Term “Xerostomia” comes from the Greek words xeros (dry) and stoma (mouth) which means dry mouth. Dry mouth is one of the most common and most troublesome symptom for which patients need help from dentist. For the majority of patients who contact their dentist about this problem, the successful treatment is carried out.

Causes of dryness can be many and varied. Dryness of the mouth is one of the first symptoms of diabetes and immune disorders. One such is Sjögren’s syndrome. This symptom also occurs as a result of damage to the salivary glands in patients who have undergone radiation therapy to the head and neck. It represents a very difficult situation. Also, many medications can cause xerostomia.

Nowadays, more than 500 drugs have a side effect of mouth dryness. Among them the most numerous are medications to control high blood pressure, diuretics, antihistamines and drugs for the treatment of various mental disorders.

However, there is a large number of people suffering from this disease who do not seek medical attention because they do not considered it as a serious health problem. For example, women in menopause often suffer from dry mouth, but they consider it as a normal symptom. Also, cigarette and cigar smokers can have a xerostomia, but they do not associate it with smoking.

Regardless of the cause and duration of mouth dryness, a person with this problem should contact his dentist as soon as possible.  Treatment should begin to avoid many complications that develop in the mouth when there is not enough saliva.

The role of the salivary glands

Salivary glands secrete during the day around one liter of saliva. The amount varies depending on the time of day, hydration, liquid intake, general health and mental state of the person. Saliva is necessary to maintain normal functions of the mouth like taste, chewing, swallowing and speech.

It has a protective role because it protects, moisturizes and coats the mucous membranes of the mouth and teeth. It facilitates speech, helps design a morsel of food and swallowing, contributes to the taste of the food. Its minerals, proteins and antimicrobial ingredients protect against cavities. They keep the structure of tooth enamel and act against infection.

What happens when the amount of saliva is reduced in your mouth?

To demonstrate that a person who suffers from xerostomia really does not have enough saliva, the amount of saliva must be measured. It has been shown, namely, that people who sometimes complain of this disease have normal salivation. Such apparent or paradoxical xerostomia may be caused as a change in the quality of saliva when the amount of saliva is not reduced. In this case more mucous than serous saliva is excreted, which creates a feeling of stickiness and dryness.

When the saliva is secreted less than 300 ml per day (0.2 ml / min), it is a sign of dysfunction of the salivary glands. Reduced secretion of saliva is called – Hyposalivation.

Mouth dryness can be acute, short-term and transient or it may last for a long time or even a lifetime. It depends on the cause and manner of treatment.

Short-term dryness of the mouth usually lasts only as long as the cause is present. It usually appears in stressful situations or in situations of tension, fear and depression. It can appear after a brief intake of certain drugs, in states with fever and dehydration of the organism. Also, mouth breathing and insufficient stimulation of activity of the salivary glands (eg. eating soft foods), cigarette smoking and alcohol can lead to xerostomia.

Long-term dryness of the mouth or complete loss of saliva are consequences of the permanently impaired function of the salivary glands. This can be caused  by variety of systemic diseases: diabetes, autoimmune connective tissue diseases (Sjögren’s syndrome in particular), liver cirrhosis, diseases of the central and peripheral nervous system. It can be caused by numerous medications, radiation of the head and neck, chemotherapy, and certain infectious diseases (HIV, Hepatitis C).

Because of numerous causes a large number of people suffer from mouth dryness, particularly the elderly who are generally more prone to illness. They also on average are taking more types of medications.

Decreased secretion of saliva and xerostomia can also occur in young adults, adolescents and children who take certain medications that can reduce the secretion of saliva.

Complications of xerostomia

People with xerostomia are at increased risk for the development of numerous oral diseases: caries, gingivitis, periodontal disease (“periodontitis”) and infections of the mucous membrane. Most common type of infection of mucous membrane is fungal infection. Therefore, xerostomia requires increased oral hygiene and the treatment to prevent the development of mentioned oral diseases.

Caries

Reduced amount of saliva results in the increase of bacteria on teeth.  That is what causes tooth decay. Colonization of bacteria on the teeth and the oral mucous membranes contributes to the development of gingivitis.  And after that periodontitis. It may seem that taste loss is not a major problem in patients with xerostomia. 

The enhanced sense of dryness in the mouth and difficulty with chewing and swallowing lead to the consumption of softer and sweeter food. That is suitable for the development of caries. Often patients reach for greater consumption of sugar and sweet drinks to encourage salivation and keep their mouth moist. But that just speeds up the development of caries and inflammation of oral mucous membranes.

Candidiasis

Increased number of fungal colonies from the genus Candida on the oral mucous membranes of healthy persons is usually associated with poor oral hygiene. Later that contributes the need for restorations and its continuous use.

When the mouth is dry, it favors settling fungi on mucous membranes. It is an essential factor in the development of fungal infections. The risk of infection is increased in people who wear dentures, smokers and patients with diabetes.

The risk is also high in patients with Sjögren’s syndrome and patients with connective tissue diseases treated with corticosteroids or other immunosuppressive agents. Such agents contribute to the development of candidiasis because these medications reduce the natural resistance of the oral mucous membrane.

When there is not enough saliva wearing dentures is very difficult. The oral mucous membrane beneath the denture is sensitive and prone to injury and inflammation.

Oral symptoms 

In addition to dryness, patients also complain of mucosal burning, pain, or change or lack of taste. There is an increased demand for drinking water during meals. Also there are problems with chewing and swallowing. Person often avoids eating dry food. Patients with Sjögren’s syndrome, in which connective oral tissue is affected, also complain on the dryness of the eyes, and salivary glands (especially parotid gland) become visibly increased.

As xerostomia progresses, inflammatory changes and damages in the mucosa of the mouth occur. The mucous membrane of the lips is thinner, it cracks and peels off. Buccal mucosa is clearly wrinkled, tongue is red and smooth, and the patients complain of strong sensation of mucosal burning. The mucous membrane of the lips stick to the teeth and with people who wear dentures the oral mucous membranes can easily be damaged.

All these complications of xerostomia emerge and evolve quickly. That significantly affects the quality of oral and general health. Therefore, dry mouth should not be considered a trivial problem. It’s treatment should begin as soon as possible. Because of the severeness of xerostomia complications, treatment is often prolonged and more expensive. Doctors constantly explore therapeutic options. They seek new, more effective and more comprehensive medications with a minimum of side effects. Medications aim to reduce the dryness of the mouth and prevent the development of possible complications.

The treatment of xerostomia

The treatment of xerostomia is carried out depending on the cause and the degree of damage to the salivary glands. In practice, it is often focused on palliative therapy which means to relieve symptoms and prevent oral complications.

The practice of wearing and occasional wetting mouth with bottled water during the day, which has become popular, can also provide relief. At home, frequently rinsing the mouth with water, or drinking sips of water during meals can help alleviate the symptoms of xerostomia.

When xerostomia occurs as a result of medications, it is recommended to replace the medication or reduce the dose in agreement with the competent doctor. This is helpful if a replacement drug has a similar mode of action.

There are several ways available for treating:

A preventive approach

To all people with this disease who have natural teeth, preparations of fluoride and saturated solution of calcium and phosphate should be transcribed. Fluoride incorporates into the enamel and restores parts of the tooth. A solution containing calcium and phosphate ions (artificial saliva) stops the progression of tooth decay. It makes teeth more resistant.

Symptomatic treatment

This treatment is carried out in patients with xerostomia when it is not possible to stimulate the secretion of saliva. It means that the saliva must be compensated. This is achieved by taking enough fluids during the day and keeping the mouth moist. This is achieved by using solutions of artificial saliva.

Saliva substitutes or artificial saliva are liquids or gels containing hydroxymethylcellulose, hydroxypropylcellulose, carboxymethylcellulose, polyglycerylmethacrylate, mucin or xanthan gum. They may have a calming effect on the oral mucosa. The main disadvantages are their short duration of action, and they do not protect neither from developing caries nor from mucosal infection.

Commercial mouthwashes which contain alcohol further dry out oral mucosa. They should be avoided by patients with xerostomia.

The artificial saliva, supersaturated solution of calcium and phosphate, was primarily developed for the treatment of patients on radiation and chemotherapy. Also for prevention of oral mucositis, and later for the treatment of dry mouth.

In this solution calcium and phosphate ions show the beneficial effects in stopping the development of caries. By their diffusion between intercellular spaces in the lining cell epithelium healing is stimulated. Calcium ions also play a crucial role in the inflammatory process in the blood coagulation cascade and tissue repair. On the other hand phosphate ions are a key factor in the renewal of the mucous membrane by maintaining it’s pH balance and in prevention of infection.

Local stimulation of saliva secretion

Doctors recommend to people who have, to some extent, preserved function of the salivary glands, so the secretion of saliva can be triggered by the stimulus of chewing or rinsing the mouth with sour solutions. Also, effective is a biostimulation of salivary glands with laser therapy and acupuncture. Electrical stimulation shows modest effects. Eating candies to stimulate saliva secretion, due to the sugar content which favors the development of caries, should be avoided.

Systematic stimulation of salivation

This includes taking medicines for systemic use. From twenty four drugs only four are tested and applied in practice. These are parasympathomimetics: bromhexine, anetoletrition, pilocarpine-hydrochloride and cevimeline. As these drugs have known contraindications, and during the application a number of unpleasant side effects can be developed, they can not be taken by all patients with dry mouth.

If you suffer from this disease, talk to your dentist!

Conclusion

Drugs for local use and artificial saliva still give hope to patients in treatment of xerostomia. It is expected from these products to simultaneously moisturize and protect the oral mucous membranes and teeth. The fact is that there are few preparations for topical application available, which fully comply with these requirements. So today, in the treatment of this disease, advantage is given to solutions that provide moisture and stimulate the secretion of saliva, and because of the content of calcium and phosphate ions they also act on the restoration of tooth enamel, have anti fungal activity and protect the mucous membranes of the mouth in patients undergoing treatment with radiation and chemotherapy.

                 If you suffer from dry mouth of known or unknown causes,              contact your dentist or GP!

       This disease is not a normal state of the oral cavity and should be treated!