Dry Mouth (Xerostomia): What is it & how is it treated?

Saliva contributes significantly to the normal functions of chewing, taste, swallowing, speech, and the initiation of digestion. It keeps the oral environment moist and thus helps prevent the accumulation of microbes, while its antimicrobial action protects the teeth from decay.

The beneficial properties of saliva become particularly evident in conditions of dry mouth.

Xerostomia (dry mouth) is the sensation of oral dryness that, in most cases, is due to reduced function of the salivary glands and decreased saliva production.

Individuals with xerostomia present with:

• difficulty chewing and swallowing dry foods,
• burning sensation (causalgia),
• taste and smell disturbances,
• bad breath,
• smooth, dry, lobulated, and often reddened tongue,
• oral candidiasis (fungal infection),
• inflammation at the corners of the mouth (angular cheilitis),
• dryness and peeling of the lips,
• problems with denture retention,
• increased tendency for tooth decay and periodontal (gum) diseases.

What causes it?

The most common cause, in over 90% of cases, is chronic medication use, as approximately 80 categories of medications include dry mouth among their side effects. The most significant medications include psychotherapeutic drugs, antihistamines, antiparkinsonian agents, antihypertensives, diuretics, antiepileptics, among others.

Xerostomia is classified as temporary and permanent (prolonged).

Temporary xerostomia is caused by:

• dehydration,
• viral and bacterial infections,
• mouth breathing,
• excessive smoking and alcohol consumption,
• anxiety, fear, depression.

Permanent (prolonged) xerostomia, in addition to chronically administered medications, can be observed in individuals:

• with Sjögren syndrome,
• who have received radiation therapy in the head and neck area for the treatment of certain forms of cancer,
• who are undergoing hemodialysis,
• who suffer from systemic diseases such as uncontrolled diabetes mellitus, HIV infection that causes AIDS,
• who have sustained trauma or undergone surgery in the head and neck area.

How is it treated?

The management of xerostomia depends on its underlying cause, e.g., referral to the attending physician to explore the possibility of replacing the responsible medication or modifying its dosage.

Preventive therapy in patients with prolonged oral dryness includes:

• meticulous oral hygiene,
• use of fluoride toothpaste,
• daily use of fluoride rinse and chlorhexidine solution,
• regular dental check-ups every 6 months.

The management of mucosal dryness is achieved through:

• administration of topical moisturizers — saliva substitutes in gel, solution, or spray form,
• sugar-free chewing gum or candies,
• systemic administration of medications such as pilocarpine and cevimeline.

It is also imperative to manage the complications of xerostomia, such as oral candidiasis, with the administration of topical or systemic antifungal medications.