xerostomia

also known as dry mouth , is dryness in the mouth,

which may be associated with a change in the
composition of saliva, or reduced salivary flow,
.or have no identifiable cause
This symptom is very common and is often seen as
a side effect of many types of medication. It is more
common in older people,and in persons who breathe
through their
mouths Dehydration, radiotherapy involving
the salivary glands
 chemotherapy and several diseases
can cause reduced salivation
(hyposalivation), or a change in saliva
consistency and hence a complaint of
xerostomia. Sometimes there is no
identifiable cause, and there may
sometimes be a psychogenic reason for
.the complain
 Signs and symptoms
:Hyposalivation may give the following signs and symptoms
Dental caries (xerostomia related caries) – Without the buffering )1
effects of saliva, tooth decay becomes a common feature and may
progress much more aggressively than it would otherwise
.("rampant caries")
It may affect tooth surfaces that are normally spared, e.g., cervical
.caries and root surface caries
This is often seen in patients who have had radiotherapy involving
.the major salivary glands, termed radiation-induced caries
Therefore, it is important that any products used in managing dry
mouth symptoms are sugar-free, as the presence of sugars in the
mouth support the growth of oral bacteria, resulting in acid
production and development of dental caries
Acid erosion: Saliva acts as a buffer and )2
helps to prevent demineralization of
teeth.
3) Oral candidiasis – A loss of the
antimicrobial actions of saliva may also
lead to opportunistic
infection with Candida species
4) Burning mouth syndrome – a burning
or tingling sensation in the mouth
5) Saliva that appears thick or ropey
A lack of saliva pooling in the floor )7
of the mouth during examination.
8) Dysphagia – difficulty swallowing
and chewing, especially when eating
dry foods. Food may stick to the tissues
during eating.
9) Gloves or a dental mirror may stick
to the tissues.
10) Dry, sore, and cracked lips and
.angles of mouth
 Causes
The differential of hyposalivation significantly overlaps with that
of xerostomia. A reduction in saliva production to about 50% of
the normal unstimulated level will usually result in the sensation
of dry mouth. Altered saliva composition may also be responsible
.for xerostomia
Physiologic: Salivary flow rate is decreased during sleep, which )1
may lead to a transient sensation of dry mouth upon waking. This
disappears with eating or drinking or with oral hygiene. When
associated with halitosis, this is sometimes termed "morning
breath". Dry mouth is also a common sensation during periods of
anxiety, probably owing to enhanced sympathetic drive. During
periods of stress, our body responds in a ‘fight or flight’ state that
will interfere with the saliva flow in the mouth Dehydration is
.known to cause hyposalivation
Drug induced: Aside from physiologic causes of )2
xerostomia, iatrogenic effects of medications are the most
common cause. A medication which is known to cause
xerostomia may be termed xerogenic. Over 400 medications
are associated with xerostomia. Although drug induced
xerostomia is commonly reversible, the conditions for which
these medications are prescribed are frequently chronic.[
The likelihood of xerostomia increases in relation to the total
number of medications taken, whether the individual
medications are xerogenic or not.
The sensation of dryness usually starts shortly after starting
the offending medication or after increasing the dose.
Anticholinergic, sympathomimetic, or diuretic drugs are
usually responsible
Celiac disease: Xerostomia may be the only )3
symptom of celiac disease, especially in adults, who
often have no obvious digestive symptoms.
4) Sjögren's syndrome: Xerostomia may be caused by
autoimmune conditions which damage saliva-
producing cells. Sjögren's syndrome is one such
disease, and it is associated with symptoms including
fatigue, myalgia and arthralgia.
The disease is characterised by inflammatory changes
in the moisture-producing glands throughout the
body, leading to reduced secretions from glands that
produce saliva, tears and other secretions throughout
the body
Other causes : Oral dryness may also be caused
by mouth breathing, usually caused by partial
obstruction of the upper respiratory tract.
Examples:
include hemorrhage, vomiting, diarrhea,
and fever.
Alcohol may be involved in the cause of salivary
gland disease, liver disease, or dehydration.
Smoking is another possible cause
Hormonal disorders, such as poorly controlled
diabetes
 Treatment
The successful treatment of xerostomia is difficult to
achieve and often unsatisfactory. This involves finding
any correctable cause and removing it if possible, but in
many cases it is not possible to correct the xerostomia
itself, and treatment is symptomatic, and also focuses on
.preventing tooth decay through improving oral hygiene
Where the symptom is caused by hyposalivation
secondary to underlying chronic disease, xerostomia can
be considered permanent or even progressive. The
management of salivary gland dysfunction may involve
the use of saliva substitutes and/or saliva stimulants