Xerostomia

Question 1

Etiology of Xerostomia (Most Frequent)

Answer 1

Medication side effect, Head/neck radiation therapy, Sjogren syndrome

Question 2

Classes of Drugs with >10% Xerostomia Incidence (nine)

Answer 2

Anticholinergic - Atropine
Antihistamines - Loratradine
Antihypertensives - Lisinopril
Antidepressants - Citalopram, Haloperidol, Phenelzine
Diuretics - HCTZ
Muscle relaxants - Tizandinine
Pain medication - Opioids
Sedative - Diazepam

Question 3

Radiation Therapy and Xerostomia

How quickly does salivary flow decrease? By how much?

Answer 3

Salivary flow decreases 50-60% within the first week.

Question 4

Radiation Dose and Salivary Recovery

Answer 4

Recovery unlikely with parotid mean radiation doses > 24-26 Gy.

Question 5

Sjogren Syndrome Characteristics

Answer 5

Oral and ocular dryness, Lymphocytic infiltration, More common in women > 40, Primary vs. Secondary

Question 6

Sjogren Syndrome Onset

Answer 6

Unusual after 65; dry mouth after this age more likely due to age-related exocrine atrophy.

Question 7

Other Potential Causes of Xerostomia

Answer 7

Autoimmune disorders (SLE, RA, Thyroid disease, PBC), Mouth breathing, Dehydration, Diabetes, Nerve damage, ESRD, GVHD, HIV/AIDS

Question 8

Xerostomia Pathophysiology (Salivary Glands)

Answer 8

Salivary acini and ducts produce serous and mucinous fluids. Nerve stimulation releases ACh (M3 receptors) to produce saliva.

Question 9

Medication-Induced Xerostomia Mechanism

Answer 9

Affects CNS or neuroglandular junction. Suppresses ACh production or occupies muscarinic/adrenergic receptors.

Question 10

Radiation-Induced Xerostomia Mechanism

Answer 10

Quantitative and qualitative changes in salivary glands. Serous acini are most susceptible. Acinar atrophy and chronic inflammation.

Question 11

Sjogren Syndrome Pathophysiology

Answer 11

Autoimmune disorder that affects moisture producing glands in the body. Sicca is latin for dryness.

Question 12

Xerostomia Symptoms

Answer 12

Oral dryness, Burning/soreness, Diminished/altered taste, Difficulty swallowing, Thickened saliva, Sensitivity to foods, Loss of appetite

Question 13

Xerostomia Evaluation

Answer 13

Clinical diagnosis (history and physical). Check medication list. Sialometry (stimulated <0.5-0.7 mL/min, unstimulated <0.1 mL/min)

Question 14

Xerostomia Evaluation (Additional Tests)

Answer 14

Sialography, Biopsy (if systemic cause suspected), Labs (ESR, anemia, RF, autoantibodies for Sjogren), Lip biopsy

Question 15

Xerostomia Treatment (Initial)

Answer 15

Patient education (frequent sipping, sugar-free gum/candy, avoid triggers, oral hygiene). Local measures (artificial saliva)

Question 16

Xerostomia Treatment (Pharmacological)

Answer 16

Sialogogues (Pilocarpine, Cevimeline - stimulate saliva). Topical Physostigmine (cholinesterase inhibitor). Malic acid, Anethole trithionate

Question 17

Xerostomia Differential Diagnosis

Answer 17

Primary/Idiopathic Sjogren’s syndrome (aka Sicca Syndrome), Other autoimmune diseases, Drug-induced sicca syndrome. Rule out: Sarcoidosis, GPA, IgG4-related disease, HCV, HIV, GVHD, ESRD, Head/neck radiation

Question 18

Xerostomia Complications

Answer 18

Poor nutrition, Gingivitis/Periodontitis, Caries, Halitosis, Candidiasis, Enamel erosion, Anxiety/Depression

Question 19

Xerostomia Deterrence/Patient Education

Answer 19

Communicate symptoms, Preventative measures (sipping water, chewing gum, humidifier, avoid triggers), Regular dental follow-up