Dry Mouth

Dry Mouth 

Definition

Dry mouth, known medically as xerostomia, is the abnormal reduction of saliva due to medication, disease, or medical therapy.

Description

Dry mouth due to the lack of saliva can be a serious medical problem. Decreased salivation can make swallowing difficult, can decrease taste sensation, and can promote tooth decay.

Causes and symptoms

Dry mouth, resulting from thickened or reduced saliva flow, can be caused by a number of factors: medications, both prescription and over-the-counter; such systemic diseases as anemia, HIV infection, or diabetes, manifestations of Sjögren's syndrome (as rheumatoid arthritis, lupus, chronic hardening and thickening of the skin, or chronic and progressive inflammation of skeletal muscles); infections of the salivary glands; blockage of the salivary ducts caused by stones or tumors forming in the ducts through which the saliva passes; dehydration; such medical therapies as local surgery or radiation; secretion reduction normally involved in the aging process; and emotional stress.

Diagnosis

The diagnosis of dry mouth is not difficult. The patient will state that his or her saliva is very thick or nonexistent. Finding the cause of dry mouth may be more difficult and require some laboratory testing. Salivary gland biopsy for stones or tumors should be performed if indicated.

Treatment

The treatment of dry mouth involves the management of the condition causing it. If dry mouth is caused by medication, the medication should be changed. If dry mouth is caused by blockage of the salivary ducts, the cause of the blockage should be investigated. When systemic diseases, such as diabetes and anemia, are brought under control dry mouth problems may decrease.

The use of caffeine-containing beverages, alcoholic beverages, and mouthwashes containing alcohol should be minimized. The drinking of water and fruit juices will decrease dry mouth problems. Chewing gum and lemon drops can be used to stimulate saliva flow. Bitters also can initiate salivary flow as long as the salivary glands and ducts are functional. Commercial saliva substitutes are available without prescription and can be used as frequently as needed. Use of a humidifier in the bedroom reduces nighttime oral dryness.

Dry mouth caused by the aging process or radiation therapy for cancer can be treated by such oral medications as pilocarpine (Salagen). Drugs that are given to increase the flow of saliva are known as sialogogues.

Prognosis

The prognosis for patients with xerostomia due to medication problems is good, if the offending agent can be changed. Dry mouth due to systemic problems may be eliminated or improved once the disease causing the dry mouth is under control. Persistent xerostomia can be managed well with saliva substitutes.

Prevention

A patient needs to ask his or her health care provider if any medication to be prescribed will cause dry mouth. Patients with persistent xerostomia need to practice good oral hygiene and visit a dentist on a regular basis; the lack of adequate saliva can cause severe dental decay. The salivary glands are very sensitive to radiation, so any patient scheduled for radiation therapy of the head and neck needs to discuss with the radiation therapist ways to minimize exposure of the salivary glands to radiation.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Dentistry in Medicine." Section 9, Chapter 103 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Bruce, S. D. "Radiation-Induced Xerostomia: How Dry Is Your Patient?" Clinical Journal of Oncology Nursing 8 (February 2004): 61-67.

Nagler, R. M. "Salivary Glands and the Aging Process: Mechanistic Aspects, Health-Status and Medicinal—Efficacy Monitoring." Biogerontology 5 (March 2004): 223-233.

Pinto, A., and S. S. De Rossi. "Salivary Gland Disease in Pediatric HIV Patients: An Update." Journal of Dentistry for Children (Chicago) 71 (January-April 2004): 33-37.

Porter, S. R., C. Scully, and A. M. Hegarty. "An Update of the Etiology and Management of Xerostomia." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 97 (January 2004): 28-46.

Organizations

American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. http://www.ada.org.

American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000. http://www.amaassn.org.

Key terms

Salivary duct — Tube through which saliva is carried from the salivary gland to the mouth.

Salivary gland — Gland in which saliva forms.

Sialogogue — A medication given to increase the flow of saliva.

Xerostomia — The medical term for dry mouth.