Xerostomia
Feb 21, 2009
Dry mouth (Xerostomia) is caused by a lack of normal salivary function, through either a reduction in salivary flow or alteration of salivary composition. Three pairs of major salivary glands (parotid, submandibular, and sublingual) and an abundance of minor salivary glands scattered throughout the oral cavity produce saliva. The combined product of these glands provides a complex fluid, consisting of antibodies, electrolytes, proteins, glycoproteins, and lipids. Many studies have shown that saliva plays a significant role in the health of the teeth and oral mucosa.
Individuals who have had a decrease in the amount of saliva can exhibit many problems with their teeth and oral mucosa. Such manifestations can include increased dental caries, dehydration of the mucosa (mucositis), and oral infections, which will lead to discomfort and difficulty in chewing, swallowing, and speaking.
The most common causes of xerostomia include medical treatments and systemic disorders. The medical treatments that interfere with salivary function are medications, radiotherapy, surgery and trauma. Radiation therapy for head and neck cancer causes permanent salivary gland damage and is an important cause of xerostomia. The severity of xerostomia depends on the volume of tissue irradiated, length of therapy, radiation dose, and the amount of salivary gland tissue involved. Xerostomia may also be associated with a variety of systemic disorders, particularly Sjögrens syndrome (an autoimmune disorder that affects salivary and lacrimal functions as well as connective tissue), diabetes, scleroderma, and graft-versus-host disease as seen in bone marrow transplant patients. Many drugs, including analgesics, antidepressants, antihypertensives, and antihistamines can cause xerostomia.
Complications arising from dry mouth, such as increased dental caries, difficulty in swallowing, chewing and speaking, and an increased incidence of oral infection, can lead to nutritional deficiencies, and an overall decline in the quality of life. Additionally, patients with xerostomia have difficulty in wearing removable prostheses due to the dry mucosa and increased incidence of frictional denture sores.
The management of patients suffering from xerostomia can be a challenging dilemma for both dentist and patient. Xerostomia may be an early manifestation of a physiological disorder or an underlying salivary gland disease. Therapeutic options for relief of the symptoms of xerostomia is largely palliative, as reversal of the primary cause is often not possible. There can be a poor correlation between subjective reports and actual gland function as well as a large variation in degrees of salivary function found with xerostomia. Treatment is aimed initially at restoring the flow of saliva using mechanical means such as chewing sugar-free gum, taste stimulants, or systemic salivary gland stimulants (sialogogues). Artificial saliva substitutes and mouth wetting agents may be used, although the majority provide only short term relief of symptoms, and can cause irritation of oral tissues during long-term use.
Individuals who have had a decrease in the amount of saliva can exhibit many problems with their teeth and oral mucosa. Such manifestations can include increased dental caries, dehydration of the mucosa (mucositis), and oral infections, which will lead to discomfort and difficulty in chewing, swallowing, and speaking.
The most common causes of xerostomia include medical treatments and systemic disorders. The medical treatments that interfere with salivary function are medications, radiotherapy, surgery and trauma. Radiation therapy for head and neck cancer causes permanent salivary gland damage and is an important cause of xerostomia. The severity of xerostomia depends on the volume of tissue irradiated, length of therapy, radiation dose, and the amount of salivary gland tissue involved. Xerostomia may also be associated with a variety of systemic disorders, particularly Sjögrens syndrome (an autoimmune disorder that affects salivary and lacrimal functions as well as connective tissue), diabetes, scleroderma, and graft-versus-host disease as seen in bone marrow transplant patients. Many drugs, including analgesics, antidepressants, antihypertensives, and antihistamines can cause xerostomia.
Complications arising from dry mouth, such as increased dental caries, difficulty in swallowing, chewing and speaking, and an increased incidence of oral infection, can lead to nutritional deficiencies, and an overall decline in the quality of life. Additionally, patients with xerostomia have difficulty in wearing removable prostheses due to the dry mucosa and increased incidence of frictional denture sores.
The management of patients suffering from xerostomia can be a challenging dilemma for both dentist and patient. Xerostomia may be an early manifestation of a physiological disorder or an underlying salivary gland disease. Therapeutic options for relief of the symptoms of xerostomia is largely palliative, as reversal of the primary cause is often not possible. There can be a poor correlation between subjective reports and actual gland function as well as a large variation in degrees of salivary function found with xerostomia. Treatment is aimed initially at restoring the flow of saliva using mechanical means such as chewing sugar-free gum, taste stimulants, or systemic salivary gland stimulants (sialogogues). Artificial saliva substitutes and mouth wetting agents may be used, although the majority provide only short term relief of symptoms, and can cause irritation of oral tissues during long-term use.
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