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Dry Mouth
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Dry Mouth
, Xerostomia, Salivary Hypofunction, Decreased Saliva Secretion, Hyposalivation
See Also
Medication Causes of Dry Mouth
Definitions
Xerostomia
Perceived Dry Mouth
Not synonymous with
Salivary Gland
dysfunction
Hyposalivation
Decreased
Saliva
production
Epidemiology
Prevalence
: 10-33% in U.S.
Risk Factors
Age over 65 years old
Polypharmacy
Pathophysiology
Saliva
is produced and excreted by the
Parotid Gland
s,
Submandibular Gland
s and
Sublingual Gland
s
Parasympathetic System
stimulates watery
Saliva
secretion
Sympathetic System
stimulates viscous
Saliva
secretion
Saliva
plays vital role in
Dental Health
Re-mineralizes enamel
Buffers cariogenic acids
Removes food residue
Inhibits
Bacteria
l growth and fungal growth (e.g.
Oral Candidiasis
)
Prevents
Tooth Decay
and
Dental Caries
Prevents halitosis
Prevents
Dysgeusia
Dilutes hot, cold or spicy foods
Decreased
Saliva
tion (Hyposalivation) criteria
Stimulated
Saliva
tion <0.5 to 0.7 ml/min or
Unstimulated
Saliva
tion <0.1 ml/min
Medication-Induced Hyposalivation
Unstimulated
Saliva
flow is affected more than stimulated
Saliva
flow
Symptoms
Dry Mouth
Sensation
Mouth Sore
ness
Burning Mouth Syndrome
Halitosis
Dysgeusia
Signs
Hyposalivation
Tongue
adheres to
Oral Mucosa
Saliva
appears frothy or stringy
No significant
Saliva
ry pooling in the mouth
Sequelae of Hyposalivation
Smooth Tongue
on dorsal surface (filliform papillae atrophy)
Fissured Tongue
Oral Candidiasis
(
Thrush
)
Dental Caries
Causes
See
Medication Causes of Dry Mouth
Radiation Therapy
to head and neck
Salivary Gland
surgery
Sjogren's Syndrome
Amyloidosis
Human Immunodeficiency Virus
(
HIV Infection
)
Hepatitis C
Diabetes Mellitus
Major Depression
Mouth breathing (e.g. obstructed nares)
Granuloma
tous Disease
Sarcoidosis
Tuberculosis
Leprosy
Management
Stop, decrease frequency or decrease dosing of offending medication as much as possible
Sip water throughout the day
Commercial
Saliva
substitute (typically carboxymethylcellulose, mucin or
Glycerin
e)
Directly apply fluoride to teeth and in
Tooth
paste
Use 1.1% Fluoride gel daily
High-Fluoride toothpaste
Fluoride oral rinses
Scrupulous dental care is essential
See Dentist regularly
Saliva
stimulation
Sugar-free chewing gum (esp. Xylitol containing gums)
Lemon lozenges
Consider
Muscarinic Agonist
s in severe refractory Xerostomia (e.g.
Sjogren's Syndrome
)
Pilocarpine
(
Salagen
) 5 mg orally four times daily
Associated with
Cholinergic
, parasympathetic adverse effects (e.g. sweating,
Dizziness
)
Cevimeline
(
Evoxac
) 30 mg orally three times daily
May be better tolerated than
Pilocarpine
References
Daniels in Goldman (2000) Cecil Medicine, p. 2245
Glick (2020) Am Fam Physician 102(10):613-21 [PubMed]
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