Maximum moisturizing effect and care of dry mouth

Causes, symptoms, diagnosis y treatment of Xerostomia or Dry mouth

People over 55 years of age

Xerostomia 20%Xerostomia 40%

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, asialorrhea or hyposalivation

It is properly called XEROSTOMIA when salivary flow is reduced by half, both at rest and when stimulated.

What is Xerostomia?

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, asialorrhea or hyposalivation.

It is properly called XEROSTOMIA when salivary flow is reduced by half, both at rest and when stimulated.

People between18-35 years of age People over 55 years of age

Change in afferent stimuli. A lack of peripheral stimuli, such as an absence of teeth, leads to less afferent information through nerve stimuli, and as a consequence, less saliva production. These alterations occur in elderly people. In this situation, there is a decrease in saliva produced by submaxillary and sublingual 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 affect the 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 ducts accumulates, forming calcifications that interrupt the natural flow of saliva.

Causes of Xerostomia, or dry mouth

Alterations in the salivary glands themselves. Can be due to:

Lack of saliva production components. Can occur in patients lacking proteins, directly causing a reduction 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’s Syndrome 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

Causes of Xerostomia, or dry mouth

We can differentiate between SYMPTOMS, which the patient himself notices and

expresses, and SINGS, which are characteristics that the dentist or hygienist can detect in the 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 taste

Clinical 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 Mouth

Changes in teeth due to the loss of saliva’s protective function

Due to a loss of ions and proteins from lack of saliva, some anti-cariogenic effect is lost because 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 or irritations.

Signs and Symptoms of Xerostomia or Dry Mouth

1st step Patient’s Clinical HistoryAsk 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

Diagnosis

2nd 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. Frequent candidiases, erosions or irritations, rapidly evolving caries in the neck of the tooth. Commonly related to pharyngitis, laryngitis, dyspepsia or constipation. Saliva thick and stringy. Halitosis

3rd step Palpation of salivary glandsPalpation where the salivary glands sit, in search of tumefactions or to check their consistency and characteristics.

Diagnosis

4th 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. When saliva flow decreases to half of this at rest and with stimulation, we are talking about Xerostomia. (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 suspectedBiopsy of the minor salivary glands – morphological assessment Blood test – Specific antibodies of autoimmune diseases

Diagnosis

Treatment 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 condition of the glandular structures.

Stimulation of natural secretionAnything from gum to sialogogues such as Pilocarpine can be recommended. Pilocarpine is a stimulator of the receptors that are located in the cells of salivary and lacrimal glands; they only 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 cover oral mucosa with a thin, slippery film that protects and lubricates the oral cavity.

Treatment of Xerostomia

RECOMMENDATIONS:

Humidification of the mouth throughout the day

Treat tooth impairments Extract teeth and roots that are in poor conditions for subsequent reconstruction treatment.

Adequate and strict oral hygiene plan using a proper prophylaxis together with topical fluoride application and regular check-ups to assess patient’s oral hygiene.

Treatment of Xerostomia

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Maximum moisturizing effect and care of dry mouth

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