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Xerostomia

Overview

Xerostomia is the clinical term for the condition commonly known as dry mouth. It can occur due to internal or external factors. It is also a frequent occurrence with growing age. Less saliva production in the mouth can lead to the extreme dryness of the inner soft tissues of your oral cavity. It can cause difficulty in chewing and swallowing food. Xerostomia is a treatable condition, and it can be managed well with suitable treatment and supportive care.

Causes

Xerostomia can occur due to multiple different factors. These factors can affect individually or co-occur to cause dry mouth. It can occur due to physiological abnormalities, genetic or autoimmune disorders, dehydration, medications, and other factors. Physiological factors include aging, diabetes, mouth breathing, alcohol, smoking, anxiety, dehydration, nutritional deficiency, etc. Any trauma or injury to the facial skeleton or salivary glands can also be a cause. Infection of salivary glands or obstruction of their ducts is another major factor. Many medications, such as antidepressants, antipsychotics, opiates, antihypertensives, antihistamines, etc., can also cause xerostomia as a side effect. Patients undergoing radiation therapy are also prone to develop this condition because the heavy radiation on the head and neck region can alter the normal functioning of salivary glands. Similar effects can be caused by chemotherapy as well. Other conditions that can cause xerostomia include Sjogren’s syndrome, sicca, sarcoidosis, celiac disease, Eaton-Lambert syndrome, etc.

Risk Factors And Epidemiology

Various risk factors are associated with xerostomia, and managing these can prevent the development of the dry mouth. Smoking, alcohol, and illegal drugs such as cocaine, heroin, etc., are major risk factors for xerostomia. These factors lessen the salivary flow rate, leading to dry mouth and other complications. Diabetes mellitus is another potential risk factor. Uncontrolled diabetes can cause severe dryness of the inner linings of your oral cavity. Dehydration and nutritional deficiencies are contributing factors as well. Patients with stress or anxiety disorders are also prone to develop xerostomia. Alternatively, medications for psychological or other illnesses are a risk factor for this condition.
Xerostomia is more prevalent among the elderly population not only because of aging but other contributing factors such as the use of medications, diabetes, dehydration, etc. However, xerostomia can occur at any age and has no gender prevalence. However, xerostomia due to Sjogren’s syndrome is predominant in females.

Signs And Symptoms

Xerostomia causes mild to severe dryness in your oral cavity. Reduced saliva production can lead to the stickiness of the tissues inside your mouth. Halitosis or bad breath is a frequent complaint along with xerostomia. The affected person’s tongue may give a fissured or grooved presentation, and taste sensation may also be altered. In some cases, the tongue sticks to the palate during opening/closing the mouth or speaking due to severe dryness. Gingival bleeding and the occurrence of dental caries may be noticed. Saliva appears to form strings or ropes during the opening and closing of the mouth. A dry mouth can also cause difficulty speaking, chewing, and swallowing properly. Dry lips and dry throat are usually present as well.

Diagnosis

The diagnosis of xerostomia requires a detailed history of habits, medical history, and use of medications followed by a thorough clinical examination. The history of the affected person may point towards the diagnostic cause. Clinical examination is done with a mouth mirror. One characteristic symptom of xerostomia seen during examination is that the mirror sticks to the inner membrane. Stimulated and unstimulated salivary flow rates may be measured to detect the severity of hyposalivation. If your doctor suspects an abnormality in salivary glands or their ducts, he may perform sialography to visualize it. A radio-opaque ink is injected into the duct of the affected salivary gland, followed by an x-ray. Blood CP, random blood sugar test, urinalysis, or other suitable tests and imaging techniques may be performed if other underlying medical conditions are suspected.

Differential Diagnosis

Xerostomia occurs due to multiple causes. These include systemic, physiological, hormonal, genetic, autoimmune, psychogenic, and other causes. It is necessary to differentiate these causes by proper history, examination, and diagnostic tests to achieve successful treatment.

Treatment

Treatment of xerostomia depends on its underlying cause. If it is caused by drinking less water, fasting, or other factors of dehydration, frequent intake of water is suggested to improve the production of saliva. Smoking, alcohol, and the use of other illegal drugs are lessened or prohibited. Trauma or injury which involves the salivary gland may require surgical repair. Saliva substitutes (mucin sprays, mucin lozenges, etc.) and saliva stimulators (sugar-free chewing gum, malic acid, etc.) are recommended in certain cases to reduce the severity of symptoms. Maintenance of oral hygiene is of prime importance because the dry mouth can increase the risk of dental caries and gingivitis. However, the use of an antiseptic mouthwash is not recommended in this condition because it tends to cause further dryness. Underlying diseases should be treated with proper medication or surgery as advised by your doctor.

Medication

Xerostomia is treated symptomatically in most cases, and medications are not required. In a few cases, the use of parasympathomimetic drugs such as pilocarpine may be suggested. It should be taken in dosages as advised by your doctor.

Prognosis

The prognosis of xerostomia depends upon its management. In the elderly, it has been seen that xerostomia can only be reduced to a certain degree using home remedies. It may not be possible to cure xerostomia entirely, but it can be managed well to avoid further complications.

Prevention

Prevention of xerostomia includes proper maintenance of oral hygiene, drinking water frequently, avoiding mouth breathing, and inhibiting smoking, alcohol, caffeine, and other illegal drugs. If you have diabetes, it is necessary to follow the dietary regulations and take proper medicines to keep it controlled. This is because uncontrolled diabetes is a major risk factor for xerostomia. If you’re taking any medications for psychological or other illnesses that have the risk of causing dry mouth, ask your doctor to adjust the dosage accordingly and use salivary stimulants such as sugar-free chewing gum or popsicles to avoid xerostomia.