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Dry Mouth

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Dry Mouth, Xerostomia, Salivary Hypofunction, Decreased Saliva Secretion, Hyposalivation

  • Definitions
  1. Xerostomia
    1. Perceived Dry Mouth
    2. Not synonymous with Salivary Gland dysfunction
  2. Hyposalivation
    1. Decreased Saliva production
  • Epidemiology
  1. Prevalence: 10-33% in U.S.
  • Risk Factors
  1. Age over 65 years old
  2. Polypharmacy
  • 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
  • Symptoms
  1. Dry Mouth sensation
  2. Mouth Soreness
  3. Burning Mouth Syndrome
  4. Halitosis
  5. Dysgeusia
  • 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
  • Management
  1. Stop, decrease frequency or decrease dosing of offending medication as much as possible
  2. Sip water throughout the day
  3. Commercial Saliva substitute (typically carboxymethylcellulose, mucin or Glycerine)
  4. Directly apply fluoride to teeth and in Toothpaste
    1. Use 1.1% Fluoride gel daily
    2. High-Fluoride toothpaste
    3. Fluoride oral rinses
  5. Scrupulous dental care is essential
    1. See Dentist regularly
  6. Saliva stimulation
    1. Sugar-free chewing gum (esp. Xylitol containing gums)
    2. Lemon lozenges
  7. Consider Muscarinic Agonists in severe refractory Xerostomia (e.g. Sjogren's Syndrome)
    1. Pilocarpine (Salagen) 5 mg orally four times daily
      1. Associated with Cholinergic, parasympathetic adverse effects (e.g. sweating, Dizziness)
    2. Cevimeline (Evoxac) 30 mg orally three times daily
      1. May be better tolerated than Pilocarpine
  • References
  1. Daniels in Goldman (2000) Cecil Medicine, p. 2245
  2. Glick (2020) Am Fam Physician 102(10):613-21 [PubMed]