Diseases/Conditions Associated with Xerostomia

If you were a tooth sleuth, you would recognize the number one culprit that causes dry mouth is an individual’s medication(s) but there are a number of diseases or conditions like those listed below that can cause dry mouth. Sjögren’s syndrome, HIV/AIDS, Diabetes, Hypertension, Hepatitis C and Lymphoma are some diseases associated with dry mouth.27 Sometimes, dry mouth is worsened by a combination of disease and various medications and it is difficult to identify the main culprit(s).

  • Sjögren’s syndrome (pronounced SHOW-grins) is a chronic, serious autoimmune disease in which the body’s immune system attacks its own moisture producing glands. An estimated 1 to 4 million people are affected by this syndrome. Women are affected nine times more frequently than men.27 Dry eyes and dry mouth are a serious side effect of this condition. Sjögren’s disease may also cause dryness of other organs, affecting the kidneys, GI system, blood vessels, lung, liver, pancreas, and the central nervous system.3 Many Sjögren’s patients experience debilitating fatigue and joint pain. Keep in mind that about 50% of the time, Sjögren’s syndrome occurs alone and the other 50% of the time it occurs in the presence of other connective tissue diseases such as rheumatoid arthritis, lupus, or scleroderma.3
  • HIV-associated salivary gland disease (HIV-SGD) can resemble Sjögren’s syndrome, and both conditions are associated with bilateral parotid enlargement.4 HIV-SGD is defined as the presence of xerostomia and/or swelling of the major salivary glands and is more common in children than adults.5 Approximately 4-8% of adults with HIV infection have salivary gland disease, and it is important to note that it can also be associated with Kaposi’s sarcoma, non-Hodgkin’s lymphoma, intraglandular lymphadenopathy, and acute suppurative sialadenitis. According to the literature, salivary gland disease tends to appear in late HIV infection but it can also be the first manifestation of HIV disease. Enlargement of the salivary glands, is often left untreated and close observation is the mainstay of treatment in this case. Once HIV-SGD is established and other diseases and factors that could cause enlargement of the salivary glands are ruled out, assessment of salivary function should be performed during an initial dental examination. It is particularly important to confirm function of salivary glands by milking them in this particular disease group, too. Purulent discharge from salivary ducts could indicate an acute infection that would need to be treated appropriately. Specialist care should be obtained to rule out other possible causes of an acute infection like the possibility of a tumor or other infection or sialolithiasis. When antiretroviral therapy is implemented, oftentimes HIV-SGD will show regression.6
  • Diabetes is also associated with xerostomia. Symptoms such as alteration of taste, burning mouth, oral Candida, and signs of salivary gland enlargement, mainly the parotid, may be associated with the disease. Salivary flow rates often found to be significantly reduced in patients with type 2 diabetes, may be associated with salivary gland abnormalities.7
  • Nutritional deficiencies are often associated with xerostomia, particularly in the free-living and institutionalized elderly.8 Contributing factors that are also associated with xerostomia in this population group are chronic degenerative diseases and the usage of multiple pharmacologic agents. Nearly one in five older adults show signs of xerostomia. Elderly people with xerostomia have problems in lubricating, masticating, tolerating, tasting, and swallowing food.
  • Bulimia nervosa is an emotional disorder characterized by episodes of binge eating followed by a method of urging at least two days per week for a period of at least three months. The purge can be any of the following methods: vomiting, laxatives, diet pills, over exercising, diuretics, and/or fasting. Reductions in salivary flow rates and xerostomia have been found in these individuals.9
  • Blood and marrow transplantation is often associated with xerostomia. Salivary gland dysfunction is a common sequela of the bone marrow transplantation procedure. Researchers have determined the effect of different bone marrow transplantation protocols on parotid salivary flow rate.10 Salivary flow rate is reduced when lymph nodes are irradiated and chemotherapy or chemotherapy alone is performed. A gradual flow rate reconstitution is detected as soon as a few days after bone marrow transplantation, and complete recovery of salivary secretions occurs approximately 2-5 months after grafting. In one particular research study, total body irradiation induced irreversible damage to the parotid glands which resulted in profound xerostomia followed by opportunistic infections. Chemotherapy with or without total lymph node irradiation did not induce irreversible damage to the parotid glands.10 Oftentimes, the intense conditioning regimes of transplantation results in pronounced immunosuppression which greatly increases a patient’s risk of xerostomia along with mucositis, ulceration, hemorrhage, and infection.11
  • Rheumatoid arthritis is associated with dry mouth and up to 50 percent of individuals with rheumatoid arthritis also suffer from it. The term Sjögren’s syndrome refers to individuals with a connective tissue disorder like rheumatoid arthritis or systemic lupus erythematosus who also experience dry eyes or dry mouth.27The oral cavity and salivary glands are commonly involved in graft-versus-host disease in allograft recipients which can result in xerostomia, too. Careful attention to immediate and long-term post transplant oral care is necessary.11
  • Cancer treatment results in many different kinds of oral complications including xerostomia but the complications depend on the type of cancer treatment. Oral complications present in various forms and degrees of severity.11 Xerostomia and salivary gland dysfunction become a problem because of thickened, reduced, or absent salivary flow. The reduction or loss of saliva increases the risk of infection and compromises speaking, chewing, and swallowing. Adding medications to chemotherapy or radiation treatment can worsen xerostomia. According to the NIDCR, if the quality, or quantity, of saliva changes persists, there is a lifelong risk of rampant dental decay that may begin as soon as three months after completing radiation treatment.11Since oral complications are common in almost all patients receiving radiation for head and neck malignancies and in up to about 75% of blood and marrow transplants, it is important to determine risk for oral complications, just as oral healthcare professionals do with dental caries and gingival and periodontal diseases.11 If patients are receiving minimally myelosuppressive or nonmyelosuppressive chemotherapy, they are at lower risk than those patients who are receiving stomatotoxic chemotherapy. Stomatotoxic chemotherapy results in prolonged myelosuppression and is more common in blood and marrow transplants and patients undergoing head and neck radiation.11If possible, try to schedule a pretreatment oral evaluation of a cancer patient once a cancer diagnosis has been made. Besides being able to identify and treat problems like xerostomia, there are reasons why a pretreatment oral evaluation is helpful. A pretreatment oral evaluation with an oral healthcare provider may also:
    • Reduce the risk and severity of oral complications like xerostomia.
    • Improve the likelihood that the patient will successfully complete planned cancer treatment.
    • Prevent, eliminate, or reduce oral pain.
    • Minimize oral infections that could lead to potentially fatal systemic infections.
    • Prevent or minimize complications that compromise nutrition.
    • Prevent or reduce later incidence of bone necrosis.
    • Preserve or improve oral health. Provide an opportunity for patient education about oral hygiene and xerostomia treatment during cancer therapy.
    • Improve the quality of life.
    • Decrease the cost of care.
    • Increase communication with the patient’s oncologist.11
    • Following head and neck radiation therapy and once acute oral complications have resolved, it is important to evaluate the patient regularly for the first six months and beyond that meet the patient’s needs. However, keep in mind that oral complications can continue or emerge long after radiation therapy has ended.11

    • Mouth breathing. Obstructions or blockage of the upper airway oftentimes results in mouth breathing. These obstructions have many etiologies including chronically congested nasal passages (allergic rhinitis) or enlarged tonsils or adenoids (adenotonsillar hyperplasia or adenoid hyperplasia).12 Children who suffer from uncontrolled allergies or obstruction of the upper airways may have a longer, narrow face, narrow nostrils, shadows beneath the eyes, and constantly open lips. With chronic mouth breathing, important nasal functions are bypassed and these children fatigue more rapidly. Chronic mouth breathing is associated with xerostomia and gingivitis in susceptible patients.13