Abstract

The condition of reduced saliva production is known as Xerostomia. This research unites all the causes, clinical effects and the available and beneficial ways for Xerostomia management. When it comes to oral health problems and quality of life, Xerostomia has detrimental effects that can affect its patient badly. The aim of this research is to improve the way Xerostomia is treated and improving patient’s outcome. This study will examine concerning Xerostomia and how it affects oral health (e.g., speech, taste, swallowing, increased risk of tooth decay and fungal infections), treatment for the condition (e.g., the established reasons for the condition and how to manage these effectively such as using sugar-free gum, taking in plenty of fluids and using saliva replacements), and the underlying causes of the condition. The aim of this research is to understand the importance of a strategy to managing Xerostomia, stating that addressing symptoms alone would not enhance patients' quality of life.

Keywords: Xerostomia, saliva production, hydration, medication side effects, saliva substitutes, oral discomfort

Xerostomia, or dry mouth, is caused by decreased saliva production, causing a dry sensation in the mouth (Kontogiannopoulos et al., 2022). People suffering from Xerostomia have symptoms that affect their health, as well as their social and emotional well-being. This paper discusses how Xerostomia affects oral health, along with its historical perspective and treatment options. 

Kontogiannopoulos et al. (2023) and Nadig et al. (2017) describe the impact of Xerostomia as follows:

People with Xerostomia suffer from dental decay as well as fungal infections in the oral cavity, such as candidiasis, malodor, glossopyrosis, and periodontitis. Consequently, saliva becomes less effective at protecting the mouth against infection since it buffers acids, has antibodies, helps prevent gingival mucosal erosions and ulcerations, and aids in tooth remineralization. Besides, saliva also helps wash out food residues and bacteria. Therefore, if saliva output is decreased, the risk of plaque formation is increased, as well as a higher risk of gum infections, tooth erosion, and inflammation. Saliva also keeps our teeth protected and functions as a lubricant for the mouth and throat. If there is not enough saliva, this can lead to rampant acid production and oral bacterial infections.

According to Fleming, Craigs, and Bennett (2019), the reduction in saliva flow can be associated with difficulties swallowing (dysphagia) and changes in taste perception (dysgeusia). The authors (2019) report that about 15% of patients reported that dry mouth affected their swallowing, resulting in dietary changes and reduced food and drink intake, while approximately 60% experienced taste interference (median score of 5/10). Explaining these health issues, the research points out that this is because saliva is over 99% water, with mucin glycoproteins present in abundance to coat, lubricate and protect oral tissues (Fleming, Craigs, and Bennett, 2019). Further, saliva contains digestive enzymes including amylase and lingual lipase to help break down the food being swallowed, and the antibacterial lysozymes (Fleming, Craigs, and Bennett, 2019). Without enough saliva, the process of swallowing is impacted, choking is more likely to occur, taste experiences will be altered, and the eating experience less than enjoyable.

Dry mouth also reduces sensory feedback necessary for clear speaking by making it difficult to move the tongue and other oral structures. According to Fleming, Craigs, and Bennett (2019), 75.6% of patients experienced difficulties talking, suggesting how lack of lubrication affects speech comfort (2019). However, the study also showed that 48.1% of the patients pointed to concerns of sleep quality, medication side effects as well as symptoms such as oral dryness of the lips, throat, and nasal passages notably diminish patients' quality of life (Fleming, Craigs, & Bennett, 2019).

The increased understanding of Xerostomia over the years has helped identify the main causes, including medication side effects, radiation therapy, Sjögren’s syndrome, as well as abnormalities in the development of the glands (Kontogiannopoulos et al, 2023; Nadig et al, 2017), with further contributing factors being ageing and gender, as well as psychological effects (Fleming, Craigs, Bennett, 2019). Medications are the main cause of Xerostomia, due to the large amount of medications reducing saliva production; for example, antihistamines, antidepressants and blood pressure drugs (Fleming, Craigs, Bennett, 2019). Drugs with antisialogogic effects – defined as those leading to the reduced saliva production, including “the anticholinergics, antidepressants, antipsychotics, diuretics, antihypertensives, sedatives, anxiolytics, antihistamines, opioid analgesics, corticosteroids, benzodiazepines and nonsteroidal anti-inflammatory drugs are considered important contributors” (Fleming, Craigs, Bennett, 2019; Nadig et al, 2017). 

Besides medications, biological factors include radiation therapy and Sjögren’s syndrome are mentioned in the paper by Nadig et al., in 2017. Radiation therapy to the head area and higher doses of radiation to the neck affect salivary secretory epithelial cells in the salivary glands, inhibiting the cell function of the glands and reduce their functional capacity to secrete saliva in proportion to their damaged structures (Nadig et al., in 2017). Thus, the salivary glands become damaged and unable to function properly, causing dry mouth. Sjögren’s syndrome causes a loss of normal function specific to the target in the glands, causing them to become damaged and leading to the development of inflammation, a hindrance to the function of the glands, causing them to produce less saliva (Dodds, Haddou and Day, 2023; Nadig et al., in 2017). Consequently, dry mouth develops.   

Nadig et al’s study on the prevalence of dry mouth reveals that 68% of the study sample are female while only 34% are male (2017). Females have a dry mouth at a much higher prevalence compared with males, with 79% of female and 21% of male patients experiencing dry mouth. A relationship exists between males and females and the development of dry mouth in females, due to “the volume of the submandibular salivary glands in females was 50% of that of the submandibular salivary glands of the males” (Nadig et al., 2017). The social and psychological factors, including depression, anxiety and stress, can also be attributed to the causes of dry mouth (Nadig et al., 2017).

One of these is medication-related adverse effects. My 80-year-old grandfather has asthma and takes an oral inhaler on a daily basis. These inhalers include corticosteroid are proven to reduce inflammation in the airways (Fleming, Craigs, Bennett, 2019; Nadig et al, 2017). Certain adverse effects are common with all drugs, and some of them cause dryness in the mouth. I have noticed that dentures can change how saliva feels in the mouth. While dentures may not directly reduce saliva production, they can alter how saliva is delivered, causing a feeling of dryness. Finally, as is usual among elderly persons, my grandfather's reduced salivary gland function is made worse by his medications. 

Nevertheless, different Xerostomia treatments are available, production and/or reducing symptoms associated with Xerostomia. Chewing sugar-free gum is one accessible strategy to produce saliva. According to Dodds, Haddou and Day (2023), this will help stimulate salivation and can be of particular benefit because it encourages greater moisture in the mouth. Individuals can also stay hydrated with water, chew sugar-free gum, and use saliva substitutes including over-the-counter saliva substitute sprays or gels used in the mouth as ‘artificial saliva,’ as well as natural products (2023). Natural products appear to be an especially promising approach in the treatment of Xerostomia. These products are noted to stimulate saliva production, have protective properties through antioxidant and anti-inflammatory actions to soothe and stimulate taste buds, and have also been found to keep the mouth moister (Kontogiannopoulos et al., 2023). Secondly, antioxidant supplements can modulate the oxidative stress that may be produced by radiotherapy (Kontogiannopoulos et al., 2023). Adjusting medications that may contribute to dry mouth, after consulting with a healthcare provider, can also provide relief. Dodds, Haddou and Day (2023) advocate that a solid oral hygiene routine is critical in preventing complications associated with Xerostomia. Patients are encouraged to brush their teeth at least twice daily with a fluoride toothpaste, floss regularly, and schedule frequent visits to the dentist for a routine check-up. A simple habit like drinking water can also provide symptomatic relief and is a key self-management strategy (Fleming, Craigs, & Bennett, 2019). 

Xerostomia can have an immediate impact on oral health outcomes, including an increased risk of fungal infections, caries, and difficulties with speech, taste and swallowing. This is why optimal management includes both symptom control and treatment of underlying causes, such as medication side effects, underlying medical conditions, and other factors. Saliva substitutes, good dental hygiene, and following hydration guidelines are all promising ways to reduce the negative impact of Xerostomia on quality of life. 

                    References

Dodds, M. W., Haddou, M. B., & Day, J. E. (2023, June 20). The effect of gum chewing on Xerostomia and salivary flow rate in elderly and medically compromised subjects: A systematic review and meta-analysis. BMC Oral Health, 23(1). https://doi.org/10.1186/s12903-023-03084-x

Fleming, M., Craigs, C. L., & Bennett, M. I. (2019). Palliative Care Assessment of dry mouth: What matters most to patients with advanced disease? Supportive Care in Cancer, 28(3), 1121–1129. https://doi.org/10.1007/s00520-019-04908-9

Kontogiannopoulos, K. N., Kapourani, A., Gkougkourelas, I., Anagnostaki, M.-E., Tsalikis, L., Assimopoulou, A. N., & Barmpalexis, P. (2023). A review of the role of natural products as treatment approaches for Xerostomia. Pharmaceuticals, 16(8), 1136. https://doi.org/10.3390/ph16081136

Nadig, S. D., Ashwathappa, D. T., Manjunath, M., Krishna, S., Annaji, A. G., & Shivaprakash, P. K. (2017). A relationship between salivary flow rates and candida counts in patients with Xerostomia. Journal of Oral and Maxillofacial Pathology, 21(2), 316. https://doi.org/10.4103/jomfp.jomfp_231_16