Page 26 - GP Spring 2022

Xerostomia: A Clinical Review and Update of the Literature

By Maria Dimino RDH, BS, MA and Gwen Cohen-Brown DDS, FAAOMP

Introduction cific questions to ask the patient complain- life. Determining the factors contributing
Dry mouth, also known as xerostomia, is ing of xerostomia include asking about oral to xerostomia is helpful in formulating the
a common complaint among patients. In- dryness when eating if they have difficulty optimal clinical approach Most patients
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.
dividuals who suffer from this condition swallowing, if they need to sip liquids to report that the duration of their xerostomia
present with significant and direct changes swallow dry foods and if they have the per- symptoms have lasted at least several years,
to the oral cavity that can impair quality of ception of too little saliva. Some patients and over half of the patients with xerosto-
life. Xerostomia may also result in soft tis- will have speech and eating difficulties, mia reported that they have “always” expe-
sue discomfort and other oral complications halitosis, an erythematous and depapillated rienced it. Among xerostomia patients 60%
like increased caries risk and active decay, tongue, glossy and desiccated soft tissues, report waking up at night at least once and
yeast infections, and difficulty eating. There stomatodynia, and an inability to tolerate approximately one-third report taking wa-
are numerous potential etiologies to xero- spicy or hot foods. Patients with xerostomia ter before bed at night. Most of the patients
stomia; the most common ones being side are also likely to present with oral candidi- express the need to have water to swallow
effects of either over-the-counter and/or asis. Patients with dentures will have diffi- food and many also need gum or candy to
prescription-strength (OTC and Rx) med- culty with retention and are more likely to alleviate symptoms throughout the day. The
ications, with additional causes being sys- develop ulcerations and denture sore spots. most-reported oral complaint is speaking
temic diseases, dehydration, mouth breath- Denture retention is poor without saliva. difficulty, followed by approximately two-
ing, radiation and chemotherapy, salivary (Figures 1-3) thirds of the patients reporting taste distur-
gland tumors. There are some secondary bances, with oral dysesthesia (an alteration
concerns based upon the patient’s percep- of oral sensation) following as the third
tion, such as the increased use of masks due most common symptom. 4
to Covid-19. Xerostomia is rarely unifac-
torial, and as such, may be complicated to Objective Findings
treat effectively, balancing the patients’ con- The clinical presentation of xerostomia
cerns with appropriate treatment. 1 may include thick, ropey, viscous saliva, a
sticky mouth, a tongue with a white-coat-
Saliva Figure 1. Dentures ing, fissuring, or geographic pattern, gin-
Saliva is essential for a healthy oral envi- Xerostomia Figure 2. gival bleeding. Xerostomia is considered a
ronment with respect to both function and Glossodynia- complex condition that affects stomatolog-
Xerostomia
protection of the oral mucosa. Saliva cleans- ical functions and is often due to hyposali-
es, lubricates, and buffers the oral soft tis- vation. Given that the decreased production
sues. It removes debris, assists with swal- of saliva promotes dental caries, periodon-
lowing and breaking down food particles, tal disease, and other oral diseases, further
and is required to keep removable dentures investigation into a patient’s hyposalivation
well-retained. By maintaining the oral pH is needed. Related to this decrease in the
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at approximately 6.5 to 7.4, the saliva helps production of saliva, xerostomia may also
prevent acidic buildup in the mouth, thereby present clinically as oral lesions, periodon-
protecting the oral hard tissues from cario- tal disease, salivary gland infection, caries,
genic pathogens. The vast majority of sali- and fungal infections. The etiology is usual-

va is expressed through the major salivary ly considered to be multifactorial with both
glands, which account for approximately local and systemic factors contributing. It is
90% of oral saliva. The remaining 10% is Figure 3. Tongue Xerostomia important to note that although xerostomia
from the minor salivary glands. It is import- is more frequently observed clinically in the
ant to remember that salivary production Objective vs. Subjective Findings older population, it can affect the younger
does not decrease solely with aging; the It is essential when speaking with the pa- population as well, and proper diagnosing
glands do not change their ability to produce tient to assess both their subjective feelings and treatment planning needs to be done. 5
saliva unless they are affected directly. 2 along with objective clinical findings and to (Figure 4)
correlate those findings with the appropriate
Xerostomia laboratory tests. It is necessary to separate
While xerostomia is multifactorial, the those patients with perceived symptoms of
overall subjective feeling for the patient is a dry mouth from those with actual physio-
dryness to the oral mucosa. It is important to logic measurable salivary gland hypofunc-
separate the subjective and objective find- tion.
ings. Hyposalivation is not always visible,
nor is it an objective finding of a true de- Subjective Findings
crease in salivary flow. A patient may clini- Xerostomia denotes a subjective complaint
cally appear to have adequate saliva but will of dry mouth. The chief complaint may in-
complain of dryness. Other patients may clude burning and itching in the oral mucosa
clinically appear dry, with ropey viscous and tongue, difficulties with speech or dys-
saliva and their teeth, tongue, and cheeks phagia (swallowing), and difficulty eating Figure 4. Xerostomia Tongue
stuck together yet they are not uncomfort- dry or spicy foods. These can all contribute
able and do not complain of dryness. Spe- to compromising the quality of the patient’s

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