Causes, symptoms, diagnosis y treatment of Xerostomia or Dry mouth Maximum moisturizing effect and care of dry mouth
What is Xerostomia?XEROSTOMIA is a clinical condition or subjective sensation of oral dryness due to a decrease in saliva produced bypoor functioning salivary glands. Also known as Dry mouth, asialorrhea or hyposalivation XEROSTOMIA is a clinical condition or subjective sensation of oral dryness due to a decrease in saliva produced by poor functioning salivary glands. Also known as Dry mouth,It is properly called or hyposalivation. flow is reduced by half, both at rest and when stimulated. asialorrhea XEROSTOMIA when salivary It is properly called XEROSTOMIA when salivary flow is reduced by half, both at rest and when stimulated. People over 55 years of age Xerostomia 20% Xerostomia 40% People between18-35 years of age People over 55 years of age
Causes of Xerostomia, or dry mouthChange in afferent stimuli.A lack of peripheral stimuli, such as an absence of teeth, leads to less afferent informationthrough nerve stimuli, and as a consequence, less saliva production. These alterations occur inelderly people. In this situation, there is a decrease in saliva produced by submaxillary andsublingual glands, but not by the parotid. These patients will have less non-stimulated saliva,but when a stimulus is present, they will have the same amount of saliva.Central nervous system disorders (CNS).Stress, anxiety, depression, anorexia or tobacco smoking and alcohol consumption can affectthe CNS and thus inhibit nerve transmission to the salivary glands causing hyposalivation.Blockage of the drainage ducts.The obstruction of the ducts, known as Sialolithiasis, occurs when calcium in the ductsaccumulates, forming calcifications that interrupt the natural flow of saliva.
Causes of Xerostomia, or dry mouthAlterations in the salivary glands themselves. Can be due to:Lack of saliva production components. Can occur in patients lacking proteins, directly causing areduction in saliva or can be due to a lack of water intake or excessive loss thereof.Lack or destruction of the salivary parenchymal. Autoimmune diseases such as Sjögren’sSyndrome or caused by head and neck radiotherapy.The most common causes are:- Xerostomising drugs- Systemic diseases such as Sjögren’s Syndrome or diabetes- Head and neck radiotherapy- Psychological causes such as anxiety, depression or stress- Aging
Signs and Symptoms of Xerostomia or Dry MouthWe can differentiate between SYMPTOMS, which the patient himself notices andexpresses, and SINGS, which are characteristics that the dentist or hygienist can detect inthe dental office.Symptoms: -Burning tongue/mouth -Difficulty speaking, swallowing and eating -Saliva thick and stringy -Eating disorder -Dysgeusia - altered sense of taste - the patient may notice that certain foods take on a metallic tasteClinical signs:Functional and morphological changes: -Changes in the mucosa, paleness and loss of sheen, dry and scarcely hydrated tissue. -Tongue dorsum cracked, dry and red. Peeling lips. -Commonly related to pharyngitis, laryngitis, dyspepsia or constipation. -Gums tend to loose their characteristic sheen and sometimes gingivitis can appear. -Dry palate with erythematous patches.
Signs and Symptoms of Xerostomia or Dry MouthChanges in teeth due to the loss of saliva’s protective functionDue to a loss of ions and proteins from lack of saliva, some anti-cariogenic effect is lostbecause of the change in pH to one that is not the most ideal for maintaining the ecosystem.Rapidly evolving caries appear on the neck of the tooth.Greater tendency for oral infections, candidiasis commonly occurs, as well as erosions orirritations.
Diagnosis 1st step Patient’s Clinical History Ask about systemic diseases, drug intake and history of radiotherapy. Assess patient’s symptoms, feelings. Dry mouth will depend on each person’s sensation threshold. Burning tongue, burning mouth Difficulty speaking, swallowing and eating Saliva thick and stringy Eating disorder Dysgeusia - altered sense of taste - the patient may notice a metallic taste to certain foods Difficulty using dentures Halitosis
Diagnosis2nd step Exam of Mouth and MucosaCheck to see if any part of the mouth has any of the following signs or symptoms:Loss of sheen and paleness in the mucosa. Cracks in the tongue dorsum. Peeling lips. Frequentcandidiases, erosions or irritations, rapidly evolving caries in the neck of the tooth. Commonlyrelated to pharyngitis, laryngitis, dyspepsia or constipation.Saliva thick and stringy. Halitosis3rd step Palpation of salivary glandsPalpation where the salivary glands sit, in search of tumefactions or to check their consistencyand characteristics.
Diagnosis4th step Amount of saliva per length of timeThe mouth is estimated to be moistened by between 1 and 1.5 litres of saliva per day. Whensaliva flow decreases to half of this at rest and with stimulation, we are talking aboutXerostomia. (Salivary flow below 0.5 ml/min). Methods used: SIALOMETRY by drainage of saliva at rest and stimulated by means of mechanical methods (paraffin tablets in patients with teeth and chemical gustatory stimulation with 10% citric acid). SIALOGRAPHY Less reliable image technique. Slow secretion and presence of calcifications that produce obstructions are observed by contrast. GAMMAGRAPHY We can observe the form and function of salivary glands and determine if they are correct.5th step If Sjögren’s Syndrome is suspected Biopsy of the minor salivary glands – morphological assessment Blood test – Specific antibodies of autoimmune diseases
Treatment of XerostomiaTreatment is different depending on what caused it.For REVERSIBLE alterations: solve the primary alteration. For stress, anxiety, dehydration,better to fix the cause, and for drugs, reduce the dose.For IRREVERSIBLE alterations: (degeneration due to age, Sögren’s Syndrome, tumours, etc)Differential treatment depending on the level of impairment and the degree of the conditionof the glandular structures. Stimulation of natural secretionAnything from gum to sialogogues such as Pilocarpine can be recommended. Pilocarpine is astimulator of the receptors that are located in the cells of salivary and lacrimal glands; theyonly act on the remaining healthy tissue, but it is known to have many adverse effects.Substitution of natural secretionArtificial saliva:Artificial saliva is used in solutions that contain mucins or glycoproteins which generally coveroral mucosa with a thin, slippery film that protects and lubricates the oral cavity.
Treatment of XerostomiaRECOMMENDATIONS:Humidification of the mouth throughout the dayTreat tooth impairments Extract teeth and roots that are in poor conditions for subsequentreconstruction treatment.Adequate and strict oral hygiene plan using a proper prophylaxis together with topical fluorideapplication and regular check-ups to assess patient’s oral hygiene.