Background

• Xerostomia (dry mouth) is a medical condition characterized by a lack of sufficient saliva production in the mouth. Saliva plays an important role in maintaining the oral health of a person, and its deficiency can lead to several problems, such as difficulty in swallowing, chewing, and speaking, as well as a dry and sticky feeling in the mouth.
• The condition is not a disease but rather a symptom of an underlying medical problem or a side effect of certain medications. Xerostomia is a common condition that can affect people of all ages, although it is more common in older adults. It can be temporary or chronic and lead to dental problems if left untreated. 

Epidemiology

• Prevalence: Xerostomia is a common condition that affects up to 20% of the general population. It is more common in older adults, with up to 40% of individuals over the age of 60 experiencing symptoms.  
• Gender: Xerostomia affects both men and women equally.  
• Ethnicity: There is limited data on the incidence and prevalence of xerostomia in different ethnic groups.  
• Geography: There are no significant geographic differences in the prevalence of xerostomia.  
• Co-morbidities: Xerostomia is often associated with certain medical conditions, such as Sjögren’s syndrome, diabetes, and HIV/AIDS. Medications, such as antidepressants and antihistamines, can also cause xerostomia.  
• Impact: Xerostomia can have a significant impact on a patient’s quality of life, causing difficulty with speaking, eating, and swallowing. Patients with xerostomia may also experience an increased risk of dental caries and oral infections. 

Anatomy

Pathophysiology

Salivary gland dysfunction: 

The most common cause of xerostomia is a dysfunction of the salivary glands, which can be due to several factors, such as: 

• Medications: Certain medications, such as antihistamines, antidepressants, and diuretics, can cause salivary gland dysfunction, leading to xerostomia. 
• Radiation therapy: It is used to the head and neck region can damage the salivary glands and reduce saliva production. 
• Autoimmune diseases: Autoimmune diseases, such as Sjogren’s syndrome, can cause inflammation and damage to the salivary glands, leading to xerostomia. 
• Infections: Infections that affect the salivary glands, such as mumps, can cause temporary or permanent damage to the glands, leading to xerostomia. 

Nerve damage: 

• The nerve pathways that stimulate saliva production can also be damaged, leading to xerostomia. 
• Nerve damage due to surgery: Surgeries that involve the head and neck region, such as removal of the salivary glands, can damage the nerve pathways that stimulate saliva production. 
• Neurological diseases: Neurological diseases, such as Parkinson’s disease and stroke, can affect the nerve pathways that stimulate saliva production, leading to xerostomia. 

Other factors: 

• Other factors that can cause xerostomia include: 
• Dehydration: Dehydration can cause reduced saliva production, leading to temporary xerostomia. 
• Aging: As we age, the salivary glands may not function as well, leading to reduced saliva production and xerostomia. 

Etiology

• Aging: Aging is also a common cause of Xerostomia (Dry Mouth) as the salivary glands tend to produce less saliva with age. 
• Sjögren’s syndrome: It is an autoimmune disorder that affects the salivary and lacrimal glands, leading to Xerostomia (Dry Mouth) and dry eyes. 
• Dehydration: Dehydration can cause Xerostomia (Dry Mouth) as the body tends to conserve water by reducing the amount of saliva produced. 
• Mouth breathing: Breathing with the mouth instead of the nose can cause Xerostomia (Dry Mouth) as it can dry out the mouth. 
• Nerve damage: Nerve damage due to injury or surgery can affect the salivary glands and cause Xerostomia (Dry Mouth). 
• Tobacco and alcohol use: Both tobacco and alcohol use can cause Xerostomia (Dry Mouth) by reducing the flow of saliva. 
• Diabetes: Diabetes can cause Xerostomia (Dry Mouth) due to the high sugar levels in the blood, which can lead to dehydration. 
• Medications: Medications that are known to cause Xerostomia (Dry Mouth) include antidepressants, antihistamines, diuretics, and blood pressure medications. 
• Radiation therapy: Radiation therapy can cause Xerostomia (Dry Mouth) as it can damage the salivary glands. 
• Chemotherapy: Chemotherapy drugs can cause Xerostomia (Dry Mouth) by affecting the amount and quality of saliva. 
• Other medical conditions: Other medical conditions such as HIV/AIDS, Parkinson’s disease, and Alzheimer’s disease can also cause Xerostomia (Dry Mouth). 

Genetics

Prognostic Factors

• Underlying Medical Conditions: Xerostomia can be a symptom of underlying medical conditions such as Sjogren’s syndrome, diabetes, or HIV/AIDS. The prognosis of xerostomia depends on the severity and nature of the underlying condition. 
• Medications: Certain medications, such as antidepressants, antihistamines, and diuretics, can cause xerostomia as a side effect. The prognosis of xerostomia due to medication depends on the duration and type of medication used. 
• Age: Xerostomia is more common in older adults. The prognosis depends on the age of the individual and their ability to manage their symptoms. 
• Oral Health: Poor oral hygiene can lead to complications such as tooth decay and gum disease in people with xerostomia. The prognosis of xerostomia depends on the individual’s ability to maintain good oral hygiene. 
• Treatment: Treatment of xerostomia depends on the underlying cause and severity of the condition. The prognosis of xerostomia improves with proper management and treatment of the underlying cause. 

Clinical History

Xerostomia or dry mouth can affect people of all ages, but it is more common in older adults. The condition can present with varying acuity, from mild to severe. The following are some factors that may be associated with xerostomia: 

• Age group: Xerostomia is more common in older adults, especially those aged 65 and above.

Physical Examination

• Inspection of oral cavity: The dentist or healthcare professional will inspect the oral cavity, lips, and tongue for any visible signs of dryness or damage. 
• Palpation of salivary glands: The healthcare professional will palpate the salivary glands to check for tenderness or swelling. 
• Measurement of salivary flow: The healthcare professional may use diagnostic tests to measure the amount of saliva produced in the mouth. 
• Assessment of oral health: The dentist or healthcare professional will also assess the patient’s oral health, including the presence of cavities, gum disease, or other oral conditions that may contribute to dry mouth. 
• Review of medications: The healthcare professional will review the patient’s medication list to identify any medications that may be causing dry mouth as a side effect. 

Age group

Associated comorbidity

• Certain medical conditions and activities can increase the risk of developing xerostomia.
• These include autoimmune disorders, such as Sjogren’s syndrome, radiation therapy to the head and neck area, chemotherapy, nerve damage, diabetes, hypertension, and use of certain medications, such as antihistamines, antidepressants, and diuretics. 

Associated activity

Acuity of presentation

• Xerostomia can present with varying severity.
• Mild cases may only cause discomfort and thirst, while severe cases can lead to difficulty speaking, swallowing, and eating, as well as an increased risk of dental decay and infections. 

Differential Diagnoses

• Medication-induced xerostomia: Certain medications like antihistamines, decongestants, antidepressants, antihypertensives, muscle relaxants, and diuretics can cause dry mouth as a side effect. 
• Sjögren’s syndrome: An autoimmune disorder that affects the salivary and lacrimal glands, leading to dry mouth and dry eyes. 
• Diabetes mellitus: High blood sugar levels can cause dry mouth as well as increase the risk of oral infections. 
• Radiation therapy: Radiation therapy for head and neck cancer can damage the salivary glands and cause dry mouth. 
• Chemotherapy: Certain chemotherapeutic agents can cause dry mouth as a side effect. 
• Dehydration: Dehydration can cause a dry mouth and other symptoms like thirst, fatigue, and dizziness. 
• Mouth breathing: Breathing with the mouth instead of the nose can cause dry mouth. 
• Smoking: Smoking may cause dry mouth and increase the risk of oral cancer. 
• Anxiety: Anxiety and stress can cause dry mouth due to increased sympathetic nervous system activity. 
• HIV infection: People with HIV infection may experience dry mouth due to decreased salivary gland function. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

• Increasing fluid intake 
• Using a humidifier in dry environments.
• Avoiding tobacco and alcohol consumption 
• Chewing sugar-free gum or sucking on sugar-free candies to stimulate saliva production 
• Avoiding spicy or acidic foods that may irritate the mouth 
• Using a saliva substitute to lubricate the mouth 

• Saliva-stimulating medications such as pilocarpine and cevimeline 
• Saliva substitutes and oral lubricants such as oral gels and sprays 
• Antifungal medications if a fungal infection causes the xerostomia 
• Antibiotics if a bacterial infection causes the xerostomia 

• Sialagogues, such as lemon or vitamin C, to increase saliva production 
• Dental treatments to prevent tooth decay and gum disease, which can be more common in individuals with xerostomia 
• Treatment of underlying conditions that may be causing xerostomia, such as radiation therapy or chemotherapy for cancer 
• Salivary gland surgery to remove obstructions or tumors that may be causing xerostomia 

• The phase of management can also vary depending on whether the treatment is aimed at relieving symptoms or addressing the underlying cause of xerostomia.
• In acute cases, the primary focus is on relieving symptoms and maintaining hydration. In chronic cases, the underlying cause of xerostomia must be addressed to prevent complications such as tooth decay and gum disease.
• Additionally, patient education on maintaining proper oral hygiene and avoiding exacerbating factors is important in the management of xerostomia. 

Medication

Future Trends

Media Gallary

References

• https://www.nidcr.nih.gov/health-info/dry-mouth. 
• https://emedicine.medscape.com/article/1076199-overview. 
• https://www.nidcr.nih.gov/health-info/dry-mouth/more-info/treatment.