Dry mouth

Definition

Dry mouth, known medically as xerostomia, is the abnormal reduction of saliva due to medication, disease, or medical therapy.

Description

Dry mouth due to the lack of saliva can be a serious medical problem. Decreased salivation can make swallowing difficult, decrease taste sensation, and promote tooth decay.

Causes & symptoms

Dry mouth, resulting from thickened or reduced saliva flow, can be caused by a number of factors: medications, both prescription and over-the-counter; systemic diseases, such as anemia or diabetes, manifestations of syndromes such as rheumatoid arthritis, lupus, chronic hardening and thickening of the skin, or chronic and progressive inflammation of skeletal muscles; infections of the salivary glands; blockage of the salivary ducts caused by stones or tumors forming in the ducts through which the saliva passes; dehydration; medical therapies, such as local surgery or radiation; secretion reduction due to the normal aging process; and emotional stress.

Dry mouth, together with dry eyes, is a core symptom of Sjögren's syndrome, named for the Swedish physician who first described it. Sjögren's syndrome is an autoimmune disorder in which the body's white cells attack the glands that produce saliva and tears. It is a common cause of dry mouth in the elderly.

Although psychiatric disorders involving dry mouth are unusual, several cases have been reported of somato-form disorders in which dry mouth is a central symptom. Somatoform disorders are psychiatric disturbances characterized by external physical symptoms or complaints that are related to psychological problems rather than organic illness.

Diagnosis

The diagnosis of dry mouth is not difficult. The patient will state that his or her saliva is very thick or non-existent. Finding the cause of the dry mouth may be more difficult and require some laboratory testing. Salivary gland biopsy for stones or tumors should be performed if indicated.

Treatment

To treat dry mouth, the use of caffeine-containing beverages, alcoholic beverages, and mouthwashes containing alcohol should be minimized. Drinking water and fruit juices will decrease dry mouth problems. Chewing gum and lemon drops can be used to stimulate saliva flow. Bitters also can initiate salivary flow as long as the salivary glands and ducts are functional. Commercial saliva substitutes are available without prescription and can be used as frequently as needed. Use of a humidifier in the bedroom reduces nighttime oral dryness.

Herbal therapy

There are several herbal remedies that may be effective in increasing saliva production and preventing dry mouth. Drinking ginger, chamomile, or Chinese green tea at frequent intervals stimulates salivary flow. A Chinese herbal mix of ophiopogois, pinelliae tuber, zizyphi fructus, glycyrrhiaze, ginseng radix, and oryzae semen has been evaluated as treatment for dry mouth. Studies have shown this formula is effective in relieving dry mouth in half of those tested, including severe cases, such as cancer patients undergoing radiation therapy.

Nutritional therapy

Because dry mouth often causes gum disease, patients should take vitamin C and beta-carotene supplements as a preventive measure.

Acupuncture

Acupuncture has been tried since the late 1990s as a treatment for dry mouth caused by cancer treatments. Practitioners at a California clinic that offers acupuncture to cancer patients use a total of eight needles, to stimulate three points on each ear and one on each index finger. Of the 50 patients who have been treated with acupuncture in this clinic, 35 reported significant improvement in their salivation, and 13 reported that the improvement lasted for over three months before they required another treatment.

Allopathic treatment

Treatment of dry mouth involves management of the underlying condition. If dry mouth is caused by medication, the medication should be changed. If dry mouth is caused by blockage of the salivary ducts, the cause of the blockage should be investigated. When such systemic diseases as diabetes and anemia are brought under control, dry mouth problems may decrease.

Some new medications have been developed to treat dry mouth associated with cancer therapy and Sjögren's syndrome. Amifostine (Ethyol), a medication that protects the cells of the mouth against radiation and chemotherapy agents, has been approved by the Food and Drug Administration (FDA) as a treatment for dry mouth related to cancer therapy. Pilocarpine hydrochloride (Salagen) is a drug that was approved in 1998 for treating dry mouth associated with Sjögren's syndrome; it works by stimulating the salivary glands to produce more moisture. A study published in 2002 indicates that pilocarpine also relieves dry mouth in cancer patients. Cevimeline (Evoxac) is a newer drug that was approved by the FDA in February 2000 for the treatment of dry mouth associated with Sjögren's syndrome. All three medications appear to give good results and to be well tolerated by patients.

Expected results

The prognosis for patients with xerostomia due to medication problems is good, if the offending agent can be changed. Dry mouth due to systemic problems may be eliminated or improved once the disease causing the dry mouth is under control. Persistent xerostomia can be managed well with saliva substitutes.

Prevention

A patient needs to ask his or her health care provider if any medication to be prescribed will cause dry mouth. Patients with persistent xerostomia need to practice good oral hygiene and visit a dentist on a regular basis; the lack of adequate saliva can cause severe dental decay. The salivary glands are very sensitive to radiation, so any patient scheduled for radiation therapy of the head and neck should discuss minimizing exposure of the salivary glands to radiation with the radiation therapy provider.

Copyright 2008 The Gale Group, Inc. All rights reserved.