Dry Mouth or Xerostomia - Causes and Treatment

What Is Saliva?

Saliva is a clear watery fluid that is produced 24 hours a day by the salivary glands. It contains many minerals, antibacterial, and antifungal properties. Saliva also contains enzymes that help digestion. It is a buffer solution and helps in maintaining the mouth's pH.

What Are the Functions of Saliva?

• Oral Hygiene: It helps prevent dental caries and gum diseases, as it has a flushing action inside the mouth. It helps in the continuous flushing of the debris and pathogens from the teeth and gums. It also aids in the remineralization of teeth, as it contains many minerals like calcium, fluoride, phosphorus, etc.

• Lubrication: It keeps the oral mucosa moist and hydrated, preventing the oral cavity from thinning, ulceration, and inflammation. It also prevents the mucosa from getting injured during chewing and other oral activities.

• Swallowing: As the food is mixed with saliva while chewing, it converts food into an easily swallowable bolus. With the help of saliva, one can chew as well as swallow without any pain or discomfort.

• Digestion: Due to the presence of salivary enzymes, saliva helps at the beginning of digestion right from the mouth itself.

• Maintains Taste Sensations: With the help of saliva, the chemicals present in food are carried to the taste buds, where the taste sense can be perceived. In the lack of saliva, the sense of taste can get disturbed and reduced.

What Is Xerostomia?

The term is derived from a Greek word, where Xero means dry, and Stoma means mouth. Xerostomia is a medical term that refers to a subjective complaint of dry mouth resulting from reduced salivary production by the salivary glands. Reduced salivary production is not sufficient to keep the oral cavity wet.

How Common Is Dry Mouth?

This condition is more commonly seen in females. It can affect the life of the individual suffering from it and cause considerable discomfort, which can cause severe anxiety and hamper the quality of life. It can affect about 15 to 20% of the population.

What Causes Dry Mouth?

It can be due to a single or multiple causes. It increases the urge to drink more water, which never feels satisfied, and makes the saliva thick, stringy, and mucous-like.

The following are the causes of dry mouth:

• Damage to Salivary Glands: Saliva is secreted by the salivary glands. Therefore, damage to salivary glands or surgical removal of the glands due to some conditions like tumors, trauma to the salivary glands, ionizing radiations, etc., can damage the salivary glands, leading to a nonreversible dry mouth.

• Side Effects of the Medication: Dryness of mouth is the most common side effect of certain medicines. For example, blood pressure medications, anti-allergics, decongestants, muscle relaxants, diuretics, antidepressants, etc. The side effects resolve gradually when the medication intake is stopped.

• Nerve Damage: Surgeries of the head and neck can damage nerves that supply the secretomotor fibers to the salivary glands and cause severe dry mouth.

• Severe Dehydration: Deficient water intake can even reduce the watery nature of saliva, causing dry mouth and making the saliva thick.

What Are the Conditions That Cause Dry Mouth?

The conditions which cause dry mouth are the following:

• Sjogren’s Syndrome: It is an autoimmune disease in which the immune system of the individual starts to damage the cells of salivary glands, tear glands, etc., leading to dry mouth.

• Diabetes.

• Smoking.

• Aging.

• Stroke.

• Chemotherapy.

• Radiation therapy.

• Mouth breathing.

• Snoring.

• Alzheimer's disease.

• Parkinson's disease.

• Oral thrush or yeast infection of the mouth.

• Cystic fibrosis.

• HIV/AIDS.

What Are the Symptoms of Dry Mouth?

• The mucous membranes inside the mouth can appear thinned out or atrophic, pale, ulcerated, or fissured.

• There can be a foul smell coming from the mouth or bad breath.

• Lips can appear dry and cracked. Cracks at the corners of the mouth are also known as angular cheilitis.

• The teeth can be seen sticking to the cheeks and inner lips.

• There can be ulcers in the mouth, inflammation, and pain.

• The tongue can lose papillae which contain taste buds, causing loss of taste. The tongue can become red and inflamed, leading to a sore tongue.

• In extreme cases or long-standing dry mouth, there can be constant burning sensation and numbness in the mouth, leading to a condition known as burning mouth syndrome.

• There can be deposits over teeth, with an increase in tooth decay and gum diseases.

• There can be lisping or difficulty in speaking words.

• Painful chewing and swallowing.

• Increase in frequency of fungal infection in mouth and tongue causing oral thrush.

• Throat irritation and dryness.

• Sticky and stringy saliva.

• Painful tongue or glossodynia,

• Difficulty in chewing and swallowing dry and crumble foods.

• Patients who wear dentures experience problems like poor denture retention, formation of denture sores, and sticking of the tongue to the palate.

• Salivary gland infection or sialadenitis.

• Frequent gum infections.

• Increased thirst, especially at night.

• Dysgeusia or taste disorders.

How Is Dry Mouth Diagnosed?

• Sialography: An x-ray based examination of salivary glands and their ducts to rule out stones and other forms of obstructions.

• Sialometry: In this procedure, saliva is collected by placing a collection device over the duct opening. Citric acid is used to stimulate saliva flow.

• Biopsy: It is helpful to check suspected causes like cancer and Sjogren's syndrome.

How Can We Manage Dry Mouth?

Management of dry mouth will depend on the cause.

1. Many a time, treating the underlying cause can help in relieving the symptoms.

2. If dry mouth is due to a side effect of any medication, you should consult your physician to either reduce the dose of the medicine or change it to a drug that is less likely to cause dry mouth.

3. Go for a regular dental checkup so that oral hygiene can be meticulously maintained, get the cavities filled, and oral prophylaxis can be done for preventing tooth and gum infections.

4. Use fluoridated toothpaste and fluoride-containing oral rinse prescribed by your dentist.

What Lifestyle Modification Should I Follow for Dry Mouth?

• Avoid sticky or sugary, or spicy food.

• Do not use tobacco products in any form like chewing or smoking tobacco because they can increase dryness and cause irritability.

• Try breathing through your nose and avoid mouth breathing.

• Avoid caffeine and alcohol that can increase the dryness and irritation associated with dry mouth.

• Do not use over-the-counter decongestants and antihistamine medication as these can further increase the dryness.

What Are the Home Remedies Available for Treating Dry Mouth?

• Drink water or sugar-free candies and suck ice chips to moisten your oral cavity.

• Use over-the-counter salivary substitutes like Xylitol, Carboxymethylcellulose, or Hydroxyethylcellulose.

• Use a room humidifier to keep the room moist while you are sleeping.

• Use a moisturizer for your lips to avoid cracked lips.

What Can I Do to Increase Salivary Secretion in Dry Mouth?

• You can chew sugar-free chewing gums and suck tart or sour candies, as they help stimulate saliva flow.

• Certain oral moisturizing gels containing lubricating, antibacterial, and antifungal properties can be advised, such as an oral base. These help in keeping the oral cavity moist.

• Avoid regular alcohol-containing mouthwashes as they have a drying effect on the mouth. Specialized mouthwashes containing Methylcellulose like Biotene mouthwash should be used for gargling.

• There are also kinds of toothpaste that can be used for dry mouth.

• Some prescription medications are also available, which help in increasing saliva production. Pilocarpine and Cevimeline are the generic names of the drugs used to enhance saliva in the mouth. Cevimeline sold under the brand name Evoxac is used to treat dry mouth in Sjogren’s syndrome. Sjogren’s syndrome is an autoimmune condition characterized by dry eyes, dry mouth, dry skin, and muscle aches.

What Are the Treatment Modalities Under Research?

There are also new treatments in the study for the treatment of dry mouth. Scientists also are studying the possibility of replacing the diseased salivary gland with an artificial salivary gland.

What Are the Complications of Dry Mouth?

• Mouth ulcers.

• Cracked lips.

• Oral thrush or yeast infection of the mouth.

• Increases the risk of gum diseases and dental cavities by increasing plaque deposition.

• Difficulty in chewing and swallowing, which eventually leads to poor nutrition.

Conclusion:

Dry mouth can be managed with supportive or palliative treatment, so individuals suffering from dry mouth should not lose hearts. Follow the instructions given by your dentist, which can help you manage a dry mouth.