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Dry Mouth

Dry mouth

Definition

Dry mouth, known medically as xerostomia, is the abnormal reduction of saliva due to medication, disease, or medical therapy.

Description

Dry mouth due to the lack of saliva can be a serious medical problem. Decreased salivation can make swallowing difficult, decrease taste sensation, and promote tooth decay.

Causes & symptoms

Dry mouth, resulting from thickened or reduced saliva flow, can be caused by a number of factors: medications, both prescription and over-the-counter; systemic diseases, such as anemia or diabetes, manifestations of syndromes such as rheumatoid arthritis , lupus, chronic hardening and thickening of the skin, or chronic and progressive inflammation of skeletal muscles; infections of the salivary glands; blockage of the salivary ducts caused by stones or tumors forming in the ducts through which the saliva passes; dehydration; medical therapies, such as local surgery or radiation; secretion reduction due to the normal aging process; and emotional stress .

Dry mouth, together with dry eyes, is a core symptom of Sjögren's syndrome , named for the Swedish physician who first described it. Sjögren's syndrome is an autoimmune disorder in which the body's white cells attack the glands that produce saliva and tears. It is a common cause of dry mouth in the elderly.

Although psychiatric disorders involving dry mouth are unusual, several cases have been reported of somato-form disorders in which dry mouth is a central symptom. Somatoform disorders are psychiatric disturbances characterized by external physical symptoms or complaints that are related to psychological problems rather than organic illness.

Diagnosis

The diagnosis of dry mouth is not difficult. The patient will state that his or her saliva is very thick or non-existent. Finding the cause of the dry mouth may be more difficult and require some laboratory testing. Salivary gland biopsy for stones or tumors should be performed if indicated.

Treatment

To treat dry mouth, the use of caffeine-containing beverages, alcoholic beverages, and mouthwashes containing alcohol should be minimized. Drinking water and fruit juices will decrease dry mouth problems. Chewing gum and lemon drops can be used to stimulate saliva flow. Bitters also can initiate salivary flow as long as the salivary glands and ducts are functional. Commercial saliva substitutes are available without prescription and can be used as frequently as needed. Use of a humidifier in the bedroom reduces nighttime oral dryness.

Herbal therapy

There are several herbal remedies that may be effective in increasing saliva production and preventing dry mouth. Drinking ginger, chamomile , or Chinese green tea at frequent intervals stimulates salivary flow. A Chinese herbal mix of ophiopogois, pinelliae tuber, zizyphi fructus, glycyrrhiaze, ginseng radix, and oryzae semen has been evaluated as treatment for dry mouth. Studies have shown this formula is effective in relieving dry mouth in half of those tested, including severe cases, such as cancer patients undergoing radiation therapy.

Nutritional therapy

Because dry mouth often causes gum disease , patients should take vitamin C and beta-carotene supplements as a preventive measure.

Acupuncture

Acupuncture has been tried since the late 1990s as a treatment for dry mouth caused by cancer treatments. Practitioners at a California clinic that offers acupuncture to cancer patients use a total of eight needles, to stimulate three points on each ear and one on each index finger. Of the 50 patients who have been treated with acupuncture in this clinic, 35 reported significant improvement in their salivation, and 13 reported that the improvement lasted for over three months before they required another treatment.

Allopathic treatment

Treatment of dry mouth involves management of the underlying condition. If dry mouth is caused by medication, the medication should be changed. If dry mouth is caused by blockage of the salivary ducts, the cause of the blockage should be investigated. When such systemic diseases as diabetes and anemia are brought under control, dry mouth problems may decrease.

Some new medications have been developed to treat dry mouth associated with cancer therapy and Sjögren's syndrome. Amifostine (Ethyol), a medication that protects the cells of the mouth against radiation and chemotherapy agents, has been approved by the Food and Drug Administration (FDA) as a treatment for dry mouth related to cancer therapy. Pilocarpine hydrochloride (Salagen) is a drug that was approved in 1998 for treating dry mouth associated with Sjögren's syndrome; it works by stimulating the salivary glands to produce more moisture. A study published in 2002 indicates that pilocarpine also relieves dry mouth in cancer patients. Cevimeline (Evoxac) is a newer drug that was approved by the FDA in February 2000 for the treatment of dry mouth associated with Sjögren's syndrome. All three medications appear to give good results and to be well tolerated by patients.

Expected results

The prognosis for patients with xerostomia due to medication problems is good, if the offending agent can be changed. Dry mouth due to systemic problems may be eliminated or improved once the disease causing the dry mouth is under control. Persistent xerostomia can be managed well with saliva substitutes.

Prevention

A patient needs to ask his or her health care provider if any medication to be prescribed will cause dry mouth. Patients with persistent xerostomia need to practice good oral hygiene and visit a dentist on a regular basis; the lack of adequate saliva can cause severe dental decay. The salivary glands are very sensitive to radiation, so any patient scheduled for radiation therapy of the head and neck should discuss minimizing exposure of the salivary glands to radiation with the radiation therapy provider.

Resources

BOOKS

Lee, K. J., ed. Essential Otolaryngology. 7th ed. New York: McGraw-Hill, 1998.

Rakel, Robert, ed. Conn's Current Therapy. Philadelphia: W.B. Saunders Company, 1997.

PERIODICALS

Johnstone, P. A., R. C. Niemtzow, and R. H. Riffenburgh. "Acupuncture for Xerostomia: Clinical Update." Cancer 94 (February 15, 2002): 11511156.

Koukourakis, M. I. "Amifostine in Clinical Oncology: Current Use and Future Applications." Anticancer Drugs 13 (March 2002): 181209.

Leek, H., and M. Albertsson. "Pilocarpine Treatment of Xerostomia in Head and Neck Patients." Micron 33 (2002): 153155.

Petrone, D., J. J. Condemi, R. Fife, et al. "A Double-Blind, Randomized, Placebo-Controlled Study of Cevimeline in Sjögren's Syndrome Patients with Xerostomia and Keratoconjunctivitis Sicca." Arthritis Rheum 46 (March 2002): 748754.

Ship, J. A., S. R. Pillemer, and B. J. Baum. "Xerostomia and the Geriatric Patient." Journal of the American Geriatric Society 50 (March 2002): 535543.

Sugano, Sumio, Isamu Takeyama, Sadao Ogino, et al. "Effectiveness of Formula Ophiopogoins in the Treatment of Xerostomia and Pharyngoxerosis." Acta Otolanryngol (Stockh) 252 (1996): 124129.

Votta, T. J., and L. Mandel. "Somatoform Salivary Complaints. Case Reports." New York State Dental Journal 68 (January 2002): 2226.

ORGANIZATIONS

American Dental Association. 211 E. Chicago Ave. Chicago, IL 60611. (312) 440-2500. <http://www.ada.org>.

American Medical Association. 515 N. State Street, Chicago, IL 60612. (312) 464-5000. <http://www.ama-assn.org>.

Mai Tran

Rebecca J. Frey, PhD

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Xerostomia

Xerostomia

Description

Xerostomia, also known as dry mouth, is marked by a significant reduction in the secretion of saliva. Signs and symptoms of xerostomia include:

  • dryness of the mouth
  • cracked lips, cuts, or cracks at the corners of the mouth
  • taste changes
  • a burning sensation of the tongue
  • changes in the surface of the tongue
  • difficulty wearing dental appliances (like dentures)
  • difficulty swallowing fluids accompanied by an increase in thirst

Xerostomia makes the mouth less able to neutralize acid, clean the teeth and gums, and protect itself from infection. This can lead to the development of gum disease and cavities.

Saliva is necessary for carrying out the normal functions of the oral cavity, such as taste, speech, and swallowing. Saliva provides calcium and phosphate, minerals that protect the teeth against softening. It also contains substances inhibiting the production of bacteria that cause tooth decay. In addition, saliva buffers the acids produced when leftover food particles are broken down by bacteria.

Xerostomia causes the following mouth changes that can contribute to discomfort for the patient, and an increased risk for oral lesions:

  • Saliva becomes thick and is less able to lubricate the mouth.
  • Acids in the mouth cannot be neutralized, leading to mineral loss from the teeth.
  • There is an increased risk for cavities because the mouth is less able to control bacteria.
  • Plaque becomes thicker and heavier because of the patient's difficulty in maintaining good oral hygiene.
  • The acid produced after eating or drinking sugary foods leads to further mineral loss from the teeth, causing even more tooth decay.

Causes

Xerostomia in cancer patients is primarily caused by the effects of radiation therapy on the salivary glands, usually the result of radiation to the head and neck area. These changes may occur rapidly and cannot normally be reversed, especially if the salivary glands themselves are irradiated. Within one week of starting radiation treatment, the production of saliva drops and continues to decrease as treatment continues. The severity of xerostomia is dependent upon the radiation dose and how many salivary glands are irradiated. Typically, the salivary glands inside the upper back cheeks (the parotid glands) are more affected than others. Salivary glands that are not irradiated may become more active as a way of compensating for the loss of saliva from the destroyed glands.

A number of medications can cause xerostomia, including many drugs used in the management of cancer or cancer treatment side effects. Some of these are: atropine, amitriptyline , carbamazepine , diphenhydra-mine , gabapentin , haloperidol, loperamide, lorazepam , meperidine , and scopolamine , among several others.

Treatments

A number of clinical trials are investigating drugs called radioprotectors, which are given at the time of radiation therapy in an attempt to prevent xerostomia. If xerostomia has already developed, there are a number of measures that may help to both alleviate the symptoms of dry mouth and prevent cavities and gum disease. These measures include:

  • cleaning the mouth well at least four times per day (after every meal and at bedtime)
  • rinsing the mouth immediately after every meal
  • using fluoride toothpaste to brush the teeth
  • sipping water frequently
  • rinsing the mouth with a salt and baking soda solution four to six times per day (1/2 tsp. salt, 1/2 tsp. baking soda, and 8 oz of water)
  • avoiding foods and liquids containing large amounts of sugar
  • avoiding mouthwashes containing alcohol
  • using moisturizer on the lips
  • using saliva substitutes to help relieve discomfort
  • using prescription oral pilocarpine (Salagen), which can stimulate saliva secretion from the remaining salivary glands
  • applying a prescription-strength fluoride gel daily at bedtime to clean the teeth

Xerostomia usually cannot be reversed when the cause is the destruction of the salivary glands by radiation treatments. It may be reversible if related to a medication. All of the treatment measures serve to increase the level of comfort, decrease the chance for oral lesions, and reduce the occurrence of gum disease and cavities.

Resources

PERIODICALS

Cerrato, Paul L. "Managing Dry Mouth in Head and Neck Cancer." RN 63 (April 2000): 102.

"Dry Mouth from Drugs: More Than Just an Annoying Side Effect." Tufts University Health and Nutrition Letter 18 (May 2000): 3.

OTHER

Hodson, D.I., et al. "Symptomatic Treatment of Radiation-induced Xerostomia in Head and Neck Cancer Patients."Cancer Care Ontario Practice Guideline Initiative April 2000. 18 July 2001 <http://hiru.mcmaster.Ca/ccopgi/guidelines/head/cpg5_5f.html>

"Oral Complications of Chemotherapy and Head/Neck RadiationSupportive Care." CancerNet PDQ 18 July 2001<http://cancernet.nci.nih.gov>.

Deanna Swartout-Corbeil, R.N.

KEY TERMS

Oral cavity

The collective term for several structures in the mouth: the lips, teeth, gums, tongue, pharynx, and salivary glands.

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Dry Mouth

Dry Mouth

Definition

Dry mouth, known medically as xerostomia, is the abnormal reduction of saliva due to medication, disease, or medical therapy.

Description

Dry mouth due to the lack of saliva can be a serious medical problem. Decreased salivation can make swallowing difficult, can decrease taste sensation, and can promote tooth decay.

Causes and symptoms

Dry mouth, resulting from thickened or reduced saliva flow, can be caused by a number of factors: medications, both prescription and over-the-counter; such systemic diseases as anemia, HIV infection, or diabetes, manifestations of Sjögren's syndrome (as rheumatoid arthritis, lupus, chronic hardening and thickening of the skin, or chronic and progressive inflammation of skeletal muscles); infections of the salivary glands; blockage of the salivary ducts caused by stones or tumors forming in the ducts through which the saliva passes; dehydration ; such medical therapies as local surgery or radiation; secretion reduction normally involved in the aging process; and emotional stress.

Diagnosis

The diagnosis of dry mouth is not difficult. The patient will state that his or her saliva is very thick or nonexistent. Finding the cause of dry mouth may be more difficult and require some laboratory testing. Salivary gland biopsy for stones or tumors should be performed if indicated.

Treatment

The treatment of dry mouth involves the management of the condition causing it. If dry mouth is caused by medication, the medication should be changed. If dry mouth is caused by blockage of the salivary ducts, the cause of the blockage should be investigated. When systemic diseases, such as diabetes and anemia, are brought under control dry mouth problems may decrease.

The use of caffeine-containing beverages, alcoholic beverages, and mouthwashes containing alcohol should be minimized. The drinking of water and fruit juices will decrease dry mouth problems. Chewing gum and lemon drops can be used to stimulate saliva flow. Bitters also can initiate salivary flow as long as the salivary glands and ducts are functional. Commercial saliva substitutes are available without prescription and can be used as frequently as needed. Use of a humidifier in the bedroom reduces nighttime oral dryness.

Dry mouth caused by the aging process or radiation therapy for cancer can be treated by such oral medications as pilocarpine (Salagen). Drugs that are given to increase the flow of saliva are known as sialogogues.

Prognosis

The prognosis for patients with xerostomia due to medication problems is good, if the offending agent can be changed. Dry mouth due to systemic problems may be eliminated or improved once the disease causing the dry mouth is under control. Persistent xerostomia can be managed well with saliva substitutes.

Prevention

A patient needs to ask his or her health care provider if any medication to be prescribed will cause dry mouth. Patients with persistent xerostomia need to practice good oral hygiene and visit a dentist on a regular basis; the lack of adequate saliva can cause severe dental decay. The salivary glands are very sensitive to radiation, so any patient scheduled for radiation therapy of the head and neck needs to discuss with the radiation therapist ways to minimize exposure of the salivary glands to radiation.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Dentistry in Medicine." Section 9, Chapter 103 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Bruce, S. D. "Radiation-Induced Xerostomia: How Dry Is Your Patient?" Clinical Journal of Oncology Nursing 8 (February 2004): 61-67.

Nagler, R. M. "Salivary Glands and the Aging Process: Mechanistic Aspects, Health-Status and MedicinalEfficacy Monitoring." Biogerontology 5 (March 2004): 223-233.

Pinto, A., and S. S. De Rossi. "Salivary Gland Disease in Pediatric HIV Patients: An Update." Journal of Dentistry for Children (Chicago) 71 (January-April 2004): 33-37.

Porter, S. R., C. Scully, and A. M. Hegarty. "An Update of the Etiology and Management of Xerostomia." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 97 (January 2004): 28-46.

ORGANIZATIONS

American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. http://www.ada.org.

American Medical Association. 515 N. State St., Chicago, IL 60612. (312) 464-5000. http://www.amaassn.org.

KEY TERMS

Salivary duct Tube through which saliva is carried from the salivary gland to the mouth.

Salivary gland Gland in which saliva forms.

Sialogogue A medication given to increase the flow of saliva.

Xerostomia The medical term for dry mouth.

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dry mouth

dry mouth (dry) n. a condition that occurs as a result of reduced salivary flow from a variety of causes, including therapeutic agents, Sjögren's syndrome, connective-tissue disease, diabetes, excision or absence of a major salivary gland, or radiotherapy to the head that destroys the salivary glands. Medical name: xerostomia.

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xerostomia

xerostomia (zeer-oh-stoh-miă) n. see dry mouth Compare ptyalism.

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