Medical Conditions and Lifestyle
It often takes years to get an accurate diagnosis of hyposalivation or xerostomia.10 Some health care providers consider dry mouth a vague symptom or a life inconvenience, but in direct contrast, those with dry mouth actually require more careful management by dental professionals, especially if the patient has cognitive issues.53
Dry mouth syndrome is now a well-recognized complication for a number of medical conditions including autoimmune disorders, radiation treatment to the head and neck area, salivary gland dysfunction, chronic renal failure, liver disorders, rheumatoid diseases, HIV/AIDS, Parkinson’s disease, thyroid disease, and diabetes mellitus.2,5,8-10,12,31,36,54-60 Hyposalivation is also an issue for those who experience hormonal imbalance, nasal blockage, sleep apnea, chronic obstructive pulmonary disease, gastric esophageal reflux disease and high fevers.2,31,62-64
Typically, there are natural decreases in salivary flow with age, especially in women.14,16,19-22 Decreased estrogen levels, as a result of either natural or surgically induced menopause, can lead to decreased salivary flow. Dry mouth is common for those with late stage terminal illness and severe dry mouth often occurs within the last few weeks of life.65-68
Sjögren’s Syndrome is the classic dry mouth disease, known as primary Sjogren’s (Figure 2). Dry mouth is a frequent symptom for many autoimmune disorders often resulting in a diagnosis of secondary Sjögren’s. Ninety percent of those diagnosed with Sjögren’s are women. It is not uncommon for a patient to be diagnosed with multiple auto immune disorders.2,5,10,19 Autoimmune disorders tend to cluster in families; however, members of the same family may have different conditions.
Figure 2. Sjögren’s Syndrome.
Image courtesy of Dr. Géza T. Terézhalmy.
Dry mouth is the most common side effect for both prescribed and over-the-counter medications, including herbal preparations and supplements.2,31,38 A wide range of medications can mediate or potentiate dry mouth issues. Medications used to control or modulate hypertension, anxiety, depression, pain, seasonal allergies, asthma, appetite control, and nausea can each contribute to hyposalivation.69-75 Medical marijuana also causes dry mouth.
Seniors are at the highest risk for dry mouth for two reasons. They are more likely to have one or more diseases that cause dry mouth, and this age cohort has higher rates of polypharmacy. It is estimated that those above the age of 60 take, on average, three medications daily, increasing the overall risk for dry mouth.2,31,38