Xerostomia - A Short Review

 

Priyadharshini.R¹, Kartikeyan Murthykumar¹, Rajanivetha.R¹, Nirmal Kumar¹, R Gayathri Devi²

¹3^rd year BDS, BDS Saveetha  Dental College and Hospitals, Chennai, India

²2^nd year, BDS Saveetha  Dental College and Hospitals, Chennai, India

 

ABSTRACT:

Xerostomia refers to a subjective sensation of a dry mouth; it is frequently, but not always associated with salivary gland hypofunctions. Xerostomia is a common problem that has been reported in 25% of older adults. In the past, complaints of dry mouth in older patients often were ascribed to the predictable result of aging. However, it is now generally accepted that any reductions in salivary functions associated with age are modest and probably are not associated with any significant reductions in salivary functions. Instead, xerostomia in older adults is more likely to be the result of other factors, especially medications. More than 500 drugs have been reported produce xerostomia as a side effect and also Sjogrens syndrome plays a role in the cause of xerostomia. This review briefly discuss about the drugs causing xerostomia and about the Sjogrens syndrome.

 

 

 

INTRODUCTION:

Xerostomia (also termed as dry mouth) is the medical term for the subjective symptoms of dryness in the mouth, which may be associated with a change in the composition of saliva  or reduced salivary flow  or have no identifiable cause (1).  Xerostomia is the subjective feeling of oral dryness, which is often associated with hypofunction of the salivary gland (2).

 

The term is derived from the Greek word (xeros) meaning “dry” and (stoma) meaning “mouth” (3). This symptom is very common and is very often seen as side effects of  many types of medication. It is more common in older people and in persons who breathe through their mouths (1).

 

Absence of saliva:

If the salivary flow is absent or less in the oral cavity it may lead to many sorts of diseases and problems some are dental caries, oral candidiasis, dysphagia, dysgeuia, intra oral halitosis, difficulty in wearing dentures, mouth soreness, oral mucositis, food may stick to the teeth, dry sore, and cracked lips and angles of mouth (4).

Xerostomia may be a symptom of a serious systemic diseases, such as systemic lupus erthymatosus, rheumatoid arthritis, scleroderma, sarcoidosis, amyloidosis, Sjogren’s syndrome and hypothyroidism.

 

Drugs with actions on salivation:

There is usually a fair close temporal relationship between starting the drug treatment or increasing the dose, and experiencing dry mouth. However, remarkably few studies on drug-related oral dryness have examined salivary flow, much of the data, unfortunately, being based on a subjective complaints of ‘dry mouth’ (5).

 

Drugs Inducing Xerostomia:

Several hundred medications can cause xerostomia (6), including antihypertensive, anorexiants, antiacne agents, antianxiety agents, anticholinergic, anticonvulsants, antidiarrheals, antiemetics, anti-inflammatory, antinauseants, antiparkinsonian agents, antipsychotics, antidepressants, analgesic, bronchodilators, decongestants, muscle relaxants, sedatives, tranquilizers, diuretics, and antihistamines (7). These drugs affect the saliva’s quantity and possibly quality, but usually the problem is temporary or reversible. The most common cause of drug-induced xerostomia is the altering of neural pathways that stimulate the salivary glands secretions (8).

 

The list of medications associated with xerostomia continues to grow as new drugs are released. Other drug classes now known to cause xerostomia include the proton pump inhibitors, protease inhibitors and reverse transcriptase inhibitors for HIV infection, analgesic and narcotics for pain control, a variety of anti-infective agents and some anti-neoplastic agents.

 

Some of the medications causing xerostomia are:

·        Abciximab

·        Adenosine

·        Alprazolam

·        Atenolol

·        Clozapine

·        Codeine

·        Cyclosporine

·        Diazepam

·        Diaoxide

·        Diclofenac potassium

·        Enoxacin

·        Lovastatin with niacin

·        Modafinil

·        Thalidomide

·        Tolcapone

 

Non- Pharmacological  causes of dry mouth:

·        Accidental or surgical trauma

·        Autoimmune or chronic disease.

·        Bone marrow transplant

·        Endocrine disorders.

·        Hyposecretory conditions.

·        Mental illness

·        Radiation    

 

Sjogren’s syndrome:

Sjogren’s syndrome is a chronic autoimmune disease in which the body’s white cell destroy the exocrine glands, specifically the salivary and lacrimal glands, that produce saliva and tears, respectively (9). The immune-mediated attack on the salivary and lacrimal gland leads to the development of xerostomia and dry eyes, which takes place in association with lymphocytic infiltration of glands (10). That inflammatory process eventually severely damages and destroys the glands. There have been numerous reports describing lung (11,12), renal (13), and central nervous system (14-16) involvement.

 

CONCLUSION:

Since several pharmacological and non pharmacological agents causes xerostomia a precise knowledge about sjogren’s syndrome and drug inducing xerostomia must be established in the upcoming years.

 

REFERENCES:

1.       Scully, Crispian (2008). Oral and maxillofacial medicine: the basis of diagnosis and treatment (2^nd ed.). Edinburg: Churchill Livingstone. pp. 17, 31, 41,79-85. ISBN 978044306.

2.       Tyldesley, Anne Field, Lesley Longman in collaboration with William R. (2003). Tyldesley’s Oral medicine (5^th ed.). Oxford : Oxford University Press. pp. 19, 90-93.

3.       Cathy L. Bartels, Pharm. D., Assistant Professor, Pharmacy Practice, School of Pharmacy and Allied Health Sciences, University of Montana.

4.       Bouquot, Brad W. Neville, Douglas D. Damm, Carl M.Allen, Jerry E. (2002). Oral and maxillofacial pathology (2.ed.). Philadelphia: W.B. Saunders.  pp.398-399.

5.       Boyd LD, Dwyer JT, Papas A (1997). Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors : a case study. Nutr Rev 55:362-368.

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9.       Borchers, A. T., Naguwa, S. M., Keen, C.L. and Gershwin, M.E. Immunopathogenesis of  Sjogren’s syndrome. Clin. Rev. Allergy Immunol. 25, 89-104 (2003).

10.     Nocturne, G. and Mariette, X. Advances in understanding the pathogenesis of primary Sjogren’s syndrome. Nature Reviews Rheumatology 9, 544-556 (2013).

11.     Mialon P, Barthelemy L, Sebert P, Le Henaff C, SarniD, Pennec YL et al. A longitudinal study of lung impairment in patients with primary Sjogren’s syndrome. ClinExpRheumatol 1997;15:349-54.

12.     Franquet T, Gimenez A, Monill JM, Diaz C, Geli C. Primary Sjogren’s syndrome and associated lung disease: CT findings in 50 patienrs. Am J Roentgenol. 1997;169:655-8.

13.     Shiozawa S, Shiozawa K, Shimizu S, Nakada M, IsobeT, Fujita T. Clinical studies of renal disease in Sjogren’s syndrome. Ann Rheum Dis 1987;46:768-72.

14.     Moutsopoulos HM, Sarmas JH, Talal N. Is central nervous system involvement a systemic manifestation of primary Sjogren’s syndrome? Rheum Dis Clin North Am 1993;19:909-12.

15.     Hietaharju A, Jantti V, Korpela M, Frey H. Nervous system involvement in systemic lupus erythematosus, Sjogren syndrome and scleroderma. ActaNeuroScand 1993;36:340-7.

16.     Alexander E. Central nervous system disease in Sjogren’s syndrome. New insights into immunopathogenesis. Rheum Dis Clin North Am 1992; 18:637-72.

 

 

Received on 10.08.2014       Modified on 16.08.2012

Accepted on 19.08.2012      © RJPT All right reserved