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I am an elderly man suffering from an embarrassing problem: I can't seem to prevent my mouth from filling up with saliva. This spit sometimes escapes at the most inopportune times. My family doctor and my dentist have not been very helpful in finding a solution. Can you offer me any advice? Sam, via e-mail
Prof. Rafi Feinmesser, head of the ear-nose-and-throat department at the Rabin Medical Center, Beilinson Campus in Petah Tikva, comments:
Some people salivate more than others. Suffering from hypersalivation that really bothers you, as in your case, is caused either by medications that you are taking, or they may be a side effect or early sign of neurological disorders. If you are taking medications for chronic illness, go to the doctor who prescribed them and have him check whether hypersalivation is a side effect of any of them. If he identifies such a drug, a different drug without this side effect can often be substituted.
Children with Down syndrome who suffer from hypersalivation often undergo surgery to reroute the flow of excess saliva, but such an operation would seem to me to be too drastic and complicated for an elderly person. There are cardiology drugs that have the side effect of drying up saliva, but an older person should not take them to benefit from this as the medications can affect the heart.
However, Botox (botulinum toxin) can be injected by a neurologist to reduce salivation. The first shot is effective for about six months, but the next one can last for a year or so. Since you should be examined by a neurologist to rule out the possibility that your hypersalivation is an early sign or symptom of a neurological disease, ask him or her about Botox injections.
I'd like to know whether tooth whitening, at home or in the dentist's office, is a useful and harmless procedure. Some dentists I've met say it's fine, while others discourage it. Who should not use it?
Veteran Jerusalem dentist Dr. Steve Sattler comments:
There are different tooth whitening techniques, and your dentist's experience is the central factor on deciding which one to use. Consult with your dentist first about which technique is best for you. It should be noted that all techniques require constant maintenance. Every few months, the dentist will refresh the whitening; this includes a cleaning. It is well accepted that home whitening is less effective than professional whitening in the dental office. People with either weak teeth, porous (crumbly) teeth or chronic gum problems should not undergo teeth whitening.
Judy Siegel-Itzkovich adds:
According to the American Dental Association (ADA), home whitening products take two basic approaches. Some contain bleach that permeates the teeth to remove both internal, or "intrinsic," stains and those on the outside of the teeth. Others use mechanical or chemical means to loosen or buff away the junk that stains the outside. The effectiveness of any tooth-bleaching method comes down to two factors: the concentration of bleaching agent (usually hydrogen peroxide or carbamide peroxide) and the length of time that agent is in direct contact with the teeth. The ADA says that whitening is basically a continuum: The less expensive, less complicated procedure produces less impressive results, while the most expensive, more complicated procedures can produce dramatic changes in color. The ADA regards tooth whitening as a pretty safe procedure. But bleaching agents can cause short-term tooth sensitivity and, if poorly applied, temporarily make your gums and other parts of your mouth hurt. Both problems should go away if you don't use the bleach for a day or so. Israel's Health Ministry, as well as the ADA, views tooth-whitening products as cosmetics, not drugs. So as long as manufacturers don't say their products cure or prevent disease or make other health claims, they're free to say just about anything they like without substantiating those claims with research.
Rx For Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx For Readers, the Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and residence.