Xerostomia can result from a number of factors, including the use of certain medications
Apart from dry mouth, symptoms may include halitosis, thirst, and difficulty eating or talking
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Treatment depends on the severity of the condition and the individual, and may include the use of artificial saliva's or saliva stimulants
Untreated xerostomia will result in dental caries
What is dry mouth (xerostomia)?
Dry mouth (xerostomia) is sometimes referred to as hyposalivation (hypo = less, salivation = secretion of saliva). If left untreated, rampant dental caries will start
as soon as three months after the onset of xerostomia.
Factors that will influence or cause xerostomia
Biological ageing
With ageing, the probability of experiencing dental problems increases. It is however seldom the act of growing older itself that is responsible for dental problems such as xerostomia. Rather, it the factors related to ageing, such as the consequence of diseases that the elderly are more likely to have, or the consequence of medications taken for these diseases, that are the culprits.
Certain diseases and conditions
Rheumatoid conditions, e.g. Sjogren's Syndrome
Dysfunction of the immune system, e.g. HIV/AIDS
Hormonal disorders, e.g. Diabetes Mellitus
Neurological disorders, e.g. Parkinson's disease
Prolonged illnesses, e.g. Lupus, Multiple Sclerosis
Anaemia
Stress
Removal or tumours of the salivary glands
Conditions that necessitate the surgical removal of salivary glands will cause immediate xerostomia.
Tumours of the salivary glands might reduce the flow of saliva block it altogether.
Functional problems
Persons with a decreased chewing ability will tend to eat softer and liquified foods. This tends to decrease the flow of saliva, since the need for saliva is less.
Radiation therapy
Head, neck and oral cancers are often treated with radiation, resulting in post-irradiation xerostomia, due to permanent damage to the salivary glands from the radiation.
Drugs or medications
This is the most common cause of diminished flow and is also most common in people older than 65. There are more than 400 drugs that have xerostomia as a side effect. Here is a list of the most common ones:
Amphetamines
Antianxiety drugs
Antidepressants (tricyclics)
Anticholinergics (atropine)
Anticonvulsants
Antihistamines
Antihypertensives
Antiparkinsonians
Antipsychotics
Antispasmodics
Appetite suppressants
Barbiturates
Bronchodilators
Decongestants
Diuretics
Hypnotics
Muscle relaxants
Opioid (narcotic) analgesics
Anorexia Nervosa and Bulimia Nervosa
Frequent vomiting and the use of laxatives can reduce the flow of unstimulated saliva (the saliva secreted without eating). The use of psychoactive medicines, especially antidepressants that are often prescribed for eating disorders, can contribute to dry mouth.
Menopause
Women who are going through menopause will occasionally experience a problem with gums that become dry and shiny, and that bleed easily (menopausal gingivostomatitis). Mouth dryness and a burning sensation in the mouth are common complaints. Treatments focus on excellent oral hygiene, controlling the inflammation, and even using supplements such as vitamin C and complexes.
Signs and Symptoms
The following are common signs and symptoms of xerostomia:
Difficulty talking
Halitosis (foul odour of the mouth)
Frequent thirst
Burning sensation of the tongue
Difficulty in eating, especially dry foods
Difficulty in wearing dentures, since the retention of dentures is dependent on saliva for adhesion
Dry, cracked lips and corners of the mouth
Impaired taste
What are the consequences of xerostomia?
Since saliva is the body's built-in cleansing mechanism and first line of defence against plaque, a reduction or lack of saliva will have definite effects on the oral environment as follows:
Plaque accumulation
Food accumulation
Increased risk of dental caries, especially on the roots of teeth, due to acids not being neutralised by the saliva
Difficulty in eating, swallowing and talking
What to do when you have xerostomia
The type of treatment will depend on the severity of the xerostomia. What works for one person might not work for another, and what works today might not work tomorrow. You should try various methods to alleviate dry mouth, and keep on using the most successful methods. Various methods are listed as follows:
Use sugar-free lozenges to coat the mouth
Frequently sip water, and keep water at your bedside during the night
Sugarless chewing-gum is a simple and effective method of increasing salivation, although it is only effective while you are chewing the gum. The use of xylitol (a sweetener that does not ferment) has been found to combat caries in people suffering from xerostomia.
Use artificial salivas such as carboxymethylcellulose or mucin
Use saliva stimulants such as pilocarpine hydrochloride, but under strict supervision of your doctor
Use fluoride as often as possible to combat caries. The fluoride in toothpaste is a very low concentrate, and will be ineffective. Use a fluoride rinse such as 0.05% Sodium Fluoride (NaF) solution (an over-the-counter product) daily, or fluoride gels or varnishes which are routinely applied professionally
Dietary adjustments include avoiding tobacco and smoking, alcoholic beverages, and foods high in sugar
A thorough oral hygiene regime is very important. Heavy plaque accumulations will occur with dry mouth and this will lead to dental caries
Dry mouth (xerostomia) can result in oral discomfort and can have serious consequences. If you feel you have this symptom, please see your oral health professional.
Reviewed by Dr Neil Campbell, CEO of the South African Dental Association.
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