Weakened mouth and throat muscles, weakened hands and arms to brush teeth, and tube feeding all are changes which require special treatment for mouth care. Food can easily collect in pockets in the mouth as well as between teeth. It is important that you take care of your mouth to prevent harmful bacteria from developing.

Freshness
An applicator with lemon and water can be used to freshen the mouth if other methods are a problem.

Furry Tongue
Some ALS patients with bulbar symptoms develop a furry tongue. Water may be used to clean the tongue with an applicator or washcloth. If the tongue appears white for any length of time, consult your ALS team or your doctor. Sometimes a condition called 'thrush' can develop. It is a fungal infection and is easily treated.

Going to the dentist
Not many dentists will know about ALS, its effect on your ability to keep your teeth clean, excess saliva, or the precautions they should take because of a patient's swallowing problems. Make your dentist fully aware of these problems.

Suction
Another method for moving food caught in pockets of the mouth is a suction unit, which is also used for removing excess saliva to reduce drool.

Toothbrushes
For those with weakened hands and arms, an electric toothbrush can be very useful for brushing your teeth. Others may find that a hard toothbrush is very helpful for removing build-up which occurs on the teeth, particularly after tube feeding.

Build-up of saliva is a common problem among people with ALS who have tongue and throat muscles that are weak and not able to automatically swallow the saliva that builds up in the mouth. A tenacious mucus can also build up in the mouth, compounding the problem.

This build-up of saliva can cause choking and disrupt sleep. Relief may come from home remedies, over-the-counter products, and prescription drugs and, in extreme cases, even surgical procedures. Advice should be obtained from your doctor and/or your local pharmacist. An obvious side effect of drugs to relieve a build-up of saliva is a dry mouth. It's a question of finding the right balance for you.

The following have proven helpful for managing saliva:

• Portable suction machine;
• Decongestants and over-the-counter medications used for colds and allergies;
• Antidepressants - Amitriptyline may reduce saliva and enable sleep;
• Anticholinergic drugs to reduce spasms of smooth muscle in the bronchi and decrease gastric, bronchial and salivary secretions;
• Transderm V patches usually used for motion sickness also tend to dry up saliva.

The following have proven helpful for treating thick mucus:

• Apple juice or hot tea with lemon
• SSK1 (potassium iodide) 10 drops in a glass of water 2–3 times per day. This may take 1–2 weeks to be effective. A prescription is required;
• An expectorant cough syrup;
• Meat tenderizer mixed with a little water can be used to coat the tongue or can be placed under the tongue.

Cautions
For over-the-counter medication, generic labels are usually cheaper.

Sleepiness is often the side effect of medications for a dry mouth.

Beware: anything containing alcohol can increase muscle weakness, at least temporarily.

Beware of anything that slows breathing.

Beware: before putting any medication, crushed or otherwise in a feeding tube, check with a pharmacist to ensure that it won't harden and clog the tube.

Excess Saliva - has one advantage! If you have excess saliva, and are still able to eat, mixing more saliva with your food, makes it both easier to swallow, and easier to digest.

Although management of saliva is common in many people with ALS, especially those with difficulty swallowing, some are troubled by excessive mouth dryness. A dry mouth can cause thick mucus to form, which may in turn cause serious choking problems.

Excessive dryness is usually caused by one or more of the following:

• Breathing primarily through the mouth, rather than the nose can dry out the lining in your mouth. If you consistently wake up with a dry mouth, thick mucus and/or a sore throat you may be breathing through your mouth while sleeping;
• A side effect from some surgical operations;
• Stress from chronic anxiety or depression;
• A side effect from some medications;
• The natural process of aging;
• Smoking.

The following have proven helpful for a dry mouth:

• Make a conscious effort to breathe through your nose;
• If you sleep with your mouth open, ask your doctor or occupational therapist about the possibility of a chin-strap to wear at night;
• If you suffer from nasal congestion, ask your doctor for assistance. Nasal congestion leading to a dry mouth can cause thick mucus to form, which in turn may cause serious choking problems;
• Increase your liquid intake. Ask your speech pathologist which consistency is best for you;
• Use a vaporizer. (Clean the vaporizer once a week with vinegar and water.)