Xerostomia is insufficient salivation, accompanied by increased dryness of the oral mucosa. It is manifested by a feeling of dryness in the mouth and throat, burning of the tongue, difficulty chewing, swallowing, speech, taste disturbance and a feeling of metallic taste in the mouth. It is often a manifestation of the underlying disease (diabetes mellitus, Parkinson’s disease, HIV, etc.), a side effect of medications, radiation or chemotherapy. The cure of xerostomia depends on the possibility of eliminating the cause of its occurrence. Symptomatic therapy includes the appointment of galantamine, potassium iodide, pilocarpine, novocaine blockades and physiotherapy procedures on the salivary glands.
Xerostomia is a symptom of dry mouth, which appears with a decrease in salivation, or with the complete cessation of salivation. Xerostomia is not an independent disease, but in the presence of constant dry mouth, it is necessary to undergo a comprehensive examination to identify pathological conditions that caused the symptoms of xerostomia.
Saliva is a lubricating substance that facilitates the process of chewing and swallowing, in addition, it washes bacteria from the teeth and has an anti-inflammatory effect. The substances contained in saliva remineralize enamel and neutralize the action of acids and alkalis that come with food.
Most often, xerostomies are a side effect of medications. Senile people are more susceptible to the phenomena of constant dry mouth due to taking a large number of drugs of different pharmacological groups. The combined effect of the drugs increases the likelihood of side effects and makes their manifestations more pronounced.
Symptoms of xerostomia can manifest in diabetes mellitus, iron deficiency anemia and hypertension. Cystic fibrosis, rheumatoid arthritis and HIV infection are often accompanied by xerostomias. In Shane’s syndrome, autoimmune disorders cause dystrophy of the salivary and lacrimal glands, which is manifested by dryness of the oral mucosa, xerostomia and hypofunction of the lacrimal glands. Mumps and other viral infections affecting the salivary glands, the innervation system and blood supply affect the production of saliva and cause symptoms of xerostomia.
Short-term xerostomies cause any state of dehydration of the body. These are feverish conditions, fluid loss due to vomiting and diarrhea, blood loss, burn disease and limited fluid intake into the body. During radiation therapy and for some time after discontinuation of treatment, a symptom of xerostomia is observed. Xerostomies are especially pronounced during radiation therapy of oncological diseases of the head and neck.
With surgical removal of the salivary glands, xerostomia becomes permanent and the only option for correction is the use of oral moisturizers. Violations of the central mechanism of salivation by the type of neurogenic xerostomia are often observed in spinal dryness, brain contusions and toxic-infectious lesions of the central nervous system. Senile atrophy of the salivary glands, sialoadenitis, Mikulich’s disease are risk factors. With these conditions, the likelihood of developing xerostomias increases.
Temporary xerostomies can also develop in the absence of pathologies, for example, with disorders of nasal breathing, which can lead to nasal polyps, curvature of the nasal septum. In elderly people, due to the weakness of the muscles that raise the lower jaw, xerostomia occurs from the fact that during a night’s sleep the mouth is constantly open. Unreasonable and frequent mouthwashes, especially with aggressive disinfectants, lead to atrophy of the salivary glands and to the appearance of symptoms of xerostomia.
Xerostomies are characterized by dry mouth. As salivation decreases, the probability of suppuration increases. With xerostomias, the risk of infectious diseases of the soft tissues of the oral cavity, including fungal ones, increases. With increasing dryness in the mouth, xerostomias are manifested by perversions of taste and a decrease in taste sensations.
The degree of manifestation of xerostomias is determined by the severity of the signs. So, in the initial stages of xerostomia, the parotid and submandibular salivary glands secrete the amount of saliva within the normal range, therefore, the state of salivation compensation is noted. At this stage of the disease, dry mouth appears only after prolonged conversations and overwork. On examination, the mucous membrane of the oral cavity is moist, saliva is slightly foamy.
Then the period of partial decompensation begins. Signs of xerostomia become more pronounced, which is manifested by constant dry mouth, speech and eating are difficult. Patients already at this stage feel dry mouth during meals, so they wash down dry food with water. The mucous membrane of the oral cavity is slightly moistened, has a pale pink hue and glitters.
The III degree of xerostomia is characterized by complete suppression of the functions of the salivary glands. Patients complain of a sharp dry mouth, soreness during conversation and eating. Glossitis, stomatitis are added; due to the dryness of the mucous membrane, the oral cavity is covered with ulcers and erosions. Lips are also dry and flaky, sometimes covered with crusts. If the cause of xerostomia is dysfunction of the salivary glands, then often in addition to dry mouth, multiple caries is noted.
In addition to the main manifestations of xerostomia, thirst, problems with swallowing food and fetid breathing can be observed. Patients often suffer from angina, and during the recovery period, hoarseness and sore throat cause discomfort and are the main cause of speech problems. In patients with xerostomia, the tongue becomes bright red, there are jams and cracks in the corners of the mouth, which are often infected. At the stage of partial compensation and at the stage of decompensation, dryness in the nasal passages appears, carious disease joins, periodontal pathologies are possible. If patients wear removable dentures, then there are difficulties with their operation and frequent injuries to the oral mucosa.
Diagnosis and treatment
Diagnosis of xerostomias includes a detailed survey of the patient in order to find out what drugs he took, including without a doctor’s prescription. Additionally, ultrasound of the salivary glands and sialography are performed.
Symptomatic therapy for xerostomias greatly facilitates the patient’s condition, but after discontinuation of treatment, manifestations of xerostomias reappear. Therefore, it is important for the dentist to establish the main cause of this symptom. Xerostomias that have arisen as a result of taking medications, dehydration are quickly amenable to correction. Whereas xerostomia after radiation therapy is almost impossible to eliminate, since radiation can reduce the ability of the salivary glands to produce saliva.
Pathogenetic therapy of xerostomias is aimed at eliminating the causes of dry mouth. To improve the condition, solutions of potassium iodide, pilocarpine and galantamine are prescribed. Lubrication of the oral cavity with vitamin A solution helps both to reduce the symptoms of dryness and to heal wounds and microcracks. Novocaine blockades in the parotid and submandibular salivary glands and physiotherapy procedures, such as galvanotherapy of the salivary glands, electrophoresis with potassium iodide and vibration massage, can improve the patient’s condition even with xerostomias in the decompensation stage.
In order for the oral cavity to always be moistened, it is recommended to drink water often in small portions. Non-carbonated mineral or drinking water, if you drink it during the day and during night awakenings, is a symptomatic remedy, but significantly improves the condition of the oral mucosa. Sugar-free hard candies help to improve the functioning of the salivary glands and increase the total volume of saliva. Usually, patients with xerostomia chew chewing gum, this helps to increase salivation, but sugar-free chewing gum should be recommended to reduce the likelihood of caries.
With xerostomias, it is necessary to avoid eating salty and dry foods, as well as foods and beverages with caffeine and high sugar content. Alcoholic beverages and alcohol-containing mouthwash dry the mucous membrane and cause hyposalivation. Patients with xerostomia are recommended to give up smoking, use oral moisturizers and toothbrushes with soft bristles so as not to injure the thinned and dry oral mucosa.
After successful elimination of the symptoms of xerostomia, it is necessary to avoid relapses. This is achieved through rational drug treatment of diseases, it is necessary to use those drugs that do not affect the work of the salivary glands. The prognosis for xerostomies is determined by the nature of the underlying disease and the degree of dysfunction of the salivary glands. But in all cases, except for complete atrophy of the salivary glands, it is possible to achieve a significant improvement in the condition or complete cure.
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