Xerostomia

Xerostomia is the medical term for a dry mouth, and is most commonly due to hyposalivation.

Epidemiology

Xerostomia is the most frequently observed salivary abnormality in clinical practice ¹.

Clinical presentation

• dryness of the mouth

• uncomfortable swallowing

• vocalisation difficulties: tongue may adhere to the palate impairing speech

• taste disturbances: ageusia and dysgeusia

• fetor oris

Complications

A chronic lack of saliva can result in several sequelae, with potentially serious morbidity:

• caries

• infections

  • cheilitis

  • oral candidiasis

  • acute bacterial sialadenitis

Pathology

Etiology

Most people experience a dry mouth from time to time, whether related to 'nerves' or because they are mildly dehydrated. 

Physiological

• anxiety

• "mouth-breathers"

• old age: reduced saliva production

Iatrogenic

• medication

  • anticholinergic activity

    • anticholinergics: atropine, hyoscine

    • proton pump inhibitors (PPIs), e.g. omeprazole

    • antidepressants, e.g. tricyclics, SSRIs

    • benzodiazepines, e.g. diazepam

    • opioids

    • antihistamines

  • agents affecting sympathetic system

    • sympathomimetic ​agents: e.g. ephedrine

    • antihypertensives 

  • agents promoting fluid depletion

    • diuretics

• radiotherapy: including radioiodine for thyroid disease

• graft-versus-host disease

Disease states

• thirst due to volume depletion: commonest cause

• salivary gland pathology

  • Sjögren syndrome

  • sarcoidosis

  • HIV

  • cystic fibrosis

  • hepatitis C

• agenesis/hypoplasia of the salivary glands: rare ¹

• psychosomatic: no objective evidence of salivary dysfunction

Treatment and prognosis

• treat underlying cause e.g. Sjögren syndrome

• artificial saliva

• optimal oral hygiene

• sialogogues

History and etymology

Xerostomia is derived from the Classical Greek, ζηρος (xeros) meaning dry, and στομα (stoma) meaning mouth ^2,3.