions with calcium supplements. You may need to take calcium supplements several hours before or after taking your medications.
• Meals and snacks. If your calcium supplements contain calcium carbonate, take them with food. The stomach acid produced when you eat helps the absorption of calcium carbonate. If your calcium supplements contain calcium citrate, you can take them with or without food.

If you're still not sure about the best time to take your calcium supplements, check with your doctor or pharmacist for guidance.

Choosing calcium supplements

To determine which calcium supplement may be best for you, consider these factors:
Amount of elemental calcium
Elemental calcium is key because it's the actual amount of calcium in the supplement. It's what your body absorbs for bone growth and other health benefits. The Supplement Facts label on calcium supplements is helpful in determining how much calcium is in one serving. Some will list the milligrams of calcium in one serving. Others will list only the Percent Daily Value. If only the Percent Daily Value is listed, you can determine how many milligrams of calcium are in one serving by multiplying the Percent Daily Value in one serving by 1,000 milligrams.
For example, if the label shows that two tablets make up one serving and provide 60 percent of the Percent Daily Value, multiply 60 percent by 1,000 (0.60 x 1,000), which equals 600 milligrams of calcium for two tablets. Each tablet, then, would have 300 milligrams of calcium.
Be sure to note the serving size (number of tablets) when determining how much calcium is in one serving. And don't confuse the weight of the serving size with the amount of calcium. The weight of the serving size is the weight of the elemental calcium and the compound it's combined with.
Tolerability
Calcium supplements cause few, if any, side effects. But side effects can sometimes occur, including gas, constipation and bloating. In general, calcium carbonate is the most constipating. You may need to try a few different brands or types of calcium supplements to find one that you tolerate the best.
What prescriptions you take
Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. Ask your doctor or pharmacist about possible interactions and which type of calcium supplement would work for you.
Quality and cost
Look for "USP" or "CL" on the calcium supplement label. Supplements that bear the United States Pharmacopeia (USP) or ConsumerLab.com (CL) abbreviation meet voluntary industry standards for quality, purity, and tablet disintegration or dissolution. Different types of calcium supplements have different costs. Comparison shop if cost is a factor for you.
Absorbability
Your body must be able to absorb the calcium for it to be effective. Chewable and liquid calcium supplements are absorbed most readily. The USP or CL abbreviation on the label also is an indication of better absorbability. To aid absorption, some types of calcium supplements should be taken with food, while for other types it may not matter.
Supplement forms
Calcium supplements are available in a variety of forms, including tablets, capsules, chews, liquids and powders. If you have trouble swallowing pills, you may want a chew or liquid calcium supplement.
Possible link to heart disease
It's not definitive but there may be a link between certain calcium supplements and heart disease. The calcium supplements of concern are those that contain only calcium — not supplements that combine calcium and vitamin D or multivitamin supplements with calcium. It's thought that the calcium in some supplements could make its way into fatty plaques in your arteries, causing those plaques to harden and increasing your risk of heart attack.

Calcium and diet

Your body doesn't produce calcium, so you must get it through other sources. Calcium can be found in a variety of foods, including:

• Dairy products, such as cheese, milk and yogurt
• Dark green leafy vegetables, such as broccoli and kale
• Fish with soft bones that you can eat, such as sardines and canned salmon
• Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices

In general, one serving of each of these calcium-rich foods provides about 300 to 400 milligrams (mg) of calcium, or about one-third of the RDA.
Even if you eat a healthy, balanced diet, you may find it difficult to get enough calcium if you:

• Follow a vegan diet
• Have lactose intolerance, because you may limit dairy products
• Consume large amounts of protein or sodium, which can cause your body to excrete calcium
• Have osteoporosis
• Have osteopenia
• Are receiving long-term treatment with corticosteroids
• Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease and celiac disease

In these situations, calcium supplements may help you meet your calcium requirements.

Types of calcium supplements

With the wide range of calcium supplements available in different doses, preparations and combinations, choosing one can be confusing. What's best for you depends largely on your needs and preferences, including any medical conditions you have or medications you take. There's not one best type of calcium supplement for everyone.
The mineral calcium — often referred to as elemental calcium — exists naturally along with other substances, called compounds. Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of elemental calcium. Common calcium supplements may be labeled as:

• Calcium carbonate (40 percent elemental calcium)
• Calcium citrate (21 percent elemental calcium)
• Calcium gluconate (9 percent elemental calcium)
• Calcium lactate (13 percent elemental calcium)

In addition, some calcium supplements are combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.

Calcium and calcium supplements: Achieving the right balance

Calcium is important for optimal bone health throughout your life. The Institute of Medicine recently updated the recommended daily allowance (RDA) for calcium and vitamin D. Does your diet deliver?
Although diet is the best way to get calcium, calcium supplements are an option if your diet falls short. Before you consider calcium supplements, though, be sure you understand how much calcium you need, the pros and cons of calcium supplements, and which type of calcium supplement to choose.

The benefits of calcium

Your body needs calcium to build and maintain strong bones. If your body lacks sufficient calcium over many years, you could face health problems related to weaker bones:

• Children may not reach their full potential adult height.
• Adults may have more bone fractures.
• The risk of osteoporosis increases.

Some research studies have suggested that calcium, along with vitamin D, may have benefits beyond bone health, perhaps protecting against cancer, diabetes and high blood pressure. But definitive evidence about such health benefits is lacking.

Calcium requirements

How much calcium you need depends on your age and sex. Note that the upper limit in the chart represents the safe boundary — it's not how much you should aim to get. If you exceed the upper limit, you increase your risk of health problems related to excessive calcium.

Can poor oral health cause heart disease? Will taking care of my teeth help prevent heart disease?

Poor oral health — not regularly brushing or flossing — is unlikely to be the primary cause of heart disease. But poor oral health combined with other risk factors may contribute to heart disease.
Bacteria on your teeth and gums could travel through your bloodstream and attach to fatty plaques in your arteries (atherosclerosis), making the plaques become more swollen (inflamed). If one of the plaques bursts and causes a blood clot to form, you can have a heart attack or stroke.
It's possible that swelling in gums leads to swelling in other parts of your body, including your arteries. This swelling can also contribute to heart disease.
Regardless of whether you have heart disease, it's important to take care of your teeth and gums. Steps to good oral hygiene include:

• Brushing your teeth at least twice daily
• Flossing your teeth daily
• Replacing your toothbrush at least every three months
• Getting regular dental checkups, as recommended by your dentist

When to see the dentist

To prevent gum disease and other oral health problems, schedule regular dental cleanings and exams — generally once or twice a year. In the meantime, contact your dentist if you notice any signs or symptoms that could suggest oral health problems, such as:

• Red, tender or swollen gums
• Gums that bleed when you brush or floss
• Gums that begin pulling away from your teeth
• Loose permanent teeth
• Changes in the way your top and bottom teeth align with each other
• Unusual sensitivity to hot and cold
• Persistent bad breath or an unusual taste in your mouth

Remember, early detection and treatment of problems with your gums, teeth and mouth can help ensure a lifetime of good oral health.