Dry Mouth

What is Xerostomia and what causes it?

Xerostomia simply means “dry mouth”; it is most commonly a side-effect of medications but can also be due to salivary gland damage due to disease, trauma or radiation therapy (1).  

The tissue is usually still moist, just not enough to ensure comfort.  More subtly, it leads to a distinct increase in tooth decay (caries) as the bacteria that cause decay thrive in a slightly dry environment with minimal saliva to dilute the acids produced by various bacteria.

How common is dry mouth?

Prevalence estimates are widely variable with estimates ranging from 0.9% to 64.8%(1), but it typically occurs in older patients, especially those with multiple medications (2) or those with diabetes (3).  

How do I know if I have xerostomia?

Oh, you’ll know!  Patients usually tell us when they have persistent dry mouth.

We will carefully examine your medical history and look for medications, including over the counter medications, known to reduce saliva flow.  A definitive diagnosis may involve your MD ordering imaging of salivary glands, blood tests, biopsy (to rule out Sjogren’s syndrome) and possibly a measurement of saliva flow rate (4).

What are the consequences of dry mouth?

Dry mouth is uncomfortable for even a short time, but when the condition becomes chronic it can lead to often dramatically increased tooth decay rates, development of periodontal disease, intolerance of oral appliances such as dentures and bite-guards, and an increase in oral infections such as Candidiasis (5,6).  Persistent dry mouth can also lead to difficulty eating, speaking or swallowing, a prickly or burning sensation and bad breath.  

In short – many serious problems from ‘just’ dry mouth.  

Can’t you just drink more water?

Xerostomia is not simply being thirsty, but rather a persistent dry mouth.  Water simply provides a brief reprieve.  Often we see these patients clutching a bottle of water throughout appointments, taking a sip whenever possible.  The prolonged opening of a dental appointment is hard for a xerostomia patient to tolerate, and yet they are at a high risk of decay (caries).  

Can Xerostomia be treated?

Yes.  Treatment may include speaking to your physician to see if your current medications can be safely switched to reduce dryness and to ensure no underlying diseases exist. 

Saliva replacement products that offer a sticky, saliva-like feel to them offer greater relief than water alone.  Severe cases can be usually be addressed medically by your dentist or physician using saliva promoting drugs such as pilocarpine or cevimeline.  Patients often report significant improvement with these medications.  

Prescription Medications for Dry Mouth

1. Pilocarpine (Salagen)

Pilocarpine is a cholinergic agonist that stimulates saliva production by activating muscarinic receptors(7). It is often prescribed for patients with Sjögren’s syndrome or those who have undergone radiation therapy.

• Dosage and Administration: Pilocarpine is typically taken as a 5 mg tablet three to four times daily.
• Efficacy: Studies have shown that pilocarpine significantly increases saliva flow and improves symptoms of dry mouth. One study reported that pilocarpine effectively improved xerostomia symptoms in patients with head and neck cancer undergoing radiation therapy .
• Side Effects: Common side effects include sweating, nausea, rhinitis, and urinary frequency.

2. Cevimeline (Evoxac)

Cevimeline is another cholinergic agonist that binds to muscarinic receptors to stimulate saliva production(7). It is specifically indicated for patients with Sjögren’s syndrome.

• Dosage and Administration: The typical dosage is 30 mg three times daily.
• Efficacy: Research indicates that cevimeline improves salivary flow rates and alleviates symptoms of dry mouth. A study highlighted its effectiveness in increasing saliva production and reducing the discomfort associated with xerostomia .
• Side Effects: Side effects may include sweating, headache, nausea, and diarrhea.

Custom trays may be used to apply topical fluoride to the teeth at home in order to reduce risk of decay.  Other treatments include using sugar-free candy or chewing-gum to stimulate saliva.  Treatments are carefully tailored to suit the patient’s needs and preferences.  With a wide variety of treatments available it makes no sense to suffer.   Get the treatment you deserve.

Please feel free to share this or any Dental Health Matters article and if you have any questions, please email me at Doodes@ParkBlvdDentistry.com.

References:

1. J Public Health Dent. 2006 Spring;66(2):152-8.  Prevalence of xerostomia in population-based samples: a systematic review.  Orellana MF)
2. Liu B, Dion MR, Jurasic MM, et al; Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Jul;114(1):52-60. doi: 10.1016/j.oooo.2011.11.014. Epub 2012 May 4
3. Malicka B, Kaczmarek U, Skoskiewicz-Malinowska K; Prevalence of xerostomia and the salivary flow rate in diabetic patients. Adv Clin Exp Med. 2014 Mar-Apr;23(2):225-33.
4. Malicka B, Kaczmarek U, Skoskiewicz-Malinowska K; Prevalence of xerostomia and the salivary flow rate in diabetic patients. Adv Clin Exp Med. 2014 Mar-Apr;23(2):225-33.
5. Furness S, Worthington HV, Bryan G, et al; Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD008934.
6. Epstein JB, Beier Jensen S; Management of Hyposalivation and Xerostomia: Criteria for Treatment Strategies. Compend Contin Educ Dent. 2015 Sep;36(8):600-3.
7. Leal, S. C., Bittencourt, M. S., & Leal, L. F. (2010). Pharmacological treatment for xerostomia in Sjögren’s syndrome patients: A review and update. The Journal of Clinical Rheumatology, 16(5), 206-210.