Dry Mouth Syndrome (Xerostomia)

Dry mouth, sometimes referred to by the term xerostomia, occurs when there is a problem with the salivary glands, resulting in decreased saliva production. This impacts on various processes, including, speaking, taste, chewing, swallowing, oral hygiene and the wearing of dentures. It also results in oral discomfort.

Dry mouth occurs in about 10% of the population and is a symptom rather than a disease on it's own. There are various causes of dry mouth, and it is essential to establish the cause before determining how to treat it.   

Signs And Symptoms Of Dry Mouth  

Oral signs and symptoms often associated with Dry Mouth:

• Saliva is thick, ropy and reduced in amount
• Painful sensation in the tongue
• Coating of the tongue
• Cracked, dry or scaled lips
• Dry cheeks
• Inflamed, painful and infected salivary glands
• Increase in dental caries or decay
• Infection of the gums
• Difficulty with chewing, especially dry foods
• Difficulty with swallowing (dysphagia)
• Difficulty with speech
• Impaired taste (dysgeusia)
• Bad breath (halitosis)
• Oral Thrush (Candidiasis)
• Difficulty with managing dentures

Other bodily signs and symptoms often associated with Dry Mouth:

• Dry, crusty nose with decreased sense of smell
• Dry, itchy eyes, with sticking of lids together, blurred vision, light over- sensitivity
• Dry throat, persistent dry cough
• Arthritis, pain, swelling and stiffness of the joints
• Constipation
• Acid reflux
• Dry, itchy, burning vagina/vulva, frequent fungal infections
• Difficulty breathing
• Weight loss, depression, fatigue, weakness, general aching, depression  

Causes Of Dry Mouth

The following are causes for a decrease in production of saliva, resulting in dry mouth:

Medications-
There are over 600 medications that can cause the salivary glands to produce less saliva. Anticholinergic, antidepressant, antihistamines and diuretics are just some. If you are at all concerned that your medication may be causing dry mouth, see your doctor. For a list of medications.

Radiotherapy and Chemotherapy-
Radiotherapy and Chemotherapy. This is in particular for patients with head and neck cancer. You should speak to your doctor, speech pathologist or clinical care nurse if you are experiencing dry mouth whilst undertaking treatment. 

Salivary duct stones-
These result in blockages of the salivary glands, ceasing the flow of saliva. If you believe this be the cause of your dry mouth, please speak to your doctor, speech pathologist or specialist. 

Tumors or other obstructions-
Generally a tumor will only affect one salivary gland, therefore the other glands will continue to secrete saliva. If you believe this be the cause of your dry mouth, please speak to your doctor, speech pathologist or specialist. 

Nerve damage-
Damage to the nerves which innervate the salivary glands can affect the amount or type of saliva produced, depending upon which gland is affected. Damage can result from surgery, physical injury or compression from tumors located in the head or neck region. If you believe this be the cause of your dry mouth, please speak to your doctor, speech pathologist or specialist. 

Dehydration-
Dehydration can result from any number of causes, ranging from blood loss, renal failure of modified dietary intake which does not allow sufficient hydration. Lack of fluid in the body results in decreased amounts and thick, ropey saliva being produced. 

Inflammation of salivary glands-
Inflammation of the salivary glands can result from infection in the oral cavity i.e. stomatitis. Any inflammation of the glands will constrict the opening of the gland, decreasing the flow of saliva. Your dentist or doctor can be consulted if you are experiencing any infection in the oral cavity. 

Syndromes or diseases-
The major disorder that affects saliva production is an autoimmune disease Sjogren's Syndrome, which destroys mucous producing glands (including salivary glands). Other diseases which may result in a dry mouth are:
* AIDs
* Parkinson's Disease
* Diabetes
* Bone Marrow Disorders
You should speak to your doctor or specialist if you are experiencing dry mouth as a secondary symptom to a disease 

Limited Stimulation of the salivary glands-
The glands are stimulated to produce saliva when chewing occurs. Limited chewing, for any reason, can result in decreased stimulation of the salivary glands, and therefore decreased salivation.

Mouth breathing-
People who breathe through their mouth as opposed to their nose often experience dry mouth due to air drying out the mucosal lining of their mouth. 

Decreased saliva production and thick, ropey saliva

In most cases of where the level of saliva secreted in the oral cavity is altered, there is a decrease in the production of saliva. This results in a dry mouth, or what is referred to as xerostomia. Xerostomia can be a secondary symptom of disease, medications and chemotherapy/radiotherapy. Xerostomia can also be a primary disorder on its own. 

Social Implications of Dry Mouth

When discussing social implications related to saliva management, one most often associates these issues with those who drool. However, a lack of oral secretions can also result in embarrassment or social isolation:

• Saliva's natural cleansing ability is reduced, resulting in dental caries, inflammation and infection, ulcers and candidiasis (thrush). Tablets can become attached to the inside of the mouth, which if remaining for extended periods of time can cause tissue breakdown underneath the debris. Where oral hygiene is compromised, individuals with dry mouth may suffer from bad breath.
• As one of the many functions of saliva is too lubricate the oral cavity, a dry mouth can cause pain in the oral cavity when eating, wearing dentures and even speaking. This can lead to avoidance of social situations such as dining out in restaurants or speaking to strangers or in public.
• Saliva also contributes to taste perception, therefore sense of taste and smell can both be affected. This can again lead to avoidance of eating in public.
• There may also be difficulty sleeping due to uncomfortable oral dryness.