Xerostomia

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Xerostomia
Xerostomia.jpg
SJÖGREN'S syndrome: Along with the symptoms of keratoconjunctivitis sicca and xerostomia. This woman has marked enlargement of the left parotid gland and slight enlargement of the right parotid gland.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
ICD-10 K11.7, R68.2
ICD-9 527.7
DiseasesDB 17880

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Xerostomia is the medical term for a dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties or cottonmouth.

Xerostomia can cause difficulty in speech and eating. It also leads to halitosis and a dramatic rise in the number of cavities, as the protective effect of saliva is no longer present, and can make the mucosa of the mouth more vulnerable to infection. Notably, a symptom of methamphetamine abuse usually called "meth mouth" is largely caused by xerostomia.

Causes

It may be a sign of an underlying disease, such as Sjögren's syndrome, poorly controlled diabetes, dehydration , or a side effects of medication.

Other causes of insufficient saliva include anxiety, alcohol, trauma to the salivary glands or their ducts or nerves, excessive mouth breathing, previous radiation therapy, and also a natural result of aging. The vast majority of elderly individuals will suffer xerostomia to some degree. Playing or exercising a long time outside on a hot day will often cause your saliva glands to simply dry up as your bodily fluids are concentrated elsewhere. Drugs have also been known to cause this problem, such as cannabis, and DXM.It can also be associated with rare condition like Eaton-Lambert syndrome.

Causes by organ system

Cardiovascular No underlying causes
Chemical / poisoning

3-Quinuclidinyl benzilate, Arsenic Poisoning

Dermatologic No underlying causes
Drug Side Effect

Abciximab (patient information), Acamprosate calcium, Acitretin (patient information), Actiq, Adderall, Ajulemic acid, Albuterol (patient information), Alfentanil Hydrochloride Injection (patient information), Anticholinergic, Azelastine, Benzatropine, Benztropine Mesylate Oral (patient information), Benzydamine, Benzylpiperazine, Bepridil (patient information), Bevacizumab Injection (patient information), Biperiden, Brompheniramine (patient information), Budesonide, Buprenorphine, Bupropion, Buspirone (patient information), Butorphanol, Butorphanol Injection (patient information), Calcitriol (patient information), Calcium carbonate (patient information), Carbamazepine (patient information), Cetuximab Injection (patient information), Cevimeline, Chlordiazepoxide (patient information), Chloropyramine, Chlorpheniramine (patient information), Chlorpromazine (patient information), Chlorprothixene, Clomipramine (patient information), Clonazepam (patient information), Clonidine, Clozapine, Codeine, Cyclobenzaprine (patient information), Cyproheptadine (patient information), Desloratadine, Dextroamphetamine, Diazepam (patient information), Dicyclomine (patient information), Diethylpropion (patient information), Diltiazem (patient information), Dimenhydrinate, Diphenhydramine, Diphenoxylate and Atropine (patient information), Dosulepin hydrochloride, Doxylamine (patient information), Duloxetine, Eribulin, Erlotinib (patient information), Esomeprazole (patient information), Estazolam (patient information), Exenatide Injection (patient information), Fencamfamine, Fesoterodine, Fexofenadine (patient information), Flavoxate (patient information), Fluacizine, Flucytosine, Fluphenazine (patient information), Fosamprenavir (patient information), Frovatriptan (patient information), Gabapentin (patient information), Galantamine (patient information), Ganciclovir (patient information), Gatifloxacin (patient information), Glimepiride (patient information), Glipizide (patient information), Glyburide (patient information), Glycopyrrolate (patient information), Guanabenz (patient information), Guanethidine (patient information), Guanfacine (patient information), Haloperidol Oral (patient information), Hexamethonium, Hydroxyzine (patient information), Hyoscyamine (patient information), Iloperidone, Imipramine (patient information), Insulin Aspart (rDNA Origin) Injection (patient information), Interferon beta-1a Subcutaneous Injection (patient information), Ipratropium Oral Inhalation (patient information), Isocarboxazid (patient information), Isoetharine Oral Inhalation (patient information), Isoproterenol Oral Inhalation (patient information), Isosorbide (patient information), Ketorolac, Ketotifen, Lacosamide, Leflunomide, Letrozole, Levalbuterol Oral Inhalation (patient information), Levocetirizine, Levodopa and Carbidopa (patient information), Levomepromazine, Lithium (patient information), Lofepramine, Lorcaserin, Loperamide, Lopinavir and Ritonavir (patient information), Loratadine (patient information), Lorazepam (patient information), Loxapine Oral (patient information), Meperidine (patient information), Meropenem Injection (patient information), Mesalamine (patient information), Mesoridazine Oral (patient information), Metaproterenol (patient information), Metformin (patient information), Methylphenidate Transdermal (patient information), Metoprolol (patient information), Metronidazole Oral (patient information), Miglitol (patient information), Milnacipran hydrochloride, Moclobemide, Modafinil (patient information), Moxonidine, Nabilone (patient information), Nabumetone (patient information), Nalbuphine injection (patient information), Nateglinide oral (patient information), Nefazodone (patient information), Nialamide, Nicardipine (patient information), Nitroglycerin ointment (patient information), Nortriptyline (patient information), Olanzapine (patient information), Omeprazole (patient information), Orphenadrine (patient information), Oxaliplatin injection (patient information), Oxazepam (patient information), Oxcarbazepine (patient information), Peginterferon alfa-2a (patient information), Peginterferon alfa-2b (patient information), Penbutolol (patient information), Pentamidine Isethionate, Pergolide (patient information), Perphenazine oral (patient information), Phentermine (patient information), Pimozide (patient information), Pindolol (patient information), Pioglitazone (patient information), Pirbuterol acetate oral inhalation (patient information), Pizotifen, Pramipexole (patient information), Prazepam (patient information), Pregabalin (patient information), Procarbazine (patient information), Procyclidine (patient information), Propafenone (patient information), Propantheline (patient information), Protriptyline (patient information), Quazepam, Quetiapine (patient information), Quinethazone, Rabeprazole (patient information), Rasagiline (patient information), Reboxetine, Repaglinide (patient information), Reserpine (patient information), Ribavirin (patient information), Rimabotulinumtoxinb, Rilmenidine, Risedronate (patient information), Risperidone (patient information), Rizatriptan (patient information), Ropinirole (patient information), Rosiglitazone (patient information), Salmeterol oral inhalation (patient information), Scopolamine patch (patient information), Selegiline (patient information), Sibutramine (patient information), Solifenacin (patient information), Sorafenib (patient information), Spironolactone (patient information), Sulpiride, Sunitinib (patient information), Temazepam (patient information), Thalidomide, Thioridazine (patient information), Thiothixene Oral (patient information), Tizanidine, Tolazamide (patient information), Tolbutamide (patient information), Tolterodine (patient information), Topiramate, Tranylcypromine (patient information), Trazodone (patient information), Triamterene (patient information), Triazolam, Tricyclic antidepressant, Trifluoperazine Oral (patient information), Trihexyphenidyl (patient information), Trimipramine (patient information), Tripelennamine, Trospium Trospium (patient information), Vicodin, Vinpocetine, Zaleplon (patient information), Zimelidine, Zoledronic Acid Injection (patient information), Zolmitriptan, Zolpidem (patient information), Zonisamide (patient information), Zopiclone, Zotepine,

Ear Nose Throat

Excessive mouth breathing

Endocrine

Diabetes

Environmental

Multiple chemical sensitivity

Gastroenterologic

Zenker's diverticulum

Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic

Radiation therapy

Infectious Disease

Botulism

Musculoskeletal / Ortho No underlying causes
Neurologic

Ramsay Hunt syndrome type II

Nutritional / Metabolic

Hyperglycemia

Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity

Albuterol, galantamine, methylphenidate transdermal, omeprazole

Psychiatric

Anxiety,depression

Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy

Sjogren's syndrome, Eaton-Lambert syndrome

Sexual No underlying causes
Trauma

Trauma to the salivary glands

Urologic No underlying causes
Miscellaneous

Dehydration, hyperosmolar syndrome

Causes in alphabetical order


Differential Diagnosis

In alphabetical order. [1] [2]

With parotid gland swelling

Without parotid gland swelling

Treatment

Treatment involves finding any correctable causes and fixing those if possible. In many cases it is not possible to correct the xerostomia itself, and treatment focuses on relieving the symptoms and preventing cavities. Patients who have endured chemotherapy usually suffer from this post- treatment. Patients with xerostomia should avoid the use of decongestants and antihistamines, and pay careful attention to oral hygiene. Sipping sugarless fluids frequently, chewing xylitol-containing gum[3], and using a carboxymethyl cellulose saliva substitute as a mouthwash may help. Aquoral may be prescribed to treat xerostomia. Non-systemic relief can be found using an oxidized glycerol triesters treatment used to coat the mouth.

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. Jensen JL, Langberg CW (1997): Temporary hyposalivation induced by radiation therapy in a child. Tidsskr Nor Loegeforen 21:3077-9

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