Part II: Why Does Diabetes Cause Malfunctioning Salivary Glands, and What Dry Mouth Treatments Are Available?

In Part I of our series, we discussed diabetes and its impact on oral health. In Part II, we’ll discuss how diabetes affects normal saliva production and seven treatment options to make the condition more manageable. 

Normal Saliva Production

The parasympathetic nervous system, activated during rest and digestion, is the main driver of saliva production, releasing a steady flow of saliva to keep the mouth wet, help digestion, and protect against bacteria. Saliva production is usually triggered by the senses — i.e., the sight, smell, or thought of food can cause the brain to send signals to the salivary glands to produce and release saliva. The sympathetic nervous system also plays a role, producing thicker, more mucus-rich saliva. 

The two systems work together to ensure that the saliva flow can adapt to different needs — keeping the mouth hydrated under normal circumstances and conserving fluid in response to stress or dehydration.

Three main pairs of salivary glands produce saliva, along with numerous minor salivary glands in the mouth. Saliva production begins with blood flowing into these glands, where specialized cells called acinar cells draw water, electrolytes, and other small molecules out to form saliva. 

Once the acinar cells create the saliva, it flows through a network of ducts within the glands, where further modifications occur. Cells lining these ducts adjust the concentration of electrolytes, including sodium, potassium, chloride, and bicarbonate, to ensure the saliva has the right consistency and pH balance. The saliva is then released into the mouth through the duct openings, lubricating the oral cavity, aiding digestion, and protecting against bacteria.

When Salivary Glands Malfunction

When salivary glands malfunction, they either produce too little saliva (hypofunction) or, in rare cases, excessive saliva. In some cases, they produce enough saliva, but of poor quality, so its benefits are not recognized. Both lack of saliva or poor quality saliva can lead to dry mouth, also known as xerostomia.

Salivary glands can malfunction due to any number of reasons, including damage from radiation therapy, nerve dysfunction, or certain medications. Without sufficient saliva, the mouth becomes dry and more prone to many uncomfortable symptoms, including frequent oral infections, cavities, gum disease, difficulty chewing, swallowing, and speaking, a change in taste, and more.

The Connection Between Diabetes and Dry Mouth

Diabetes, a chronic metabolic disorder, is characterized by the body’s inability to regulate blood glucose levels effectively. There are two types of diabetes, and in both types, the root issue is the disruption of insulin production or use. Insulin, a hormone produced by the pancreas, enables glucose from the bloodstream to enter cells, where it is used for energy, making it a crucial hormone for the entire functioning of the body. 

Diabetes and dry mouth are linked due to the nature of the conditions, with diabetes typically causing dry mouth through various mechanisms. The main ways diabetes can cause dry mouth are: 

1. Dehydration due to polyuria: High blood sugar levels increase the body’s need to eliminate excess glucose from the bloodstream, which it does through frequent urination. As the body loses fluids more frequently, it becomes more susceptible to dehydration, which reduces the overall water available for various bodily functions, including saliva production. Without sufficient fluids to produce saliva, the condition of dry mouth ensues. 
2. Autonomic neuropathy: Chronic high blood sugar can cause nerve damage throughout the body, including the nerves that control the salivary glands, which is known as autonomic neuropathy. These damaged nerves in the salivary glands reduce the amount of saliva produced, which can lead to a persistent sensation of dry mouth, even if fluid intake is adequate. 
3. Diabetes-related medications: Many diabetes patients are prescribed medications like diuretics and antihypertensives to manage high blood pressure or other complications, particularly in cases where diabetes has affected cardiovascular or kidney health.

• Diuretics help lower blood pressure by prompting the kidneys to remove extra salt and water from the body, which increases the frequency of urination. This, in turn, leads to less fluids available for saliva production.  
• Antihypertensives, particularly ACE inhibitors and beta-blockers, are commonly used to manage blood pressure, but many of these have side effects that include dry mouth.

1. Polypharmacy: When diuretics, antihypertensives, and other prescription medications are taken simultaneously (known as polypharmacy), the risk of dry mouth increases. This is true for anyone taking more than one medication at a time, not just those with diabetes. 

Diagnosing Dry Mouth

Diagnosing dry mouth in people with diabetes isn’t hard, especially because it’s a well-known symptom of the disease. Doctors will typically ask their patients for a complete medical and dental history, and can perform several tests, including:

• Sialometry, saliva flow rate tests
• Salivary gland scans, used to evaluate persistent dry mouth, particularly,  to evaluate the source of salivary gland (infection, inflammation, obstruction).

Seven Dry Mouth Management Strategies for People with Diabetes

As dry mouth can affect daily functions like eating and talking, management is essential. Here are seven ways to do it:

• Blood sugar control: Blood sugar control  — i.e., diabetes control — is the number one way to manage dry mouth. The more a person can maintain healthy blood sugar levels, the less dry mouth symptoms will impact their lives. 
• Hydration: Drinking sufficient water is crucial for managing dry mouth and minimizing its damage. Drinking water gives the body the best chance of having enough fluid to produce saliva. 
• Medication reviews and adjustments: As medications are a leading cause of dry mouth, people with diabetes should have regular medication reviews with their healthcare providers. While some medications are indispensable, sometimes there are similar ones without the detrimental side effects, or changing the dose can minimize the impact of the side effects. 
• Good oral health practices: Dry mouth can severely impact the oral health of a person with diabetes, which is why regular brushing, flossing, and dental checkups are essential. 
• Lifestyle habits: Caffeine, nicotine, and alcohol exacerbate dry mouth symptoms. Reducing the intake of these substances can help manage the symptoms. Additionally, reducing sugar intake is an effective way of maintaining oral health, as sugar is the enemy of teeth. 
• Artificial saliva: Artificial saliva, which is usually an over-the-counter product that comes in the form of gel, spray, or mouthwash, provides temporary relief of uncomfortable symptoms.
• Saliva stimulants: Saliva stimulants don’t seek to offer temporary relief but to address dry mouth at its root by stimulating the salivary glands to produce more saliva. Saliva stimulants can take the form of sugar-free gum or candies, prescription medications, and electrostimulation devices like the SaliPen, all of which stimulate saliva production. 

While all of the above are viable dry mouth management options for people with diabetes, it’s crucial to consult a medical professional before trying anything new. Diabetes is a fickle disease that acts differently in different people. People with diabetes should work together with medical professionals to find the ideal management system that works best for them. 

FAQS

Why do so many people with diabetes have dry mouth?

Diabetes often causes frequent urination, which depletes the body of fluids and doesn’t leave enough for saliva production. Additionally, nerve damage can lead to malfunctioning salivary glands, while some diabetes medications cause dry mouth. 

Is dry mouth manageable?

There are many different dry mouth treatments that make the condition manageable. It’s best to talk to your healthcare provider to discuss the treatment options most suitable for you. 

Is electrostimulation an effective dry mouth treatment?

Yes, electrostimulation is an effective dry mouth treatment. The SaliPen, a small handheld device, is FDA approved for saliva stimulation. It sends small electrical impulses into the mouth to stimulate the salivary glands. 

Where can I purchase the SaliPen?

Right here.