Contents

Search

xerostomia (asialism, aptyalism, dry mouth, hyposalivation)

A dryness of the mouth, having varied etiology, resulting from diminished or arrested salivary secretion (asialism). Etiology: 1) Sjogren's syndrome - unlikely to cause xerostomia [5] 2) pharmaceutical agents [6] a) diuretics b) antihistamines c) anticholinergics d) antidepressants 1] tricyclic antidepressants 2] SSRI e) antipsychotics f) opiates g) clonidine h) metoprolol [5] i) antineoplastic agents 3) therapeutic irradiation of the head for head & neck cancer [8] 4) diabetes mellitus type1 in poor control 5) obstructive sleep apnea [5] 6) mucocutaneous vesiculobullous dermatitis - lichenoid dermatitis (lichen planus) [5] 7) salivary stones generally do not cause xerostomia [5] Pathology: - inhibition of normal functions of saliva - antibacterial activity - inhibition of demineralization - lubrication - secretions facilitating taste sensors Clinical manifestations: 1) intra-oral dryness or burning 2) alterations in tongue surface 3) dysphagia 4) cheilosis 5) dysgeusia 6) dysarthria 7) development of root caries Complications: 1) cervical or incisal caries 2) oral candidiasis 3) overgrowth of anaerobic bacteria a) periodontal inflammation b) acute necrotizing ulcerative gingivitis (trench mouth) Management: 1) swishing water in the mouth frequently [6] 2) oral hygiene with soft toothbrush [5] 3) fluoride mouth rinses 4) saliva substitutes - Biotene, MouthKote 5) salivary stimulation with sugarless candies 6) avoidance of sugar-containing drinks or food 7) limit caffeine, tobacco, alcohol [6] 8) pilocarpine [4] a) Salagen tablets b) 4-5 drops of 2% pilocarpine ophthalmic in 4 oz H2O QID 9) cevimeline (Evoxac) [4] 10) use a humidifier at night

Related

pilocarpine (Pilocar, Isopto Carpine, Salagen, Ocusert Pilo) salivation sialorrhea; hypersalivation; ptyalism Sjogren's syndrome (autoimmune epitheliitis)

General

salivary gland disease

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 186
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Prescriber's Letter 8(7):40 2001
  5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  6. Holt PR, Annals of Long-Term Care suppl, Feb 2004
  7. Prescriber's Letter 17(10): 2010 Treatment of Dry Mouth Detail-Document#: 261006 (subscription needed) http://www.prescribersletter.com
  8. Jensen SB, Pedersen AM, Vissink A et al A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010 Aug;18(8):1061-79. PMID: 20333412
  9. Gibson B, Periyakaruppiah K, Thornhill M et al. Measuring the symptomatic, physical, emotional and social impacts of dry mouth: a qualitative study. Gerodontology. 2020;37(2):132-142 PMID: 31347735 https://onlinelibrary.wiley.com/doi/10.1111/ger.12433
  10. Marcott S, Dewan K, Kwan M et al. Where dysphagia begins: polypharmacy and xerostomia. Fed Pract. 2020;37(5):234-241 PMID: 32454578 PMCID: PMC7241606 Free PMC article
  11. Millsop JW, Wang EA, Fazel N. Etiology, evaluation, and management of xerostomia. Clin Dermatol. 2017;35(5):468-476 PMID: 28916028 https://www.sciencedirect.com/science/article/abs/pii/S0738081X17301062
  12. Dry Mouth http://www.nohic.nidcr.nih.gov/pubs/drymouth/dmouth.htm