Have you ever felt the dryness of mouth during the period of anxiety or stress for example during the period of your school examination? Dry mouth is also referred in the medical literature as xerostomia. Xerostomia is the most common salivary gland problem. It is estimated that dry mouth affects one in four individuals at some point in their life.
Dry mouth makes daily functions difficult such as speaking, eating, and swallowing.
Clinical features of Dry Mouth
There is dryness of oral tissues and soreness. The changes in the mucosa of the tongue are more prominent and characterized by the presence of red and atrophic appearance with prominent lobules and fissures on the surface of the tongue. Their loss of protective function that is associated with salivary flow leads to dental caries, fungal infections, and ascending bacterial sialadenitis. Patients with reduced salivary flow also report difficulty in speaking, mastication, swallowing, and difficulty in controlling dentures.
Causes of Dry Mouth
Medications are among the most common cause of dry mouth. Medications that cause dry mouth are anticholinergic drugs, tricyclic antidepressants, antihistamines, antihypertensive agents, cytotoxic drugs, and diuretics.
Radiation therapy uses to treat the head and neck cancers results in irreversible damage to the salivary glands. Systemic diseases and syndromes such as diabetes, acquired immune deficiency syndrome, ectodermal dysplasia, and Sjögren syndrome are associated with varying degrees of oral dryness. Dehydration because of high temperature and humidity or because of the use of diuretics also produces dry mouth. Psychogenic state, anxiety, and depression cause dry mouth due to an increase in sympathetic activity. In some patients, during the anxious state, there is abundant or excess saliva but the patient complains of dry mouth. Certain physiological states also produce dry mouth such as pregnancy.
Complications associated with Xerostomia
Due to reducing the salivary flow a plethora of adverse effects and complications develop in the dry mouth patients. These complications include more susceptibility to microbial infections such as dental caries, fungal infections, ascending bacterial infection and inflammation of the salivary gland, and halitosis or bad breath due to reduce the clearance of food by the saliva and increase microbial growth in the oral cavity.
Diagnosis of dry mouth
The diagnosis of dry mouth is based on the history of the patient and intraoral examination. Sialometry is performed to measure the salivary flow rate. The normal salivary flow rate is 0.1 ml/min. The salivary gland biopsy is performed to diagnose salivary gland neoplasia and Sjögren syndrome.
Treatment of Dry mouth
The dry mouth treatment is according to the cause and there no single management plan for patients with dry mouth. The following paragraphs will only outline the general management of a patient with dry mouth.
The dose of the drugs that produce xerostomia should be modified or some alternative drug should be used. The change in dosage of the drug or any alternative drug should be used in consultation with the patient general medical practitioner. The alcohol and tobacco should be avoided as they worsen the symptoms of xerostomia and also injurious to health. The chewing gums stimulate the salivary flow but the sorbitol containing chewing gums should be used as these are less cariogenic as compared to sucrose-containing chewing gums. The cholinergic drugs such as pilocarpine are prescribed to stimulate the saliva formation. These drugs are also referred to as sialogogues or the salivary gland stimulants but these drugs are only effective when there is residual healthy salivary tissue. Partial relief may be obtained by the administration of artificial saliva especially after radiation therapy. These artificial salivary substitutes are available over the counter. These available salivary substitutes lack the protective proteins that are present in the natural saliva.
In patients with dry mouth, the maintenance of Oral hygiene is essential to prevent dental decay and other bacterial and fungal infections. For maintenance of oral hygiene products with strong flavors and with alcohol should be avoided as these products may further irritate the oral mucous membrane. Similarly, sugar-containing products should be avoided as these products increase the susceptibility of dry mouth patients to dental caries.
Home remedies for dry mouth
Dry foods should be avoided as these worsen the symptoms of xerostomia. Water can be sipped throughout the day. Protect the lips with a lubricant such as petroleum jelly. Avoid hot and humid environments and consider placing a humidifier in the office or at home. Avoid caffeine-containing drinks that contain caffeine because of its diuretic effect. It is also important to avoid over the counter medications such as antihistamines as they worsen the symptoms of existing xerostomia.
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