Xerostomia
Xerostomia is the medical term for a dry mouth, and is most commonly due to hyposalivation.
Epidemiology
Xerostomia is the most frequently observed salivary abnormality in clinical practice .
Clinical presentation
- dryness of the mouth
- uncomfortable swallowing
- vocalisation difficulties: tongue may adhere to the palate impairing speech
- taste disturbances: ageusia and dysgeusia
- fetor oris
Complications
A chronic lack of saliva can result in several sequelae, with potentially serious morbidity:
- caries
- infections
- cheilitis
- oral candidiasis
- acute bacterial sialadenitis
Pathology
Etiology
Most people experience a dry mouth from time to time, whether related to 'nerves' or because they are mildly dehydrated.
Physiological
- anxiety
- "mouth-breathers"
- old age: reduced saliva production
Iatrogenic
- medication
- anticholinergic activity
- anticholinergics: atropine, hyoscine
- proton pump inhibitors (PPIs), e.g. omeprazole
- antidepressants, e.g. tricyclics, SSRIs
- benzodiazepines, e.g. diazepam
- opioids
- antihistamines
- agents affecting sympathetic system
- sympathomimetic agents: e.g. ephedrine
- antihypertensives
- agents promoting fluid depletion
- diuretics
- anticholinergic activity
- radiotherapy: including radioiodine for thyroid disease
- graft-versus-host disease
Disease states
- thirst due to volume depletion: commonest cause
- salivary gland pathology
- agenesis/hypoplasia of the salivary glands: rare
- psychosomatic: no objective evidence of salivary dysfunction
Treatment and prognosis
- treat underlying cause e.g. Sjögren syndrome
- artificial saliva
- optimal oral hygiene
- sialogogues
History and etymology
Xerostomia is derived from the Classical Greek, ζηρος (xeros) meaning dry, and στομα (stoma) meaning mouth .
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