Overview of Drugs
and Dry Mouth
The Complexities of the Drug-Dry Mouth Relationship
Search for drugs that may cause Dry Mouth
Diagnosis of Dry Mouth: Symptoms, signs, causes
Dry Mouth and
Salivary Flow
Treatment of Drug-induced Xerostomia
Sources of Information/Abbreviations
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Diagnosis of Dry Mouth: Symptoms, signs, causes

Symptoms Frequently Associated With Xerostomia

Dry mouth, when present for extended periods of time, is frequently associated with other oral symptoms, as well as with symptoms present in other parts of the body. Sometimes, the oral dryness is the patient's most distressing symptom; sometimes, it is one of the other symptoms or a combination of symptoms. These symptoms are shown in Table 1:

[ TABLE 1 ]  Xerostomia: Associated Symptoms
ORAL SYSTEMIC
SALIVA: Decrease in amount, foamy, viscous, ropy THROAT and LARYNX: Dryness, hoarseness, persistent dry cough
LIPS: Dry, cracked, fissured (cheilosis) NOSE: Dryness; frequent crust formation, decrease in olfactory acuity
TONGUE: Burning (glossopyrosis), pain (glossodynia) EYES: Dryness, burning, itching, gritty sensation, feeling that the lids stick together, blurred vision, sensitivity to light
CHEEKS: Dry SKIN: Dryness, butterfly rash, vasculitis
SALIVARY GLANDS: Swelling, pain JOINTS: Arthritis; pain, swelling, stiffness
THIRST: Frequent ingestion of fluids, especially while eating; keep water at bedside GI TRACT: Constipation; Gastroesophageal Reflux (GERD)
MASTICATION: Difficulty with eating dry foods; difficulty with the use of a denture VAGINA/VULVA: Dryness, burning, itching, history of recurrent fungal infections, dyspareunia
SWALLOWING: Difficulty with (dysphagia) GENERAL SYMPTOMS: Fatigue, weakness, generalized aching, weight loss, depression
SPEECH: Difficulty with (dysphonia)
TASTE: Difficulty with (dysgeusia)
Adapted from Sreebny LM: in “Saliva and Oral Health”, Second Edition, Edgar WM and O’Mullane DM, Eds., Published by British Dental Association, London, 1996.



Oral Signs Associated With Xerostomia and Salivary Gland Hypofunction

The persistence of oral dryness and the continued decrease in the flow of saliva significantly changes the environment of the oral cavity. Whole saliva is the principal protector of the oral tissues. As the saliva level drops, the mouth becomes more susceptible to infections and diseases; both the hard and soft tissues are involved (Table 2).

[ TABLE 2 ]  Oral Signs Associated with Dry Mouth and Salivary Gland Hypofunction
    Increase in the prevalence of Dental Caries
 
  1. Dental Caries present in oral sites not usually prone to decay e.g. lower anterior teeth, cervical areas
  2. Frequent recurrent decay
    Oral Mucosa: Dry, Pale
    Recurrent Yeast Infection: Candidiasis
    Depressed Oral Clearance: Retention of Food and Bacteria
    Tongue: Fissuring, Lobulation
    Lips: Cheilosis, Fissuring
    Major Salivary Glands: Swelling, Tenderness



Extra-Oral Signs Frequently Associated with Xerostomia and Salivary Gland Hypofunction

Oral dryness is frequently associated with generalized desiccation. In such cases, in addition to the SGH, there is generalized exocrine gland hypofunction. A good example of this is found in Sjögren’s Syndrome and other autoimmune diseases. The signs of disease seen in such conditions follow (Table 3):

[ TABLE 3 ]  Extra-Oral Signs Frequently Observed in Connection with Xerostomia and Salivary Gland Hypofunction
Site Clinical Sign
Eyes Keratoconjunctivitis sicca; decreased lacrimation
Nose Nasal crusts, epistaxis, decreased olfactory acuity
Sweat Glands Xeroderma
The Respiratory Tract Bronchitis, pneumonitis, interstitial fibrosis
The Gastrointestinal (G.I.) tract Pharyngitis, laryngitis, reflux esophagitis, heartburn, constipation
Vagina / Vulva Recurrent fungal infections; dyspareunia



The Causes of Oral Dryness

The causes of oral dryness and salivary gland hypofunction are shown in Table 4. The data show that mainly systemic, not local factors, induce salivary gland, as well as, generalized exocrine gland hypofunction. It is important to recognize that drugs may be the principal cause of the desiccation or, as is often the case, a contributory factor to it. Implicit in these observations is the fact that the treatment of oral dryness involves multiple therapies.

[ TABLE 4 ]  The Cause of Salivary Gland Hypofunction and Xerostomia
I. Water / Metabolite Loss:
        Dehydration:
             Impaired water intake
             Loss of water through the skin (fever, burns, excessive sweating)
             Blood loss
             Emesis
             Diarrhea
             Renal water loss:
                     Polyuria (Diabetes Insipidus)
                     Osmotic diuresis (Diabetes Mellitus)
             Protein Calorie Malnutrition
 
II. "Damage" to the Salivary Glands:
         Therapeutic irradiation to the head and neck region
         Autoimmune diseases:
         (Sjögren's Syndrome [SS], Graft-versus-host-disease [GHVD], Systemic
         Lupus Erythematosis [SLE], Rheumatoid Arthritis [RA], etc.)
         HIV-1 Infection (HIV disease)
         Ageing (?)
 
III. Interference with Neural Transmission:
         Medications / Drugs
         Autonomic dysfunction e.g. ganglionic neuropathy
         Conditions affecting the CNS (e.g. Alzheimer's disease)
         Psychogenic disorders (Depression, anxiety)
         Trauma
         Decrease in mastication
 
IV. Unknown
 
Adapted from Sreebny LM: Saliva in Oral Health, Second Edition, Edgar WM and O'Mullane DM, Eds., Published by British Dental Association, London, 1996.


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