Dry mouth
Summary/Definition
Xerostomia, also known as dry mouth, is a subjective symptom characterized by a sensation of dryness of the mouth. This symptom is known to be caused by an objective decrease in the volume of saliva secreted or a change in its composition. It is more common in the elderly than in the young and occurs in about 30 per cent of the population aged 65 years and over. It is important to note that dry mouth is not necessarily related to the aging process but is most often caused by medications for chronic diseases or other factors. The salivary glands perform many important functions, and even if the volume of saliva secreted is halved, this does not usually cause significant discomfort. Therefore, a dry mouth sensation and associated discomfort indicates a significant decrease in saliva production. Dry mouth can make swallowing and speech difficult, contribute to caries and tooth decay, and be accompanied by manifestations such as oral fungal infections, sore tongue, bad breath and changes in taste perception. Dry mouth can also contribute to the development of oral diseases such as ulcers.
Dry mouth can be classified into primary and secondary dry mouth depending on its causes. Primary xerostomia is associated with salivary gland abnormalities such as salivary gland tumors, infections, radiation therapy, Sjögren’s syndrome, etc. Secondary xerostomia is not related to salivary gland problems, but is caused by side effects of medications, avitaminosis, anaemia, ageing, diabetes and other factors. The most common causes of dry mouth are medication and radiation therapy.
Symptoms
The main symptoms experienced by people with dry mouth are:
The main manifestations of dry mouth
- Difficulty in swallowing food.
- Difficulty in pronouncing words.
- Unpleasant sensations when eating certain foods (especially spicy or salty foods).
- Sleep disturbance due to dry mouth or throat.
- Pain or discomfort in the oral mucosa (especially on the tongue).
- Disturbance of the sense of taste.
- Unpleasant breath odour.
- Problems with the use of removable dentures, pressure and pain in the gums under the dentures.
There may be discomfort when eating, changes in taste perception, burning sensation in the mouth, bad breath, and difficulty in wearing removable dentures.
Diagnostics
The physical examination includes an assessment of the degree of dry mouth and associated symptoms. Medical history is taken to check for systemic diseases such as hypertension, diabetes, neurological disorders, and the patient’s current medication list. Information is gathered regarding swelling of the salivary glands, the degree of dehydration, and the presence of sialadenitis caused, for example, by general anaesthesia and other factors. During the physical examination, the oral mucosa is checked to detect dryness and to assess the condition of the tongue and teeth. Tests to measure the volume of saliva secreted may be performed to determine the presence of dry mouth more accurately. Sialography, which is an examination of the salivary gland ducts, is an effective method of detecting narrowing or the presence of stones in these ducts. Additional blood, tissue and other diagnostic tests may be ordered as needed.
Treatment and course of the disease
In the case of dry mouth, the focus is on eliminating and preventing the underlying causes of the condition. One of the most common causes of dry mouth is medication, and therefore, after consultation with a doctor, the dosage or concentration of the medication taken is adjusted. Xerostomia can predispose to pathologies such as candidiasis and ulcers of the oral mucosa. Therefore, careful oral hygiene and care are important. Patients with Sjögren’s syndrome or who have undergone radiotherapy to the head and neck region may be prescribed saliva stimulants such as pilocarpine and cevimeline. These medications are effective for patients who retain some level of salivary gland function. Alternatively, artificial saliva products in the form of gels or sprays may be used to replace the lack of salivary secretion, and salivary gland electrical stimulation may be recommended.
