What is the medical term for dry mouth?

Xerostomia: The Medical Term for Dry Mouth

Xerostomia is the medical term for dry mouth, which refers to the subjective sensation of oral dryness that may or may not be associated with decreased salivary gland function. 1

Definition and Clinical Significance

• Xerostomia represents the subjective complaint or sensation of dry mouth, while hyposalivation refers to the objective reduction in salivary flow 2
• This condition can significantly impact quality of life by causing difficulties with eating, speaking, swallowing, and wearing dentures 1
• If left untreated, xerostomia can lead to dental caries, oral infections such as candidiasis, and deterioration of oral health 3

Common Causes

• Medication use: The most common cause of xerostomia in the general population, particularly in older adults 3

  • Medications with anticholinergic properties are frequently implicated 4
  • Polypharmacy increases the risk of xerostomia 3

• Medical conditions:

  • Sjögren's syndrome (an autoimmune disorder affecting salivary and lacrimal glands) 1
  • Diabetes mellitus 1
  • Chronic kidney disease can cause salivary disorders 5
  • Dehydration 4

• Treatments:

  • Radiation therapy to the head and neck region 1
  • Immunotherapy can cause sicca syndrome (dry mouth usually without dry eyes) 6

• Other factors:

  • Advanced age 3
  • Alcohol and caffeine consumption 3

Clinical Manifestations

• Difficulty chewing, swallowing, and speaking 1
• Oral discomfort and burning sensation 7
• Problems wearing dentures 7
• Altered taste sensation 1
• Increased risk of dental caries and oral infections 1
• Poor diet and malnutrition due to eating difficulties 7
• Decreased social interaction 7

Diagnosis

• Diagnosis is primarily based on patient-reported symptoms, as there is little correlation between subjective complaints and objective tests of salivary flow 4
• A thorough intraoral and extraoral clinical examination is essential 7
• Assessment may include evaluation for:
  • Reduced salivation 6
  • Oral mucosal dryness 6
  • Presence of dental caries 7
  • Signs of oral infections such as candidiasis 1

Management Approaches

Non-pharmacological Interventions

• Dietary modifications:

  • Improve hydration and limit caffeine intake 6
  • Avoid crunchy, spicy, acidic, or hot food/drink for comfort 6

• Topical measures:

  • Water sips, saliva substitutes, and moisture-preserving mouth rinses, toothpaste, or spray 6
  • Salivary stimulants such as sugarless chewing gum, lozenges, or candy 6

• Oral hygiene:

  • Ongoing dental care and caries prevention 7
  • Regular dental check-ups to prevent complications 7

Pharmacological Interventions

• Systemic sialagogues (medications that stimulate saliva production):

  • Pilocarpine (5-10 mg three times daily) - FDA-approved for xerostomia in Sjögren's syndrome and post-radiation therapy 8
  • Cevimeline - another cholinergic agonist used for moderate to severe xerostomia 6

• For immunotherapy-related sicca syndrome:

  • Prednisone at 20-40 mg daily for 2-4 weeks, then taper for moderate to severe cases 6

Special Considerations

• Radiation-induced xerostomia:

  • Intensity-modulated radiation therapy (IMRT) can reduce xerostomia by sparing salivary glands 6
  • Studies show IMRT significantly lowers rates of clinician-rated severe xerostomia compared to conventional radiotherapy 6

• Immunotherapy-related sicca syndrome:

  • Distinct from Sjögren's syndrome, with abrupt onset of dry mouth usually without dry eyes 6
  • May be partially improved with steroids but usually requires chronic care 6
  • Severe cases may require holding immunotherapy 6

Clinical Pearls and Pitfalls

• Xerostomia should not be considered a trivial problem as it significantly impacts quality of life 2
• Review medication regimens and consider alternatives for drugs with anticholinergic effects when possible 7
• In patients with residual salivary gland function, salivary stimulants are generally more beneficial than salivary substitutes 4
• Severe sicca syndrome, if left untreated, can result in dental caries and eventually tooth loss 6
• For patients receiving head and neck radiation, IMRT techniques can help preserve salivary gland function 6