Many people with hepatitis C experience a dry mouth. This may be made worse by certain medications e.g. methadone or anti-depressants. Saliva provides lubrication that allows for speech, taste and chewing food. It also prevents bacteria, viruses and fungi from causing infections in the mouth, such as tooth decay and gum disease. Comfort may be improved by taking frequent sips of water, chewing sugarless gum (this will stimulate salivary flow) or by using a salivary substitute.
Tooth decay happens as a result of several factors including poor oral hygiene (inadequate removal of dental plaque), high carbohydrate consumption, lack of fluoride applied to the teeth or reduced salivary protection. In early stages decay may be reversible. Prevention of tooth decay is best achieved by good oral hygiene using a soft bush and fluoride toothpaste. Reduce intake of sweetened foods and beverages. Do not brush immediately after a sweet snack but instead smear the teeth with a small amount of fluoride toothpaste. Chewing sugarless gum will stimulate salivary flow and neutralise acid. Applying a small amount of fluoride gel with a toothbrush or finger once a day, will harden and protect them.
Caution: Products containing significant amounts of fluoride, such as supplements (gel, mouth wash), should not be swallowed and must be kept out of reach of children.
Gum infections
Healthy gums are pink, firm and do not bleed when brushed. The earliest sign of gum infection is bleeding from the gum margin on brushing. Other signs are swelling or redness of the gums, receding gums, loose teeth and persistent bad taste or bad breath.
The main cause of gum infection is plaque, a colourless sticky film of bacteria and food debris that forms on the teeth. The bacteria produce toxins which cause the inflammation. If plaque is left undisturbed it will harden to form calculus. Some people have a lower resistance to gum infection than others e.g. those on interferon. Smoking may also lead to a worsening of the gum condition.
Gum infection may be prevented by thorough tooth brushing with a soft toothbrush angled at 45 degrees to the gum margin and moved in tiny circles. This should be done carefully once every day. Dental floss should be passed gently between the contacts of the teeth and rubbed up and down on adjacent tooth surfaces. Interspace brushes may be used where there are spaces between the teeth. Some antibacterial mouthwashes contain high levels of alcohol and should be avoided. Periogard is alcohol free and is an excellent mouthwash. Reduce or cease smoking and make regular dental visits for cleaning.
Caution: People with liver cirrhosis, platelet abnormalities and other bleeding disorders and those taking interferon should discuss the need or special precautions with their dentist, prior to treatment. Modifications may need to be made to their home prevention regime.
Sensitive teeth
If enamel is lost from the surface of the tooth, or if the root surface is exposed a sharp pain may be felt when having hot, cold or sweet food and drinks. Causes of sensitive teeth are poor tooth brushing technique, frequent intake of erosive foods (lemons, grapefruit, wine, vinegar and fizzy drinks), frequent vomiting or gastric reflux and grinding of teeth (often whilst sleeping). A dentist may provide a splint which is worn during sleep and protects the teeth from wear. The use of desensitising toothpaste or fluoride gel applied with a finger or a toothbrush may improve this condition. If sensitivity does not improve or is severe, consult your dentist.
Mouth infections
The presence of a dry mouth or taking of some medications e.g. interferon, may predispose to mouth ulcers and/or thrush. For mouth ulcers the use of chlorhexidine gel will improve comfort and aid healing. If the ulcer does not heal within two weeks it should be checked by a dentist. For thrush eating natural yoghurt daily will help but it may be necessary to take an antifungal medicine e.g. nystatin lozenges or drops. Any dentures should be soaked for one hour in a dilute Milton’s solution. If the thrush does not improve or is severe it should be checked by a dentist.
The presence of a dry mouth or taking of some medications e.g. interferon, may predispose to mouth ulcers and/or thrush. For mouth ulcers the use of chlorhexidine gel will improve comfort and aid healing. If the ulcer does not heal within two weeks it should be checked by a dentist. For thrush eating natural yoghurt daily will help but it may be necessary to take an antifungal medicine e.g. nystatin lozenges or drops. Any dentures should be soaked for one hour in a dilute Milton’s solution. If the thrush does not improve or is severe it should be checked by a dentist.
Denture care
Dentures should be rinsed after meals and brushed daily with a soft brush and a mild soap. Toothpaste contains an abrasive and will wear away dentures. Dentures should be left out at night and placed in cold water whenever they are not in the mouth. If dentures are developing a stain a small amount of vinegar or bleach may be added to the water. Dentures should fit well to maintain the health of the mouth.
Caution: Unusual lumps, swelling or persistent mouth ulcers should be reported to your dentist.
This information was compiled by B. Scopacasa BDS FRACDS, E. Coates MDS FADI FICD and R. Logan BDS MDS of the Special Needs Unit of the Adelaide Dental Hospital, copyright 1999.