Dry mouth – Psychological, Medicines, Congenital, Systemic Alterations are major causes and treatment depends on the cause.
Xerostomia -Subjective sensation of dry mouth. A clinical condition with less than normal amount of saliva. It is dryness of mouth, which is a clinical manifestation of salivary gland dysfunction. It can produce negative effecton patient’s quality of life, affects dietary habits, nutritional status, taste, tolerance to dental prosthesis and increase the susceptibility of Dental caries.
Symptoms can range from mild discomfort to oral diastases.
It is common, sometimes overlooked condition typically associated with salivary gland hypo function.
EPIDEMIOLOGY
Xerostomia is very common symptom .it is generally present in 20% population. However the more prevalence of xerostomia is in females then males and elderly population is at higher risk i.e 50%.
CAUSES
Psychological – Anxiety and Depression causes reduced salivary flow. Examples – Most students have often feltit during examination times like vivas .
Medicines – Many medicines available can cause salivary gland to make less saliva. Example – Medicines for High blood pressure , depression , bladder control issues, antihistamines .
Congenital – Rare absence of one or major salivary gland causes salivary gland dysfunction.
Systemic Alterations – Xerostomia is associated with Diabetes mellitus, HIV/AIDS, Parkinson’s disease.
Deficiency – Vitamin A deficiency , Riboflavin deficiency , Anemia is recognized as cause of xerostomia.
Radiation therapy – Salivary gland can be damaged if they are exposed to radiation during cancer treatments.
Chemotherapy – Drugs used for cancer treatment cause thick, ropy saliva thus causing dry mouth.
Surgery or physical trauma – Trauma or surgery to salivary gland duct result in damage to the gland, duct, blood or nerve supply thus causing decrease saliva flow and dry mouth sensation .
Local causes – Mouth breathing, excessive use of Alcohol , Smoking and Ageing.
CLINICAL FEATURES
It is important to establish whether dryness is continual or intermittent , associated with any relevant medical history , associated with pain or swelling or is unilateral or bilateral .
Symptoms of Dry mouth
Clinically, dry mouth with thick and ropy saliva can be noticed
Sticky ,dry feeling in mouth
Increased thirst
Increase uptake of fluid especially during eating
Difficulty in speech
Difficulty in eating and swallowing
Abnormal taste of mouth
Cracked Lips
Dry , Rough tongue
Burning feeling in the mouth
Bad breath
Intolerance to dental appliances
Frequent oral infections
More prone to infections like Oral Candidiasis (Fungal infection ) due to reduction in cleansing and antimicrobial function of saliva
Incidence of Dental caries .
Symptoms outside mouth in xerostomia
Xeropthalmia (dry eyes )
Dryness of other mucosa egnasal , laryngeal
Itching
Change of voice
Other signs and symptoms are associated if xerostomia is due to Sjogren’s syndrome such as pain in joints .
DIAGNOSIS
Your Doctor or Dentist will review your Medical history , medications, local causes to identify the cause of dryness of mouth . He or She may also prescribe Blood tests or other tests to check the flow of saliva you produce so as to prescribe the treatment accordingly .
Saivary test such as Sialometry is used to measure the salivary flow. The test is simple and non invasive and involves measurement of saliva patient produces at a certain time.
TREATMENT
Depending on the cause like Medicines, Calculi in salivary gland ,emotional problems your healthcare provider could prescribe the treatment .
Stimulation of saliva production –
Local treatment – Chewing sugar free gums , mints , lozenges . Although the effect is short lived and frequent administration could be inconvenient but it can provide relief for some time .
Systemic treatment – Pilocarpinedrug, has pharmacologic effect it increases the secretion of saliva . The usual dose is 5 mg TDS . It could increase short duration (3 hours) saliva flow without any accompanying side effects.
Symptomatic treatment – Number of salivary substitutes are available in market for treatment of xerostomia that could stimulate artificial saliva formation.
Oral hygiene products – Patients could use oral hygiene products which include lysozyme, lactoferrin.
Discontinuation of drug – Any drug causing dry mouth should be identified .Alternatives of the drug or dose management should be done by Doctor or dentist.
HELPFUL TIPS / HOME CARE REMEDIES
You can relieve dry mouth symptoms by –
Sucking sugar free candy or chewing gums to stimulate saliva flow mint and citrus flavored candies are good choice. Some candies contain XYLITOL that prevent cavities too.
Sucking ice cubes made by freezing fresh juices in ice- cube trays with sticks.
Soft and liquid food are easy to swallow .
Drink plenty of water or sugarless drink during meals. Try to sip water more often in a day . This will make chewing and swallowing more easy and will also improve taste of the food .
Avoid dry food , cookies , chocolates , pastry and acidic food as they stick to the roof of the mouth.
Avoid salty food more often as it causes increase in burning sensation in mouth .
Avoid Alcohol and smoking. If you are current smoker should consider quitting smoking .
Maintain Oral hygiene by Brushing, flossing twice a day
Schedule your visit to dentist to monitor the condition of teeth, gingiva, mucosa and to get advice on preventive measures .
DENTAL IMPLICATIONS WITH XEROSTOMIA
The patients with Dry Mouth should include the following Dental and Oral health implications –
Brush your teeth twice a day with fluoridated tooth paste.
Flossing every day.
Scheduled dental visit twice a year
Prompt treatment of oral and bacterial infections without causing any delay
Dr Jyotsana Anand Suri
Certified medical content writer
Email: jyotsana789@gmail.com
