Because xerostomia and salivary gland hypofunction are common, all patients should routinely be evaluated for these conditions.

	SIGNS AND SYMPTOMS

TOP SIGNS AND SYMPTOMS COMMON CAUSES COMPLICATIONS EVALUATION AND MANAGEMENT

 
Patients with dry mouth may be asymptomatic (have no complaints) or complain of dry mouth or hoarse voice, and may experience trouble eating, speaking, swallowing or chewing. They also may report a frequent need to sip water while eating dry food or awakening at night with oral dryness. Difficulties in wearing oral prostheses and appreciating the taste of food, as well as a sore and painful mouth, are other common complaints.

Although a patient may not complain of having a dry mouth, the history or presence of such conditions as recurrent dental caries, oral yeast infections, inflamed soft tissue, and chapped or cracked lips and tongue, as well as swollen salivary glands, in the absence of other local or systemic conditions, should raise the suspicion of reduced saliva secretion.

	COMMON CAUSES

TOP SIGNS AND SYMPTOMS COMMON CAUSES COMPLICATIONS EVALUATION AND MANAGEMENT

 
In the past, head-and-neck radiation therapy was considered the most common cause of xerostomia and salivary gland hypofunction. However, in recent years, medications have emerged as the most common cause, especially in the geriatric patient population. More than 400 medications are known to cause dry mouth as a potential adverse effect. The following groups of medications are some of the more common categories that have been associated with xerostomia or salivary gland hypofunction:

– cardiovascular medications (-blockers,, ß-blockers, diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers);

– antidepressants;

– sedatives;

– central analgesics;

– anti-Parkinson’s medications;

– anti-allergy medications;

– antacids.

Chronic xerostomia and salivary gland hypofunction also can be linked to a variety of medical conditions, such as Sjögren’s syndrome, sarcoidosis, uncontrolled diabetes, depression, HIV infection and central nervous system disorders.

	COMPLICATIONS

TOP SIGNS AND SYMPTOMS COMMON CAUSES COMPLICATIONS EVALUATION AND MANAGEMENT

 
The absence of saliva alters the oral environment and increases the risk of developing dental caries and fungal and periodontal diseases (see "Signs and Symptoms" above). Associated oral discomfort also may lead to dehydration and nutritional deficiency in elderly patients.

	EVALUATION AND MANAGEMENT

TOP SIGNS AND SYMPTOMS COMMON CAUSES COMPLICATIONS EVALUATION AND MANAGEMENT

 
Because xerostomia and salivary gland hypofunction are common, potentially asymptomatic conditions that have many causes and complications, all patients should routinely be evaluated for these conditions. A comprehensive interview (medical history) and a head-and-neck clinical evaluation usually will identify people who will benefit from further diagnostic evaluations (that is, salivary flow rate measurement, minor salivary gland biopsy, blood and microbial tests). A history of frequent carious lesions; recurrent yeast infections; bleeding gums and sore mouth in the absence of local oral factors; lack of a saliva pool and saliva on palpation of major salivary glands; and an unusual pattern of carious lesions commonly indicate the need for further diagnostic evaluation.

Significant emphasis should be placed on preventive oral care in the management of patients with these conditions. Management of these conditions may include daily oral hygiene, frequent professional oral evaluations and care, hydration, lubrication, stimulation of the salivary glands, nutritional counseling and avoidance of such irritants as alcohol and tobacco. Medications available by prescription (pilocarpine hydrochloride [Salagen, MGI Pharma, Bloomington, Minn.], cevimeline hydrochloride [Evoxac, Daiichi Pharmaceutical Co., Tokyo]) also may be included as treatment.

For further information on xerostomia and salivary gland hypofunction, please visit the following sites:

"www.sjogrens.org"; "www.cdha.org/articles/drymouth.htm"; "www.northwestdentists.com/xerostomia.htm"; "www.nohic.nidcr.nih.gov/pubs/drymouth/dmouth.htm"; "www.oralcancer.org/public.dir/xerostom.html"; "www.nidcr.nih.gov/spectrum/nidcr2/2textsec5.htm"; "www.umanitoba.ca/outreach/wisdomtooth/drymouth.htm".