Q I have recently noticed that my mouth has become very dry. What could have caused this and are there any implications for my teeth and gums?
A There are many reasons why you may have a dry mouth (Xerostomia). Some are of a temporary nature and some permanent.
The temporary reasons would include as a side effect of a number of prescription medicines; smoking; diabetes; and a range of medical conditions such as Sjögren's syndrome. Sjögren's syndrome is a chronic disease in which white blood cells attack the moisture-producing glands.
The hallmark symptoms are dry eyes and dry mouth, but it is a systemic disease, affecting many organs and may cause fatigue. It is one of the most prevalent autoimmune disorders (an immune response against your own cells).
Saliva plays a very important role in protecting the health of the teeth and gums. It also plays a significant role in the comfortable wearing and retention of dentures.
Saliva has a neutralising effect on the acids produced by the bacteria in our mouths, which in turn can cause decay. Therefore, if you have a dry mouth, your teeth are more prone to decay, particularly if your gums have receded and the roots are exposed.
Saliva has a lubricating effect on the teeth and gums, which in turn allow us to speak, chew and swallow comfortably. The lubricating effect also helps to keep the gums healthy as saliva has its own antibacterial effect.
Dry mouth can also lead to poor sense of taste, bad breath and even soreness or burning sensation.
Sipping water can alleviate these symptoms but you can also get saliva substitutes and dry mouth kits from your pharmacist to help you cope.
Topical fluoride applications by your dentist, and the use of specific high concentration fluoride toothpaste such as Gelkam and Stop will help prevent root caries. It is recommended to consult your dentist.
Q I am a 49-year-old man and my father died from kidney cancer when he was 65 years of age. How common is kidney cancer? What are the symptoms and how is it diagnosed? Are there any risk factors and what are the treatment options? Is it possible to lead a normal life with one kidney if the other is removed?
A The most common malignant tumour of the kidney is renal cell carcinoma and its incidence is increasing.
The National Cancer Registry of Ireland reported 375 cases of kidney cancer in both sexes in 2005 and 180 patients died from the disease.
Many kidney tumours do not produce any symptoms. Some patients will be diagnosed as a result of blood in the urine or flank pain (the majority of people with blood in their urine or flank pain will not have a kidney tumour).
Increasingly, kidney tumours are picked up incidentally when having a scan (most often ultrasound or Computerized Tomography (CT) scan) for an unrelated problem such as abdominal pain or gallbladder trouble.
Most cases of kidney cancer occur sporadically. However, there seems to be a higher risk in certain groups including those with other conditions such as polycystic kidney disease or von Hippel Lindau disease (this is a rare inherited genetic condition involving the abnormal growth of tumours in various parts of the body). Other higher risk groups are smokers and patients with exposure to asbestos.
Surgery (nephrectomy) to remove the whole kidney or the part involved with tumour is the most common primary treatment and this can be performed either by laparoscopic (keyhole surgery) or open surgery.
More recently, different energy sources (freezing, heat, radio frequency) have been used to destroy the tumour while leaving the kidney in the body. The long-term results in terms of tumour control are not well known with these new approaches.
Most people can live a normal life with a single, adequately functioning kidney.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from John Adye-Curran, dental surgeon, Rathfarnham, Dublin, and Omer Raheem, specialist registrar in urology