Dry Mouth and Hyposialia in the Elderly
Dry mouth or xerostomia is a common symptom in the elderly. Sometimes, it is a reason to consult a dentist. It can be:
- Subjective: sensation of dry mouth without hyposialia;
- Objective: sensation of dry mouth with hyposialia.
- REMINDERS :
- Salivary glands :
The salivary glands produce and secrete saliva. They are located in and around the mouth and throat. The main salivary glands are the parotid, submandibular, and sublingual glands.
In addition, numerous small, so-called “minor” salivary glands line the tongue, lips, inside of the cheeks (vestibular mucosa) and are found abundantly on other mucous membranes of the mouth and throat.
- Saliva :
Saliva is a biological fluid essential for maintaining oral health and the proper functioning of many oral functions (chewing, tasting, digestion, speaking, etc.).
Saliva flow varies from person to person, but is remarkably stable within a given individual. The average person produces 500 ml of saliva in 24 hours. High saliva flow is associated with good oral health, and low saliva flow is associated with oral diseases.
Saliva doesn’t just moisten the mouth. Normal saliva contains antibodies, enzymes, and buffer solutions. Saliva plays an important role in speech, taste, chewing, swallowing, digestion, nutrition, and in protecting the mouth, lips, and esophagus. It prevents cavities by maintaining a neutral oral pH and limiting the acid produced by the breakdown of sugars.
Without the cleansing and protective effect of normal saliva flow, periodontal disease becomes more common. A constantly dry mouth unprotected by saliva contributes to bad breath. Dry mouth reduces the comfort of full dentures, as these appliances require a layer of saliva to properly adhere to the oral tissue.
It can be difficult to swallow medication with less saliva; this can lead to non-compliance with medication treatment. Dry mouth can also delay the dissolution of sublingual nitroglycerin tablets, for example.
- Salivary flow rates :
The volume of salivary secretion is highly variable (between 0.5 and 1.5 liters, with an average of 0.75 liters in 24 hours). It is influenced by multiple factors such as:
- the degree of hydration,
- body position,
- circadian and circannual rhythms,
- the size of the glands
- the medications or drugs taken.
The contribution of each gland also varies depending on the type of stimulation (gustatory and/or masticatory), the state of alertness of the subjects (circadian cycle) and the circannual cycle. During the circadian cycle, secretion is low during sleep, while peaks occur during periods of stimulation (during meals and especially during acid stimulation). At the circannual level, secretion is low during summer, while it is maximum in winter. These variations also affect the concentration level of electrolytes and proteins present in saliva.
- DEFINITIONS :
- Xerostomia :
Xerostomia is a dry mouth caused by decreased or absent saliva production.
It refers to all the subjective symptoms felt by the patient.
Xerostomia is a common complaint affecting approximately 20% of older adults.
- Hyposialia :
Corresponds to an objective decrease in salivary flow.
- Asialie :
It refers to the total absence of salivary flow.
- ETIOLOGIES :
- Diseases :
Dry mouth can be a single occurrence, but it is most often caused by one of the following underlying health problems:
- Addison’s disease (endocrine disease)
- alcoholic cirrhosis
- Alzheimer’s disease
- cystic fibrosis
- depression
- general dehydration
- hyperlipidemia
- salivary gland infection
- uncontrolled hypertension
Dry mouth also occurs in people with autoimmune disease; in people infected with HIV, the immune system attacks the salivary glands and causes inflammation.
Dry mouth can occur in the presence of systemic diseases such as rheumatoid arthritis. Diabetes can cause swelling of the salivary glands, particularly the parotid glands.
Sjögren’s syndrome is an autoimmune disease that mistakenly attacks the moisture-producing glands, causing dry eyes and mouth. This disease, which is very common and affects more women than men, most often occurs after the age of 50.
- Drugs :
Prescription and over-the-counter medications are one of the most common causes of dry mouth. Some of the medications most likely to cause this problem include:
- anticholinergics
- antidepressants
- antihypertensives
- antipsychotics
- decongestants
- diuretics
- painkillers
- Other causes :
- Cancer therapy : Chemotherapy drugs can alter the nature and quantity of saliva. Radiation therapy to the head and neck can cause damage to the salivary glands, resulting in a marked decrease in saliva production.
- Alcohol : Alcoholics may have swollen salivary glands, usually on both sides of the mouth.
- Nerve damage : Any injury or surgery that causes damage to the neck and head area can also lead to dry mouth.
- Reduced Chewing Ability : Reduced chewing ability results in the establishment of a liquid or soft food diet, which causes decreased saliva flow.
- Obstruction: The formation of stones in the parotid or submandibular glands can obstruct the flow of saliva.
- Dehydration : Fever, excessive sweating, vomiting, diarrhea, blood loss, or burns cause dehydration; therefore, they can also lead to dry mouth.
- Menopause
- DRY MOUTH AND AGING :
Until recently, dry mouth was considered a normal part of aging. Researchers now know that healthy older adults do not produce less saliva than others. When older adults experience dry mouth, it’s because they have a medical condition or are taking medication.
- SIGNS AND SYMPTOMS OF DRY MOUTH :
| Signs and symptoms | |
| Saliva | Reduced, thick and/or viscous |
| Language | DryRough or irritatedRed and soreTingling or burning sensation |
| Taste | Altered or lost |
| Swallowing | Difficulty chewing and swallowingAcid reflux |
| Mucous membrane | Sensitive to acidic, salty and spicy foods |
| Teeth | Dental caries |
| Lips | DryCrackedSores or cracks at the corners of the mouth |
| Breath | Bad breath more frequentSulfur-like odor |
Other signs not related to the mouth, but frequently observed: Dry eyes, constipation , dry nose, fatigue, dry skin, weight loss , heartburn, reduced sweating , recurrent vaginal infections.
- TREATMENTS FOR DRY MOUTH :
- Topical agents :
Topical agents are commonly recommended to treat dry mouth. These products have chemical and physical characteristics that resemble those of natural saliva. Their side effects are rare, and those with dry mouth should use these products as often as needed to moisten their mouth. Before using their dentures, people with dry mouth should moisten the surface with one of these products.
- Systemic treatment :
Oral pilocarpine stimulates saliva flow from the minor salivary glands. These glands are known to be rich in mucin, a component of saliva that acts as a lubricant and protects the lining of the mouth and throat.
Adverse effects of pilocarpine are dose-related. Sweating, along with chills, nausea, dizziness, urinary frequency, palpitations, and gastrointestinal disturbances are the most common side effects. Patients with uncontrolled asthma, acute iritis, or narrow-angle glaucoma should not take pilocarpine.
Pilocarpine appears to be moderately effective in relieving symptoms of dry mouth.
Because the modes of action of pilocarpine and artificial saliva are different, both can be used simultaneously to relieve dry mouth.
- Other treatments :
- Chewing sugar-free gum can stimulate saliva flow. Chewing gum moves saliva between the teeth, which helps prevent cavities.
- Biotène products (chewing gum, mouthwash, toothpaste) help block the production of acid by the bacteria that form plaque.
- Topical anesthetics, such as 2% viscous lidocaine, can be used before meals or at bedtime to relieve pain associated with mouth ulcers.
- Promising new treatments are currently being researched. Scientists are looking for ways to repair damaged salivary glands and are developing an artificial salivary gland implant.
Table: Products used to treat dry mouth
CONCLUSION
Dry mouth is a common condition among older adults. In fact, during old age, several factors (diseases, medications) can cause dry mouth by slowing down the activity of the salivary glands . This lack of saliva can be a source of cavities, caries, and various infections, since saliva helps maintain a suitable level of bacteria in the mouth.
Dry Mouth and Hyposialia in the Elderly
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