Dry mouth (xerostomia) is a subjectively unpleasant sensation of dryness of the mucous membrane, difficulty in eating, speech disorders caused by insufficient saliva secretion. The symptom occurs with lesions of the salivary glands, endocrine and metabolic disorders, pathology of the respiratory, digestive and urinary systems. To establish the degree of xerostomia and find out the causes, sialometry, sialography, and ultrasound are performed. To alleviate unpleasant symptoms, it is recommended to use moisturizing oral fluids, cholinergic drugs.
With insufficient salivation, there is a constant dryness of the mucous membrane, burning and discomfort (“burning mouth” syndrome), speech difficulties. It becomes difficult for the patient to chew and swallow solid food. Some patients constantly drink water or use special formulations to maintain the moisture of the epithelium. When examining the oral cavity, there is a small amount of viscous saliva, loss of luster and dryness of the mucosa, surface defects of the epithelium are revealed.
Saliva has trophic and protective properties for tooth enamel, therefore, with xerostomia, teeth are affected by caries. The absence of lysozyme and nuclease causes a decrease in primary immune defense, which leads to candidiasis, which manifests itself as a white coating on the epithelial membrane. Dryness and cracks of the lips are observed, often angular cheilitis is formed - long-term non-healing "jams" in the corners of the mouth. Elderly patients may complain of constant trauma to the mucosa when wearing prostheses.
Possible physiological dry mouth, caused by natural causes, and pathological. Taking into account the mechanism of development, neurogenic xerostomia is distinguished, which is caused by a violation of the central regulation of salivation, and medication, provoked by long-term use of antihypertensive drugs, atropine. In diagnostic terms, the most valuable is the classification according to the severity of the course, based on the subjective complaints of patients and objective signs. Based on this, there are three degrees of severity of the symptom:
Both some physiological factors and various pathological conditions lead to subjectively felt drying of the epithelium. The natural causes of dry mouth are the use of pickles, herring, and other foods containing a lot of salt. Drying of the mucous membranes is noted with insufficient humidity in the room. Dryness of the mouth of varying intensity, associated with sympathetic release, is possible with conflicts, quarrels, fear, and chronic stress.
The most common cause of severe xerostomia is inflammation of the salivary glands. The pathological process is at first unilateral, after a few days the inflammation passes to the opposite side. Patients complain of swelling in the area of the salivary glands, fever, painful opening of the mouth. Eating is difficult due to pain and dryness of the epithelium, which is caused by the cessation of secretion from the affected gland. Chronic sialadenitis is characterized by moderate pain, normal size of the salivary gland.
Complaints about drying out of the mouth are presented by patients with mumps - a viral infection that affects mainly the parotid salivary glands in children, less often - submandibular and sublingual. The symptom is combined with general intoxication, soreness and swelling of the glands on both sides, deforming the contours of the patient's face. Severe xerostomia with high fever, swelling, hyperemia in the area of inflammation, serve as symptoms of an abscess of the salivary gland, complicating the course of sialadenitis, sialolithiasis.
Dryness of the oral mucosa against the background of insufficient secretion of lacrimal fluid, burning in the eyes, drying out and peeling of the skin is typical for autoimmune gland damage in Sjögren's disease. Normal salivation is prevented by infiltration of the ducts by lymphocytes and plasma cells, an autoimmune reaction with the formation of antibodies to the glandular epithelium. The parotid glands usually increase in size symmetrically; when examining the mouth, bright pink reddening of the mucous membrane, contact bleeding, folding of the tongue, and multiple caries are revealed.
The close location of all anatomical structures, common innervation and blood supply cause disruption of the salivary glands when various organs of the oropharynx and nasopharynx are affected. Dryness of the epithelium is observed in inflammatory processes, some rare pathological conditions - glossalgia, parotid fistula, galvanosis. Common causes of xerostomia are:
The appearance of dry mouth is characteristic of intestinal infections, especially those accompanied by watery diarrhea and leading to severe dehydration. Xerostomia is pathognomonic of cholera, the gastrointestinal form of salmonellosis. It is possible to identify a symptom in the febrile period of other infectious pathologies - brucellosis, ornithosis, Crimean fever. The mucous membrane of the oral cavity dries up in the polyuric stage of hemorrhagic fever with renal syndrome, which is due to dehydration due to the release of up to 5 liters of urine per day.
Xerostomia with thirst and polyuria is a specific symptom of diabetes. In patients with type 1 diabetes, microangiopathies and elevated blood glucose are predisposing factors for dry mouth. In elderly patients with insulin-dependent diabetes, the symptom is considered a manifestation of diabetic polyneuropathy. In addition to dry mouth, the patient is concerned about constant weakness, itching, rashes, pustules, and fungal skin lesions. Similar symptoms occur with steroid diabetes.
The prerequisites for dryness of the central genesis are the discoordination of the work of the nervous system, the disruption of connections between the higher cortical structures and the autonomic nuclei of the medulla oblongata. The symptom is observed in patients with neurosis, panic attacks, organic anxiety disorder. Drying of the oral mucosa is characteristic of peripheral autonomic failure, polyneuropathy of pregnant women. Xerostomia develops in Lambert-Eaton syndrome, an autoimmune disease that affects the presynaptic membranes of neurons.
Dryness of the oral mucosa is a common symptom of pancreatic damage. With fibrosis of the organ, it is caused by secondary diabetes, with pancreatitis and split pancreas - digestive disorders. The symptom is detected in chronic gastritis and is combined with epigastric pain, stool instability, nausea and vomiting. Dryness, which is accompanied by pain in the right hypochondrium, a feeling of bitterness in the mouth, nausea, often becomes a sign of hepatitis.
In diseases of the urinary system, dry mouth is usually due to two mechanisms: dehydration due to polyuria and the accumulation of toxic protein compounds in the bloodstream. With renal colic caused by obstruction of the ureter or pyelocaliceal system, the situation is aggravated by pain syndrome with a pronounced sympathoadrenal reaction. In this condition, in addition to dry mouth, unbearable pain in the lower back, nausea and vomiting, and painful tenesmus are disturbing.
Often, xerostomia is provoked by nephrosclerosis, polycystic disease, and other severe kidney diseases with increasing chronic renal failure. The combination of dryness with edema, back pain is characteristic of nephritic syndrome of various etiologies. Drug-induced nephropathy is often accompanied by drug-induced xerostomia. The feeling of dryness in the mouth is typical for paraneoplastic nephropathy, which occurs with severe metabolic and immunological disorders.
Xerostomia in exogenous poisoning and endotoxemia is provoked by disruption of all body systems, discoordination of the nervous and humoral regulation of saliva secretion. With foundry fever and other poisonings with the inhalation of aggressive substances, the situation is aggravated by the direct damaging effect of vapors on the oral mucosa. The prerequisites for dryness of the mucous layer are:
In cancer cachexia, xerostomia occurs as a result of gross disturbances in the functioning of the body caused by endogenous intoxication with tumor metabolic products and decaying cancer cells. The condition is accompanied by dyspeptic disorders, exhaustion, severe anemia, changes in emotional and mental status, and insomnia. Dry mouth worries patients with massive intoxication of the body with tissue decay products in gangrene.
The secretion of saliva has not only nervous, but also humoral regulation. Various deviations from the normal levels of hormones and biologically active substances cause disturbances in the activity of all organs, including the salivary glands. The appearance of dryness of the oral mucosa is associated with secondary fluid losses that develop with violations of water-salt metabolism and homeostasis. Xerostomia is potentiated by such endocrine disorders as:
Xerostomia in critical conditions is due to several mechanisms: severe dehydration, impaired neurohumoral regulation, reflex reactions with excessive irritation of pain receptors. For these pathologies, the patient's condition is typically severe and extremely severe, dysregulation of basic vital functions. The patient needs urgent medical attention. Dry mouth is caused by:
Patients complaining of dry mouth usually go to the dentist and may then be referred to other specialists to clarify the diagnosis. Diagnostic search involves the appointment of laboratory and instrumental methods aimed at clarifying the state and function of the salivary glands, ascertaining the initial cause of the symptom. The most informative are:
Ultrasound examination of the salivary glands
Dry mouth of physiological genesis goes away on its own with the correction of the diet, the cessation of stressful influences. In other cases, to alleviate the condition and improve the quality of life, solutions are used to moisturize the mucosa, cholinergic agents. It is advisable to use a humidifier, especially during the heating season. To prevent secondary lesions of the oral cavity, it is necessary to observe hygiene, use irrigators and dental floss. To determine the cause of xerostomia and prescribe treatment, it is important to consult a specialist.