Author: Victoria Lun
Editors: Simran Grewal, Jarshini Nanthakumar, Dina Abbas
Overview
Xerostomia (also known as dry mouth) is a condition associated with hyposalivation – a measurement of reduced salivary flow (Kunin et al., 2018). Saliva is an important component of the mouth as salivary secretions are vital in many functions including immune defense, lubrication of the oral cavity, tasting, swallowing, and speaking (Kunin et al., 2018). With inadequate salivary flow rates, xerostomia can lead to tooth decay, tooth sensitivity, and oral infections (ADA, 2021).
Epidemiology
There is limited information about the prevalence of Xerostomia; however, a study conducted in 2006 estimated the range to be approximately 0.9% to 64.8% based on data collected from Scandinavian countries (ADA, 2021; Talha et al., 2020).
For patients with Sjogren syndrome (an autoimmune disorder of the exocrine glands (Fox, 2005)) or who have undergone radiation therapy for head and neck cancers, the prevalence of xerostomia is 100% (Talha et al., 2020).
Etiology
Some causes of xerostomia include medications with adverse side effects such as (Talha et al., 2020; Tanasiewicz et al., 2016):
- Diuretics
- Anticholinergic
- Antihistamine
- Antihypertensive
- Antidiarrheal
- Antidepressants
- Anxiolytics
- Appetite Suppressant
- Anti Migraine medications
- Bronchodilators
- Neuroleptics
Other causes of Xerostomia may include radiation or chemotherapy treatments for patients with head and neck cancer, autoimmune disorders (most commonly Sjogren syndrome), aging, and other underlying medical conditions (i.e. HIV/AIDS or diabetes) (Talha et al., 2020; Tanasiewicz et al., 2016 ).
Symptoms
Functional symptoms include (ADA, 2021; Milsop et al., 2017):
- Altered taste
- Difficulty wearing dentures
- Difficulty chewing, swallowing and tasting
- Difficulty speaking
Morphological symptoms (ADA, 2021; Milsop et al., 2017):
- Bad breath
- Cracked and peeled lips
- Difficulty wearing dentures
- Dry or burning feeling of the mouth
- Dry or sore throat
- Hoarseness
- Mouth infection
- Mouth sores
- Glossitis
- Halitosis
- Dental caries
Risk Factors
Common risk factors include (ADA, 2021; Milsop et al., 2017; Talha et al., 2020):
- Aging (perhaps due to polypharmacy and health complications),
- Autoimmune disease (i.e rheumatoid arthritis)
- Other underlying health conditions
- The use of tobacco
- Alcohol consumption
- Overconsumption of caffeine
- Overconsumption of spicy foods
- Endocrine diseases (i.e diabetes)
- Infectious diseases (i.e Hepatitis C virus)
- Granulomatous diseases (i.e. Tuberculosis)
Diagnosis
Clinical Features
A medical history is obtained to diagnose Xerostomia, with a particular focus on the patient’s symptoms and their medication use history (Villa, 2015). Additionally, oral, neck and head examinations are performed, (ADA, 2021).
During an oral examination, features to be detected include a glassy oral mucosa, absent doral papillae, foamy saliva, greater than two cervical caries, buccal mucosa, or lobulated tongue (Milsop et al., 2017).
Pathological Features
Salivary flow rates can be measured with ease and efficiency (Villa, 2015). Sialometry measures either the stimulated or unstimulated flow rate to compare to baseline levels (Talha et al., 2020).
Sialography is a 3D imaging technique that identifies salivary stones and masses (Talha et al., 2020).
A biopsy may be performed if the cause of Xerostomia is suspected to be systemic (Talha et al., 2020).
Treatment
Non-Pharmacological Treatment
Patient education regarding oral hygiene and dental care are important, along with lifestyle changes such as increasing the frequency of water intake, chewing sugar-free gum, avoiding tobacco, alcohol, spicy or hard-to-chew foods (Milsop et al., 2017; Talha et al., 2020).
Alternatively, sprays, lozenges or gels can be taken before meals as saliva substitutes, but they may be ineffective (Talha et al., 2020).
Furthermore, intraoral electrostimulation increases salivary flow; however, this is not practical for everyday use (Villa, 2015).
Pharmacological Treatment
In situations in which Xerostomia is caused by the use of medications, the medication should be stopped, if possible (Talha et al., 2020).
Sialogogue drugs such as pilocarpine (5 mg – 30 mg) and cevimeline (30mg) are approved by the Food and Drug Administration (FDA) for symptomatic treatment of xerostomia (Milsop et al., 2017; Talha et al., 2020).
Topical treatments for early stage Xerostomia include sugar-free salivary stimulants (i.e candy) (Milsop et al., 2017).
References
American Dental Association (ADA). (2021, February 22). Xerostomia (Dry Mouth). https://doi.org/10.1007/s13167-018-0145-7
Fox R. I. (2005). Sjögren’s syndrome. Lancet (London, England), 366(9482), 321–331. https://doi.org/10.1016/S0140-6736(05)66990-5
Kunin, A., Polivka, J., Moiseeva, N., & Golubnitschaja, O. (2018). “Dry mouth” and “Flammer” syndromes—Neglected risks in adolescents and new concepts by predictive, preventive and personalised approach. The EPMA Journal, 9(3), 307–317. https://doi.org/10.1007/s13167-018-0145-7
Millsop, J. W., Wang, E. A., & Fazel, N. (2017). Etiology, evaluation, and management of xerostomia. Clinics in Dermatology, 35(5), 468–476. https://doi.org/10.1016/j.clindermatol.2017.06.010
Talha, B., & Swarnkar, S. A. (2021). Xerostomia. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK545287/
Tanasiewicz, M., Hildebrandt, T., & Obersztyn, I. (2016). Xerostomia of Various Etiologies: A Review of the Literature. Advances in Clinical and Experimental Medicine, 25(1), 199–206. https://doi.org/10.17219/acem/29375
Villa, A., Connell, C. L., & Abati, S. (2014). Diagnosis and management of xerostomia and hyposalivation. Therapeutics and Clinical Risk Management, 11, 45–51. https://doi.org/10.2147/TCRM.S76282
Leite, C. A., Galera, M. F., Espinosa, M. M., de Lima, P. R. T., Fernandes, V., Borges, Á. H., & Dias, E. P. (2015). Prevalence of Hyposalivation in Patients with Systemic Lupus Erythematosus in a Brazilian Subpopulation. International Journal of Rheumatology, 2015, 730285. https://doi.org/10.1155/2015/730285
Yang, H., Bian, S., Chen, H., Wang, L., Zhao, L., Zhang, X., Zhao, Y., Zeng, X., & Zhang, F. (2018). Clinical characteristics and risk factors for overlapping rheumatoid arthritis and Sjögren’s syndrome. Scientific Reports, 8, 6180. https://doi.org/10.1038/s41598-018-24279-1
