Dry Mouth

Xerostomia (also termed dry mouth as a symptom or dry mouth syndrome as a syndrome) is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow (hyposalivation), or have no identifiable cause. This symptom is very common and is often seen as a side effect of many types of medication. It is more common in older people (mostly because this group tend to take several medications) and in persons who breathe through their mouths (mouthbreathing). Dehydration, radiotherapy involving the salivary glands, and several diseases can cause hyposalivation or a change in saliva consistency and hence a complaint of xerostomia. Sometimes there is no identifiable cause, and there may be a psychogenic reason for the complaint. A mouth ulcer (also termed an oral ulcer, or a mucosal ulcer) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. The two most common causes of oral ulceration are local trauma (e.g. rubbing from a sharp edge on a broken filling) and aphthous stomatitis ("canker sores"), a condition characterized by recurrent formation of oral ulcers for largely unknown reasons. Mouth ulcers often cause pain and discomfort, and may alter the person's choice of food while healing occurs (e.g. avoiding acidic or spicy foods and beverages). They may form individually or multiple ulcers may appear at the same time (a "crop" of ulcers). Once formed, the ulcer may be maintained by inflammation and/or secondary infection. Rarely, a mouth ulcer that does not heal for many weeks may be a sign of oral cancer. The symptoms are: Dental caries, Acid erosion, Oral candidiasis, Ascending (suppurative) sialadenitis, Dysgeusia, Intraoral halitosis, Oral dysesthesia, Saliva that appears thick or ropey, Mucosa that appears dry, Dysphagia, Difficulty wearing dentures, Mouth soreness and oral mucositis, Lipstick or food may stick to the teeth, Dry, sore, and cracked lips and angles of mouth, Thirst. The alterations in the sense of taste, usually a metallic taste, and sometimes smell are the only symptoms.

The duration of the symptoms of dysgeusia depends on the cause. If the alteration in the sense of taste is due to gum disease, dental plaque, a temporary medication, or a short-term condition such as a cold, the dysgeusia should disappear once the cause is removed. In some cases, if lesions are present in the taste pathway and nerves have been damaged, the dysgeusia may be permanent. Xerostomia is a very common symptom. A conservative estimate of prevalence is about 20% in the general population, with increased prevalences in females (up to 30%) and the elderly (up to 50%). BMS is fairly common worldwide, (however, other sources describe it as rare), and affects up to five individuals per 100,000 general population. People with BMS are more likely to be middle aged or elderly, and females are three to seven times more likely to have BMS than males. Some report a female to male ratio of as much as 33 to 1. BMS is reported in about 10-40% of women seeking medical treatment for menopausal symptoms, and BMS occurs in about 14% of postmenopausal women. Males and younger individuals of both sexes are sometimes affected.Asian and native American people have considerably higher risk of BMS. Sjogren’s syndrome is the third most common rheumatic autoimmune disorder, behind only rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). There are no geographical differences in the prevalence of Sjögren’s Syndrome. Sjögren's syndrome has been reported in all areas of the world, although regional epidemiology is not a thoroughly researched area. Depending on the criteria for determining prevalence, studies estimate the prevalence of Sjogren’s syndrome at 500,000 to 2 million patients in the United States. Moreover, other broader studies of prevalence of Sjögren's syndrome range widely with some reports of up to a prevalence of 3% of the population. Few studies that have been conducted on the incidence of Sjögren's syndrome report that the incidence of the syndrome varies between 3 and 6 per 100,000 per year. Nine out of ten Sjögren's patients are reported to be women. In addition to prevalence in women, having a first-degree relative with an autoimmune disease and previous pregnancies have been identified as epidemiological risk factors. Differences in prevalence due to race and ethnicity are unknown. Although Sjögren's occurs in all age groups, the average age of onset is between ages 40 and 60, although experts note that up to half of all cases may be left undiagnosed or unreported.

The prevalence of Sjogren’s syndrome generally increases with age. Sjogren’s syndrome has been known to be reported in 30-50% of patient’s with rheumatoid arthritis, as well as 10-25% with systemic lupus erythematosus A topical analgesic (e.g. benzydamine mouthwash) may reduce pain. Topical (gels, creams or inhalers) or systemic steroids may be used to reduce inflammation. An antifungal drug may be used to prevent oral candidiasis developing in those who use prolonged steroids. People with mouth ulcers may prefer to avoid hot or spicy foods, which can increase the pain. Self-inflicted ulceration can be difficult to manage, and psychiatric input may be required in some people. Treatment is cause related, but also symptomatic if the underlying cause is unknown or not correctable. It is also important to note that most ulcers will heal completely without any intervention. Treatment can range from simply smoothing or removing a local cause of trauma, to addressing underlying factors such as dry mouth or substituting a problem medication. Maintaining good oral hygiene and use of an antiseptic mouthwashes/sprays (e.g. chlorhexidine) can prevent secondary infection and therefore hasten healing. BMS has been traditionally treated by reassurance and with antidepressants, anxiolytics or anticonvulsants. However a systematic review of treatments for BMS concluded that clear, conclusive evidence of an effective treatment was not available in published research. There is a suggestion that Alpha lipoic acid and clonazepam (a benzodiazepine) may have some benefit, but the research methods used in these randomized control trials were imperfect or their results have not been corroborated by multiple trials. Similarly with the results of one randomized control trial which reported some evidence that cognitive behavioral therapy may be beneficial. Other treatments which have been used include atypical antipsychotics, histamine receptor antagonists, and dopamine agonists. Other Advanced treatment Methods are Artificial saliva and pilocarpine, Zinc supplementation. Zinc infusion in chemotherapy, Altering drug therapy, Alpha lipoic acid, Managing dysgeusia.