Dry mouth, also known as xerostomia or hyposalivation, is a growing issue plaguing people of all ages in the United States. The prevalence of xerostomia in population-based studies ranges from 10% to 46% and is worst at night when saliva flow drops during sleep.
In addition to the unpleasant sensation of dry mouth, adverse consequences include halitosis, sleep disturbance, acid reflux while sleeping, gum disease, and tooth decay. Common causes of dry mouth include head or neck radiation for cancer treatment, Sjögren’s syndrome, side effects of medications, and mere aging. Researchers estimate that dry mouth is caused by 75% of the 20 most commonly prescribed medications.
As dental professionals, we frequently recommend oral moisturizers to remedy dry mouth. Oral moisturizers can reduce the unpleasant feeling and many of the consequences of dry mouth. However, many oral moisturizers have a pH level that is acidic and may cause net erosion or demineralization of enamel or dentin, increasing the risks of caries and tooth fracture.
To be safe for teeth while alleviating dry mouth, because there is not enough saliva to dilute and wash away acidic residue, it’s imperative that oral moisturizers have a pH value that causes no net erosion of enamel or dentin.
I’m alarmed that seven oral care product manufacturers are selling oral moisturizers for dry mouth in the United States that are dangerously acidic and proven to cause erosion of teeth. Oral moisturizers are intended to linger in the mouth as long as possible, making acidity a serious problem for people who do not have enough saliva.
In August 2017, Alex J. Delgado and Vilhelm G. Olafsson reported that, to be safe, oral moisturizers should have a pH of about 6.7 or higher. They noted that moisturizers with a pH below 5.5 are dangerous, citing one with a pH of 3.0. In March 2018, with additional researchers at the University of Florida, Delgado and Olafsson published tests of more oral moisturizer products. This study measured pH levels, titratable acidity, and actual erosion of dentin.
The researchers identified seven oral moisturizers sold in the United States as dangerously acidic with a pH below 5.5 and causing teeth erosion:
- OraMoist by DenTek (2.9 pH)
- Mouth Kote by Parnell Pharmaceuticals (3.0 pH)
- Cotton Mouth Lozenges by Cotton Mouth Candy Company (3.1 pH)
- MedActive Oral Relief Lozenges (3.2 pH)
- Hager Pharma Dry Mouth Drops (4.4 pH)
- Rite Aid Dry Mouth Discs (5.1 pH)
- CVS Pharmacy Dry Mouth Discs (5.3 pH)
As dentists, we see the ravages of xerostomia in our patients. These troubling results prompted me to initiate a petition from dental professionals to the manufacturers of these seven dry mouth products. We’re seeking immediate removal of these products from shelves until their acidity levels can be reformulated.
It is counterproductive for dry mouth patients to be offered remedies that escalate demineralization of enamel or dentin. Effective remedies for dry mouth that are non-acidic are available, such as OraCoat’s XyliMelts and XyliGel, which proves that a viable product can be formulated.
I encourage my colleagues to join me in bringing awareness to this unaddressed problem that has a negative effect on unsuspecting dry mouth sufferers. By signing this petition or by writing directly to these manufacturers, we will let them know that the products they are selling are unacceptable. It’s simply a disservice to patients to offer oral moisturizers with a pH level less than 5.5 over the counter.
Ideally, all over-the-counter oral moisturizers would have a pH of at least 6.7. My hope is to garner enough signatures of dental professionals to catalyze a change in how oral moisturizers are produced nationwide and to preserve the dental health of the millions of Americans who are plagued by dry mouth.
If you are a dentist, dental hygienist, or assistant, please join me in signing this petition to the manufacturers of these seven products urging them to withdraw these dangerously acidic oral moisturizers from the market. All dental professionals interested in reading and signing the petition can visit gopetition.com/petitions/stop-sales-of-seven-dangerously-acidic-dry-mouth-products.html.
When you sign, please include your credentials such as DDS, DMD, RDH, or RDA right after your last name in the field for last name. Your email address is required for verification, but it won’t be shown to the public.
Please recruit other dental professionals to also sign the petition. Our mission is to look out for the wellness of our patients and to help them identify solutions to the challenges they face. Many patients don’t understand how detrimental low pH can be coupled with xerostomia. Let’s help our patients protect their dental health.
Dr. Grillo is a 1995 University of Washington School of Dentistry graduate practicing in North Central Washington. He balances clinical practice with his role as content director for Legwork, a rapidly growing dental software company. He purchased his current practice in 2001, after serving four years as a US Navy Dental Officer. He’s now the senior partner of Grillo Robeck Dental, an innovative practice blending technology with exceptional staffing to provide relationship-based healthcare.