Dry Mouth (Xerostomia)
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Dry mouth, usually called ‘xerostomia’ (zeer-oh-stomia), is a common symptom most often caused by a decrease in the amount of saliva or a change in the quality of saliva. The exact number of people affected by dry mouth is unknown but it appears to be a common condition. Estimates range from 1% to 65%, depending on the types of patient populations studied.
Saliva is an essential body fluid that contributes to the protection and preservation of the oral cavity and plays a major role in maintaining oral health and comfort. It is produced by the three pairs of major salivary glands and hundreds of minor salivary glands. Its value is seldom appreciated until there is not enough. Saliva is necessary to moisten the mouth, to lubricate
food for easier swallowing, to protect oral hard and soft tissues, to modulate oral microbial populations, to provide initial digestive enzymes, and to promote soft tissue repair and oral cleansing. Cleary, the lack of adequate saliva can lead to numerous clinical conditions affecting one’s oral and systemic health, comfort and quality of life. As a result, detecting the early signs of dry mouth is critical.
Role of Saliva
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Causes of Dry Mouth
Dry mouth is typically caused by a multitude of factors including: medication side effects, various disease states (see Right), head & neck irradiation, dehydration, surgery, smoking, and mouth breathing.
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Diseases Associated with Dry Mouth
•Sjögren’s syndrome
•HIV / AIDS
•Diabetes
•Hypertension
•Hepatitis C
•Lymphoma
Diagnosing Dry Mouth
The diagnosis of dry mouth is usually made after your dentist or physician carefully assesses your medical history and the clinical findings. Your doctor will want to determine if your dry mouth is caused by a change in salivary function, its severity, and its cause. In some cases, they may need to order more specialized tests to assess your particular situation (see Table
below).
Diagnostic Considerations for Dry Mouth
- History — Specifics of the complaint of dry mouth are obtained: duration,
frequency, and severity. The history of dryness at other sites (eyes, nose,
throat, skin, vagina) is documented. A complete medical and prescription drug
history is obtained. - Examination — Major salivary glands are palpated for the presence of
tenderness, firmness, or enlargement. The amount and quality of saliva coming
from the ducts inside the mouth is assessed. The presence of dry or reddish
oral mucosa is noted. The extent and pattern of dental decay is evaluated. - Salivary flow rate — In this test, the amount of saliva produced during a
specified amount of time may be measured. The test is non-invasive and
painless. - Scintigraphy — Performed in the hospital, this test measures the rate at
which a small amount of injected radioactive material is taken up from the
blood by the salivary glands and secreted into the mouth. It is another method
to measure salivary flow rate. - Biopsy of minor salivary glands — A small, shallow incision is made inside
the lower lip to remove at least four of minor salivary glands. A pathologist
then examines them for changes characteristic of the salivary component of
Sjögren’s syndrome.
QUESTIONS AND ANSWERS ABOUT DRY MOUTH
Q: Which medications are associated with dry mouth?
A: Over 1100 medications, either prescription or over the counter, have the potential to cause dry mouth (Table
below). It has been reported that taking more than one medication with dry mouth as a side effect increases one’s probability of experiencing dry mouth and / or its severity. Some medications are more drying than others. Your dentist may recommend you speak with your physician to determine if adjusting or changing your medications could help reduce your dry mouth
Antiacne agents
Antianxiety agents
Anticonvulsants
Antidepressants
Antidiarrheal agents
Antidysrhythmics
Antihistamines
Antinausea agents
Antipsychotics
Anorexiants
Antacids
Bronchodilators
Decongestants
Diuretics
High blood pressure medications
Muscle relaxants
Narcotic analgesics
Nonsteroidal anti-inflammatory drugs
Opioid analgesics
Parkinson’s disease medications
Sedatives
Smoking-cessation agents
Urinary incontinence agents
Q: What is Sjögren’s syndrome?
A: Sjögren’s syndrome is an autoimmune condition characterized by dry mouth and dry eyes. Other potential symptoms include debilitating fatigue and joint pain. An estimated 1 – 4 million people are affected by the syndrome and women are
affected nine times more frequently than. Sjögren’s syndrome can affect any age group but most patients are diagnosed in their early 50’s. It is not unusual for their dryness symptoms to have existed for years prior to the diagnosis.
Oral dryness in these patients my progress up to point and then level off; or it may progressively worsen. Further information on this important disease is available at the Sjögren’s Syndrome Foundation website: http://www.sjogrens.org/ .
Q: Is there a relationship between rheumatoid arthritis and dry mouth?
A: Yes, up to 50% of individuals with rheumatoid arthritis also suffer from dry mouth. The term secondary Sjögren’s
syndrome is used to refer to individuals with a connective tissue disease such as rheumatoid arthritis or systemic lupus erythematosus who also experience dry eyes and dry mouth.
Q: How does radiation treatment cause dryness?
A: Radiation therapy is often used to treat patients diagnosed with head and neck cancer. While the radiation is
targeted to destroy only cancer cells, it invariably also destroys other healthy cells in the site being treated. If salivary glands are within that treatment site, they may be irreversibly damaged and no longer able to produce saliva. Patients suffering from radiation-induced dry mouth produce less saliva and their remaining saliva tends to feel thick and ropey. The degree of dryness is directly dependent on the extent of the salivary gland damage and varies from patient to patient. Once the salivary gland has been injured, it cannot repair itself, so the dryness will persist.
Q: How is dry mouth treated?
A: Please see the PATIENT INFORMATION SHEET: Management of Dry Mouth.
The information contained in this monograph is for educational purposes only.
This information is not a substitute for professional medical advice diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.
ABOUT THE AMERICAN ACADEMY OF ORAL MEDICINE (AAOM) – The AAOM is a 501c6,
nonprofit organization founded in 1945 as the American Academy of Dental
Medicine and took its current name in 1966. The members of the American Academy
of Oral Medicine include an internationally recognized group of health care
professionals and experts concerned with the oral health care of patients who
have complex medical conditions, oral mucosal disorders, and / or chronic
orofacial pain. Oral Medicine is the field of dentistry concerned with the oral
health care of medically complex patients and with the diagnosis and
non-surgical management of medically-related disorders or conditions affecting
the oral and maxillofacial region.
The American Academy of Oral Medicine • (425) 778-6162 www.aaom.com • PO Box 2016 • Edmonds • WA
98020-9516
A: Sjögren’s syndrome is an autoimmune condition characterized by dry mouth and dry eyes. Other potential symptoms include debilitating fatigue and joint pain. An estimated 1 – 4 million people are affected by the syndrome and women are
affected nine times more frequently than. Sjögren’s syndrome can affect any age group but most patients are diagnosed in their early 50’s. It is not unusual for their dryness symptoms to have existed for years prior to the diagnosis.
Oral dryness in these patients my progress up to point and then level off; or it may progressively worsen. Further information on this important disease is available at the Sjögren’s Syndrome Foundation website: http://www.sjogrens.org/ .
Q: Is there a relationship between rheumatoid arthritis and dry mouth?
A: Yes, up to 50% of individuals with rheumatoid arthritis also suffer from dry mouth. The term secondary Sjögren’s
syndrome is used to refer to individuals with a connective tissue disease such as rheumatoid arthritis or systemic lupus erythematosus who also experience dry eyes and dry mouth.
Q: How does radiation treatment cause dryness?
A: Radiation therapy is often used to treat patients diagnosed with head and neck cancer. While the radiation is
targeted to destroy only cancer cells, it invariably also destroys other healthy cells in the site being treated. If salivary glands are within that treatment site, they may be irreversibly damaged and no longer able to produce saliva. Patients suffering from radiation-induced dry mouth produce less saliva and their remaining saliva tends to feel thick and ropey. The degree of dryness is directly dependent on the extent of the salivary gland damage and varies from patient to patient. Once the salivary gland has been injured, it cannot repair itself, so the dryness will persist.
Q: How is dry mouth treated?
A: Please see the PATIENT INFORMATION SHEET: Management of Dry Mouth.
The information contained in this monograph is for educational purposes only.
This information is not a substitute for professional medical advice diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.
ABOUT THE AMERICAN ACADEMY OF ORAL MEDICINE (AAOM) – The AAOM is a 501c6,
nonprofit organization founded in 1945 as the American Academy of Dental
Medicine and took its current name in 1966. The members of the American Academy
of Oral Medicine include an internationally recognized group of health care
professionals and experts concerned with the oral health care of patients who
have complex medical conditions, oral mucosal disorders, and / or chronic
orofacial pain. Oral Medicine is the field of dentistry concerned with the oral
health care of medically complex patients and with the diagnosis and
non-surgical management of medically-related disorders or conditions affecting
the oral and maxillofacial region.
The American Academy of Oral Medicine • (425) 778-6162 www.aaom.com • PO Box 2016 • Edmonds • WA
98020-9516