Xerostomia

Muhammad Sanim Bin Satri

SCM 028833

What is Xerostomia
xeros = dry
stoma = mouth
defined as dry mouth
Not a disease
but rather a symptom of many medical conditions

Associated with;
Change in salivary composition
Reduced salivary flow rate (hyposalivation)

Salivary flow rate

Normal:
Unstimulated: in a normal person is 0.3 0.4
ml per minute,

Abnormal:
Unstimulated: below0.1 ml per minuteis
significantly abnormal.
Stimulated: saliva flow rate less than0.5
mlper gland in 5 minutes or less than 1 ml per
gland in 10 minutes is decreased.

Michaels : 0.2ml/min, consider low

hyposalivation

Causes?

Physiologi
c

Pathologic

Physiologic Causes
During sleep
Major salivary glands are inactive

Dehydration
Body trying to reduce loss of water

Age-related
Probably due to pathologic causes

Pathologic Causes
Diseases

Sjogrens syndrome (SS) most common

Sarcoidosis
Amyloidosis
Psychogenic
depression, anxiety, stress or fear

Many more. rheumatoid arthritis, systemic lupus erythematosus, scleroderma, diabetes mellitus, hypertension, cystic fibrosis,
bone marrow transplantation, endocrine disorders, nutritional deficiencies, nephritis, thyroid dysfunction and neurological
diseases such as Bell's palsy and cerebral palsy

Cancer therapy
most common toxicity associated radiation therapy at neck and head
May interrupt normal salivary productions by the salivary glands
The amount of radiation used in radiation therapy is measured in gray (Gy), and varies depending on the type
and stage of cancer being treated. For curative cases, the typical dose for a solid epithelial tumor ranges from
60 to 80 Gy, while lymphoma tumors are treated with 20 to 40 Gy.

Medications/Drugs
*Michael took a kind of drug before showing xerostomia

Drug Induced Xerostomia

The most common cause of xerostomia
Xerogenic drugs include:
42 drugs categories
56 drugs subcategories
Thats about 400 commonly used drugs

Mainly:
Antihistamines, antidepressents,
anticholergenic, anorexiants,
antihypertensives, antipsychotics, etc.

Not permanent,
disappear once doses are reduced or totally
stopped

Drug Induced Xerostomia

Things that can be done:
Review the medication
Change the time taken
Xerostomia worsen during sleep/between
meals/morning-avoid these times

Opt for different medication or

dosages

Complications related
taste disorders (dysgeusia)
painful tongue (glossodynia)
oral candidiasis,
salivary gland infection (sialadenitis),
Increased dental caries/calculus,
Halitosis
# Mostly due to reduced
antimicrobial action (normally
done by saliva)

Treatment
Difficult to achieve
Often unsatisfactory
MUST find the underlying causes
But still need to be managed
because it may lead to many complications by increasing the saliva

Managed by:
Saliva substitutes
Exp: artificial saliva/water
Improve xerostomia only not other symptoms due to lack of accurate natural salivary composition

Saliva stimulants

Exp: Organic acids/chewing gum

Imporve xerostomia and other symptoms
More recommended
But not effective if xerostomia is caused by destroyed glands

Reference
Michael Friedman. (24th August 2014).Dental Health and Dry Mouth.
Available: http://www.webmd.com/oral-health/guide/dental-health-dry-mouth.
Last accessed 9th April 2015.
Cathy L. Bartels. ().Xerostomia.Available: https://www.google.com.my/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0CCMQFj
AC&url=http%3A%2F%2Fwww.oralcancerfoundation.org%2Fcomplications
%2Fxerostomia.php&ei=m4wmVfjfHNGkuQTM5IGoCw. Last accessed 9th April
2015.
Mayo Clinic Staff. (10th May 2014).Dry Mouth.Available:
http://www.mayoclinic.org/diseases-conditions/drymouth/basics/definition/con-20035499. Last accessed 9th April 2015