I Brush My Teeth Twice a Day. So Why Am I Losing Them?

People assume if your gums bleed, you must not be taking care of your teeth. I brush my teeth twice a day. When I had Invisalign, I brushed them even more. So imagine my frustration when I would spit into the sink and see blood almost every morning. The first thought people have is, "Do you have gingivitis?"

Actually, no.

I have Sjögren's disease.

Because of my diagnosis, I already knew my teeth would require extra attention, but I never imagined how much of my life would revolve around dental care. Today, I regularly see a dentist, an orthodontist, a periodontist, and even a dental surgeon.

Yes...all because of one autoimmune disease.

Why dry mouth is so much more than feeling thirsty

Most people hear "dry mouth" and think it's just an inconvenience. They picture someone reaching for a bottle of water. The reality is much more serious.

Saliva does far more than simply keep your mouth moist. It protects your teeth, washes away bacteria, neutralizes acids, and helps prevent infection and decay.

Think of your mouth like a car. A car can't run without oil. If your engine loses its oil, eventually everything begins to break down. That's exactly what happens with Sjögren's. When your body stops producing enough saliva, your mouth loses one of its most important defenses.

The daily struggles nobody warns you about

As someone who speaks professionally and manages projects, I spend a lot of time talking. I can't tell you how many times I've suddenly developed severe "cotton mouth" in the middle of a conversation or even started choking while talking because my mouth had become so dry.

Water isn't optional for me. It's survival.

Facing tooth loss, extractions, and my third root canal

Despite brushing, flossing, and doing everything I'm supposed to do, I've still lost teeth because cavities develop much more easily without enough saliva. I'm currently on my third root canal and hoping this tooth can be saved because, unlike the first one, this one is visible when I smile. The first root canal I had was way in the back, and honestly, I told them, "Just pull it."

Unfortunately, Sjögren's doesn't stop creating new dental challenges.

Nighttime is especially difficult. Before I was diagnosed, I actually wondered if I had diabetes because I woke up so thirsty every single night. Instead, I learned that dry mouth often becomes even worse while we sleep.

My husband makes sure I never go to bed without something to drink on my nightstand because he knows there's a good chance I'll wake up feeling like I've spent the night in the middle of the desert.

Sometimes no amount of water feels like enough.

Then there's the part no one really talks about. Bad breath. When your mouth doesn't produce enough saliva, bacteria thrive. Even if you're brushing regularly, dry mouth can cause persistent bad breath.

It's embarrassing. You become hyperaware every time you talk to someone, wondering if they notice.That's why I almost always carry mints or Listerine strips with me — not because I forgot to brush my teeth, but because my autoimmune disease makes it difficult for my mouth to do what it was designed to do.

What has actually helped me protect my smile

Over the years, I've learned that standard dental care often isn't enough for people living with Sjögren's.

Because plaque builds up faster and the risk of cavities is much higher, my dentist prescribed prescription-strength sodium fluoride to use twice daily to help protect my teeth. It has become part of my everyday routine, just like my medications.

Here's what helped me:

• Drink water constantly—even when you don't feel thirsty.
• Never leave home without mints or Listerine strips.
• Ask your dentist if prescription-strength fluoride is appropriate for you.
• See your dentist more frequently than the average person.
• Don't ignore bleeding gums, tooth sensitivity, or dry mouth.
• Tell every dental provider that you have Sjögren's disease.
• Remember that dry mouth isn't just uncomfortable—it can permanently affect your oral health.

Living with Sjögren's has taught me that oral health isn't just about brushing your teeth. Sometimes, despite doing everything right, your autoimmune disease still wins a few battles. But knowing what you're up against — and working with the right dental team — can help you protect your smile for years to come.

If you're living with Sjögren's, know this: if you've ever felt discouraged because you're taking great care of your teeth but still dealing with cavities, bleeding gums, or root canals, you're not alone. Your experience is real, and your mouth deserves the same compassion and specialized care as the rest of your body.