Xerostomia Or Dry Mouth Origins, Causes,Treatment And Diagnosis

Xerostomia is the subjective sensation of oral dryness due to the decrease of saliva, caused by an alteration of the functioning of the salivary glands. 

dry mouth

The presence of saliva in the oral cavity is very important because thanks to it the oral tissues are kept moist, facilitating speech, chewing, swallowing, etc. Saliva also allows the function of cleaning the mouth, as well as regulating the accumulation of bacteria. A suitable level of saliva can prevent an imbalance of microorganisms in the oral environment that can lead to the appearance of cavities, gum disease, halitosis or bad breath, among others.And helps in maintaining the good oral hygiene.

Xerostomia manifests itself in one in five adults, which is equivalent to 20% of the population between 18 and 30 years old, and 40% in those over 50 years of age. It should be noted that it affects twice as many women as men. According to statistical data, xerostomia is becoming increasingly important in society. It is a condition that alters the general health and quality of life.

ORIGIN AND TYPES

Xerostomia, although producing great discomfort in the oral cavity of the people who suffer it, is not a disease but a clinical situation, which is reached by multiple causes.

To understand this complex situation, we will consider, according to the level of glandular activity, two types of xerostomia:

Reversible xerostomia is characterized by recording residual glandular activity, where salivary secretion can be stimulated or regulated. This type of xerostomizing effect is produced by medications, chemotherapeutic, smoking, etc.

In irreversible xerostomia, there is irreparable damage to the glandular level that prevents its functioning. This clinical picture can be found in patients with a diagnosis of Sjögren's syndrome or patients with head and neck cancer receiving large doses of radiation as treatment.

CAUSES

The causes of xerostomia are diverse, the most frequent are the following:

Usually speaking in public increases the need for salivation to help vocalize words better, and by prolonging it in time can cause the lack of saliva and the need to ingest liquids.
Stress, anxiety and depression affect the central nervous system and, therefore, organs and glands are affected throughout the body, including salivary.
Diabetes and other systemic diseases also affect the whole organism, altering glandular functioning.
Therapy with certain drugs such as antihistamines, antihypertensives, diuretics; and oncological drugs, have as collateral effects the decrease of the saliva and even the atrophy of the mucous glands.
On the other hand, the absence of teeth causes a decrease of stimuli in the mouth and, as a consequence, there is a lower production of saliva.
In addition an unbalanced diet with excess carbohydrates and deficits of fruits and vegetables can cause alteration of saliva production.
Also the consumption of tobacco and alcohol can diminish this salivary secretion, since it inhibits the transmission of nerve impulses.

CLINICAL FEATURES:

The lack of wetting of the oral cavity can provoke diverse clinical manifestations that reduce the quality of life of the patient suffering from xerostomia.

The most frequent difficulties occur during: chewing, swallowing, phonation, and alterations of taste (dysgeusia), mouth pasty upon awakening, burning mouth.

The decrease of the saliva makes the soft tissues more susceptible to the dryness, redness, irritation, presence of cracks, facilitating the attack of the opportunistic microorganisms. This in turn favors inflammation of the mucous membranes (mucositis), inflammation of the gums (gingivitis), presence of painful ulcerations and local infections caused by fungi such as candidiasis, fissures in the lips, halitosis. It is often related to pharyngitis, laryngitis, dyspepsia or constipation.

The main effects of decreased salivary flow on dental tissue are increased carious lesions and dental sensitivity.

In patients with xerostomia with dental prostheses, rubbing causes erosions on the buccal mucosa.

DIAGNOSIS

There are multiple tests, but the best known for examining the salivary flow are sialometry (measures the amount of saliva); biopsy of salivary glands (note the presence of inflammation and destruction of glandular tissue); ultrasound, magnetic resonance imaging and computed tomography. These tests are useful for the diagnosis of pathologies of the salivary glands. All this without ignoring, clinical history and clinical examinations intra and extraoral.

DENTAL TREATMENT

Among the general measures to be taken into account are the control of systemic diseases, the most important of which will be Sjögren's syndrome and the side effects caused by radiotherapy in the treatment of head and neck cancer.

In these patients with dry mouth it is fundamental to change, suppress or reduce the xerostomizing drugs that they are taking. It is important to consider the psychological factors that are becoming more frequent in the onset of xerostomia, especially chronic anxiety and excessive stress.

When planning treatment, it will first be necessary to identify if the process that generates dry mouth is reversible or irreversible. That way we will know if the altered factor can be corrected and if residual glandular activity remains that can be recovered.

It is important to know whether glandular activity can still be stimulated mechanically, chemically or gustatively. Substances that promote the secretion of saliva are called sialogogs. Depending on their level of action can be divided into systemic (pharmacological substances) and topical agents (gustatory stimulants). On the other hand, there are wetting agents or salivary substitutes, which, through the use of formulations with Betaine, Xylitol, Allantoin, Aloe vera and Sodium Fluoride as part of daily oral hygiene, help to moisturize the oral mucosa.

Xylitol has beneficial oral effects: a bacteriostatic and moisturizing effect, while enhancing the anticaries effect and remineralizing Sodium Fluoride. Betaine, Allantoin and Aloe vera for their anti-irritating, regenerating and healing actions of the tissues, prevent fissures of the tongue, lips and palate, improving the symptomatology of patients with xerostomia.

There are formulations that include malic acid as a salivary secretion stimulating agent with no erosive effect on tooth enamel.

Oral hygiene is essential in case of dry mouth, oral hygiene techniques should be strengthened by using a dental brush with soft filaments, toothpaste and specific mouthwashes, moisturizing gels, to help keep the mucosa lubricated.

In addition, it is recommended to make periodic reviews to the dentist.