Xerostomia, what is it?
Xerostomia is a subjective sensation of dry mouth that occurs very frequently, associated with a decrease in saliva production by the salivary glands. Even so, there are cases where the salivary glands function normally. This problem causes significant discomfort for the patient, and can even lead to other health issues, so it should not be ignored. Therefore, it is important to always make the diagnosis with a qualified health professional to identify xerostomia, understand possible causes, and provide adequate treatments.
Xerostomia, or dry mouth, what can it be?
When the sensation of dry mouth persists for some time, there may be:
Sticky and dry mucous membranes;
Thick or viscous, frothy saliva;
Bad breath;
Difficulty chewing, speaking, or swallowing;
Dry and rough tongue, cracked, with atrophy of the papillae;
Dry throat or sore throat;
Changes in taste;
The appearance of cracks in the lips, which can even become inflamed and infected (angular cheilitis), as well as ulcers in the mouth.
Secondarily, there may be an increase in plaque, cavities and gum diseases.
Causes of Xerostomia
Xerostomia can have various origins. On one hand, there may be a medical cause, such as the introduction of medications (iatrogenic origin), while on the other hand, it may have environmental origins. Below, we categorize them simply:
Iatrogenic origin
Medications: Certain prescription and over-the-counter medications, such as antihistamines, decongestants, antihypertensives, muscle relaxants, and antidepressants can cause xerostomia. There are hundreds of medications associated with xerostomia as a side effect. Additionally, the quantity of medication also influences this, even if the medications are not xerostomic.
Oncological treatments: Radiotherapy treatments in the head and neck can affect the salivary glands, leading to decreased saliva production;
Systemic diseases: Conditions such as Sjögren's syndrome, Diabetes, Parkinson's disease, Hepatitis C, HIV, Nervous System disorders, and Graft versus Host Disease can also cause dry mouth.
Local factors
Lifestyle: Certain harmful habits, such as smoking or consuming excessive alcohol, can also affect saliva production;
Oral breathing: When breathing is predominantly through the mouth, due to nasal canal obstruction, the mouth becomes drier;
Dehydration: Not drinking enough fluids or being subjected to conditions that cause excessive sweating, vomiting, diarrhea, blood loss, or fever can result in the sensation of dry mouth;
Nerve damage: Certain injuries to the head or neck can affect the nerves of the salivary glands, also leading to reduced saliva production;
Developmental factors
Agenesis or aplasia of the salivary glands (where one or more glands are absent or their development is imperfect or incomplete).
The treatment of xerostomia will depend on the correct identification of the origin, that is, the diagnosis. This can make the difference between a complete cure of the condition or merely its management.
But how is the diagnosis of xerostomia carried out?
The diagnosis of xerostomia generally involves a set of steps to determine not only its origin but also the most appropriate treatment. The diagnostic process for xerostomia thus includes:
Appropriate clinical history, including the collection of information about family history, medical and dental history, medication;
Oral clinical examination;
Measurement of salivary flow rate, essentially the amount of saliva produced per minute;
Laboratory tests to rule out any underlying diseases;
Imaging studies of the salivary glands, looking for morphological changes, the presence of salivary stones, for example.
Treatment of Xerostomia
The main objectives of treating xerostomia are to address underlying causes, manage symptoms, and prevent complications. Some of the principal treatments include:
Ensure hydration: Increase fluid intake to help keep the mouth hydrated;
Using salivary substitutes: In certain cases, salivary substitutes may be recommended, such as in spray or gel form, which provide temporary relief from the sensation of a dry mouth.
Medications: Drugs such as pilocarpine and cevimeline may also be prescribed to help stimulate saliva production;
Good oral hygiene with appropriate products, usually containing lactoperoxidase, lysozyme, and lactoferrin. It is essential to ensure regular brushing as well as the use of dental floss, keeping appointments with the dentist or oral hygienist at least every six months, in order to control any side effects that xerostomia may provoke on oral health, such as dental decay;
Dietary changes: In cases of xerostomia, caffeine, alcohol, and tobacco should be avoided as they significantly dry out the oral cavity.
Additionally, it may be necessary to discontinue or alter medications or dosages that are part of the daily therapy.
What are the complications of xerostomia if left untreated?
If left untreated, xerostomia can:
Increase the risk of dental caries, periodontal disease;
Increase the risk of fungal infections, such as candidiasis;
Complicate the chewing process, which can have nutritional and thus systemic consequences.
