Information ⬇
Editors
Dryness of the Mouth
Essentials
- Dry mouth may be caused by a systemic disease or by medication.
- The development of dental caries, tenderness of the mouth and mucosal infections caused by reduced salivary flow rate is prevented by providing up-to-date treatment and information.
Symptoms of dryness of the mouth
- Hyposalivation (reduced salivary flow rate) enhances and often leads, for example, to
- rapid decay of the teeth
- mucosal irritation (e.g. candidosis, mucosal ulcers)
- foul-smelling breath
- soreness of the tongue ("burning mouth syndrome")
- unusual taste sensations (e.g. metallic taste)
- difficulty in wearing removable dentures
- difficulties with speech, eating and swallowing.
Diagnosis of dry mouth
- Diagnostically relevant questions include:
- Is it difficult to swallow dry food (biscuits, bread) without drinking simultaneously?
- Does the mouth feel dry when speaking?
- Do you also need to moisten your mouth at night?
- Do your teeth feel rough and sharp?
Measurement of salivary flow rate
- Can be performed by a dentist or an oral hygienist. The easiest and most common method to measure salivary flow rate http://www.dynamed.com/condition/xerostomia#SIALOMETRIC_TESTS is to quantify the amount of saliva produced during 5 min. chewing on a piece of paraffin wax. Normally this amount exceeds 5 ml. Subjective feelings of a dry mouth (xerostomia) usually appear if the stimulated flow rate is less than 2.5 ml in 5 minutes.
- The base rate of saliva flow should be at least 0.5 ml in 5 minutes. The resting salivary flow rate is measured in the same manner, only without chewing.
Aetiology of the dryness of the mouth
- Medication, especially multiple medicines at the same time
- The most common drugs that reduce the secretion of saliva include many antihypertensive drugs, diuretics, anticancer drugs, several psychopharmacological and neurological drugs, anti-allergy drugs and cough medicines, as well as some analgesic, antipyretic and antirheumatic drugs.
- Rheumatic diseases, in particular Sjögren's syndrome Primary Sjögren's Syndrome
- Diseases of the salivary glands
- Irradiation to the head and neck region
- Mouth breathing
- Hormonal changes, e.g. climacteric
- Anorexia nervosa, fasting
- Labile juvenile (type 1) diabetes
Oral hygiene
- Cleaning the teeth and interdental spaces http://www.dynamed.com/condition/xerostomia#PATIENT_EDUCATION daily is essential. In addition to fluoride dentifrice the use of some other local fluoride supplement, such as fluoride-containing mouthwashes or fluoride tablets, is recommended.
- Dental prostheses should be cleaned especially well. The prostheses should not be kept in the mouth at night but instead in a dry and airy container, at least if there is inflammation or ulceration under the prostheses.
- A patient who suffers from dryness of the mouth needs expert advice on how to clean his/her teeth and dentures and on daily preventive dental care. The patient should visit the dentist every 3-6 months, i.e. more frequently than usual.
Chewing
- The 5-6 daily normal, regular meals and snacks should contain food that requires extensive chewing. Ending a meal by eating vegetables, nuts or cheese, which all neutralize bacterial acids, is beneficial.
- Rinsing the mouth or drinking water after each meal is recommended.
- Sugar-containing snacks, and acidic fruits or drinks should be avoided between meals. Plain water or mineral water are both safe for the teeth.
Xylitol-containing chewing gum, tablets and lozenges
- Chewing gum flavoured with xylitol is the best way to enhance salivary flow rate between and immediately after meals or snacks.
- If chewing capability is poor, the use of xylitol-sweetened tablets or lozenges or lozenges containing xylitol, calcium and fluoride, is recommended.
- If the mouth is very dry, the lozenges will not dissolve. There is a special product (Tooth Mousse® ) that is spread on the teeth and that protects both the teeth and the oral mucosa (available from dental shops and net stores).
Oral moisturizing agents
- It is most important that the patient drinks sufficient amounts of plain water or non-flavoured mineral water and frequently rinses the mouth with water.
- Saliva substitutes http://www.dynamed.com/condition/xerostomia#SALIVARY_SUBSTITUTES relieve the symptoms of dry mouth longer than any drinks and may be helpful especially during the night. Commercial saliva substitutes are available in pharmacies. They can be used regularly if needed.
- Dry oral mucosal membranes may also be moisturized with vegetable or olive oil or with a suitable skin oil.
- Mouth breathing can be avoided with oil-containing nasal sprays or drops.
Evidence Summaries ⬆