What is Dry Mouth?
Xerostomia (Dry mouth) is described as dry mouth condition caused by decreased or absence of salivary flow in the oral cavity. Hyposalivation is the symptom of decreased salivary flow caused by decreased salivary function, while xerostomia is the symptom of mouth dryness. It is one of the most prevalent disabling illnesses affecting oral health.
Dry mouth is a common problem among older persons, affecting about 13-28% of the population. Saliva deficiency or absence causes severe morbidity and lowers a person’s quality of life. The third most prevalent adverse effect of drugs is dry mouth. A substantial link exists between hyposalivation and periodontal infection.
Salivary Composition: A Biological Fluid
The majority of saliva is produced by three primary salivary glands: the parotid gland, the submandibular gland, and the sublingual gland. Salivary flow in the mouth cavity contains fluoride, calcium, and phosphate minerals and serves an important protective function for both soft and hard tissues. In a healthy condition, the typical daily output of saliva is 1-1.5L/day. Dry mouth occurs when the stimulated salivary flow rate (s-SFR) is between 0.7mL/min (5 minutes) and 0.1mL/min (5-15 minutes).
The pH of saliva ranges between 6 and 7.4 under normal conditions. Saliva also includes significant quantities of potassium and bicarbonate ions, and to a lesser level sodium and chloride ions. The reduction in salivary flow causes ionic instability, mainly with calcium, phosphates, and bicarbonates, reducing the capacity of the saliva to operate effectively. Salivary functions include digesting, phonation and taste, lubrication, antibacterial activity, mucosal integrity management, washing, remineralization, and swallowing.
Common Causes of Dry Mouth
The major etiological factors for dry mouth are illustrated in the table below.
|Medication Induced||400+ (Over the Counter) & prescription contribute directly or indirectly to oral dryness. Anticholinergic effects (Antidepressant, Antihistamines, Antihypertensive, Diuretics, Decongestants, Anticholinergic, Antiemetics, Muscle relaxants, Pain medications etc.)|
Head & Neck Radiation
|Acute or Chronic. These therapies can cause xerostomia/salivary gland hypofunction via direct toxicity to salivary glands and oral tissues or indirect damage due to regional or systemic toxicity. Infection & damage due to radioactive iodine usage (50 Gy).|
|Autoimmune Disease||Sjogren disease (Dry Mouth and Eyes)|
|Physiological||Xerostomia affects 30% of patients older than 65 years and up to 40% of patients older than 80 years; this is primarily an adverse effect of medication(s), although it can also result from comorbid conditions such as diabetes, Alzheimer’s disease, or Parkinson’s disease.|
|Systemic Disease||Uncontrolled Diabetes, Hypertension, HCV, Hormonal Changes, Nerve damage, Stroke, HIV infections, Cystic fibrosis etc.|
|Life Style||Excessive consumption of Alcohol, Tobacco, Caffeine, and Spicy Food.|
Signs and Symptoms of Dry Mouth
Individuals suffering from xerostomia frequently complain about difficulties eating, speaking, swallowing, and wearing dentures. Denture wearers may experience issues with denture retention, ulcers, and the tongue adhering to the palate. Patients with xerostomia frequently complain of taste disturbances, a sore tongue, and an increased thirst, particularly at night. Xerostomia (Dry mouth) can cause increased dental caries, parotid gland enlargement, lip inflammation and fissuring, tongue and buccal mucosa inflammation or ulcers, oral candidiasis, salivary gland infection, halitosis, and cracking and fissuring of the oral mucosa.
Diagnosis of Dry Mouth
Dry mouth (Xerostomia) is diagnosed by taking a thorough medical history that includes medication, systemic illness, and a history of chemotherapy or radiation. Clinical examinations of the oral cavity are performed, as well as salivary tests to determine salivary flow rate, pH, and buffering capacity. Salivary glands are further investigated using imaging techniques such as MRI, ultrasound, and CT scan.
Management of Dry Mouth
The treatment of dry mouth is based on a correct diagnosis and an understanding of the underlying causes. Drug adjustments, artificial salivary replacements, salivary stimulants, lifestyle changes, surgical treatments, gene therapy, and comprehensive dental care are all part of the treatment. Maintaining regular oral hygiene using quality oral care products is critical in the management of dry mouth. The bulk of dental care products on the market contain with colors, preservatives, alcohol, artificial flavoring agents, and are acidic in nature, exacerbating the dry mouth problem and disrupting the oral cavity’s environment.
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