6 things that you should know about Xerostomia: What is, causes, symptoms, diagnosis and drugs that can cause Xerostomia.

1. Causes, symptoms, diagnosis y treatment
of Xerostomia or Dry mouth
Maximum moisturizing effect and care of dry mouth

2. What is Xerostomia?
XEROSTOMIA is a clinical condition or subjective sensation of oral dryness due to a decrease in saliva produced by
poor functioning salivary glands. Also known as Dry mouth, asialorrhea or hyposalivation
XEROSTOMIA is a clinical condition or subjective sensation of oral dryness due to a
decrease in saliva produced by poor functioning salivary glands. Also known as Dry mouth,
It is properly called or hyposalivation. flow is reduced by half, both at rest and when stimulated.
asialorrhea XEROSTOMIA when salivary
It is properly called XEROSTOMIA when salivary flow is reduced by half, both at rest and
when stimulated.
People over 55 years of age
Xerostomia 20%
Xerostomia 40%
People between18-35 years of age People over 55 years of age

3. Causes of Xerostomia, or dry mouth
Change in afferent stimuli.
A lack of peripheral stimuli, such as an absence of teeth, leads to less afferent information
through nerve stimuli, and as a consequence, less saliva production. These alterations occur in
elderly people. In this situation, there is a decrease in saliva produced by submaxillary and
sublingual glands, but not by the parotid. These patients will have less non-stimulated saliva,
but when a stimulus is present, they will have the same amount of saliva.
Central nervous system disorders (CNS).
Stress, anxiety, depression, anorexia or tobacco smoking and alcohol consumption can affect
the CNS and thus inhibit nerve transmission to the salivary glands causing hyposalivation.
Blockage of the drainage ducts.
The obstruction of the ducts, known as Sialolithiasis, occurs when calcium in the ducts
accumulates, forming calcifications that interrupt the natural flow of saliva.

4. Causes of Xerostomia, or dry mouth
Alterations in the salivary glands themselves. Can be due to:
Lack of saliva production components. Can occur in patients lacking proteins, directly causing a
reduction in saliva or can be due to a lack of water intake or excessive loss thereof.
Lack or destruction of the salivary parenchymal. Autoimmune diseases such as Sjögren’s
Syndrome or caused by head and neck radiotherapy.
The most common causes are:
- Xerostomising drugs
- Systemic diseases such as Sjögren’s Syndrome or diabetes
- Head and neck radiotherapy
- Psychological causes such as anxiety, depression or stress
- Aging

5. Signs and Symptoms of Xerostomia or Dry Mouth
We can differentiate between SYMPTOMS, which the patient himself notices and
expresses, and SINGS, which are characteristics that the dentist or hygienist can detect in
the dental office.
Symptoms:
-Burning tongue/mouth
-Difficulty speaking, swallowing and eating
-Saliva thick and stringy
-Eating disorder
-Dysgeusia - altered sense of taste - the patient may notice that certain foods take on a
metallic taste
Clinical signs:
Functional and morphological changes:
-Changes in the mucosa, paleness and loss of sheen, dry and scarcely hydrated tissue.
-Tongue dorsum cracked, dry and red. Peeling lips.
-Commonly related to pharyngitis, laryngitis, dyspepsia or constipation.
-Gums tend to loose their characteristic sheen and sometimes gingivitis can appear.
-Dry palate with erythematous patches.

6. Signs and Symptoms of Xerostomia or Dry Mouth
Changes in teeth due to the loss of saliva’s protective function
Due to a loss of ions and proteins from lack of saliva, some anti-cariogenic effect is lost
because of the change in pH to one that is not the most ideal for maintaining the ecosystem.
Rapidly evolving caries appear on the neck of the tooth.
Greater tendency for oral infections, candidiasis commonly occurs, as well as erosions or
irritations.

7. Diagnosis
1st step Patient’s Clinical History
Ask about systemic diseases, drug intake and history of radiotherapy.
Assess patient’s symptoms, feelings.
Dry mouth will depend on each person’s sensation threshold.
Burning tongue, burning mouth
Difficulty speaking, swallowing and eating
Saliva thick and stringy
Eating disorder
Dysgeusia - altered sense of taste - the patient may notice a metallic taste to certain
foods
Difficulty using dentures
Halitosis

8. Diagnosis
2nd step Exam of Mouth and Mucosa
Check to see if any part of the mouth has any of the following signs or symptoms:
Loss of sheen and paleness in the mucosa. Cracks in the tongue dorsum. Peeling lips. Frequent
candidiases, erosions or irritations, rapidly evolving caries in the neck of the tooth. Commonly
related to pharyngitis, laryngitis, dyspepsia or constipation.
Saliva thick and stringy. Halitosis
3rd step Palpation of salivary glands
Palpation where the salivary glands sit, in search of tumefactions or to check their consistency
and characteristics.

9. Diagnosis
4th step Amount of saliva per length of time
The mouth is estimated to be moistened by between 1 and 1.5 litres of saliva per day. When
saliva flow decreases to half of this at rest and with stimulation, we are talking about
Xerostomia. (Salivary flow below 0.5 ml/min). Methods used:
SIALOMETRY by drainage of saliva at rest and stimulated by means of mechanical methods
(paraffin tablets in patients with teeth and chemical gustatory stimulation with 10% citric
acid).
SIALOGRAPHY Less reliable image technique. Slow secretion and presence of calcifications
that produce obstructions are observed by contrast.
GAMMAGRAPHY We can observe the form and function of salivary glands and determine if
they are correct.
5th step If Sjögren’s Syndrome is suspected
Biopsy of the minor salivary glands – morphological assessment
Blood test – Specific antibodies of autoimmune diseases

10. Treatment of Xerostomia
Treatment is different depending on what caused it.
For REVERSIBLE alterations: solve the primary alteration. For stress, anxiety, dehydration,
better to fix the cause, and for drugs, reduce the dose.
For IRREVERSIBLE alterations: (degeneration due to age, Sögren’s Syndrome, tumours, etc)
Differential treatment depending on the level of impairment and the degree of the condition
of the glandular structures.
Stimulation of natural secretion
Anything from gum to sialogogues such as Pilocarpine can be recommended. Pilocarpine is a
stimulator of the receptors that are located in the cells of salivary and lacrimal glands; they
only act on the remaining healthy tissue, but it is known to have many adverse effects.
Substitution of natural secretion
Artificial saliva:
Artificial saliva is used in solutions that contain mucins or glycoproteins which generally cover
oral mucosa with a thin, slippery film that protects and lubricates the oral cavity.

11. Treatment of Xerostomia
RECOMMENDATIONS:
Humidification of the mouth throughout the day
Treat tooth impairments Extract teeth and roots that are in poor conditions for subsequent
reconstruction treatment.
Adequate and strict oral hygiene plan using a proper prophylaxis together with topical fluoride
application and regular check-ups to assess patient’s oral hygiene.

12. Drugs that can cause Xerostomia

13. Maximum moisturizing effect and care of dry mouth
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