Xerostomia also is known as Dry Mouth is caused by lower levels or the absence salivation within the mouth. This condition can often lead to discomfort which negatively affects your ability speak, swallowing, an ability to wear dentures, producing bad breath and compromise your oral hygiene due to reducing the oral pH and an increase in bacterial growth.
Persistent xerostomia can lead to severe tooth decay and oral candidiasis. Xerostomia is a common complaint image among older adults and affects about 20% of the elderly.
The stimulation of the oral mucosa signals the salivary nucleus in the medulla an efferent response trigger. The efferent nerve impulses generate acetylcholine released at the nerve endings of the salivary glands, which activate the muscarinic (M3), leading to an increase in the production of saliva and salivation.
Cortical inputs of other stimuli can also modulate medullary signals that are responsible for the flow of saliva (e.g. As taste, smell, anxiety). Etiology xerostomia is generally caused by medicines irradiation of head and neck (to treat cancer) Systemic diseases are the least common cause, but xerostomia usually happens in Sjögren’s syndrome and may as a result of HIV / AIDS, uncontrolled diabetes and certain other diseases occur.
Medication drugs are the most common cause; more than 400 prescription drugs and many-the-counter medications cause reduced saliva production. Some of the most common include the following: anti-parkinson anticholinergic medicines antineoplastic (chemotherapy). Some causes of xerostomia cause, Examples drugs:
- anticholinergic antidepressants
- Anxiolytics leisure activity (illegal) cannabis methamphetamine tobacco. Other antihypertensive agents antineoplastic (chemotherapy). Anti-Parkinson drugs
- methadone and other opioids Systemic diseases – amyloidosis HIV infection Leprosy Sarcoidosis Sjogren’s syndrome TB Other – excessive mouth breathing head and neck trauma radiotherapy Viral infections Chemotherapeutic agents cause severe dry mouth and stomatitis during administration; these problems usually disappear after completion of therapy.
Other known classes of substances that cause xerostomia are antihypertensives, anxiolytics, and antidepressants (SSRIs less severe than tricyclics). The increase in illegal methamphetamine use has led to an increased incidence of so-called. “Meth mouth,” which means advanced tooth decay caused by methamphetamine-induced xerostomia. The damage is compounded by that produced by the drug and the heat of the inhaled fumes grinding and clenching. This combination results in very rapid destruction of the teeth.
Tobacco consumption usually causes a drop in saliva production. Radiotherapy – As in radiation therapy of head and neck tumors, salivary glands were mitbestrahlt can as a side effect a strong dry mouth occur (severe, chronic xerostomia from 5200 cGy, but even lower doses may have a temporary drying trigger).
Assessment history to history of the current disease should include the rate of disease onset, temporal patterns (e.g. constant versus intermittent, occurring only after waking.). Triggering factors, including the situational or psychogenic factors (such as whether xerostomia only. in times of psychological stress or certain activities occurs) assessment of Flüssigskeitsstatus (z. B. daily fluid intake, repeated vomiting or diarrhea), and sleeping habits.
The use of recreational drugs should be correctly identified. A review of organ systems should investigate symptoms of the causative diseases including dry eye, dry skin, rashes and joint pain (Sjogren’s syndrome). The history should examine associated symptoms of xerostomia, including Sjogren’s syndrome, the course of radiotherapy, head and neck trauma and the diagnosis or risk factors for HIV infection medication profile should be reviewed for potential triggering drugs (see table: Some causes of xerostomia).
Physical examination physical examination focuses on the oral cavity, and in particular any apparent dryness (e.g., whether the mucous membrane is dry, sticky or moist. If the saliva fluffy in appearance, thick, ropy or is typically), the presence of by Candida albicans, lesions caused and the condition of the teeth. The presence and severity of xerostomia can be determined in several ways.
For example, a tongue depressor for 10 s can be held against the buccal mucosa. The spatula immediately falls when it is released, the flow of saliva is considered normal. The more difficult it is to solve the tongue depressor on the cheek, the stronger the xerostomia. In women, the “lipstick sign” may, where lipstick adheres the front teeth, be a useful indicator of dry mouth. If there is dryness that occurs, the submandibular gland, the sublingual gland, and the parotid gland should be scanned while observing the ductal openings for the flow of saliva. The opportunities are on the tongue base forward for the submandibular and sublingual glands and in the middle of the cheek inside the parotid glands. If the channel is dried with gauze before palpation, which is helpful for the investigation.
When a measuring container is available, the patient can spit out once to empty the mouth, and then spit the whole saliva for several minutes in the tank. The normal production is 0.3-0.4 ml/min. Significant xerostomia, it is 0.1 ml/min. Caries could at the edges of dental fillings or unusual positions (z. B. gumline, incisal edges or cusp tips of the teeth) be found. A frequent indication of a C. albicans infection includes erythema and atrophy (eg., Loss of papillae on the dorsum of the tongue). Less common is the more common white, curd-like tongue coating, under which it bleeds when moved – This can be a warning.
The following findings are of particular importance: Extensive dental caries accompanied by dry eyes, dry skin, rash or joint pain risk factors for HIV interpretation of the results xerostomia is diagnosed by symptoms, appearance and despite massaging the salivary glands lack of saliva. No further observation requires it when xerostomia occurs after the beginning of a new drug and stops after discontinuation of the same or if symptoms occur within a few weeks after irradiation of the head and neck. Xerostomia, which suddenly occurs after a head and neck trauma can be caused by nerve damage. The simultaneous occurrence of dry eyes, dry skin, rash or joint pain, especially in a patient indicates Sjogren’s syndrome.
Severe tooth discoloration and deterioration that are disproportionate to the normal findings may be indicative of illicit drugs, particularly methamphetamines. Xerostomia, which occurs only during the night or on waking, may be indicative of excessive mouth breathing in a dry environment sein. Tests Sialometrie salivary gland biopsy In patients in whom the cause of xerostomia is unclear, a Sialometrie can be performed by a collecting container to the main ducts is maintained, and then the Speichelprodution is excited with citric acid or by chewing paraffin. The normal parotid salivary flow rate is about 0.4-1.5 ml/min.
The salivary flow monitoring can also help determine the success of treatment. The cause of xerostomia is often obvious, but if the etiology is unclear and is considered a systemic disease as possible should be further investigation as the biopsy of the minor salivary glands (for the detection of Sjögren’s syndrome, sarcoidosis, amyloidosis, TB or cancer) and a HIV test done. The lower lip is a suitable location for a biopsy.
Therapy treating the cause and removal of causative medications if possible cholinergic drugs saliva substitutes regular oral hygiene and dental care to prevent tooth decay, if possible, should be ascertained the cause of xerostomia and treated. The drugs plans of patients with drug-induced xerostomia, whose treatment cannot be changed to another medication should be adjusted so that maximum daytime efficiency is achieved because xerostomia night rather leads to tooth decay. Customized occlusal splints ( “night guards”) with-applied fluoride can help prevent tooth decay in these patients. All drugs, “easy-to-take” – substances such as liquids should be considered, and sublingual dosage forms should be avoided.
The mouth and throat should be lubricated with water before swallowing capsules or tablets or before using sublingual nitroglycerin. Patients should avoid decongestants or antihistamines. Patients in whom a continuous positive airway pressure is applied for obstructive sleep apnea may benefit from the moisturizing effect of this method.
Patients being treated with oral appliances can benefit from a room humidifier. Symptom control Symptomatic treatment consists of measures to bring about the following: increase in the existing saliva secretions Lost replace caries control medications that increase saliva production, are cevimeline or pilocarpine, both cholinergic agonists. Both acting cholinergic-agonist, which cevimeline (30 mg po three times daily) lower (cardiac) M2 receptor activity unfolds as pilocarpine and has a longer half-life. The main side effect is nausea (feeling sick).
After exclusion of ophthalmological and cardiorespiratory contraindications also can pilocarpine (5 mg 3 times a day p.o.) administered; possible side effects include sweating, skin redness, and polyuria. Helpful unsweetened drinks can (in frequent small sips), chewing gum and xylitol containing-counter saliva substitutes (having carboxymethyl cellulose or hydroxyethyl cellulose) or glycerol. Vaseline can be applied to the lips or under the dentures to drying, cracking, pain and mucosal injuries to alleviating.
A cold air humidifier may help mouth breathers who have their worst symptoms at night usually. Particularly careful oral hygiene is essential. Patients should brush and floss regularly use (including just before bedtime) using fluoride rinses or gels daily and; the use of newer toothpaste with additions of calcium and phosphorus can also help to avoid a pervasive decay. Regular preventive dental appointments with plaque removal are recommended.
A useful treatment option may be customized mouth trays, prevent (1.1% sodium fluoride or 0.4% tin fluoride) that you wear at night. Also, a dentist can 5% sodium fluoride varnish 2 to 4 times/year apply. Patients should avoid sugary or acidic food and drinks and lovely food dry, sharp, astringent or excessively hot or cold. It is particularly important to avoid sugar at bedtime is.
Basics of Geriatrics Although xerostomia is more common in older people, this is due to the fact older people usually take more drugs, developing a correlation between age is xerostomia.
Summary drugs are the most common cause, but systemic diseases (mainly Sjögren’s syndrome or HIV), and radiation therapy can also cause xerostomia. Symptomatic treatment, including the increase of the existing salivation by stimulants or drugs and artificial saliva substitutes, xylitol containing gum and sugar-free candies can be helpful. Patients with xerostomia have to suffer a high risk of tooth decay; particularly careful oral hygiene, additional preventive measures in-home care and professionally applied fluoride are essential.