What are the causes of xerostomia?

Causes of Xerostomia

Xerostomia (dry mouth) is primarily caused by medications, systemic diseases, and radiation therapy to the head and neck region. 1

Medication-Related Causes

• Anticholinergic medications: Most common medication-related cause

  • Antidepressants (particularly tricyclics)
  • Antimuscarinics
  • Antihistamines
  • Decongestants
  • Antiparkinsonian drugs
  • Anxiolytics
  • Antipsychotics
  • Some pain medicines 1

• Other medications:

  • Diuretics
  • Calcium channel blockers
  • Lithium
  • Prolonged use of NSAIDs
  • Hypnotics
  • Sedatives
  • Analgesics
  • Antipyretics
  • Opioids
  • Antibiotics 1

Disease-Related Causes

• Autoimmune disorders:

  • Sjögren's syndrome (primary or secondary) 2
  • Rheumatoid arthritis 2

• Endocrine disorders:

  • Diabetes mellitus
  • Thyroid disease 1

• Neurological conditions:

  • Parkinson's disease
  • Alzheimer's disease and other dementias 1

• Renal disorders:

  • Chronic kidney disease
  • End-stage renal disease requiring hemodialysis 1

• Other conditions:

  • Salivary gland hypofunction
  • Dehydration
  • Mouth breathing
  • Advanced age (salivary flow naturally decreases with aging) 1

Treatment-Related Causes

• Radiation therapy to the head and neck region (damages salivary glands) 1
• Chemotherapy (can temporarily affect salivary function)
• Bone marrow transplantation 3

Lifestyle-Related Factors

• Dehydration
• Alcohol consumption (has diuretic effect) 1
• Caffeine consumption (has diuretic effect) 1
• Tobacco use
• Recreational drug use

Clinical Impact of Xerostomia

Xerostomia can significantly impact quality of life and health outcomes by causing:

• Difficulty with chewing, swallowing, speaking, and tasting
• Increased risk of dental caries and oral infections (especially candidiasis)
• Oral discomfort and pain
• Problems with denture retention
• Sleep disturbances (need to drink water at night)
• Nutritional deficiencies due to eating difficulties 1, 4

Management Considerations

For patients with xerostomia, management should focus on:

1. Identifying and addressing the underlying cause when possible
2. Using salivary substitutes (e.g., Biotene) for symptomatic relief
3. Considering salivary stimulants like pilocarpine (5-10 mg three times daily) for appropriate patients 2
4. Implementing rigorous oral hygiene and preventive dental care
5. Reviewing and potentially modifying medication regimens when medication-induced 4

Early recognition and management of xerostomia is essential to prevent complications and improve quality of life, particularly in elderly patients who are often taking multiple medications that can cause or exacerbate this condition.