A condition known as dry mouth, or xerostomia, occurs when your salivary glands are unable to produce enough saliva to keep your mouth moist. It frequently occurs as a result of the side effects of specific drugs, aging-related problems, or radiation therapy for cancer. Less frequently, a disorder that affects the salivary glands directly may be the source of dry mouth.
By neutralizing the acids that bacteria make, inhibiting bacterial development, and washing away food particles, saliva helps prevent tooth decay. Additionally, saliva improves flavor perception and facilitates chewing and swallowing. Saliva also contains enzymes that help in digestion. Reduced saliva production and dry mouth can have a variety of effects, from minor irritation to serious consequences.
Pathophysiology
Stimulation of the oral mucosa signals the salivatory nuclei in the medulla, triggering an efferent response. The efferent nerve impulses release acetylcholine at salivary gland nerve terminals, activating muscarinic receptors (M3), which increase saliva production and flow. Medullary signals responsible for salivation may also be modulated by cortical inputs from other stimuli (eg, taste, smell, anxiety).
Causes that develops Xerostomia
Possible causes include:
Medications: Many prescription and OTC medications cause dry mouth, including antihistamines, decongestants, hypertensive medications (for high blood pressure), antidiarrheals, muscle relaxants, urinary continence drugs, some Parkinson’s disease medications, as well as a number of antidepressants.
Age: Even though the dry mouth is not a natural part of aging, older adults tend to take more medications than the rest of the population. Many of the medications taken by seniors cause dry mouth.
Cancer treatment: Radiotherapy (radiation therapy) to the head and neck can damage the salivary glands, resulting in less saliva being produced. Chemotherapy can alter the nature of the saliva, as well as how much of it the body produces.
Injury or surgery: This can result in nerve damage to the head and neck area can result in dry mouth.
Tobacco: Either chewing or smoking tobacco increases the risk of dry mouth symptoms.
Dehydration: This is caused by lack of sufficient fluids.
Exercising or playing in the heat: The salivary glands may become dry as bodily fluids are concentrated elsewhere in the body. Dry mouth symptoms are more likely if the exercise or playing continues for a long time.
Some health conditions, illnesses, and habits can cause dry mouth, such as:
Anxiety disorders
Depression
HIV/AIDS
Parkinson’s disease
Poorly controlled diabetes
Sjögren’s syndrome
Sleeping with the mouth open
Snoring
Stroke and Alzheimer’s disease, although these are more likely to cause a perception of dry mouth even when the salivary glands are functioning appropriately
Risk Factors for Xerostomia
Frequently a consequence of:
Stress
Radiation therapy of the head and neck
Glandular fibrosis or destruction
Mouth breathing
C Pap use
Circadian rhythms
Gender
A side effect of certain diseases and infections include Sjögren’s syndrome, Sarcoidosis, HIV/AIDS, Alzheimer’s disease, Diabetes, Anemia, Cystic fibrosis, Crohn’s disease, Systemic Lupus, Erythematosus, Rheumatoid arthritis, Hypertension, Parkinson’s disease, Stroke, Mumps, Scleroderma, and Hepatitis.
A side effect of using recreational drugs include Methamphetamines, Cocaine, and Ecstasy
Symptoms and associated complications
A lack of moisture in the oral cavity can cause several different clinical signs and symptoms that hamper the quality of life of patients that suffer from xerostomia. If you’re not producing enough saliva, you may notice these signs and symptoms all or most of the time:
Dryness or a feeling of stickiness in your mouth
Saliva that seems thick and stringy
Bad breath
Difficulty chewing, speaking and swallowing
Dry or a sore throat and hoarseness
Dry or grooved tongue
A changed sense of taste
Problems wearing dentures
In addition, dry mouth may result in lipstick sticking to the teeth.
The most common complications are related to:
Chewing
Swallowing
Phonation
An alteration of taste perception (dysgeusia),
Pasty morning mouth
Burning mouth sensation
A decrease in saliva makes the soft tissues more susceptible to dryness, redness, irritation and cracking, facilitating the attack of opportunistic microorganisms. This, in turn, promotes inflammation of the mucosa (mucositis), inflammation of the gums (gingivitis), the presence of painful ulcerations and local fungal infections such as candidiasis, lip fissures, halitosis. It is often related to pharyngitis, laryngitis, dyspepsia or constipation.
The main effects of reduced salivary flow on dental tissues include an increase in carious lesions and tooth sensitivity.
In patients with xerostomia who wear dental prostheses, rubbing causes erosion on oral mucosa.
Diagnosis and Test for Xerostomia
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, and 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 are 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.
Treatment and Medications
You can do some things to relieve dry mouth temporarily. But for the best long-term dry mouth remedy, you need to address its cause.
Extraction relieve your dry mouth:
Chew sugar-free gum or suck on sugar-free hard candies to stimulate the flow of saliva. For some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.
Limit your caffeine intake because caffeine can make your mouth drier.
Don’t use mouthwashes that contain alcohol because they can be drying.
Stop all tobacco use if you smoke or chew tobacco.
Sip water regularly.
Try over-the-counter saliva substitutes – look for products containing xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or ones containing carboxymethylcellulose or hydroxyethyl cellulose, such as Biotene Oral Balance.
Try a mouthwash designed for dry mouth — especially one that contains xylitol, such as Biotene Dry Mouth Oral Rinse or ACT Total Care Dry Mouth Mouthwash, which also offers protection against tooth decay.
Avoid using over-the-counter antihistamines and decongestants because they can make your symptoms worse.
Breathe through your nose, not your mouth.
Add moisture to the air at night with a room humidifier
Saliva is important to maintain the health of your teeth and mouth. If you frequently have a dry mouth, taking these steps to protect your oral health may also help your condition:
Avoid sugary or acidic foods and drinks because they increase your risk of tooth decay.
Brush with a fluoride toothpaste — ask your dentist if you might benefit from prescription fluoride toothpaste.
Use a fluoride rinse or brush-on fluoride gel before bedtime. Occasionally a custom-fit fluoride applicator (made by your dentist) can make this more effective.
Visit your dentist at least twice yearly to detect and treat tooth decay or other dental problems.
If these steps don’t improve your dry mouth, talk to your doctor or dentist. The cause could be a medication or another condition.
Avoidance of Xerostomia
There are some actions you can take to lessen dry mouth, such as:
Drinking water or other sugar-free beverages frequently and at meals
Avoiding caffeine-containing beverages like coffee, tea, and certain sodas.
Professional advice on mouthwashes and other oral care items that help to moisturize the mouth.
To increase saliva production, chew sugarless gum or consume sugarless hard candies. Candy with flavors of citrus, cinnamon, or mint are good options.
Avoid alcohol and smoke, which can dry out your mouth.
Reduce your intake of salty or spicy foods, which can hurt your dry mouth.
Skip the sweet and acidic foods.
Use a nighttime humidifier