Dry Mouth (Xerostomia)
Dry Mouth (Xerostomia) is a condition usually associated with salivary gland hypofunction (reduced salivary flow). It affects at least one in 10 adults. In adults older than 65, prevalence is about 25% while in institutionalized elders can be as high as 50%. Many oral and systemic conditions can cause a change in the flow and composition of saliva. Prescription medications are implicated in 64% of xerostomia (dry mouth) cases. The major drug groups are antihypertensive , antidepressants, other include analgesics, statins, antihistamines and anticancer meds.
Local factors: include aphasia of salivary gland, tumors, sialoliths (salivary gland stones), abnormalities of salivary ducts and radiation damage.
Systemic factors: include dehydration, sympathetic response, nerve damage, hormonal imbalances, inflammatory response due to infection or autoimmune disease, or conditions such as anxiety, bulimia, depression, diabetes and thyroid disease.
Oral Symptoms: Dry cracked lips and corners of the mouth, thick or ropey saliva, dry thin, pale oral mucosa, loss of moist. Complications: cavities on roots and teeth, reddened fissured lobulated tongue, opportunistic infections such as viral infection or overgrowth of Candida. Also gingivitis, aphtous ulcer (canker sore), cracked and bleeding tissue.
Risk assessment: If some one answers yes to any of the following questions they could be at risk of abnormal salivary gland function.
- Does the amount of saliva in your mouth seem too little?
- Do you have any difficulty swallowing?
- Does your mouth feel dry when eating a meal?
- Do you sip liquids to aid in swallowing dry food?
- Smoking causes severe functional alterations in the salivary glands.
- Sodium Lauryl sulfate (SLS)
- Alcohol based mouthwashes
Treatment:
- Hydration: If not contraindicated by medical condition increase water intake to 8-10 (eight ounce) glass per day, use of humidifier and keep water close by at night time.
- Stimulation of salivary flow: regular gum chewing (xylitol containing gum), sonic brushing, acupuncture and electric stimulation
- Prevent cavities: minimize sugar intake, use MI paste nightly, floss daily and use a tongue scraper, uses of rinses that reduce bacteria causing cavities such as Tooth and gum tonic or alcohol free Peridex (daily one week per month for 6 months). One minute rinse with 10% Betadine reduces Lactobacillus for 3-4 months.
- Prevent soft tissue injury and infection (folic acid aids healing of trauma and aphthous ulcer) Improve comfort: eating moist food, moisturizing lips, using saliva stimulants and substitutes. Dry mouth gels can be used under dentures. Aloe Vera, slippery elm bark and carrageen adds moisture and have a slippery feel and forms a protective coating on the oral mucosa.
- Sucking on Xylitol containing lollipops or candies (does not have sugar) when needed.