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Dry Mouth

Category(s): Exocrine glands/Oral

Overview

Synonyms : Xerostomia
Dry mouth is a condition which results from a decreased amount of saliva in the mouth. Xerostomia may make it difficult to eat, speak, and digest food and may cause malnutrition. Severe dry mouth and salivary gland dysfunction may produce significant anxiety, permanent throat and mouth disorders, and may impair quality life of a person.

Dry mouth affects about 10 per cent of all people and tends to be more common in women than men. Disorders of saliva production have an effect on elderly people and those who are taking prescription and nonprescription medicines most frequently.

Saliva is a vital part of a healthy mouth and is frequently taken for granted. The lubricating properties of saliva give comfort and assist protect the oral tissues against sores, ulcers, and other frictional movements which accompany normal eating and speaking.

Saliva neutralizes acids and helps protect against tooth decay, and viral, bacterial, or fungal threats. Saliva helps digest food and helps teeth in remineralization.

Saliva is also a very important contributor to a person's ability to taste, as it acts as a solvent for the taste stimuli. When saliva volume is inadequate, all of these functions are impaired.

Xerostomia is a medical word used for dry mouth due to lack of saliva; there is not adequate saliva to keep the mouth wet or there is reduced or absent saliva flow.

Cases / year in India :

Symptoms

Common symptoms include:

  • Frequent thirst
  • A sticky, dry feeling in the mouth
  • A dry feeling in the throat
  • Sores in the mouth; cracked lips; sores or split skin at the corners of the mouth 
  • A dry, red, raw tongue
  • A burning or tingling sensation in the mouth and especially on the tongue
  • Bad breath
  • Problems speaking or trouble tasting, chewing, and swallowing
  • Hoarseness, dry nasal passages, sore throat.

Causes

Causes of dry mouth include:

Side effect of certain medications: Dry mouth is a general side effect of many prescription and nonprescription drugs, such as drugs used to treat depression, allergies, pain, anxiety, and colds (decongestants and antihistamines), acne, hypertension (diuretics), obesity, diarrhea, epilepsy, nausea, urinary incontinence, asthma (certain bronchodilators), Parkinson's disease, and psychotic disorders.
Dry mouth may also be a side effect of sedatives and muscle relaxants.

Side effect of certain diseases and infections: Dry mouth may be a side effect of medical conditions, e.g. HIV/AIDS, Sjogren's syndrome, diabetes, Alzheimer's disease, anemia, cystic fibrosis, rheumatoid arthritis, Parkinson's disease, hypertension, stroke, and mumps.

Side effect of certain medical treatments: Damage to the salivary glands, the glands which make saliva, may reduce the amount of saliva produced such as the damage could stem from radiation to the neck and head, and chemotherapy treatments, for cancer.

Nerve damage: Dry mouth may be a result of nerve damage to the neck and head area from an injury or surgery.

Dehydration: Conditions which cause dehydration, e.g. excessive sweating, fever, diarrhea, vomiting, burns and blood loss may cause dry mouth.
Surgical removal of the salivary glands.

Lifestyle: Chewing tobacco or smoking may affect how much saliva a person make and aggravate dry mouth. 

Diagnosis

Diagnosis include:

The doctor will examine the patient's mouth and review his/her medical history.                                                                            
Blood tests and imaging scans of the salivary glands may be recommended by the doctor.

Saliography: It is a radiographic test of the salivary glands and ducts after administering a radiopaque material into the ducts. It may be helpful in identifying salivary gland stones and masses.                                                    
Sialometry: It is a simple procedure that measures the flow rate of saliva. Collection devices are placed over submandibular/sublingual gland duct orifices or the parotid gland and saliva is stimulated with citric acid.

Biopsy: In this a small sample of salivary gland tissue is taken. Generally used in the diagnosis of Sjogren's syndrome. 


Treatment

Treatment for xerostomia includes:

Medications: If medication is thought to cause dry mouth  the doctor will either change the dosage or prescribe another drug which is less likely to cause dry mouth.

Stimulating saliva production: A medicine like pilocarpine or cevimeline, may be prescribed, to stimulate the production of saliva.

Symptomatic treatment for dry mouth includes 4 areas:

  • Controlling dental caries    
  • Increasing the flow of saliva
  • Replacing lost secretions
  • Some specific measures, like treating infections.
  • A patient with xerostomia should give special attention to dental or oral hygiene.
  • Brushing teeth and flossing regularly is very important.
  • Sipping fluids (sugarless, non-carbonated) and using a carboxymethyl cellulose saliva substitute as a mouthwash may help.

Person with xerostomia should avoid:

  • Spicy foods                        
  • Astringents                                
  • Sugary foods or drinks
  • Acidic foods or drinks
  • Dry foods
  • Excessively hot or cold drinks
  • Avoid alcohol consumption or it should be kept to a minimum .
  • Caffeine consumption should be kept to a minimum.
  • Smoking or chewing or tobacco should be avoided.
  • Eating foods like carrots or celery may help with residual salivary gland function.
  • Humidity: A humidifier can add moisture to a bedroom. This may decrease dry mouth symptoms that develop during sleep.

Latest Treatment

The most commonly used treatment is the use of artificial saliva substitutes in the form of a spray, gel or lozenge, to keep your mouth moist.

Biotene mouthwash, spray, and gel may also be prescribed.

  • If the cause is due to some medication, the doctor will either reduce the dosage or prescribe another medication.
  • Commonly prescribed medications for stimulating the production of saliva include:
    • Pilocarpine (Salagen) or cevimeline (Evoxac).
    • Bethanechol is another possible choice for parasympathomimetic agent.
  • Carboxymethyl cellulose saliva substitute is recommended for use as a mouthwash and chewing xylitol (sugarless) chewing gum is advised.
  • Recently, stem cells have been shown to generate new salivary glands with the help of silk fibers.

Medicines