Saliva is a 99% water-based secretion of salivary glands that contains enzymes, minerals, electrolytes, proteins, immunoglobulins, cytokines, and growth factors.
Saliva plays a vital role in maintaining oral health by keeping it clean and moist and aids in speech, chewing, and digestion.
The condition in which salivary flow is reduced and patient experiences dryness of mouth is termed as 'Xerostomia’.
This condition mostly affects higher age groups, 50-80, with a higher predilection in women.
Effects of Xerostomia
- oral discomfort,
- impaired speech, swallowing, and taste perception.
- increased risk of dental caries
- oral infections like candidiasis
- Bad breath or Halitosis
- Gum diseases
Etiological Factors of Xerostomia
Xerostomia is multifactorial and may be caused by local or systemic causes.
- Local Factors
- Medications like antihistamines, antihypertensives, antidepressants, etc.
- Radiotherapy of head and neck region
- Alcohol, tobacco, or caffeine consumption
- Dehydration
- Systemic Causes
- Endocrinological disorder like Diabetes Mellitus
- Autoimmune diseases like Sjogren syndrome, Systemic Lupus erythematosus, Rheumatoid arthritis
- Hepatitis C viral infection
- Tuberculosis or Sarcoidosis
Have you ever noticed dryness in your mouth when you are anxious or stressed? That’s because your sympathetic nervous system activates during such situations, triggering a fight-or-flight response and reducing saliva production.
Diagnosis of Xerostomia
- History-taking
- Clinical Examination
- Sialometry-standardized diagnostic test
Management of Xerostomia
- Preventive approach
Patient is motivated to keep good oral health and eliminate local factors causing xerostomia:
- maintain oral hygiene,
- reduce consumption of refined carbs and sugars, and
- topical application of fluorides [toothpastes and mouthwashes].
- elimination of substances like caffeine, tobacco and alcohol
- reduction or discontinuation of xerogenic medications
- Saliva stimulants
If salivary glands that produce saliva aren’t damaged completely, saliva production can be stimulated with acids and drugs
- Sugar-free chewing gums
- Citrus fruits
- Cholinergic agents like Pilocarpine, Cevimeline
- Artificial Substitutes
The artificial saliva substitutes are available in the form of polymers that mimic saliva and reduce dryness of the mouth.
- Cellulose-based [carboxymethylcellulose, hydroxyethylcellulose]
- Water-soluble [Xanthan Gum]
- Liposome-coated polymers
- Pilocarpine-loaded polymers
These are available in various formulations such as cleansers, gels, sprays, or lozenges.
Xerostomia is a condition that affects oral-health-related quality of life. Although there are developments of various artificial salivary substitutes, no one can completely mimic saliva; hence, even today, focus remains on improving oral health quality and symptomatic relief.
MBH/AB