Xerostomia should be considered if the patient complains of dry mouth, particularly at night, or of difficulty eating dry foods such as crackers. Diagnosis and evaluation of xerostomiaĭiagnosis of xerostomia may be based on evidence obtained from the patient’s history, an examination of the oral cavity and/or sialometry, a simple office procedure that measures the flow rate of saliva. Xerostomia can lead to markedly increased dental caries, parotid gland enlargement, inflammation and fissuring of the lips (cheilitis), inflammation or ulcers of the tongue and buccal mucosa, oral candidiasis, salivary gland infection (sialadenitis), halitosis and cracking and fissuring of the oral mucosa. Patients with xerostomia often complain of taste disorders (dysgeusia), a painful tongue (glossodynia) and an increased need to drink water, especially at night. Denture wearers may have problems with denture retention, denture sores and the tongue sticking to the palate. Dry, crumbly foods, such as cereals and crackers, may be particularly difficult to chew and swallow. Individuals with xerostomia often complain of problems with eating, speaking, swallowing and wearing dentures. Some common problems associated with xerostomia include a constant sore throat, burning sensation, difficulty speaking and swallowing, hoarseness and/or dry nasal passages.1 Xerostomia is an original hidden cause of gum disease and tooth loss in three out of every 10 adults.11 If left untreated, xerostomia decreases the oral pH and significantly increases the development of plaque and dental caries.Oral candidiasis is one of the most common oral infections seen in association with xerostomia. It can affect nutrition and dental, as well as psychological, health. Xerostomia is often a contributing factor for both minor and serious health problems. Saliva possesses many important functions including antimicrobial activity, mechanical cleansing action, control of pH, removal of food debris from the oral cavity, lubrication of the oral cavity, remineralization and maintaining the integrity of the oral mucosa. In addition, saliva contains several antimicrobial constituents, including thiocyanate, lysozyme, immunoglobulins, lactoferrin and transferrin. Saliva also contains large amounts of potassium and bicarbonate ions, and to a lesser extent sodium and chloride ions. The pH of saliva falls between 6 and 7.4. Saliva contains two major types of protein secretions, a serous secretion containing the digestive enzyme ptyalin and a mucous secretion containing the lubricating aid mucin. Saliva is the viscous, clear, watery fluid secreted from the parotid, submaxillary, sublingual and smaller mucous glands of the mouth. Efferent nerve signals, mediated by acetylcholine, also stimulate salivary glandular epithelial cells and increase salivary secretions. The medullary signal may also be affected by cortical inputs resulting from stimuli such as taste, smell, anxiety or depression. When the oral mucosal surface is stimulated, afferent nerve signals travel to the salivatory nuclei in the medulla. Stimulation of this receptor results in increased watery flow of salivary secretions. Normal salivary function is mediated by the muscarinic M3 receptor. However, xerotomia does not appear to be related to age itself as much as to the potential for elderly to be taking medications that cause xerostomia as a side effect. Xerostomia is a common complaint found often among older adults, affecting approximately 20 percent of the elderly. It may or may not be associated with decreased salivary gland function. Xerostomia is not a disease, but it may be a symptom of various medical conditions, a side effect of a radiation to the head and neck, or a side effect of a wide variety of medications. Xerostomia is defined as dry mouth resulting from reduced or absent saliva flow. Helping patients with dry mouth Introduction
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