Xerostomia

Xerostomia is the perceived sensation of dry mouth caused by reduced salivary flow (hyposalivation) or changes in saliva. It can occur with normal hydration but often accompanies objective decreases in saliva production. While it affects people of all ages, it is more common in older adults, especially those taking multiple medications or receiving head and neck radiation.

Common causes include medications with anticholinergic or drying effects (such as antihistamines, antidepressants, antipsychotics, diuretics, and certain blood pressure drugs), radiation therapy to the head and neck, autoimmune diseases such as Sjögren’s syndrome, diabetes, dehydration, mouth breathing, and lifestyle factors like alcohol use, caffeine, tobacco, and poor oral hydration.

Symptoms range from a dry, sticky mouth and thirst to difficulty speaking, swallowing, or tasting food. Complications may include increased dental caries, gum disease, oral infections (such as candidiasis), mucosal soreness, angular cheilitis, bad breath, and impaired quality of life.

Diagnosis relies on history and clinical examination, supported by objective tests such as sialometry to measure unstimulated and stimulated salivary flow. In some cases, tests for autoimmune disease or imaging of salivary glands are indicated.

Management focuses on addressing underlying causes and relieving symptoms. This includes good oral hygiene and regular dental care, saliva substitutes and sugar-free gum or lozenges (often containing xylitol), and, when appropriate, sialagogues such as pilocarpine or cevimeline under medical supervision. Additional measures include hydration, avoiding caffeine and alcohol, humidifiers, and cessation of tobacco. Fluoride protection and timely treatment of infections help prevent complications.