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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 |
| |
- Dental Caries present in oral sites not usually prone to decay e.g. lower anterior teeth, cervical areas
- 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 |
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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: |
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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) |
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Ageing (?) |
| |
| III. Interference with Neural Transmission: |
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Medications / Drugs |
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Autonomic dysfunction e.g. ganglionic neuropathy |
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Conditions affecting the CNS (e.g. Alzheimer's disease) |
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Psychogenic disorders (Depression, anxiety) |
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Trauma |
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Decrease in mastication |
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| 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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