Xerostomia  ???

What in the world does this word mean ? It is the medical term for the complaint of dry mouth due to a lack of saliva. When you cut your finger, what's the first thing you do? You jam it in your mouth and lick it clean, right? Mammals instinctively lick their wounds because saliva has antibiotics in it. If a baby chimp shows its mother a cut on its arm, she licks it. It's instinct. Ever gone into a child's room and see the drool on his pillow? It's amazing he doesn't drown in his sleep every night. Now....how about someone in their 50's, who might take a glass of water to bed with them because when they wake up in the middle of the night, their mouth is drier than the Sahara. Of course as we age even more, the drier the mouth becomes and when you don't have saliva in your mouth, you don't have antibodies, which help prevent tooth decay.

According to statistics from AARP the average American older than 75 has more than 11 drugs prescribed to them each year. Antihistamines, antidepresants, antipsychotics, anti-Parkinson agents, diuretics, sedatives, analgesics, bronchodilators and skeletal muscle relaxants ALL contribute to xerostomia. I have seen a number of patients over the years that were without decay for many years and then at their next routine checkup......... multiple decay areas. This can many times be directly linked to a change in prescription medications. If you take the time to unfold the handout that comes with your next prescription medication, put it under a microscope and read it.....you'll see all the possible side effects and listed there you likely will find "xerostomia" as one.

Now compound that with Grandma in the nursing home and between the lack of oral hygiene and diet, the mouth becomes very acidic where bacteria love to grow. There is good information about obtaining a beter pH in the mouth so as to lessen the effects of the acidity. You can find this at www.carifree.com. One of the best things on this website is a 'Mouth Spray'. There are numerous other 'Saliva substitutes" on the market that can be purchased at any drug store.

An increase in oral hygiene (brushing, flossing, rinsing) becomes imperative. The drier the mouth, the more the plaque (decay causing bacteria) actually sticks to the teeth. It takes MUCH more effort to remove this plaque......but it can be done. For someone who has xerostomia, I highly recommend at least an electric brush and fluoride. Fluoride comes in 2 different forms, there is a prescription fluoride toothpaste (prescription due to the high concentrate that a child should not use) and prescription gel. The VERY best way to deliver the gel is by means of 'flouride trays'. These trays are made from impressions of the teeth and then a flexible clear thin material is heated and pressed over the models. By placing the gel into the trays once or twice a day and leaving them in the mouth for 5 to 10 minutes, the flouride is held in direct contact to the teeth where it can react and strengthen the teeth the best.

There are numerous other causes of xerostomia and they are listed below.

More Scientific Information

Saliva

Saliva possesses many important functions including antimicrobial activity, mechanical cleansing action, control of pH, removal of food debris from the oral cavity, lubrication of the oral cavity and remineralization.

Complications associated with xerostomia

Xerostomia is often a contributing factor for both minor and serious health problems. It can affect nutrition and dental health. Some common problems include a constant sore throat, burning sensation, difficulty speaking and swallowing, hoarseness and/or dry nasal passages. Xerostomia is a hidden cause of gum disease and tooth loss in three out of every 10 adults. It also decreases the oral pH and significantly increases the development of plaque and dental decay. Oral candidiasis (fungal) is one of the most common oral infections seen.

Signs and symptoms of xerostomia

Individuals with xerostomia often complain of problems with eating, speaking, swallowing and wearing dentures. Dry, crumbly foods, such as cereals and crackers, may be particularly difficult to chew and swallow. People often complain of taste disorders, a painful tongue and an increased need to drink water, especially at night.

Diagnosis and evaluation of xerostomia

Diagnosis may be obtained from an examination of the oral cavity and/or sialometry, a simple office procedure that measures the flow rate of saliva. In women, the "lipstick sign," where lipstick adheres to the front teeth, may be a useful indicator.

Common causes

Medications

Perhaps the most prevalent cause of xerostomia is medication. More than 400 commonly used drugs can cause xerostomia. The main ones are antihistamines, antidepressants, anticholinergics, anorexiants, antihypertensives, antipsychotics, anti-Parkinson agents, diuretics, sedatives, antiemetics, antianxiety agents, decongestants, analgesics, antidiarrheals, bronchodilators and skeletal muscle relaxants. It should be noted that, while there are many drugs that affect the quantity and/or quality of saliva, these effects are generally not permanent.

It may be possible to change medications or dosages to provide increased salivary flow. Symptoms are often worse between meals, at night and in the morning. Therefore, consider modifying drug schedules.

Diseases and other conditions

The most common disease causing xerostomia is Sjögren's syndrome (SS), a chronic inflammatory autoimmune disease that occurs predominantly in postmenopausal women. It is estimated that as many as 3 percent of Americans suffer from Sjögren's syndrome, with 90 percent of these patients being women with the average age at diagnosis of 50 years.

Sarcoidosis and amyloidosis are other chronic inflammatory diseases that cause xerostomia. Other systemic diseases that can cause xerostomia include rheumatoid arthritis, systemic lupus erythematosus, scleroderma, diabetes mellitus, hypertension, cystic fibrosis, bone marrow transplantation, endocrine disorders, nutritional deficiencies, nephritis, thyroid dysfunction and neurological diseases such as Bell's palsy and cerebral palsy. Dry mouth is often exacerbated by activities such as hyperventilation, breathing through the mouth, smoking or drinking alcohol.

Cancer therapy

Xerostomia is the most common problem associated with standard radiation therapy to the head and neck. A common early complaint following radiation therapy is thick or sticky saliva. The degree of permanent xerostomia depends on the volume of salivary gland exposed to radiation and the radiation dose. Patients experiencing xerostomia from radiation therapy or cancer chemotherapy are at particular risk of mouth bacterial infections.

Management of xerostomia

For those whose xerostomia is related to medication use, the likely only means to deal with the dryness and maintain compliance with their medications typically includes four areas: increasing existing saliva flow, replacing lost saliva, control of dental decay and specific measures such as treatment of infections.

Self-care

Patients suffering from xerostomia should be encouraged to take an active role in management with regard to both identifying products and practices that are most useful to them and in being vigilant to minimize the risks to dental health. People should conduct a daily mouth examination, checking for red, white or dark patches, ulcers or tooth decay. If anything unusual is found, they should report it to their physician or dentist. Regular preventive dentistry becomes VERY IMPORTANT. Plaque removal and treatment of gingival (gum) infections or inflammation and dental decay are essential. Patients should also use fluoride daily.

There are a number of ways to deliver fluoride to the teeth. The most common is the use of fluoride rinses which should be held in the mouth for at least one minute. Prescription level fluoride toothpastes can be applied with a toothbrush and left in place for two to three minutes before rinsing. Prescription level fluoride gels may be brushed onto the teeth, but the optimal way of delivery is by means of custom fitting trays that are fabricated from simple dental impressions. The gel is loaded into the trays and once placed onto the teeth, they should remain for at least 5 minutes.

No food or beverage should be consumed for at least 30 minutes after fluoride application.

Because of their susceptibility to dental caries, patients with xerostomia should avoid sugary or acidic foods or beverages. If possible, tobacco and alcohol intake should be eliminated to control dental decay. Lubricants such as Orajel or Vaseline and glycerin swabs on the lips and under dentures may relieve drying, cracking and general gum soreness.

Saliva stimulants such as sugarless candies and chewing gum, may be used to stimulate saliva flow. Some people like to take frequent sips of water throughout the day and suck on ice chips. Eating foods such as carrots or celery may also help.

Over-the-counter products

There are several over-the-counter products that are available to provide assistance in the management of xerostomia. These products range from saliva substitutes and stimulants to products designed to minimize dental problems.

Saliva substitutes:

Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. These are formulated to mimic natural saliva, but they do not stimulate salivary gland production. Products come in a variety of formulations including solutions, sprays, gels and lozenges and can be found at any drug store.

Saliva stimulants:

Natrol Dry Mouth Relief stimulates saliva production. It would not be appropriate for use in patients whose salivary gland function has been lost through radiological treatment.

Dentifrices:

Biotene and Oralbalance are antixerostomia dentifrices (toothpastes, mouthwashes, gels) that are formulated to activate oral bacterial systems.

Prescription Products

Pilocarpine tablets are indicated for the treatment of symptoms of dry mouth caused by Sjögren's syndrome or by radiotherapy for cancer of the head and neck.

Cevimeline is indicated for the treatment of symptoms of dry mouth in patient's with Sjögren's syndrome.

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Dr. Maury Hafernik
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