9ĭrug substitutions may help reduce the dry mouth effects of certain medications (e.g., selective serotonin-reuptake inhibitor antidepressants tend to cause less dry mouth than tricyclic antidepressants). 13 Patients who are taking multiple medications may also be at a higher risk of dry mouth as an adverse effect of therapy. 4-6, 12 The most common types of medications causing salivary dysfunction have anticholinergic effects, e.g., tricyclic antidepressants, antihistamines, antihypertensive medications, and antiseizure/antispasmodic drugs. ![]() 10 According to the Surgeon General’s Report on Oral Health in America, 11 more than 400 over-the-counter (OTC) and prescription medications can contribute to or exacerbate oral dryness, including antihistamines (for allergy or asthma), antihypertensive medications, decongestants, pain medications, diuretics, muscle relaxants, and antidepressants. The most frequent cause of hyposalivation is use of certain medications. 3 Significant loss of salivary gland function is associated with altered taste sensation (i.e., dysgeusia). Reduced salivary flow can interfere with chewing or swallowing certain foods which may result in malnutrition. 3, 6 Xerostomia symptoms may also worsen at night because salivary output reaches its lowest circadian levels during sleep and the problem can be exacerbated by mouth breathing. 1-3 Without adequate salivary flow, tooth decay and a variety of oral infections can develop. 1, 3 Salivary proteins and mucins contribute to the lubrication and coating of oral tissues, protecting the mucosa from chemical, microbial, and physical injury. 6, 8 In addition to keeping tissues moist and helping to digest food, saliva cleanses the oral cavity, makes it possible to chew and swallow food, maintains a neutral pH, and prevents demineralization. 7 Saliva is 99% water and contains a number of electrolytes (e.g., sodium, potassium, calcium, bicarbonate, phosphate) and organic components (e.g., immunoglobulins, proteins, enzymes, mucins). 6 In healthy individuals, the daily production of saliva normally ranges from 0.5 to 1.5 liters. Saliva is a mixture of secretions from the major (i.e., parotid, submandibular, sublingual) and minor salivary glands. 5 In people with Sjögren disease or in those receiving radiation therapy for head and neck cancer, the prevalence approaches 100%. 1, 2 Estimates of xerostomia prevalence in the general population are imprecise because of limited data estimates range from 0.9% to 64.8%. Severity of dry mouth symptoms ranges from mild oral discomfort to significant oral disease that can compromise the patient’s health, dietary intake, and quality of life. ![]() Xerostomia may be alleviated by use of saliva substitutes and other palliative measures lifestyle tips (e.g., chewing sugar-free gum) and other dental/oral health specific recommendations (e.g., brushing teeth gently at least twice a day with fluoridated toothpaste) may help provide relief from or prevent adverse sequelae of dry mouth. ![]() The goals of treating xerostomia include identifying the possible cause(s), relieving discomfort, and preventing complications (e.g., dental caries and periodontal infections).Reduced salivary flow can cause difficulties in tasting, chewing, swallowing, and speaking it can also increase the chance of developing dental decay, demineralization of teeth, tooth sensitivity, and/or oral infections.Xerostomia occurs commonly in those with Sjögren disease or who are receiving radiation therapy for head and neck cancer. Causes of dry mouth can include toxicity from chemotherapy, head and neck radiotherapy, adverse effects of medications, autoimmune disease, or other conditions (e.g., uncontrolled diabetes, infections, hormonal changes).Severity of xerostomia or dry mouth symptoms ranges from mild oral discomfort to significant oral disease that can compromise the patient’s health, dietary intake, and quality of life.
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