Xerostomia Diagnosis and Treatment

Xerostomia Diagnosis and Treatment
4 min read
02 September 2023

Xerostomia, commonly known as dry mouth, occurs when the salivary glands do not produce enough saliva to keep the mouth wet. It is estimated that xerostomia affects over 30% of adults, making it a common condition that can significantly impact quality of life. Here is an in-depth look at how xerostomia is diagnosed by doctors and dentists, and the various treatment options available.

 

What Causes Xerostomia?

There are several potential causes of reduced saliva flow leading to dry mouth:

  • Medications - Over 500 prescription and over-the-counter drugs list dry mouth as a side effect. Common culprits include antihistamines, decongestants, antipsychotics, antidepressants, diuretics, muscle relaxants, and opioids.
  • Medical conditions - Sjogren's syndrome, diabetes, Parkinson's disease, stroke, and autoimmune diseases often cause salivary gland dysfunction. Head and neck cancer radiation treatment damages glands.
  • Aging - Saliva production naturally decreases as we age. Elderly people are more prone to dry mouth.
  • Nerve damage - Injuries or surgery on head and neck area can affect signals to salivary glands.
  • Dehydration - Not drinking enough fluids can make saliva thicker and stickier.
  • Habits - Breathing through the mouth, especially at night; chewing tobacco; and drinking alcohol can dry out the mouth.

Diagnosing Xerostomia

The first step is a physical examination of the mouth. The doctor or dentist will check for signs of dryness like cracked lips, dry or sticky tissues, and lack of saliva pooling in the floor of the mouth.

Patients may be asked about symptoms like difficulty chewing, swallowing, or speaking. The timing and duration of dry mouth episodes can help identify causes. Questions about medical conditions, medications, and lifestyle factors that reduce saliva flow may be useful.

Objective tests can check saliva quantity and quality:

  • Salivary flow rate - Measures how much saliva is produced over time. Patients chew a piece of wax and spit into a measuring cup. Flows under 0.1 ml/min indicate hyposalivation.
  • Examining saliva - Samples may be tested for consistency, pH, mineral content, and antimicrobial enzymes. Thick, sticky saliva or unusual pH indicates a problem.
  • Imaging - Sialography, MRI or CT scans might detect blocked salivary ducts, infections, or tumors in the glands. Useful if Sjogren's syndrome is suspected.
  • Biopsy - Removing a minor salivary gland tissue sample can check for lymphocytic infiltration indicative of Sjogren’s.

Treating Xerostomia

If an underlying health issue like medication side effects, autoimmune disorder, or dehydration is identified, treating the cause may relieve dry mouth. For other cases of chronic xerostomia, the main treatment approaches include:

Over-the-Counter Saliva Substitutes

Saliva Substitutes temporary wetting and lubrication for a couple hours. Ingredients like glycerin, xylitol, mineral oil, olive oil, and electrolytes mimic natural saliva. Brands include Biotene, Lubricity, Oasis, Moi-Stir, and Salivea.

Prescription Medications

Drugs like pilocarpine and cevimeline promote saliva production by stimulating receptors. Common side effects include sweating and urination. Evoxac is a commonly prescribed brand.

Salivary Gland Surgery

If ducts are blocked, a salivary endoscopy opens strictures and inserts stents. Damaged glands may be removed. For head/neck cancer patients, healthy glands can be repositioned to reduce radiation exposure.

Acupuncture

Some studies show acupuncture can increase saliva secretion. It may work by promoting blood flow and parasympathetic stimulation of glands. More research is needed.

Oral Devices

Special dental appliances worn at night prevent mouth breathing and keep saliva in the mouth. This reduces dryness during sleep. Custom-made devices are more effective than over-the-counter mouthguards.

Lifestyle Changes

Sipping fluids, avoiding irritants like alcohol and coffee, using a humidifier, practicing good oral hygiene, and chewing sugar-free gum can provide additional relief from xerostomia.

With proper diagnosis and treatment, dry mouth can be managed for improved oral health and quality of life. However, severe cases may be challenging to treat. Regular dental visits and follow-ups are important, even if symptoms improve.

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