Xerostomia
Encyclopedia
Xerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva
. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or drinking alcohol.
Xerostomia can cause difficulty in speech and eating
. It also leads to halitosis
and a dramatic rise in the number of cavities
, as the protective effect of saliva's remineralizing the enamel
is no longer present, and can make the mucosa and periodontal tissue of the mouth more vulnerable to infection. Heavy methamphetamine
use can cause xerostomia, usually called "meth mouth
" in this case; it can be worsened by methamphetamine at recreational doses causing tight clenching of the jaw, bruxism
(compulsive grinding of the teeth), or a repetitive 'chewing' movement as if the user were chewing, but without food in the mouth.
Hyposalivation, in turn, may be a sign of an underlying disease
, such as Sjögren's syndrome
, poorly controlled diabetes, or Lambert-Eaton syndrome, but this is not always the case.
Other causes of insufficient saliva production include anxiety
, drinking alcoholic beverage
s, physical trauma
to the salivary gland
s or their ducts or nerves, dehydration
caused by lack of sufficient fluids (extended exercise on a hot day can cause the salivary glands to become dry as bodily fluids are concentrated elsewhere), chemotherapy
, and radiation therapy
. Xerostomia is a common side-effect of various medication
s including some antidepressants, amphetamine
s and antihistamines, and of controlled substance
s such as cannabis
and heroin. The vast majority of elderly people will suffer xerostomia to some degree; the most common cause is the use of medications. Output from the major salivary glands does not undergo clinically significant decrements in healthy older people; complaints of a dry mouth and findings of salivary hypofunction in an older person are not due to age as such. The results of one study suggested that, in general, objective and subjective measurements of major salivary gland flow rates are independent of age, sex, and race; signs and symptoms of dry mouth in the elderly are not a normal sequela of aging.
Patients with xerostomia should avoid the use of decongestant
s and antihistamine
s, and pay careful attention to oral hygiene
. Sipping non-carbonated sugar
less fluids frequently, chewing xylitol
-containing gum
, and using a carboxymethyl cellulose
saliva substitute may help. Pilocarpine
may be prescribed to treat xerostomia. Cevimeline (Evoxac) has been released for treatment of dry mouth associated with Sjogren's syndrome. Like pilocarpine, it is a cholinergic agonist.
Artificial salivas are often the treatment of choice for xerostomia patients. NeutraSal®, a calcium phosphate rinse has shown symptomatic efficacy in reducing the effects of xerostomia associated with Sjogren's Syndrome patients and also in patients experiencing dry mouth due to medications. There were no adverse effects related to NeutraSal®.
Non-systemic relief can be found using an oxidized glycerol triesters treatment used to coat the mouth. Drinking water when there is another cause of the xerostomia besides dehydration may bring little to no relief and can even make the dry mouth more uncomfortable. The use by patients of an enzymatic product such as Biotene
or other topical
preparation produced "no effect on oral colonization by Candida species and cariogenic oral microflora
", although "the palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo" and did not "significantly lower salivary counts of ... Streptococcus mutans
and Lactobacilli". Tests on candida yeasts in vitro
rather than in patients found that "a lactoferrin-containing mouthwash has fungistatic properties".
Saliva
Saliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...
. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or drinking alcohol.
Xerostomia can cause difficulty in speech and eating
Eating
Eating is the ingestion of food to provide for all organisms their nutritional needs, particularly for energy and growth. Animals and other heterotrophs must eat in order to survive: carnivores eat other animals, herbivores eat plants, omnivores consume a mixture of both plant and animal matter,...
. It also leads to halitosis
Halitosis
Halitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
and a dramatic rise in the number of cavities
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
, as the protective effect of saliva's remineralizing the enamel
Remineralisation of teeth
Remineralisation of teeth is a process in which minerals are returned to the molecular structure of the tooth itself. Teeth are porous allowing fluids and demineralisation beneath the surface of the tooth. When demineralised, these pores become larger...
is no longer present, and can make the mucosa and periodontal tissue of the mouth more vulnerable to infection. Heavy methamphetamine
Methamphetamine
Methamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
use can cause xerostomia, usually called "meth mouth
Meth mouth
"Meth mouth" is an informal name for advanced tooth decay attributed to heavy methamphetamine use. According to the American Dental Association, meth mouth "is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia , extended periods of poor...
" in this case; it can be worsened by methamphetamine at recreational doses causing tight clenching of the jaw, bruxism
Bruxism
Bruxism is characterized by the grinding of the teeth and typically includes the clenching of the jaw. It is an oral parafunctional activity that occurs in most humans at some time in their lives. In most people, bruxism is mild enough not to be a health problem...
(compulsive grinding of the teeth), or a repetitive 'chewing' movement as if the user were chewing, but without food in the mouth.
Causes
Basically, xerostomia can be caused by excessive clearance (such as by excessive breathing through the mouth), or it may be caused by insufficient production of saliva (called hyposalivation).Hyposalivation, in turn, may be a sign of an underlying disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
, such as Sjögren's syndrome
Sjögren's syndrome
Sjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
, poorly controlled diabetes, or Lambert-Eaton syndrome, but this is not always the case.
Other causes of insufficient saliva production include anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, drinking alcoholic beverage
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
s, physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
to the salivary gland
Salivary gland
The salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
s or their ducts or nerves, dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
caused by lack of sufficient fluids (extended exercise on a hot day can cause the salivary glands to become dry as bodily fluids are concentrated elsewhere), chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, and radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
. Xerostomia is a common side-effect of various medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s including some antidepressants, amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
s and antihistamines, and of controlled substance
Controlled substance
A controlled substance is generally a drug or chemical whose manufacture, possession, or use are regulated by a government. This may include illegal drugs and prescription medications ....
s such as cannabis
Cannabis
Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre , for seed and seed oils, for medicinal purposes, and as a...
and heroin. The vast majority of elderly people will suffer xerostomia to some degree; the most common cause is the use of medications. Output from the major salivary glands does not undergo clinically significant decrements in healthy older people; complaints of a dry mouth and findings of salivary hypofunction in an older person are not due to age as such. The results of one study suggested that, in general, objective and subjective measurements of major salivary gland flow rates are independent of age, sex, and race; signs and symptoms of dry mouth in the elderly are not a normal sequela of aging.
Treatment
Treatment involves finding any correctable causes and removing them if possible. In many cases it is not possible to correct the xerostomia itself, and treatment focuses on relieving the symptoms and preventing cavities.Patients with xerostomia should avoid the use of decongestant
Decongestant
A decongestant or nasal decongestant is a type of drug that is used to relieve nasal congestion.-Pharmacology:The vast majority of decongestants act via enhancing norepinephrine and epinephrine or adrenergic activity by stimulating the α-adrenergic receptors...
s and antihistamine
Antihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
s, and pay careful attention to oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
. Sipping non-carbonated sugar
Sugar
Sugar is a class of edible crystalline carbohydrates, mainly sucrose, lactose, and fructose, characterized by a sweet flavor.Sucrose in its refined form primarily comes from sugar cane and sugar beet...
less fluids frequently, chewing xylitol
Xylitol
Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch...
-containing gum
Chewing gum
Chewing gum is a type of gum traditionally made of chicle, a natural latex product, or synthetic rubber known as polyisobutylene. For economical and quality reasons, many modern chewing gums use rubber instead of chicle...
, and using a carboxymethyl cellulose
Carboxymethyl cellulose
Carboxymethyl cellulose or cellulose gum is a cellulose derivative with carboxymethyl groups bound to some of the hydroxyl groups of the glucopyranose monomers that make up the cellulose backbone...
saliva substitute may help. Pilocarpine
Pilocarpine
Pilocarpine is a parasympathomimetic alkaloid obtained from the leaves of tropical American shrubs from the genus Pilocarpus. It is a non-selective muscarinic receptor agonist in the parasympathetic nervous system, which acts therapeutically at the muscarinic acetylcholine receptor M3 due to its...
may be prescribed to treat xerostomia. Cevimeline (Evoxac) has been released for treatment of dry mouth associated with Sjogren's syndrome. Like pilocarpine, it is a cholinergic agonist.
Artificial salivas are often the treatment of choice for xerostomia patients. NeutraSal®, a calcium phosphate rinse has shown symptomatic efficacy in reducing the effects of xerostomia associated with Sjogren's Syndrome patients and also in patients experiencing dry mouth due to medications. There were no adverse effects related to NeutraSal®.
Non-systemic relief can be found using an oxidized glycerol triesters treatment used to coat the mouth. Drinking water when there is another cause of the xerostomia besides dehydration may bring little to no relief and can even make the dry mouth more uncomfortable. The use by patients of an enzymatic product such as Biotene
Biotene
Biotene is a dental hygiene product manufactured by GlaxoSmithKline. It comes in a number of forms, including toothpaste, mouthwash and cream....
or other topical
Topical
In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...
preparation produced "no effect on oral colonization by Candida species and cariogenic oral microflora
Flora (microbiology)
In microbiology, flora refers to the collective bacteria and other microorganisms in an ecosystem . While the term microflora is widely used, it is technically a misnomer since the word root flora pertains to the kingdom plantae...
", although "the palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo" and did not "significantly lower salivary counts of ... Streptococcus mutans
Streptococcus mutans
Streptococcus mutans is a facultatively aerobic, Gram-positive coccus-shaped bacterium commonly found in the human oral cavity and is a significant contributor to tooth decay.The microbe was first described by J Kilian Clarke in 1924.-Introduction:...
and Lactobacilli". Tests on candida yeasts in vitro
In vitro
In vitro refers to studies in experimental biology that are conducted using components of an organism that have been isolated from their usual biological context in order to permit a more detailed or more convenient analysis than can be done with whole organisms. Colloquially, these experiments...
rather than in patients found that "a lactoferrin-containing mouthwash has fungistatic properties".