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Dry Mouth
1.What is Dry Mouth?
DRY MOUTH, also known as "XEROSTOMIA" (Greek: "xero" = dry; "stoma" = mouth), is a very common condition. It affects about one in every four to five adults, mainly women. Moreover, it's prevalence increases with age. Fifteen to 20% of young adults, circa 20 years of age, complain of oral dryness; by 60-80 years of age, roughly 30-40% of the aged suffer from oral desiccation.

DRY MOUTH is usually due to a decrease in the amount of saliva in the mouth. This neglected, but important, secretion, does much more than just moisten the mouth. It plays a significant role in speech, in taste, in chewing, in swallowing and digestion, in nutrition and in the protection of the teeth, mouth, lips and esophagus. Therefore, in addition to the discomfort of dry mouth, a prolonged reduction in the amount or flow of saliva can also have many other serious, ofttimes morbid, consequences. Moreover, dry mouth is often an indicator of associated systemic diseases.
2.What causes Dry Mouth?
With the exception of mouth breathing, the decrease in the amount of saliva, and the subsequent development of dry mouth, is mainly due to general body causes, not to local oral problems.

Medications: Over 1800 drugs can make your mouth feel dry. Eighty percent of the top 10 drugs may cause oral dryness. Moreover, the more drugs you take, the more likely you will be troubled by dry mouth. Prominent among these drugs are those prescribed for high blood pressure, anxiety, depression, allergies, weight loss, Parkinson's disease, pain and many more.

Diseases: Decreased saliva and dry mouth are associated with a number of medical and psychologic conditions. A prominent disease which causes oral dryness (and dryness of the eye) is Sjögren’s (“Showgren’s”) Syndrome. This is an autoimmune condition which is characterized by generalized dryness. The dryness is brought on by damage to the salivary and other similar glands. Sometimes, Sjögren’s Syndrome is associated with rheumatoid diseases e.g. rheumatoid arthritis, lupus or scleroderma ( a condition in which the skin becomes thick and less pliable). Other diseases which may result in dryness are diabetes, AIDS, bone marrow transplants, dehydration, etc.

Therapeutic Irradiation: Treatment for certain cancers of the head and neck can include radiation, which may damage the salivary glands, and decrease or completely stop the production of saliva. These effects are sometimes irreversible, but some medications may partly restore salivary function.

Ageing: As we get older our mouth tends to produce less saliva. Although this loss is probably not enough to cause oral dryness, per se, it contributes to this condition.

Decrease in our ability to Chew: Chewing, is the normal exercise of the mouth. Like with any other form of exercise, when you don’t use it, things begin to shrivel up. When your arm is in a cast, the muscles shrink in size. And so it is with the salivary glands. If you cut down on your chewing, they will decline in size and produce less saliva. And this induces dryness.

Depression: People who are depressed and/or overly anxious have lower rates of salivary flow.

Since so many factors cause dry mouth, it is evident that the determination of what causes your oral dryness is not a simple matter.
3.What are the Symptoms and Clinical Signs associated with Dry Mouth
Dry mouth is rarely a solitary symptom. When present for long periods of time, it induces the formation of many other oral symptoms and clinical signs. These are shown below:
Oral Changes Associated with a Decrease in the Flow of Saliva
Oral Function / Site Oral Clinical Signs
Saliva Decreased in amount; may be foamy, thick, ropy
Tongue Dry, sore, fissured, lobulated, tingling, yeast infection
Cheeks Dry, dull, pale
Mastication Difficult to eat dry foods; persistent denture troubles
Taste Difficulty with taste
Swallowing Difficulty with swallowing; acid reflux disease
Mucosa Sensitivity to acidic, salty & spicy ("hot") foods
Teeth Extensive, sometimes rampant, dental decay. Affects areas not usually prone to decay e.g. the lower incisor teeth. Root caries often present.
Often, xerostomia is associated with other widespread, systemic, sensations of dryness.
Generalized body symptoms often associated with oral dryness
Nose: Dryness, frequent crust formation, nasal bleeding, decreased sense of smell.
Eyes: Dryness, burning, tingling, itchy, gritty sensations; feeling that the lids stick together; sensitivity to light, blurred vision.
Skin: Dryness; "butterfly rash" about the face; sensitivity to cold, changes in color, especially the fingers (Raynaud's Phenomenon).
G.I. Tract (the Gut): Esophagitis constipation, acid reflux, problems with swallowing.
Pulmonary System: Dry cough, difficulty with breathing
The Joints: Rheumatoid arthritis, swelling, pain, stiffness, redness.
The Vagina: Dryness, itching, burning sensations, recurrent vaginal yeast infections, difficulty with intercourse.
Generalized Symptoms: Fatigue, weakness, loss of weight, depression.
4.The Diagnosis of Dry Mouth
The diagnosis of conditions associated with dry mouth is often a time-consuming task since its causes are so varied and the symptoms are present in so many diseases. Because the symptoms are so widespread and the clinical signs related to oral dryness so common, patients often see many doctors in their search for the cause of their problem. Indeed, ofttimes it takes months, even years, before a definitive diagnosis is made. The diagnosis may also require the services of several types of doctors. Prominent among these are the rheumatologist, the ophthalmologist and the dentist.

Four types of information may be used to identify the causative factors of dry mouth (1) A Proper History and Clinical Examination, with detailed information about your complaints and symptoms; (2) Salivary Tests which measure the flow of saliva and the condition of your salivary glands. Included among these may be Sialometry, Sialography, Salivary Scintigraphy, and/or the Lip Biopsy; (3) Tests on the Eyes (the Schirmer Test, the Rose Bengal and Lissamine Green test and/or a Slit-Lamp exam and (4) Special Blood Tests for diseases which are associated with dryness. included among these are tests for the presence of antibodies which are usually associated with Sjögren's Syndrome (ANA, SSA and SSB), the Rheumatoid Factor (RF), the Erythrocyte Sedimentation Rate (ESR), and Immunoglobilins.(IG's).
5.How do you Treat Dry Mouth?
Since Dry Mouth is caused by many things, it should not be surprising that there are different ways to treat it. If your physician or dentist can determine the cause of your oral dryness, he/she may be able to provide you with a specific cure. The trouble is, this is easier said than done.

If the dryness is due to drugs, it may be possible for your doctor to advise you to stop taking those drugs, reduce their intake or switch to another “less drying” medication. The drymouth.info drug search engine can be quite useful in this effort. Sometimes, especially, in life threatening diseases, it may not be possible to change a patient’s drug intake pattern.. If the dryness is due to a specific disease, e.g. diabetes, proper treatment of the disease will decrease the intensity of your oral symptoms. Occasionally, we do not know the causes of the diseases which produce dry mouth. This, for example, is the case with Sjögren’s Syndrome, rheumatoid arthritis and other conditions. In such cases, we try to relieve the symptoms of the disease rather than treat the disease itself.

How to Treat Dry Mouth and its Associated Symptoms

To Keep Your Mouth Moist

Sip water or other sugar-free juices frequently. It is particularly important to drink often while eating. This will aid chewing and swallowing and may enhance the taste of your food. You can carry a water bottle, like bicycle riders do, during the day and keep a glass of water at your bedside at night. Also, use a humidifier to increase the moisture content of the air in your room. Stimulate the flow of your saliva
By eating foods which require mastication
By chewing sugarless gum
By using, if possible, acid-tasting, sugarless (diabetic-type) candies..
By “sucking” a cherry or olive pit; or the rind of a lemon or lime.

To Protect the Hard and Soft Tissues of your Mouth

Ask your dentist to teach you how to properly brush your teeth, and brush them after every meal.

Use dental floss daily.

Ask your dentist to teach you how to scrape or brush the surface of your tongue, and do this every day.
Use a fluoride toothpaste daily. In some cases, your dentist may prescribe the fabrication of a “mouth-guard”, like athletes wear.
A fluoride gel is placed in these trays and they are worn for several minutes every night.
Decrease your intake of sugars and your snack frequency. Also, watch your intake of carbohydrates, like bread and pasta and cookies, etc. which tend to hang around in the mouth.
Avoid or decrease your intake of spicy, salty or very acidic foods.
Do not smoke
Avoid or decrease your intake of alcohol
Avoid or decrease your intake of caffeine-containing drinks and foods.
Chew your food slowly and thoroughly, and sip water with it before swallowing.
Salivary Substitutes (Artificial Saliva) or a mouth-gel can be used to lubricate your tissues. They sometimes make you feel less dry.
See your dentist at least 3 times a year and have him/her routinely check you for evidence of early decay.

The Use of Drugs to Increase the Flow of Saliva

Recent studies have shown that drugs called Pilocarpine (Salagen™) and Cevimeline ( Evoxac™) can decrease your sensation of oral dryness. These drugs are generally taken 3 - 4 times a day, after meals, and their effects usually last from 2 - 4 hours. The side-effects of these medications are generally modest.. These drugs, combined with other methods to stimulate the flow of saliva have made it possible for many people to find relief from their scorched-mouth feeling.

The following table lists the names of several commercially available Salivary Stimulants, Oral Moisturizers and Salivary Substitutes.
Salivary Stimulants & Subsitutes & Oral Moisturizers
Type of Product Brand Names Select Characteristics Distributor
1.Mechanical (Masticatory) Stimulants
FOODS which require mastication (apples, carrots, celery, hard breads and rolls, meats, etc)
Sugarless Gums   Sweeteners  
Biotene Xylitol Laclede Professional Products
Eclipse maltitol, sorbitol,mannitol, aspartame, acesulfame K
Certified by the American Dental Association to “prevent cavities, reduce plaque and strengthen teeth.”
Wm. Wrigley, Jr. Co.
Extra sorbitol, mannitol, maltitol, acesulfame K and aspartamel
Certified by the American Dental Association to “prevent cavities, reduce plaque and strengthen teeth.”
Wm. Wrigley, Jr. Co.
Orbit Sorbitol, mannnitol, xylitol, aspartame, acesulfame K
Certified by the American Dental Association to “prevent cavities, reduce plaque and strengthen teeth.”
Wm. Wrigley, Jr. Co.
Orbit White Maltitol, sorbitol, mannitol,aspartame, acesulfame K Wm. Wrigley, Jr. Co.
Orbit Ice White sorbitol, mannitol, maltitol syrup, aspartame, acesulfame K Wm. Wrigley, Jr. Co.
Airwaves Isomalt,sorbitol, mannitol, maltitol syrup (in Honey Lemon only), aspartame, acesulfame K Wm. Wrigley, Jr. Co.
Trident sorbitol, mannitol, acesulfame, aspartame Warner-Lambert
Xylifresh xylitol Leaf Specialty Products
2. Chemical Stimulants
Solutions Mouth-Kote Mucopolysaccaharide Sol., contains citric acid Parnell Pharmaceuticals
Optimoist Contains citric acid Colgate-Palmolive, Co.
3. Electrical Stimulant
Electrical Stimulation Salitron
Prescription required
Intra-oral electronic stimulator of saliva Biosonics, Inc.
4. Pharmacologic Stimulant
Drugs Salagen (Pilocarpine HCl); Prescription required Cholinergic agonist MGI Pharma, Inc.
Evoxac (Cevimeline HCl); Prescription required Cholinergic agonist Daiichi Parmaceutical Co. Ltd.
5. Oral Moisturizers / Salivary Substitutes
Solutions WATER ***** *****
Salivart Contain carboxymethyl cellulose and hydroxyethyl cellulose Xenex Laboratories, Inc.
Xero-Lube Colgate Hoyt/Gel-Kam
Plax Water-glycerin agent Pfizer Inc.
Gel Oral Balance Glycerate polymer Laclede Professional Products

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