Xerostomia is a medical term meaning dry mouth due to lack of saliva; individuals with xerostomia don't have enough saliva to keep the mouth wet - there is reduced or absent saliva flow.
The condition is also informally known as pasties, cottonmouth, drooth, doughmouth, or des (from desert).
This article will look at the causes, symptoms, diagnosis, and treatment of xerostomia.
Fast facts on xerostomia
Here are some key points about xerostomia. More detail and supporting information is in the main article.
- Dry mouth is more prevalent in the aging population
- Xerostomia is commonly a side effect of drugs
- Sometimes, xerostomia is due to an underlying disease such as sarcoidosis or amyloidosis
- Symptoms of xerostomia include cracked lips, bad breath, and sticky saliva
- Smoking or sleeping with the mouth open increases the chances of developing xerostomia
- Individuals with dry mouth should avoid spicy foods and sugary drinks
What is xerostomia?
Xerostomia can have a number of effects on general health and well-being.
Experts say that xerostomia is usually caused by inadequate function of the salivary glands.
Xerostomia can lead to speech and eating difficulties, halitosis (bad breath), an increase in the number of dental cavities (saliva helps prevent tooth decay), and infections in the mouth, such as thrush.
An individual with xerostomia typically finds it harder to enjoy food.
Xerostomia is a common problem. It is a frequent side effect of medication, which may improve with a new prescription or an adjustment of dosage.
We all get a dry mouth sometimes - when we are upset, under stress, or extremely frightened. Xerostomia is different - the individual's mouth is dry most of the time.
Some patients may think dry mouth is a normal part of aging - it is not. It is, however, more commonly found in older adults. Experts say the main reason is that elderly people take more medications compared with the rest of the population, and some of these medications cause xerostomia.
Xerostomia may be a symptom of a serious systemic disease, such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, sarcoidosis, amyloidosis, Sjögren's syndrome, Parkinson's, Diabetes, or hypothyroidism. A systemic disease is one that affects the entire body.
Xerostomia is not a disease, it is a symptom, just like headache is a symptom and not a disease.
Symptoms of xerostomia
Signs and symptoms of xerostomia may include:
- Bad breath
- Cheilitis - inflammation and fissuring (splitting or cracking) of the lips
- Cracking and fissuring of the oral mucosa (inner lining of the cheeks and lips), skin at the corners of the mouth may split or be sore
- Dryness in the mouth
- Dysgeusia - taste disorders
- Fungal infections in the mouth, such as thrush
- Glossodynia - painful tongue
- Increased need to drink water, especially at night
- Inflammation of the tongue, tongue ulcers
- Lipstick sticking to teeth
- More frequent gum disease
- More tooth decay and plaque
- Problems speaking
- Problems swallowing and chewing - especially dry and crumbly foods, such as crackers or cereals
- Problems wearing dentures - problems with denture retention, denture sores, and the tongue sticking to the palate
- Sialadenitis - salivary gland infection
- Sore throat
- Sticky saliva
- Stringy saliva
Causes of xerostomia
Xerostomia is often a side effect of pharmaceutical drugs.
Possible causes of xerostomia include:
Medications - many prescription and OTC medications cause dry mouth, including antihistamines, decongestants, hypertensive medications (for high blood pressure), antidiarrheals, muscle relaxants, urinary continence drugs, some Parkinson's disease medications, as well as a number of antidepressants.
Age - even though dry mouth is not a natural part of aging, older adults tend to take more medications than the rest of the population. Many of the medications taken by seniors cause dry mouth.
Cancer treatment - radiotherapy (radiation therapy) to the head and neck can damage the salivary glands, resulting in less saliva being produced. Chemotherapy can alter the nature of the saliva, as well as how much of it the body produces.
Injury or surgery - which results in nerve damage to the head and neck area can result in dry mouth.
Tobacco - either chewing or smoking tobacco increases the risk of dry mouth symptoms.
Dehydration - caused by lack of sufficient fluids.
Exercising or playing in the heat - the salivary glands may become dry as bodily fluids are concentrated elsewhere in the body. Dry mouth symptoms are more likely if the exercise or playing continues for a long time.
Some health conditions, illnesses, and habits - such as:
- Anxiety disorders
- Parkinson's disease
- Poorly controlled diabetes
- Sjögren's syndrome
- Sleeping with the mouth open
- Stroke and Alzheimer's disease - more likely to cause a perception of dry mouth even though salivary glands are functioning appropriately
The doctor or dentist will probably examine the patient's mouth and review their medical history. Blood tests and imaging scans of the salivary glands may also be ordered.
Sialometry - this is a simple procedure that measures the flow rate of saliva. Collection devices are placed over duct orifices of the saliva glands and saliva production is stimulated with citric acid.
Saliography - this is a radiographic examination of the salivary glands and ducts. It may be useful in identifying salivary gland stones and masses.
Biopsy - a small sample of salivary gland tissue is taken. Often used in the diagnosis of Sjogren's syndrome. If malignancy (cancer) is suspected, the doctor may also order a biopsy.
Many doctors report that often, even though the patient complains of severe dry mouth, the oral mucosa appears to be moist. Less frequently, it may be the other way round - the oral mucosa appears dry but the patient does not complain of dry mouth symptoms.
Treatment options for xerostomia
Often, xerostomia is treated by addressing the underlying causes.
Treatment for xerostomia depends on several factors such as whether the patient has an underlying condition or disease, or is taking certain medications that may be causing dry mouth.
If an underlying cause is found, steps need to be taken to minimize its effect.
Medications - if the dry mouth is thought to be caused by a medication, the doctor will either alter the dosage or prescribe another drug which is less likely to cause dry mouth.
Stimulating saliva production - a medication may be prescribed, such as pilocarpine (Salagen) or cevimeline (Evoxac), to stimulate the production of saliva.
Experts say that symptomatic treatment for dry mouth typically includes four areas:
- Increasing the flow of saliva
- Replacing lost secretions
- Controlling dental caries
- Some specific measures, such as treating infections
A patient with xerostomia should pay special attention to oral/dental hygiene. This includes plaque removal and treatment of gingival infections, inflammation, and dental caries. Brushing teeth and flossing regularly is important.
Sipping fluids (non-carbonated, sugarless), chewing xylitol-containing gum, and using a carboxymethyl cellulose saliva substitute as a mouthwash may help.
Mouthwashes which contain alcohol should be avoided, because they may worsen dry mouth symptoms. The patient should conduct a daily mouth examination, looking out for unusually colored patches, tooth decay, or ulcers. Anything unusual should be reported to their doctor or dentist.
The patient should not wear dentures during sleep. The dentures must be kept clean by overnight soaking. Eating such foods as carrots or celery may help with residual salivary gland function.
Breathing through the nose does not dry the mouth while breathing through the mouth does.
Humidity - a humidifier can add moisture to a bedroom. This may help reduce dry mouth symptoms that develop during sleep. Individuals with xerostomia should avoid:
- Chewing or smoking tobacco
- Sugary foods or drinks
- Acidic foods or drinks
- Dry foods
- Spicy foods
- Excessively hot or cold drinks
Alcohol consumption should be kept to a minimum or avoided altogether, and caffeine should be only be consumed in moderation.