II. Definitions

  1. Xerostomia
    1. Perceived Dry Mouth
    2. Not synonymous with Salivary Gland dysfunction
  2. Hyposalivation
    1. Decreased Saliva production

III. Epidemiology

  1. Prevalence: 10-33% in U.S.

IV. Risk Factors

  1. Age over 65 years old
  2. Polypharmacy

V. Pathophysiology

  1. Saliva is produced and excreted by the Parotid Glands, Submandibular Glands and Sublingual Glands
    1. Parasympathetic System stimulates watery Saliva secretion
    2. Sympathetic System stimulates viscous Saliva secretion
  2. Saliva plays vital role in Dental Health
    1. Re-mineralizes enamel
    2. Buffers cariogenic acids
    3. Removes food residue
    4. Inhibits Bacterial growth and fungal growth (e.g. Oral Candidiasis)
    5. Prevents Tooth Decay and Dental Caries
    6. Prevents halitosis
    7. Prevents Dysgeusia
    8. Dilutes hot, cold or spicy foods
  3. Decreased Salivation (Hyposalivation) criteria
    1. Stimulated Salivation <0.5 to 0.7 ml/min or
    2. Unstimulated Salivation <0.1 ml/min
  4. Medication-Induced Hyposalivation
    1. Unstimulated Saliva flow is affected more than stimulated Saliva flow

VI. Symptoms

VII. Signs

  1. Hyposalivation
    1. Tongue adheres to Oral Mucosa
    2. Saliva appears frothy or stringy
    3. No significant Salivary pooling in the mouth
  2. Sequelae of Hyposalivation
    1. Smooth Tongue on dorsal surface (filliform papillae atrophy)
    2. Fissured Tongue
    3. Oral Candidiasis (Thrush)
    4. Dental Caries

IX. Management

  1. Stop, decrease frequency or decrease dosing of offending medication (typically Anticholinergic drugs) as much as possible
    1. See Medication Causes of Dry Mouth
    2. Avoid Alcohol and Caffeine (Diuretic activity)
    3. Avoid Tobacco
  2. General Measures
    1. Sip water throughout the day
    2. Consider a house humidifier in dry climates and seasons
  3. Saliva stimulation
    1. Sugar-free chewing gum (esp. Xylitol containing gums, but warn regarding gas, Diarrhea)
    2. Lemon lozenges
  4. Saliva Substitute
    1. Commercial Saliva substitute such as Biotene or Hydral (typically carboxymethylcellulose, mucin or Glycerine)
    2. Products vary regarding flavor, applications and consistency
      1. Consider sprays for frequent daytime use
      2. Consider gels that coat the mouth for overnight use
  5. Dental Protection
    1. Directly apply fluoride to teeth and in Toothpaste
      1. Use 1.1% Fluoride gel daily
      2. High-Fluoride toothpaste
      3. Fluoride oral rinses
    2. Scrupulous dental care is essential
      1. See Dentist regularly
  6. Consider Muscarinic Agonists in severe refractory Xerostomia (e.g. Sjogren's Syndrome)
    1. Pilocarpine (Salagen) 5 mg tablets orally dissolved on Tongue four times daily
      1. Associated with Cholinergic, parasympathetic adverse effects (e.g. sweating, Dizziness)
    2. Pilocarpine Eye drops 4%
      1. Use two drops in a small amount of water, swish and spit four times daily
      2. Associated with fewer side effects than oral tablet preparations
    3. Cevimeline (Evoxac) 30 mg orally three times daily
      1. May be better tolerated than Pilocarpine

X. Complications

  1. Dental decay and Dental Caries
  2. Thrush
  3. Dysphagia

XI. References

  1. (2022) Presc Lett 29(9): 51
  2. Daniels in Goldman (2000) Cecil Medicine, p. 2245
  3. Glick (2020) Am Fam Physician 102(10):613-21 [PubMed]

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Related Studies

Ontology: Xerostomia (C0043352)

Definition (MEDLINEPLUS)

Dry mouth is the feeling that there is not enough saliva in your mouth. Everyone has a dry mouth once in a while - if they are nervous, upset or under stress. But if you have a dry mouth all or most of the time, it can be uncomfortable and can lead to serious health problems.

Symptoms of dry mouth include

  • A sticky, dry feeling in the mouth
  • Trouble chewing, swallowing, tasting, or speaking
  • A burning feeling in the mouth
  • A dry feeling in the throat
  • Cracked lips
  • A dry, rough tongue
  • Mouth sores
  • An infection in the mouth

Dry mouth is not a normal part of aging. Causes include some medicines, radiation therapy, chemotherapy, and nerve damage. Salivary gland diseases, Sjogren's syndrome, HIV/AIDS, and diabetes can also cause dry mouth.Treatment depends on the cause. Things you can do include sipping water, avoiding drinks with caffeine, tobacco, and alcohol, and chewing sugarless gum or sucking on sugarless hard candy.

NIH: National Institute of Dental and Craniofacial Disorders

Definition (NCI_NCI-GLOSS) Dry mouth. It occurs when the body is not able to make enough saliva.
Definition (NCI_CTCAE) A disorder characterized by reduced salivary flow in the oral cavity.
Definition (NCI) An oral condition in which salivary flow is reduced.
Definition (CSP) dryness of the mouth due to salivary gland secretion dysfunction.
Definition (MSH) Decreased salivary flow.
Concepts Sign or Symptom (T184)
MSH D014987
ICD10 K11.7
SnomedCT 162014002, 196513007, 249425009, 139281004, 266425004, 87715008, 56893005
LNC MTHU013517
English Asialia, Asialias, Hyposalivation, Hyposalivations, Mouth Dryness, Xerostomia, Xerostomias, APTYALISM, Dryness, Mouth, MOUTH DRY, ORAL DRYNESS, SALIVA DECREASED, XEROSTOMIA, dry mouth, mouth dryness (symptom), mouth dryness (xerostomia), mouth dryness, xerostomia (physical finding), xerostomia, salivary secretion disturbance: xerostomia, xerostomia (diagnosis), xerostomia was observed, Mouth became dry, Saliva decreased, Mouth dry, Dryness oral, Oral dryness, Xerostomia [Disease/Finding], decreased saliva, dryness mouth, Dry;mouth, drying mouth, hyposalivation, mouth dry, Dry Mouth, (Dry mouth) or (salivary hyposecretion) (disorder), Salivary hyposecretion (disorder), Dry mouth (finding), (Dry mouth) or (salivary hyposecretion), Dry mouth, Aptyalism, Absent salivary secretion, Aptyalia, Hyposecretion of salivary gland, Salivary hyposecretion, Clinical xerostomia, Hypoactive salivary flow, Hyposecretion of salivary gland (disorder), Inadequate salivary flow, Aptyalism (disorder), asialia, aptyalism, hyposecretion; salivary gland, mouth; dry, salivary gland; hyposecretion, Salivary hyposecretion [Ambiguous]
French XEROSTOMIE, Hyposécrétion salivaire, Bouche devenue sèche, Sécherese orale, Salive diminuée, APTYALISME, HYPO-SIALORRHEE, SECHERESSE BUCCALE, SECHERESSE DE LA BOUCHE, Bouche sèche, Xérostomie, Aptyalisme, Asialie, Hypoptyalisme, Sècheresse de la bouche, Sécheresse buccale
Portuguese XEROSTOMIA, SECURA DA BOCA, Secura da boca, Hipossecreção salivar, Boca ressequida, Saliva diminuída, APTIALISMO, DIMINUICAO DA SALIVA, SECURA ORAL, Aptialismo, Boca seca, Assialia, Hiposalivação, Secura da Boca, Xerostomia
Spanish XEROSTOMIA, Sequedad de boca, Saliva disminuida, Ptialina, Hiposecreción salival, APTIALISMO, BOCA SECA, SALIVA DISMINUIDA, SEQUEDAD DE BOCA, Sequedad Bucal, aptialismo, asialia, boca seca, flujo salival hipoactivo, flujo salival inadecuado, hiposalivación, hiposecreción de la glándula salival (trastorno), hiposecreción de la glándula salival, secreción salival ausente, xerostomía (trastorno), xerostomía, Aptialismo, Boca seca, Asialia, Boca Seca, Hiposalivación, Xerostomía
German XEROSTOMIE, Trockenheit des Mundes, orale Trockenheit, Mund wurde trocken, Speichel vermindert, Mund trocken, verminderte Speichelsekretion, APTYALISMUS, MUNDTROCKENHEIT, SPEICHEL VERMINDERT, TROCKENHEIT MUND, Aptyalismus, Asialie, Hyposalivation, Mundtrockenheit, Xerostomie
Italian Aptialismo, Bocca secca, Secchezza della bocca, Secchezza orale, Aptialia, Bocca diventata secca, Iposecrezione salivare, Saliva diminuita, Bocca asciutta, Asialia, Iposalivazione, Xerostomia
Dutch mond die droog wordt, orale droogheid, xerostomie, asialie, speeksel gedaald, speeksel hyposecretie, hyposecretie; speekselklier, mond; droog, speekselklier; hyposecretie, aptyalisme, droge mond, Asialia, Droge mond, Hyposalivatie, Mond, droge, Xerostomie
Japanese 唾液減少, 唾液欠乏, 口腔乾燥, 唾液分泌低下, ダエキケツボウ, ダエキゲンショウ, コウナイカンソウ, ダエキブンピテイカ, コウコウカンソウ, ダエキブンピツテイカ, コウクウカンソウ, 口腔乾燥症, 口内乾燥症, 口渇(口内乾燥症), 口内乾燥, 唾液分泌不全症(ダエキブンピツフゼンショウ), 唾液分泌欠如, 唾液減少症, 唾液分泌不全症
Swedish Muntorrhet
Czech xerostomie, Vyschlá ústa, Snížení produkce slin, Xerostomie, Suchá ústa, Suchost úst, Aptyalismus, Hyposekrece slin, suchost v ústech, hyposalivace
Finnish Suun kuivuus
Polish Kserostomia, Suchość jamy ustnej
Hungarian Xerostomia, Nyálhiány, Szájkiszáradás, Szájszárazság, Asialia, Száraz száj, Nyál csökkenés, Száj szárazság, Nyál hyposecretio, Aptialismus, Oralis szárazság
Norwegian Xerostomi, Tørr munn, Munntørrhet

Ontology: Reduced salivation (C0576990)

Concepts Finding (T033)
SnomedCT 300268000
English Salivation decreased, Reduced salivation, Reduced salivation (finding)
Spanish salivación reducida (hallazgo), salivación reducida