Xerostomia – Symptoms , Causes, Treatment And Prevention

Xerostomia is the dryness of the mouth due to hyposalivation. Xerostomia is not a disease but could be due to an underlying ailment including the side effects of radiation to the head and neck.

Digestion of food starts from the mouth. This is because of the enzymes of the saliva. A healthy body produces three pints or approximately 1.4 liters of saliva every day. This is very essential for not only digestion but also to keep away dental problems and dry mouth.

Hyposalivation is lack of saliva secretion in the mouth. This could be because of any underlying ailment including HIV or undetected severe diabetics.

Apart from causing a lot of discomforts xerostomia could also produce a foul-smelling odor from the mouth and could affect the quality of life.

Hence to keep your mouth watering, maintain quality life and to stay away from bad odor keep reading till the end.

Dry mouth is most common with 5.5 % to 46 % of the population and with 20 % of elderly people. Though age is the main factor for causing xerostomia even some medications and severe diabetics could cause dry mouth. Hence medications which are not suitable to the body condition could be identified with dry mouth and could be avoided.

Tooth decay, gum disease, and dental problems could be associated with dry mouth. Hence to consult a dentist in case of dry mouth is also recommended.

Dry mouth can cause obstruction of speech, lose the taste of food, make chewing and swallowing food difficult and bad odor.

Hence to find the root cause of xerostomia and giving proper treatment to cure it is important. And more important is to be aware of the causes and to prevent them from being affected by xerostomia. This could be more useful in the later part of life to have a happy and healthy living at old age.

To understand and prevent xerostomia it is pertinent to know more about saliva. This voluntarily secreted liquid from the mouth is unnecessarily spat out by many people across the world. This is one neglected substance secreted by the human body which is helpful for its various important functions.

SALIVA:

Saliva is one important secretion of the body which helps in digestion. When there is no saliva present in the mouth it becomes harder to chew, swallow and the food we eat cannot be moisturized. This causes various ailments.

Saliva consists of 99.5 % water with electrolytes, mucus, white blood cells, epithelial cells along with antimicrobial agents such as secretory IgA and lysozyme.

Enzymes in saliva play a vital role in the digestion system of the body. They are also responsible for breaking down of the food particles entrapped in the dental cervical thus protecting the teeth from decay.

Amylase protein breaks down the starches and Lingal lipase breaks down fats.

Saliva is the watery, clear, viscous fluid secreted from the mucous glands of the mouth. When these mucous glands are stimulated, afferent nerve signals travel to the salivatory nuclei in the medulla of the brain.

Due to the lack of secretion of saliva the secondary condition of Xerostomia may occur. The normal stimulated secretion of saliva in the mouth is 1.5 to 2.0 ml/min and the unstimulated salivary secretion flow rate is approximately 0.3 to 0.4 ml/min.

Hyposalivation is diagnosed when the stimulated secretion of saliva is less than 0.5 – 0.7 ml/min and the unstimulated secretion is less than 0.1 ml/min which confirms Xerostomia.

Xerostomia is diagnosed in patients with objective hyposalivation when the rate of saliva flow is less than the rate of fluid absorption across the oral mucosa glands plus the rate of fluid evaporation from the mouth.

CAUSES OF XEROSTOMIA:

The main cause of Xerostomia is hyposalivation. This may be caused by various factors.

Some common causes of Xerostomia:

• Aging:

With aging comes the inadequate nutrition and along with it diseases. Also, the medications taken by old people can cause xerostomia.

• Tobacco:

Both smoking and chewing tobacco cause dry mouth.

• Alcohol:

Alcohol consumption or mouthwashes containing alcohol can cause dry mouth.

• Oral Trush:

This is caused by a yeast infection in the throat and with simple antibiotics, it could be cured.

• Sleeping with the mouth open and snoring
• Dehydration of the body
• Diarrhea
• Breathing through the mouth
• Excessive or intense exercises and that too in hot and humid conditions
• Nerve injury due to an accident

 

Medications causing Xerostomia:

There are hundreds of medications which could cause xerostomia. The following are the few medications taken for various ailments cause xerostomia.

• Anticoagulants
• Antidepressants
• Antihypertensives
• Antiretrovirals
• Antihistamines
• Anticholinergics
• Antipsychotics
• Antiparkinson agents
• Diuretics
• Sedatives
• Hypoglycemics
• Levothyroxine
• Multivitamins & supplements
• Non-steroidal anti-inflammatory drugs
• Steroid inhalers

Diseases causing Xerostomia:

There are several underlying ailments because of which xerostomia is caused. Xerostomia or dry mouth could also be a sign or symptom of an underlying disease. Hence when confronted with a dry mouth, it is better to check out for the following diseases:

Diabetes:

Xerostomia could be the warning bell for undetected or unmanaged sugar levels in the blood.

Stroke:

Stroke can cause xerostomia and depend on the severity of the stroke or its type the symptom of dry mouth could become permanent.

Alzheimer’s Disease:

Xerostomia is closely related to Alzheimer’s disease. This is because of inadequate fluid intake along with other prescribed medicines.

Sjogren’s Syndrome:

This syndrome also is known as SS and is caused because of excess dryness in the eyes and mouth. Women around the age group of 50 years which are the postmenopausal period are more prone to this chronic inflammatory anti-immune disease.

More than 3 % of American women suffer due to SS. This could lead to Sicca complex. This is because of the infiltration of lacrimal and salivary glands resulting in xerostomia and xerophthalmia.

Enlargement of the salivary glands occurs in one-third of Sicca victims. This is incurable and only could be controlled.

HIV/AIDS:

HIV associated salivary disease is common in diagnosed children. HIV causes dry mouth and in addition to the medications taken for it could increase xerostomia.

HIV results in the enlargement of the patriot glands which causes xerostomia and this is most common in children affected by HIV.

Cancer:

The treatments for cancer can cause xerostomia in two ways:

Radiotherapy:

Radiation on the neck and head could cause damage to the saliva glands and thus make it ineffective to produce saliva.

This is caused because of the fibrosis of the salivary glands and is mostly permanent. This occurs when the radiation dose exceeds 5200 eGy.

Chemotherapy:

Chemotherapy can alter the nature of the saliva and also the amount to be produced as per the stimulations and body conditions

• Parkinson’s disease
• Anxiety disorders
• Depression
• Rheumatoid Arthritis
• Scleroderma
• Systemic lupus erythematosus
• Cystic fibrosis
• Nutritional deficiencies
• Nephritis
• Thyroid dysfunction
• Neurological diseases like Bell’s palsy and cerebral palsy

Dental diseases causing xerostomia:

The ADA or the American Dental Association has identified the following rare causes of xerostomia in a report to the ADA Council on Scientific Affairs.

• Hepatitis C
• Graft-versus-host disease
• Lymphoma
• Sarcoidosis – Granulomatous disease
• Amyloidosis – Degenerative disease
• Agenesis or Salivary Gland Aplasia
• Immunoglobulin G4 – Sclerosing Disease

SYMPTOMS OF XEROSTOMIA:

Xerostomia is a symptom of many diseases. But the symptoms of xerostomia depends on the general cause or the underlying ailment.

Common symptoms of Xerostomia:

• Dryness of the mouth
• Less saliva secretion than usual
• Trouble swallowing food especially dry foods
• Bad breath
• Dysgeusia or taste disorders
• Increased need to drink water especially in the night
• Lipstick sticking to teeth
• Altered speech or problem speaking
• Saliva becoming sticky
• Need to moisten your mouth and lips often
• Medical symptoms of Xerostomia:
• Cheilitis or fissuring and inflammation like splitting and cracking of the lips
• Cracking and fissuring of the oral mucosa which causes the corners of the mouth to split and become sore
• Thrush or fungal infections in the mouth
• Glossodynia or a painful tongue due to inflammation and tongue ulcers
• Gum disease occurring frequently
• Tooth decay and plaque becoming common
• Wearing dentures becoming a problem with denture retention, denture sores and tongue sticking to the palate
• A sore throat
• Sialadenitis or a salivary gland infection
• Burning mouth syndrome

DIAGNOSES OF XEROSTOMIA:

Diagnoses of xerostomia start with the doctor’s questionnaires on the symptoms of xerostomia. This is the vital part of the diagnoses which could give a clear picture of the severity and the cause of xerostomia.

The questionnaires may contain the following questions which have to be answered with care and concern to ascertain the exact cause of xerostomia:

• Do you have less saliva than you used to?
• Do you have trouble swallowing and that to dry foods like crackers?
• Do you need to moisten your mouth frequently or sip liquids often?
• Do your mouth feel dry at mealtime?
• Do you have any chronic illness like diabetes or hypertension?
• What are the OTC medications are taken by you?
• Do you wear dentures and is there any difficulty in wearing them recently?
• Do you have dental pain or toothaches?
• What is your daily water consumption?
• What dietary supplements do you take?
• Have you noticed recently any sores in the mouth or lips?

According to the answers and after the check up of the mouth thoroughly the doctor may prescribe the following clinical tests:

Clinical tests for Xerostomia:

Blood Test:

Blood test to identify any underlying ailment could be done.

Sialometry:

This is a simple procedure to check the flow rate of saliva. The saliva production is stimulated with citric acid by placing collection devices over the duct orifices. If the salivary flow rate is less than the prescribed levels then xerostomia is confirmed.

Saliography:

This is used to identify the salivary gland stones and masses by radiographic examination. This is done by injecting a radio-opaque media into the salivary glands.

Salivary Scintigraphy:

This is useful in assessing the salivary gland function. Technetium-99m sodium pertechnate is intravenously injected to ascertain the rate and density of uptake and the time of excretion in the mouth.

Biopsy:

This is done mostly in the diagnoses of SS or the Sjogren’s Syndrome. A small sample of salivary gland tissue is taken if any malignancy is suspected the doctor may order a biopsy.

TREATMENT FOR XEROSTOMIA:

A lot of people do not take dry mouth or xerostomia seriously. But when left untreated it may lead to serious dental health conditions, poor digestion and also increase the severity of the underlying ailment.

Before it is too late it is the right time to see a doctor or a dentist immediately. Once diagnosed with Xerostomia the following are the treatments for xerostomia.

Home or natural remedies for xerostomia:

To be hydrated at all times:

To drink a minimum of 2 – 3 liters of water daily and to have water by bedside during night times to be hydrated 24/7 365 days.

Drinking water with food:

The sipping of water or non-alcoholic beverages while eating food will help in breaking the food for xerostomia patients.

Avoiding dry foods:

It is advised to totally avoid dry foods like chips of all kinds, crackers, and snacks which could worsen the suffering of chewing and swallowing.

Moisturizing foods:

Apart from drinking water food consumed could be moisturized with foods like bone broth to make eating easy.

Breathing through the nose:

Most of us make the mistake of breathing through the mouth. This should be totally avoided and breathing should be only done through the nose for which it is present in our body.

Even while exercising breathing through the mouth should be avoided as much as possible. If you are a snoring person seek for snoring remedies to keep the mouth moist.

Coconut oil:

Coconut oil is very useful for xerostomia. It could help in many ways.

• Applying it on the cracked lips several times a day will help in keeping it moist and also prevent it from soaring.
• Coconut oil pulling is one traditional way which is beneficial in many ways. It helps to prevent bad breath. It stops tooth decay.
• Coconut oil increases the overall health and kills the microorganisms that cause bad breath.
• The lauric acid in the coconut oil helps to decrease plaque.

Use a humidifier:

Many studies have shown that those who live in hot conditions should live with a humidifier in the home. Also if the humidifier consist of diffuser fill it with your favorite essential oil for relaxation and to aid for a good night sleep.

Eat more of saliva-producing foods:

Since dry snacks are out of the option fruit snacks could replace it. Some organic apples, cucumbers can be taken whenever your mouth feels dry. The high water content of this kind of fruits will help in secreting more saliva.

Also, some fibrous foods like carrots can be eaten which requires more of chewing can spur more of saliva.

Some herbs and spices like fennel, cayenne pepper, ginger, endive and many more have shown to increase saliva.

Practice precise good dental hygiene:

• Dental hygiene is one of the basis of good health from childhood. It is to be precisely followed to keep xerostomia at bay.
• Floss, use mouthwash and brush at least twice a day. More of tooth brushing by soft bristled brushes and by low abrasive mild flavored fluoride toothpaste by the elderly people taking some medications can prevent pneumonia.
• Dentures should not be worn in the sleeping time and should be rinsed in an appropriate liquid as per the make of the dentures.

Tobacco & Alcohol Avoidance:

Alcohol should be totally avoided in any form. Even the mouthwashes should be free of alcohol. This is because alcohol dries the mouth.

Tobacco and alcohol help in dental caries and hence should be avoided.

Visit a Dentist:

Since Xerostomia involves the mouth along with it the dental parts it is impertinent to visit a dentist every 3 to 6 months. This is because whatever home remedies we follow it should be under the supervision of a qualified medical practitioner.

Medical treatment for Xerostomia:

As per the dentist’s or doctor’s advice, the medical treatments could be taken for xerostomia. This is because the side effects of certain medications could be worse than curing. Also, this could differ from the underlying ailment of the patient.

Most of the medical experts have a symptomatic treatment for dry mouth which includes four areas:

Increasing the flow of saliva:

The first important way to treat xerostomia is to secrete the saliva in the mouth. This enables the food digestion apart from making the food easily chewed, swallowed and eaten.

The increase in saliva will reduce all the impacts of xerostomia and thus start to heal.

Replacing lost secretions:

Next main area of focus is to replace the lost secretions of the saliva. This could increase the secretion of saliva.

Controlling dental caries:

The damage done to the dental part of the mouth should be controlled. This is done by controlling dental caries.

Treating infections and other specific measures:

Without the infections cured, there is no complete relief as there is always a possibility of reoccurrence. Hence treating the infections to the fullest form and curing them with specific measures is also important for the treatment of xerostomia.

OTC treatments:

To have a proper dental hygiene is essential for treating xerostomia. Hence OTC or over the counter oral rinses and mouthwashes free of alcohol should be used.

Saliva substitutes:

Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. They could only act as natural saliva but they do not stimulate gland production. Hence they are only considered as therapy rather than treatment.

These artificial saliva substitutes are available in various forms like sprays, gels, solutions, and lozenges. They mostly contain an agent to increase the viscosity. The agents are mostly carboxymethylcellulose or hydroxyethylcellulose, minerals such as calcium, phosphate ions and fluorides. They also contain preservatives such as methyl-or propylparaben and flavoring agents.

Some commercial saliva substitutes:

• Carboxymethyl or hydroxyethylcellulose solutions
• Glandosane spray
• Moi-Stir (From many multinational brands)

Saliva Stimulants:

Some saliva stimulants like ACM or Anhydrous Crystalline Maltose stimulates saliva production. This is totally not possible in the cases of xerostomia caused by radiotherapy.

ACM was found to be effective in the treatment of xerostomia caused by SS or Sjorgren’s Syndrome.

Natrol Dry Mouth Relief the patented saliva stimulant is formulated as lozenges which can be dissolved in the mouth three times a day for treatment of xerostomia.

Systemic Sialogogues:

Sialogogues are substances which stimulate saliva. The two USFDA or United States Food and Drug Administration approved sialogogues are

Pilocarpine:

Pilocarpine is a cholinergic parasympathomimetic agent with predominantly muscarinic M3 action that causes stimulation of residual functioning exocrine glands.

Cevimeline:

Cevimeline is a cholinergic agonist and a salivary gland stimulant with a stronger affinity for M3 muscarinic receptors located on lacrimal and salivary gland epithelium which leads to an increase in exocrine gland secretions including saliva and sweat.

Intraoral topical agents:

Intraoral topical agents like chewing gums, saliva stimulants and substitutes are of great help in treating xerostomia. A topical sialogogue spray with 1 % malic acid also helps in treating xerostomia.

Intraoral electrostimulation has also been tested to increase saliva flow.

Hyposalivation and Xerostomia remain a debilitating condition for many people. But with proper preventive measures and prompt treatment may reduce the suffering of Xerostomia.

Xerostomia also called pasties, cottonmouth, drooth, doughmouth or des could be prevented and controlled with proper hygiene and dental care.