The story behind xerostomia
UncategorisedPosted by: Dental Design 16th February 2023
Though the ideal goal for dentistry is always to treat the cause of a problem, sometimes this isn’t possible. In some situations, the dental team have to prioritise effective management of symptoms instead. This is true in many cases of xerostomia, or dry mouth, especially when the causes are related to a patient’s general medical condition.
Pharmacology
Xerostomia is widely defined as ‘the sensation of oral dryness’. It can make swallowing, chewing or speaking difficult, it can hinder taste, and it can cause a burning sensation in the mouth, cracked lips and bad breath.
Though various aetiologies can be attributed to xerostomia, it is most often the result of medication. [i] A wide array of drugs have been associated with dry mouth side effects, including several anticholinergic agents, antidepressants and antipsychotics, diuretics, sedatives, muscle relaxants, analgesics and antihistamines. Many people are taking multiple medications, putting them at even greater risk of dry mouth.
Research has suggested that it is the anticholinergic action of medications that lead to xerostomia. These drugs block the acetylcholine receptors, inhibiting nerve impulses and therefore preventing the salivary glands from producing and secreting saliva.[ii]
Head and neck cancer treatment
The majority of patients receiving radiation for head and neck cancer will also experience xerostomia. Studies suggest that salivary flow reduces by as much as 50-60% at this time, though this will be dependent on the radiation area and dose. In many cases, patients do not return to full, pre-treatment salivary function even once radiation is completed.ii
The location of the salivary glands means that ionising radiation often passes through them to treat head and neck tumours. Different types of salivary glands have varying sensitivity to this radiation, which can affect the production and quality of saliva in the long-term. Radiation of 52 Gy or greater is the estimated level at which the tissue becomes irreversibly damaged and chronic xerostomia can occur.[iii]
At what is already a difficult time for patients, the added complication of dry mouth adds further discomfort and concern. Treating the symptoms of xerostomia has been found to have a significant impact on quality of life for these patients.[iv]
Sjögren’s syndrome
Sjögren’s syndrome is a multi-system autoimmune disease defined by mononuclear cell infiltration of the lacrimal and salivary glands. As such, it causes glandular atrophy and hypofunction, manifesting as dry mouth and dry eyes. The second most common autoimmune rheumatic disease worldwide, it affects approximately half a million people in the UK, with women in their mid-30s to mid-50s being most at risk.[v] The pathogenesis of the condition is complicated and not yet fully understood. It is believed to result from inflammatory changes that inhibit or damage the salivary glands by either disrupting the epithelial cells, migrating T lymphocytes to the glands, creating autoantibodies, activating cytokines and interferon pathways, or damaging the acinar cells.[vi]
Systemic disease
Though less common, it is possible for certain systemic diseases to lead to xerostomia in some patients. These include asthma, diabetes mellitus, rheumatic diseases, hypertension, haematological diseases, thyroid diseases, psychiatric diseases and eating disorders.[vii] In asthmatic individuals, for example, use of certain inhalers has been linked to dry mouth symptoms.[viii] Xerostomia has also been associated with both type 1 and 2 diabetes, though how much higher the risk is for sufferers compared to those without diabetes is still debated in the literature.[ix]
People diagnosed with rheumatoid arthritis (RA) are at a higher risk of Sjögren’s syndrome, thereby increasing their chances of experiencing xerostomia as well.[x] Approximately 15-30% of those with RA have reduced salivary function[xi] and this is often both irreversible and degenerative over time.
Finding a solution
No matter what the cause of xerostomia, it is essential for the dental team to find solutions that improve their patient’s quality of life. As it may not be possible to change their medication or cure a general health condition, attention may have to turn towards alleviating the symptoms instead. The call therefore goes out for an easy-to-use, gentle yet effective product that will relieve the signs of dry mouth without causing the patient any further issues or concerns.
In such situations, dentists should consider prescribing Xerostom from Oraldent. Proven to increase salivary flow by up to 200%,[xii] the innovative product range contains only natural ingredients to deliver reliable relief from dry mouth symptoms. Available as a mouth spray, pastilles, gel, toothpaste and mouthwash, the unique formulas offer saliva stimulants, saliva substitutes and oral hygiene support – meeting all patients’ needs.
Of course, all products recommended to patients should be accompanied by educational information and any additional support that they need. The better they understand their condition, the better they can take care of their oral (and general) health for an improved quality of life.
For more details, please visit Oraldent.co.uk, call 01480 862080 or email info@oraldent.co.uk
Author
Richard Thomas – Director
[i][i] Talha B, Swarnkar SA. Xerostomia. [Updated 2022 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545287/
[ii] Scully C. Drug effect on salivary glands: dry mouth. Oral Diseases, 9: 165-176. https://doi.org/10.1034/j.1601-0825.2003.03967.x
[iii] Pinna R, Campus G, Cumbo E, Mura I, Milia E. Xerostomia induced by radiotherapy: an overview of the physiopathology, clinical evidence, and management of the oral damage. Ther Clin Risk Manag. 2015 Feb 4;11:171-88. doi: 10.2147/TCRM.S70652. PMID: 25691810; PMCID: PMC4325830.
[iv] Chambers MS, Garden AS, Kies MS, Martin JW. Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck. 2004 Sep;26(9):796-807. doi: 10.1002/hed.20045. PMID: 15350026.
[v] Khan A, Shirlaw PJ. Dry mouth and siögren’s syndrome: An overview. Prim Dent K. 2015; 4(2):70-74
[vi] Ngo DYJ, Thomson WM. An Update on the Lived Experience of Dry Mouth in Sjögren’s Syndrome Patients. Front Oral Health. 2021 Nov 2;2:767568. doi: 10.3389/froh.2021.767568. PMID: 35048069; PMCID: PMC8757894.
[vii] Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Ther Clin Risk Manag. 2014 Dec 22;11:45-51. doi: 10.2147/TCRM.S76282. PMID: 25653532; PMCID: PMC4278738.
[viii] Godara N, Godara R, Khullar M. Impact of inhalation therapy on oral health. Lung India. 2011 Oct;28(4):272-5. doi: 10.4103/0970-2113.85689. PMID: 22084541; PMCID: PMC3213714.
[ix] López-Pintor RM, Casañas E, González-Serrano J, Serrano J, Ramírez L, de Arriba L, Hernández G. Xerostomia, Hyposalivation, and Salivary Flow in Diabetes Patients. J Diabetes Res. 2016;2016:4372852. doi: 10.1155/2016/4372852. Epub 2016 Jul 10. PMID: 27478847; PMCID: PMC4958434.
[x] Arthritis Foundation. Dry mouth and arthritis. https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/physical-effects/dry-mouth-and-arthritis [Accessed December 2022]
[xi] Russell SL, Reisine S. Investigation of xerostomia in patients with rheumatoid arthritis. Clinical Practice. JADA. 1998; 129: 733-739
[xii] Ship JA, et al. Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth. Journal of Oral Rehabilitation 34 (2007) 724-732.
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