Xerostomia


Xerostomia is a manifestation of an extreme degree of hyposalivation (decreased production of saliva by the salivary glands). The causes of this condition are very numerous and are often found outside the mouth. Most often, general (somatic) diseases lead to the development of xerostomia and only their full-fledged treatment can eliminate manifestations of xerostomia.

The main manifestation of this pathological condition is the excruciating feeling of drying out of the oral cavity. In addition to the feeling of dryness in the oral cavity of patients, soreness at the time of food intake, as well as digestive disorders associated with the lack of saliva enzymes, is disturbing.

What is xerostomia

In simple terms, xerostomia is the absence of saliva in the mouth, "drought in the mouth."

Disease xerostomia is not independent, in the vast majority of cases it is either a side effect of medications, or a consequence of a physical illness.

To more fully understand the importance of the problem, one should remember what functions the saliva performs in the human body:

1. Destroys bacteria penetrated into the oral cavity. Saliva contains a lysozyme substance that makes it possible to perform this function, since it has a bactericidal effect.

2. Saliva contains enzymes that break down the complex carbohydrate chains of starch and glycogen into simpler ones, such as oligosaccharides and monosaccharides. Thus, thanks to the saliva, the digestive process starts in the oral cavity and the already prepared food lump enters the stomach.

3. Wetting and forming a food lump. This function of saliva is no less important, since in moistened and glued form food is easier to move along the esophagus into the stomach. Moreover, having got into the stomach, in the center of the food lump moistened with saliva, the process of nutrient cleavage continues, while on the periphery the action of gastric enzymes is already beginning.

4. Provides the intake of calcium, phosphorus and zinc salts in the outer layers of the tooth, which maintain the constancy of the mineral composition of the enamel of the teeth.

5. Saliva maintains the hydration of the oral mucosa. With reduced production of saliva or in its complete absence (xerostomia), the oral mucosa dry out, and cracks and ulcers develop.

Suppliers of saliva into the oral cavity are salivary glands located in the oral cavity and beyond. But, despite their location, all salivary ducts open in the oral cavity.

In total, 3 pairs of the most significant salivary glands secrete: parotid, submandibular, sublingual. In addition to them, a large number of small glands are located in the oral cavity.

The vegetative nervous system regulates the salivary glands. Her sympathetic part reduces the production of saliva, and parasympathetic, on the contrary, strengthens. The center of salivation is located in the medulla oblongata.

Violation of the regulation of the salivary glands at any level can lead to the development of xerostomia.

Causes of xerostomia

The causes of xerostomia are very diverse and numerous, namely:

1. Dehydration of the body (exsicosis). The development of dehydration can occur with insufficient intake of fluid in the body, as well as its losses in large quantities (vomiting, diarrhea, blood loss, protein starvation). In either case, the xerostomia develops.

2. Removal of the salivary glands. Salivary glands can suffer from various diseases. They can be affected by tumors, contain stones (salivary stone disease), they can form cysts. One of these causes can lead to the overlapping of the duct of the salivary gland, leading to a violation of the outflow of saliva. As a treatment, radical methods are often used - the removal of the salivary gland. Surgery to remove the salivary glands entails lowered saliva production by remaining glands, and when combined with other factors that reduce the level of saliva production by factors, the development of xerostomia.

3. Violation of the salivary glands controlling the nervous system at different levels is also a common cause of xerostomia development. Damage can be of different genesis (origin). These can be mechanical injuries, damage resulting from the progression of systemic diseases ( Alzheimer's disease , diabetes , tumors).

4. Taking medications. Disease xerostomia can be a consequence of an overdose of diuretics, which leads to increased excretion of water from the body.

Xerostomia may develop as a side effect with long-term use of such groups of drugs as antidepressants (Flekseril, Amitriptyline, Zoloft), antiallergic drugs (Dimedrol, Zirtek and others), neuroleptics (Zoloft, Lexapro), drugs for Parkinson's disease (Cyclodol, Levodopa ), derivatives of belladonna (Scopolamine, Atropine, Hyoscyamine).

5. Anesthesia. Xerostomia often develops as a side effect when exiting from anesthesia.

6. Autoimmune diseases such as Sjogren's syndrome at which the salivary and lacrimal glands are affected. In this case, xerostomia and dry eye syndrome go hand in hand.

7. The use of radiation therapy for the treatment of neoplastic diseases. It is proved that the use of radiotherapy can significantly reduce saliva production by salivary glands.

8. Sleep with an open mouth. Short-term xerostomia, caused by this cause, is most common in the elderly. The fact is, at this age, almost 100% of cases are marked by the sagging of the palatal curtain, which is accompanied by snoring during sleep, which results in a short-term xerostomia.

9. Diseases of the nose, accompanied by a significant violation of nasal breathing.

Symptoms and signs of xerostomia

Symptoms of xerostomia arise from the violation of saliva production, as a result of which it becomes unable to fully perform its functions. Based on the disturbed functions of saliva, the corresponding symptoms of xerostomia develop.

One of the brightest signs of xerostomia is the feeling of drying out of the oral mucosa. At the same time, the sensation of dryness in the mouth is not false, since saliva comes in insufficient or absent altogether.

Due to a malfunction in the wetting of the oral mucosa, the drying of all structures located in the oral cavity (tongue, teeth, gums) develops. The mucous mouth loses its shine and looks matte. There is a cracking of the tongue, gums, the inner surface of the cheeks with the subsequent formation of ulcers. The absence of bactericidal components of saliva leads to a rapid growth of pathogenic microflora, which supports inflammatory processes in the oral cavity and prevents the healing of cracks and ulcers.

Xerostomia is manifested by the development of certain difficulties in eating. Chewing food of a dry, dense consistency becomes very painful and difficult because of the lack of wetting of the food lump.

Another unpleasant manifestation of xerostomia is the gradual destruction first of the tooth enamel, and then the tooth as a whole. There is a violation of the mineralization of teeth due to the lack of saliva, which serves as a supplier of the necessary minerals in the enamel of the teeth. Moreover, reproduction of pathogenic bacteria promotes caries prosperity, even in spite of hygiene of the oral cavity. Treatment of caries leads to a temporary improvement in the condition of the teeth. If the patient does not pay due attention to his condition, the caries quickly grasps new areas of the tooth, chipped, the tooth gradually disintegrates.

Patients with xerostomia are characterized by the presence of constantly parched lips and the presence of deep painful cracks on them.

In the development of xerostomia, several stages are distinguished:

1. At the first stage, saliva is released, but in a reduced amount. After a long oral communication, there is a feeling of dryness in the mouth. This stage is most pronounced in people whose activities are connected with public speeches, reports, lectures or seminars. After some time after stopping the conversation, the necessary amount of saliva is generated and the oral mucosa remains hydrated. Other manifestations of xerostomia are absent.

2. In the second stage, xerostomia progresses. Dryness in the mouth becomes a permanent phenomenon, full hydration of the oral mucosa does not occur. There are difficulties during chewing food. During the meal, you have to drink it constantly with water. After public speaking or long conversations, you also need to wet your mouth with water. Mucous mouth loses its shine. There are microcracks of the oral mucosa and tongue. Taste sensations cease to differ well. There is multiple tooth decay with tooth decay.

3. Xerostomia reaches its peak. This is the stage of an expanded clinical picture of the disease. Cracks in the oral mucosa are modified in erosion and ulcers. There is tooth decay, tooth decay, gingivitis , stomatitis. Disturbances of digestion are noted. Lips dry out, crack. The feeling of thirst becomes constant.

Treatment of xerostomia

Treatment of xerostomia should be directed primarily at eliminating the causes of its causes. The most effective remedy for xerostomia is the implementation of therapeutic measures to eliminate the cause of the disease.

To find out the causes of this disease, the patient needs a comprehensive examination. Begin finding out the reasons with a thorough questioning of the patient. It is necessary to establish what diseases the patient suffers at present, what diseases he has suffered. Find out the information about the duration and dosages of the drugs taken.

As additional diagnostic methods, ultrasound examination of the salivary glands is used, as well as sialography (X-ray method for diagnosis of salivary glands).

Drugs with xerostomia are prescribed primarily for local administration to the salivary gland. Physiotherapeutic methods, such as galvanization and electrophoresis, have been successfully used to administer drugs. For the administration, such drugs as Pilocarpine, Galantamine, Potassium Iodide are prescribed. These drugs with xerostomia can increase the production of salivary glands of their secret (saliva).

To increase the production of saliva, patients are given sugar-free chewing gum or candy.

The simplest remedy for xerostomia is the normalization of the drinking regime. It is recommended to patients as often as possible, to drink small sips in small sips, mineral water can be used. Night time is no exception. Such a simple measure helps maintain the oral mucosa permanently moisturized, and this greatly improves her condition.

To heal cracks and ulcers, use an oil solution of vitamin A, gel Khalisal (relieves pain, reduces inflammation).

Smoking patients are advised to give up smoking, since later this harmful habit will provoke the onset of relapses.

Care should be taken to monitor oral hygiene. This will reduce the multiplication of pathogenic bacteria that cause and support inflammatory diseases in the oral cavity. It is recommended also to carry out the treatment of all carious cavities, as patients with caries teeth are a hidden source of pathogenic bacteria. Moreover, timely treatment of sick teeth prevents their rapid destruction.

For brushing teeth it is recommended to use brushes with soft bristles only. In case of increased traumatization of the oral mucosa with a toothbrush, it is recommended to dip the brush in hot water for a few seconds before brushing your teeth. This will make the brush softer.

? Xerostomia - which doctor will help ? If there is or suspected the development of xerostomia, you should not hesitate to contact a doctor like a dentist.