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SALIVARY GLANDS - XEROSTOMIA A frequent and perplexing problem seen in the Salivary Gland Center (SGC) concerns dry mouth. Since salivaÌs involvement in homeostasis is well documented, the patient with xerostomia will have a constellation of complaints. These include oral burning, pain, candidiasis, caries, taste alteration, salivary gland infections, and difficulties with speech, mastication and deglutition.
The most common cause of a xerostomia complaint is somatoform in origin. Stressed patients have as their common denominator histories of emotional disturbances, difficulty with sleeping, appetite loss, and a belief that the dryness intensifies as the day progresses. Oral signs include TMJ disturbances, bruxing, clenching, stomatodynia, dysgeusia, and masseteric hypertrophy. Precipitating factors usually comprise some oral event (dental care) or stressful social condition. Calibration of salivary volume and chemistry in these patients with disturbed salivary perceptions reveals normal salivary volume and chemistry in both resting and stimulated salivary states.
The autoimmune disease SjogrenÌs syndrome is diagnosed by its hallmarks-xerostomia, xerophthalmia and a connective tissue disease (usually rheumatoid arthritis). Despite a high liquid intake, patients have difficulty with swallowing dry foods. Pathologic loss of parenchymal cells causes a significant decrease in both resting and stimulated salivary production. Furthermore, the SGC has demonstrated a pathognomonic sialochemical profile.
Radiation for oral malignancies leads to sialadenitis, parenchymal loss and xerostomia. The extent of involvement is dependent upon radiation dosage and the beamÌs pathway. Both resting and stimulated volumes are decreased, but some improvement can be expected with time. Other causes of xerostomia include uncontrolled diabetes, dehydration, sarcoid, and HIV. The evidence for causative factors such as aging or chemotherapy is questionable.
Symptomatic treatment for xerostomia involves the use of stimulants (Salagen/pilocarpine), sugarless sour candy and chewing gum, artificial salivas, increased fluid intake, oral lubricants and a non irritating toothpaste (Biotene). The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
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host of systemic medications (psychotherapeutic drugs, antihypertensives,
sedatives, antihistamines, gastric acid inhibitors, etc) represent
another cause of xerostomia. Their anticholinergic activity only
affects resting saliva. When saliva is stimulated, the drug effect
is overcome and a normal volume is obtained. Therein lies the ability
to differentiate the medication inhibited gland (dry only at rest)
from the pathologic gland (decreased volume at rest and when stimulated).