Dry Mouth
(Xerostomia)
The dental
term "xerostomia" means dryness of the mouth
due to a decreased function of the glands that produce
saliva. 3 out of 10 people suffer from this malady enough for it to
contribute to dental decay or periodontal disease.
Some
Causes of Dry Mouth
A permanent feeling of dry mouth or decreased saliva flow
can be caused by:
- biological aging - a contributing factor, but probably does not cause it
- systemic diseases such as;
- rheumatoid conditions (example: Sjogren's Syndrome, scleroderma)
- dysfunctional immune system (example: AIDS)
- hormonal disorders (example: Diabetes)
- neurologic disorders (example: Parkinson's disease)
- decreased chewing ability- resulting in a liquid diet and soft food choice which tend to decrease the flow of saliva
- surgical removal of salivary glands
Dry
mouth can occur due to:
- radiation therapy - radiation can result in permanent
damage to the salivary glands.
- drugs or medications - over 400 drugs cause dry mouth
as a side effect. Below is a list of many of them.
This list contains both prescription and over-the-counter medications
that may cause or aggravate this condition.
As with all medications, you should discuss potential side-effects with your
Doctor or Pharmacist before use.
CATEGORY
Brand Name (generic name)
ANOREXIANT
Adipex-P, Fastin, Ionamin, Zantryl (phentermine)
Anorex SR, Adipost, Bontril PDM (phendimtrazine)
Mazanor, Sanorex (mazindol)
Pondimin, Fen-Phen (fenfluramine)
Tenuate, Tepanil, Ten-Tab (diethylpropion)
ANTIACNE
Accutane (isotretinoin)
ANTIANXIETY
Atarax, Vistaril (hydroxyzine)
Ativan (lorazepam)
Centrax (prazepam)
Equanil, Miltown (meprobamate)
Librium (chlordiazepoxide)
Paxipam (halazepam)
Serax (oxazepam)
Valium (diazepam)
Xanax (alprazolam)
ANTICHOLINERIGIC/ANTISPASMODIC
Anaspaz (hyoscyamine)
Atropisol, Sal-Tropine (atropine)
Banthine (methantheline)
Bellergal (belladonna alkaloids)
Bentyl (dicyclomine)
Daricon (oxyphencyclimine)
Ditropan (oxybutynin)
Donnatal, Kinesed (hyoscyamne with atropine, phenobarbital, scopolamine)
Librax (chlordiazepoxide with clidinium)
Pamine (methscopolamine)
Pro-Banthine (propantheline)
Transderm-Scop (scopolamine)
ANTICONVULSANT
Felbatol (felbamate)
Lamictal (lamotrigine)
Neurontin (gabapentin)
Tegretol (carbamazepine)
ANTIDEPRESSANT
Anafranil (clomipramine)
Asendin (amoxapine)
Elavil (amitriptyline)
Luvox (fluvoxamine)
Norpramin (desipramine)
Prozac (fluoxetine)
Sinequan (doxepin)
Tofranil (imipramine)
Wellbutrin (bupropion)
ANTIDIARRHEAL
Imodium AD (loperamide)
Lomotil (diphenoxylate with atropine)
Motofen (difenoxin with atropine)
ANTIHISTAMINE
Actifed (triprolidine with psuedoephedrine)
Benadryl (diphenhydramine)
Chlor-Trimeton (chlorpheniramine)
Claritin (loratadine)
Dimetane (brompheniramine)
Dimetapp (brompheniramine with phenylpropanolamine)
Hismanal (astemizole)
Phenergan (promethazine)
Pyribenzamine(PBZ) (tripelennamine)
Seldane (terfenadine)
ANTIHYPERTENSIVE
Capoten (captopril)
Catapres (clonidine)
Coreg (carvedilol)
Ismelin (guanethidine)
Minipress (prazosin)
Serpasil (reserpine)
Wytensin (guanabenz)
ANTIINFLAMMATORY ANALGESIC
Dolobid (diflunisal)
Feldene (piroxicam)
Motrin (ibuprofen)
Nalfon (fenoprofen)
Naprosyn (naproxen)
ANTINAUSEANT
Antivert (meclizine)
Dramamine (dyphenhydramine)
Marezine (cyclizine)
ANTIPARKINSON
Akineton (biperiden)
Artane (trihexyphenidyl)
Cogentin (benztropine mesylate)
Larodopa (levodopa)
Sinemet (carbidopa with levodopa)
ANTI-PSYCHOTIC
Cloriaril (clozapine)
Compazine (prochlorperazine)
Eskalith (lithium)
Haldol (haloperidol)
Mellaril (thioridazine)
Navane (thiothixene)
Orap (pimozide)
Sparine (promazine)
Stelazine (trifluoperazine)
Thorazine (chlorpromazine)
BRONCHODILATOR
Atrovent (ipratropium)
Isuprel (isoproterenol)
Proventil, Ventolin (albuterol)
DECONGESTANT
Ornade (phenylpropanolamine with hyfrochlorothiazide)
Sudafed (psuedophedrine)
DIURETIC
Diuril (chlorothiazide)
Dyazide, Maxzide (triamterene and hydrochlorothiazide)
HydroDIURIL, Esidrix (hydrochlorothiazide)
Hygroton (chlothalidone)
Laxis (furosemide)
Midamor (amiloride)
MUSCLE RELAXANT
Flexeril (cyclobenzaprine)
Lioresal (baclofen)
Norflex, Disipal (orphenadrine)
NARCOTIC ANALGESIC
Demerol (meperidine)
MS Contin (morphine)
SEDATIVE
Dalmane (flurazepam)
Halcion (triazolam)
Restoril (temazepam)
Signs
and Symptoms
If you think you experience oral dryness, here are
some common signs and symptoms.
burning sensation of the tongue
difficulty eating, especially dry foods
difficulty with speech
often thirsty
difficulty wearing dentures
dry, cracked lips, and at the corners of the mouth
impaired taste
So
What If I Have a Dry Mouth?
Having a decreased flow of saliva has some serious
consequences. Heavy plaque and food
accumulations tend to occur with dry mouth (xerostomia).
This can lead to tooth decay and gum disease. Saliva is
the body's self-cleansing mechanism. It helps remove
food, debris, and plaque from the tooth surfaces, which
helps protect against oral diseases.
Saliva also protects against cavities.
It cleanses the tooth surfaces and neutralizes acids, and
in this way, protects the tooth surface from tooth decay.
People who have dry mouth (xerostomia) are very
susceptible to cavities, especially on the roots of their
teeth. One goal of treatment is to stimulate more saliva production when
xerostomia is severe. See the notes on pilocarpine and Lozi-Flur below.
How
to Control Dry Mouth
frequently sip water
keep fluids at bedside at night
chew sugarless gum
avoid tobacco, alcohol (including mouthwashes that
contain alcohol) and foods high in sugar
adjust the air humidity in your home
use a saliva substitute - this is a commercial product
which attempts to "wet" the mouth like saliva
does; it
can be found in most pharmacies
establish a good plaque control program - since heavy
plaque accumulations occur with oral dryness
use the Retardent
/ Retardex Oral Care System with
with ClO2SysII. These are only available from dental
offices.
We maintain its availability for you. If you are not near our
practice, ask your dentist to stock this product for you.
Avoid alcohol and phenol containing mouth rinses
use fluoride - toothpaste, rinse, or gel
- Lozi-Flur tablets (available at the
office)
Finally, there may be a need for drug therapy for dry mouth:
Pilocarpine is one such preparation. The FDA has granted marketing approval for an oral preparation of pilocarpine hydrochloride (Salagen/MGI Pharma) for treatment of radiation-induced xerostomia (dry mouth) in patients with cancer of the head and neck. The product is the first pharmacologic treatment for dry mouth. Pilocarpine, which has been used for over a century to treat glaucoma, was first isolated from the leaves of the South American plants Pilocarpus jaborandi and Pilocarpus microphyllus in 1875.
An estimated 40,000 cancers of the head and neck are diagnosed each year in the United States, and most of the patients undergo radiation therapy. The radiation can cause permanent damage to the salivary glands, with a major effect on the patient's quality of life. Direct effects can include difficulty in talking, eating, and sleeping; rapid tooth decay; and increased risk of periodontal disease and oral infections. Indirect effects can include nutritional deficiencies, weight loss, and altered social habits.
Pilocarpine is a cholinergic parasympathomimetic agent with a broad range of pharmacologic effects. It increases secretion by the
exocrine glands and can affect the sweat, salivary, lacrimal, gastric, pancreatic, and intestinal glands and the mucosal cells of the
respiratory tract. The most common side effect with Salagen treatment has been moderate sweating. Other side effects have included nausea, runny
nose, chills, flushing, urinary frequency, dizziness, and fatigue. Salagen use is contraindicated in uncontrolled asthma, known
hypersensitivity to pilocarpine, and when miosis (contraction of the pupil) is undesirable, in acute iritis and narrow-angle glaucoma.
Patients with cardiovascular disease should receive pilocarpine only under close supervision. Concomitant administration of
beta-adrenergic antagonists could result in conduction disturbances.
Two pivotal studies have demonstrated the
usefulness of Salagen in improving salivary function in patients with radiation-induced
xerostomia. The first study involved 207 patients who had received radiation therapy for head and neck cancers. The patients received 5 or 10 mg pilocarpine or placebo
by mouth three times a day for 12 weeks. Oral dryness improved in 44% of the 5- mg pilocarpine group, compared with 25% of the
placebo group. Overall improvement occurred in 54% of the 5-mg group, compared with 25% in the placebo group.
The 10-mg pilocarpine group also showed significantly greater improvement than
the placebo group.
The second study a total of 162 patients received placebo or 2.5-mg pilocarpine tablets for 4 weeks, followed by 5-mg tablets for 4weeks and then 10-mg tablets for 4 weeks. Patients were permitted to adjust their individual doses for best effect (up to increase
therapeutic effect, down to reduce side effects). Overall assessments showed significantly greater improvement with
pilocarpine than with placebo. Active treatment also produced less need for artificial saliva, hard candy, water, and other "oral comfort
agents." All the drug dosages were found to be safe, and there were no serious treatment-related adverse events.
Salagen is available as 5-mg film-coated tablets. The recommended dosage is 5 mg three times a day, titrated up to 10 mg three times
a day if the lower dosage is not effective. However, the lowest effective dosage should be used to avoid or minimize side effects.
Dry
mouth (xerostomia) can result in oral discomfort and
can have serious consequences. If you feel you have this
symptom, please contact our office for assistance.
Credits: This page initially was researched by the dental hygiene students, Marie Jaworski, Mary Ann Klippenstein, Francesca Anania and Robin Chambers Class of 1997 at the University of Manitoba, Canada. Also by LaClede, the California Dental Hygienist Assoc. and the June 1994 issue of Medical Sciences Bulletin.