Page 27 - GP Spring 2022

Age/Race/Sex Potential Etiologies of Xerostomia
The mean age range of patients with Xerostomia is between 41 and The most likely etiologies of xerostomia include, but are not limited
69 years and it can affect any race. It has been reported that xero- to, antidepressants and other Rx and OTC medications, Sjögren’s
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stomia is higher in women than men in all age groups. The preva- syndrome, therapeutic radiation, dehydration, diabetes, menopause,
lence of xerostomia increases with age in both sexes, and it tends to and diseases involving salivary gland pathology. Newer concerns
be more symptomatic in the evening . 5 associated with xerostomia include Covid-19 and the potential for
mask usage as a possible issue. 6
Diagnosis of Xerostomia
Measurement of salivary output is essential to distinguish between Diabetes Mellitus
salivary and non-salivary causes of xerostomia. In other words, it Diabetes mellitus is a chronic condition characterized by hypergly-
is essential to differentiate between a non-functional gland (radia- cemia resulting from defective insulin secretion and/or sensitivity.
tion, trauma, tumor) and a gland that can still secrete saliva if stim- Gestational diabetes is currently considered to be a subcategory
ulated. Numerous methods for the measurement of unstimulated of secondary diabetes because the body is prevented from prop-
whole saliva (UWS) and stimulated whole saliva (SWS) flow rates erly using insulin. A link between better oral health and controlled
have been described that require simple equipment, are measurable periodontal disease has been shown to demonstrate better glycemic
and reproducible, and can be control and less aggressive bone loss and subsequent tooth loss.
performed in an office set-
ting with collectors designed Poor circulation associated with diabetes, especially poorly con-
specifically to collect saliva. trolled diabetes, results in poor wound health and aggravated peri-
It is also possible to measure odontal disease. 1
ductal flow of major salivary
glands (e.g., parotid sub- Dental Caries from Xerostomia
mandibular/sublingual) to Xerostomia in the oral cavity can manifest as a lack of saliva. Sali-
determine if a specific gland va rinses food residue and plaque from teeth and plays an important
is functioning; for example, Figure 5. Xerostomia Radiation role in preventing tooth decay. It also helps to limit the proliferation
after radiation treatment. of germs that break down the enamel layer in the tooth and lead
(Figure 5) to inflammation of the oral cavity. Saliva also aids in neutralizing
harmful acids in the oral cavity and the
Clinical Signs of Xerostomia minerals in saliva help treat the early
An assessment should include and stages of tooth decay. Dental caries
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document the following: cleanli- is a common consequence due to low
ness (food debris, odor, staining, salivary flow. Insufficient saliva leads
calculus)dentures (fit), gingival and to difficulty in restoring the baseline
mucosal membranes/tissues (bleed- oral pH and in regulating bacterial
ing, color, gaps, texture, loose populations and contributes to pri-
teeth, swelling), lips (chapping, mary and secondary carious lesions.
color, swelling), natural teeth (bite Since the protective effect of a regu- Figure 7. Cervical Decay
mismatch, breaks, decay, fillings, Figure 6. Xerostomia lar salivary flow is impaired, the
wear), saliva (quantity and quality), Scopolamine mouth lacks calcium, phosphate,
and tongue (color, patches, swelling, and fluoride needed to remineral-
ulcerations). (Figure 6 and Tables 1,2). ize hard tissues and the necessary
flushing effect to clear debris from
Table 1. Questions to Ask the Patient the tissues in the oral cavity. All
Does the patient have dentures/implants? Do the dentures/im- of these factors create the perfect
plants fit properly? environment for cariogenic over-
growth that can lead to rampant
Brush/floss teeth/how often? decay. (Figures 7, 8) Figure 8. Decay-#13-70M-01
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Bleeding after brushing/flossing/how often?
Bad breath that doesn’t go away? Medications (Rx and OTC)
Some medications can lead to an increase in dry mouth symptoms as
Chewing/mouth pain affecting drinking/eating/for how long? they raise the cortisol levels in the body and can simulate, or stimu-
late, the flight or fight response. It is important to remember that al-
though the salivary glands re-
Table 2. Indirect Benefits of Treating Xerostomia main functional throughout a
Treatment of underlying conditions that exacerbate wasting. person’s life, medication may
Ensure that medication can be swallowed. severely alter the ability of
the salivary gland to produce
Treat conditions that inhibit swallowing, chewing of food, and saliva. Most patients over the
speaking. age of 65 present with at least
Reduction or elimination of head and neck pain. one prescription medication
Improve quality of life. capable of causing xerosto-
mia. The prevalence of med-
ication-induced xerostomia is Figure 9. Xerostomia Anti-anxiety
common among elderly pa- medication
tients. (Figure 9)

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