That parched feeling

It’s amazing how many people suffer from xerostomia and still aren’t aware about it

Parched

It’s natural for our mouth to go dry when faced with a fearsome stimulus or when we’ve not had enough water on a hot day. However, some people feel parched even in the absence of these circumstances. Known as xerostomia, this feeling of having a dry mouth is due to lack of saliva or changes in the composition of saliva. Usually, we begin to experience dry mouth when our salivary secretion has decreased to half the normal rate. But in those with xerostomia, it can happen even when the flow of saliva is normal.

Xerostomia is not a disease in itself but can be a symptom of a variety of conditions.

What causes it?

Temporary xerostomia may occur due to stress, anxiety, depression, viral fever, dehydration due to diarrhoea or heavy exercise on a hot day, decreased water intake or short-term use of drugs affecting salivation. This condition lasts for a short while and is reversible. However, in some people, the symptoms are for a prolonged period and the condition may become chronic.

Medications: Long-term use of medications including anti-depressants, anti-hypertensives, opiates, broncho-dilators, proton pump inhibitors, anti-psychotics, antihistamines, diuretics and anti-cancer drugs.

Infections: Viral infections like mumps, hepatitis C, HTLV and HIV/ AIDS can cause a related salivary gland disease known as diffuse infiltrative lymphocytosis syndrome [DILS].

Autoimmune diseases: SjÖgren’s syndrome is an autoimmune condition with many associated symptoms including fatigue, muscle pain and joint pain. It is characterised by destruction of the moisture-producing glands throughout the body, leading to xerostomia, xerophthalmia [dry eyes], and in case of women, dry vagina.

Endocrine diseases: Hypothyroidism and diabetes are common causes of xerostomia.

Radiation therapy: Radiation therapy for cancers in which the salivary glands are close to or within the field of radiation can damage salivary glands with resultant xerostomia.

Nutritional deficiency: Deficiency of certain vitamins needed to maintain mucosal health like vitamins A , B and C can cause dry mouth even with normal salivary secretion.

Traumatic: Any trauma to the salivary glands itself or to the nerves around them can cause xerostomia.

Others: Bone marrow transplantation, patients with kidney failure on haemodialysis, Alzheimer’s disease, Parkinson’s disease, scleroderma, stroke and rare diseases like sarcoidosis too may develop xerostomia.

What are its symptoms?

  • Feeling of stickiness or dryness in the mouth and throat
  • Trouble in chewing and swallowing
  • Altered sense of taste and foul odour from the mouth
  • Difficulty in speaking
  • Cracked, dry lips that may stick to each other
  • Burning sensation in the mouth
  • Recurrent mouth infections
  • Dental caries
  • Psychological distress and depression
  • Absence of a pool of saliva in the floor of mouth. The consistency of saliva may appear frothy
  • Abnormally red, fissured and dry tongue with a pebbled, cobblestone appearance.

How it is diagnosed?

Did you know?

On an average, we secrete up to one and a half litre saliva per day.

Detail history of the patient’s health conditions and a thorough examination provides a clue to the probable underlying cause/causes of xerostomia. This is followed by a review of all the medications the patient is taking. Further blood investigations and biochemical tests may be requested to help accurately pinpoint the cause. Immunological tests for auto-antibodies like rheumatoid factor may be needed to rule out autoimmune diseases like Sjögren’s syndrome. In rare cases, imaging studies like radioisotope salivary function test, MR sialography and ultrasound examination of glands may be required. Most doctors also screen for infections such as HIV and hepatitis C. Sometimes salivary flow rate measurement is done to document hypo-salivation.

How is it treated?

The cornerstones of treatment are the prevention and treatment of complications, control of the underlying problems that may cause or contribute to xerostomia and symptom control.

In case of drug-induced xerostomia, stopping or changing the drug or reducing dosage helps. Following good oral hygiene minimises the severity of the condition. Also, chewing gum, eating candies and mints help stimulate salivary secretion. In people who have partly functioning salivary glands, using lubricants or artificial saliva diminishes the sensation of oral dryness and improve oral functioning. Some patients are prescribed medications for management of their condition. Others simply drink more water.

Some patients have also experienced good results using alternative therapies like acupuncture.

How are complications prevented?

Daily use of topical fluoride and antimicrobial mouth rinses helps prevent caries in patients with reduced salivary flow. The mouth rinses can be used twice daily to prevent demineralisation and induce re-mineralisation. Regular dental check ups help detect and treat lesions and decay. If saliva is sparingly secreted, you could be treated with fluoride applications [gel or foam formulations], varnishes, and pit and fissure sealants to prevent rapid decay of tooth structure.

Dry mouth-induced oral lesions are susceptible to developing secondary infections. One such common infection is oral candidiasis that is treated with topical anti-fungal agents.

Sipping on fluids during eating and avoiding eating dry foods helps losing sensation of taste. Patients suffering from xerostomia who use dentures can soak the dentures in a special solution that prevents germs from growing on the dentures.

Prevent the dry mouth

Appropriate fluid intake [water, watery fruits], good oral hygiene, and avoiding smoking, tobacco, alcohol or alcohol containing mouth washes and caffeine can provide good protection against xerostomia.

Chewing sugar-free gums, avoiding foods rich in sugars and acids, using toothpaste containing fluoride, humidification of bedroom during night, avoiding breathing from the mouth, following proper hygiene for dentures and oral prostheses are some of the general measures that help avoid xerostomia.

This was first published in the May 2012 issue of Complete Wellbeing.

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