Xerostomia

Template:DiseaseDisorder infobox Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Xerostomia is the medical term for a dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties or cottonmouth.

Xerostomia can cause difficulty in speech and eating. It also leads to halitosis and a dramatic rise in the number of cavities, as the protective effect of saliva is no longer present, and can make the mucosa of the mouth more vulnerable to infection. Notably, a symptom of methamphetamine abuse usually called "meth mouth" is largely caused by xerostomia.

Causes

It may be a sign of an underlying disease, such as Sjögren's syndrome, poorly controlled diabetes, dehydration , or a side effects of medication.

Other causes of insufficient saliva include anxiety, alcohol, trauma to the salivary glands or their ducts or nerves, excessive mouth breathing, previous radiation therapy, and also a natural result of aging. The vast majority of elderly individuals will suffer xerostomia to some degree. Playing or exercising a long time outside on a hot day will often cause your saliva glands to simply dry up as your bodily fluids are concentrated elsewhere. Drugs have also been known to cause this problem, such as cannabis, and DXM.It can also be associated with rare condition like Eaton-Lambert syndrome.

Causes by organ system

Cardiovascular	No underlying causes
Chemical / poisoning	3-Quinuclidinyl benzilate, Arsenic Poisoning
Dermatologic	No underlying causes
Drug Side Effect	Abciximab (patient information), Acamprosate calcium, Acitretin (patient information), Actiq, Adderall, Ajulemic acid, Albuterol (patient information), Alfentanil Hydrochloride Injection (patient information), Anticholinergic, Azelastine, Benzatropine, Benztropine Mesylate Oral (patient information), Benzydamine, Benzylpiperazine, Bepridil (patient information), Bevacizumab Injection (patient information), Biperiden, Brompheniramine (patient information), Budesonide, Buprenorphine, Bupropion, Buspirone (patient information), Butorphanol, Butorphanol Injection (patient information), Calcitriol (patient information), Calcium carbonate (patient information), Carbamazepine (patient information), Cetuximab Injection (patient information), Cevimeline, Chlordiazepoxide (patient information), Chloropyramine, Chlorpheniramine (patient information), Chlorpromazine (patient information), Chlorprothixene, Clomipramine (patient information), Clonazepam (patient information), Clonidine, Clozapine, Codeine, Cyclobenzaprine (patient information), Cyproheptadine (patient information), Desloratadine, Dextroamphetamine, Diazepam (patient information), Dicyclomine (patient information), Diethylpropion (patient information), Diltiazem (patient information), Dimenhydrinate, Diphenhydramine, Diphenoxylate and Atropine (patient information), Dosulepin hydrochloride, Doxylamine (patient information), Duloxetine, Eribulin, Erlotinib (patient information), Esomeprazole (patient information), Estazolam (patient information), Exenatide Injection (patient information), Fencamfamine, Fesoterodine, Fexofenadine (patient information), Flavoxate (patient information), Fluacizine, Flucytosine, Fluphenazine (patient information), Fosamprenavir (patient information), Frovatriptan (patient information), Gabapentin (patient information), Galantamine (patient information), Ganciclovir (patient information), Gatifloxacin (patient information), Glimepiride (patient information), Glipizide (patient information), Glyburide (patient information), Glycopyrrolate (patient information), Guanabenz (patient information), Guanethidine (patient information), Guanfacine (patient information), Haloperidol Oral (patient information), Hexamethonium, Hydroxyzine (patient information), Hyoscyamine (patient information), Iloperidone, Imipramine (patient information), Insulin Aspart (rDNA Origin) Injection (patient information), Interferon beta-1a Subcutaneous Injection (patient information), Ipratropium Oral Inhalation (patient information), Isocarboxazid (patient information), Isoetharine Oral Inhalation (patient information), Isoproterenol Oral Inhalation (patient information), Isosorbide (patient information), Ketorolac, Ketotifen, Lacosamide, Leflunomide, Letrozole, Levalbuterol Oral Inhalation (patient information), Levocetirizine, Levodopa and Carbidopa (patient information), Levomepromazine, Lithium (patient information), Lofepramine, Lorcaserin, Loperamide, Lopinavir and Ritonavir (patient information), Loratadine (patient information), Lorazepam (patient information), Loxapine Oral (patient information), Meperidine (patient information), Meropenem Injection (patient information), Mesalamine (patient information), Mesoridazine Oral (patient information), Metaproterenol (patient information), Metformin (patient information), Methylphenidate Transdermal (patient information), Metoprolol (patient information), Metronidazole Oral (patient information), Miglitol (patient information), Milnacipran hydrochloride, Moclobemide, Modafinil (patient information), Moxonidine, Nabilone (patient information), Nabumetone (patient information), Nalbuphine injection (patient information), Nateglinide oral (patient information), Nefazodone (patient information), Nialamide, Nicardipine (patient information), Nitroglycerin ointment (patient information), Nortriptyline (patient information), Olanzapine (patient information), Omeprazole (patient information), Orphenadrine (patient information), Oxaliplatin injection (patient information), Oxazepam (patient information), Oxcarbazepine (patient information), Peginterferon alfa-2a (patient information), Peginterferon alfa-2b (patient information), Penbutolol (patient information), Pentamidine Isethionate, Pergolide (patient information), Perphenazine oral (patient information), Phentermine (patient information), Pimozide (patient information), Pindolol (patient information), Pioglitazone (patient information), Pirbuterol acetate oral inhalation (patient information), Pizotifen, Pramipexole (patient information), Prazepam (patient information), Pregabalin (patient information), Procarbazine (patient information), Procyclidine (patient information), Propafenone (patient information), Propantheline (patient information), Protriptyline (patient information), Quazepam, Quetiapine (patient information), Quinethazone, Rabeprazole (patient information), Rasagiline (patient information), Reboxetine, Repaglinide (patient information), Reserpine (patient information), Ribavirin (patient information), Rimabotulinumtoxinb, Rilmenidine, Risedronate (patient information), Risperidone (patient information), Rizatriptan (patient information), Ropinirole (patient information), Rosiglitazone (patient information), Salmeterol oral inhalation (patient information), Scopolamine patch (patient information), Selegiline (patient information), Sibutramine (patient information), Solifenacin (patient information), Sorafenib (patient information), Spironolactone (patient information), Sulpiride, Sunitinib (patient information), Temazepam (patient information), Thalidomide, Thioridazine (patient information), Thiothixene Oral (patient information), Tizanidine, Tolazamide (patient information), Tolbutamide (patient information), Tolterodine (patient information), Topiramate, Tranylcypromine (patient information), Trazodone (patient information), Triamterene (patient information), Triazolam, Tricyclic antidepressant, Trifluoperazine Oral (patient information), Trihexyphenidyl (patient information), Trimipramine (patient information), Tripelennamine, Trospium Trospium (patient information), Vicodin, Vinpocetine, Zaleplon (patient information), Zimelidine, Zoledronic Acid Injection (patient information), Zolmitriptan, Zolpidem (patient information), Zonisamide (patient information), Zopiclone, Zotepine,
Ear Nose Throat	Excessive mouth breathing
Endocrine	Diabetes
Environmental	Multiple chemical sensitivity
Gastroenterologic	Zenker's diverticulum
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Radiation therapy
Infectious Disease	Botulism
Musculoskeletal / Ortho	No underlying causes
Neurologic	Ramsay Hunt syndrome type II
Nutritional / Metabolic	Hyperglycemia
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	Albuterol, galantamine, methylphenidate transdermal, omeprazole
Psychiatric	Anxiety,depression
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Sjogren's syndrome, Eaton-Lambert syndrome
Sexual	No underlying causes
Trauma	Trauma to the salivary glands
Urologic	No underlying causes
Miscellaneous	Dehydration, hyperosmolar syndrome

Causes in alphabetical order

• 3-Quinuclidinyl benzilate
• Abciximab
• Acamprosate calcium
• Acitretin
• Actiq
• Adderall
• Ajulemic acid
• Albuterol
• Alfentanil Hydrochloride Injection
• Anticholinergic
• Anxiety
• Arsenic Poisoning
• Azelastine
• Benzatropine
• Benztropine Mesylate Oral
• Benzydamine
• Benzylpiperazine
• Bepridil
• Bevacizumab Injection
• Biperiden
• Botulism
• Brompheniramine
• Budesonide
• Buprenorphine
• Bupropion
• Buspirone
• Butorphanol
• Butorphanol Injection
• Calcitriol
• Calcium carbonate
• Carbamazepine
• Cetuximab Injection
• Cevimeline
• Chlordiazepoxide
• Chloropyramine
• Chlorpheniramine
• Chlorpromazine
• Chlorprothixene
• Clomipramine
• Clonazepam
• Clonidine
• Clozapine
• Codeine
• Cyclobenzaprine
• Cyproheptadine
• Dehydration
• Desloratadine
• Dextroamphetamine
• Diabetes
• Diazepam
• Dicyclomine
• Diethylpropion
• Diltiazem
• Dimenhydrinate
• Diphenhydramine
• Diphenoxylate and Atropine
• Dosulepin hydrochloride
• Doxylamine
• Duloxetine
• Eaton-Lambert syndrome
• Eribulin
• Erlotinib)
• Esomeprazole
• Estazola
• Excessive mouth breathing
• Exenatide Injection
• Fencamfamine
• Fexofenadine
• Flavoxate
• Fluacizine
• Flucytosine
• Fluphenazine
• Fosamprenavir
• Frovatriptan
• Gabapentin
• Galantamine
• Ganciclovir
• Gatifloxacin
• Glimepiride
• Glipizide
• Glyburide
• Glycopyrrolate
• Guanabenz
• Guanethidine
• Guanfacine
• Haloperidol Oral
• Hexamethonium
• Hydroxyzine
• Hyoscyamine
• Hyperglycemia
• Hyperosmolar syndrome
• Imipramine
• Insulin Aspart (rDNA Origin) Injection
• Interferon beta-1a Subcutaneous Injection
• Ipratropium Oral Inhalation
• Isocarboxazid
• Isoetharine Oral Inhalation
• Isoproterenol Oral Inhalation
• Isosorbide
• Ketorolac
• Ketotifen
• Levalbuterol Oral Inhalation
• Levodopa and Carbidopa
• Levomepromazine
• Lithium
• Lofepramine
• Loperamide
• Loratadine (patient information)
• Lorazepam (patient information)
• Loxapine Oral (patient information)
• Meperidine (patient information)
• Meropenem Injection (patient information)
• Mesalamine (patient information)
• Mesoridazine Oral (patient information)
• Metaproterenol (patient information)
• Metformin (patient information)
• Methylphenidate Transdermal (patient information)
• Metoprolol (patient information)
• Metronidazole Oral (patient information)
• Miglitol (patient information)
• Milnacipran hydrochloride
• Moclobemide
• Modafinil (patient information)
• Moxonidine
• Multiple chemical sensitivity
• Nabilone (patient information)
• Nabumetone (patient information)
• Nalbuphine injection (patient information)
• Nateglinide oral (patient information)
• Nefazodone (patient information)
• Nialamide
• Nicardipine (patient information)
• Nitroglycerin ointment (patient information)
• Nortriptyline (patient information)
• Olanzapine (patient information)
• Omeprazole (patient information)
• Orphenadrine (patient information)
• Oxaliplatin injection (patient information)
• Oxazepam (patient information)
• Oxcarbazepine (patient information)
• Peginterferon alfa-2a (patient information)
• Peginterferon alfa-2b (patient information)
• Penbutolol (patient information)
• Pergolide (patient information)
• Perphenazine oral (patient information)
• Phentermine (patient information)
• Pimozide (patient information)
• Pindolol (patient information)
• Pioglitazone (patient information)
• Pirbuterol acetate oral inhalation (patient information)
• Pizotifen
• Pramipexole (patient information)
• Prazepam (patient information)
• Pregabalin (patient information)
• Procarbazine (patient information)
• Procyclidine (patient information)
• Propafenone (patient information)
• Propantheline (patient information)
• Protriptyline (patient information)
• Quetiapine (patient information)
• Quinethazone
• Rabeprazole (patient information)
• Radiation therapy
• Ramsay Hunt syndrome type II
• Rasagiline (patient information)
• Reboxetine
• Repaglinide (patient information)
• Reserpine (patient information)
• Ribavirin (patient information)
• Rilmenidine
• Risedronate (patient information)
• Risperidone (patient information)
• Rizatriptan (patient information)
• Ropinirole (patient information)
• Rosiglitazone (patient information)
• Salmeterol oral inhalation (patient information)
• Scopolamine patch (patient information)
• Selegiline (patient information)
• Sibutramine (patient information)
• Sjogren's syndrome
• Solifenacin (patient information)
• Sorafenib (patient information)
• Spironolactone (patient information)
• Sulpiride
• Sunitinib (patient information)
• Temazepam (patient information)
• Thioridazine (patient information)
• Thiothixene Oral (patient information)
• Tolazamide (patient information)
• Tolbutamide (patient information)
• Tolterodine (patient information)
• Topiramate
• Tranylcypromine (patient information)
• Trazodone (patient information)
• Triamterene (patient information)
• Triazolam (patient information)
• Tricyclic antidepressant
• Trifluoperazine Oral (patient information)
• Trihexyphenidyl (patient information)
• Trimipramine (patient information)
• Tripelennamine
• Trospium (patient information)
• Vicodin
• Vinpocetine
• Zaleplon (patient information)
• Zenker's diverticulum
• Zimelidine
• Zoledronic Acid Injection (patient information)
• Zolmitriptan
• Zolpidem (patient information)
• Zonisamide (patient information)
• Zopiclone
• Zotepine

Differential Diagnosis

In alphabetical order.

With parotid gland swelling

• Heerfordt's Disease
• Sicca Syndrome
• Sjögren's Syndrome

Without parotid gland swelling

• Advance age
• Alcoholism
• Antihistamines
• Antihypertensives
• Antiparkinsonian drugs
• Antispasmodics
• Atropine
• Bronchodilators
• Continuous vomiting
• Decongestants
• Diabetes Mellitus
• Diarrhea
• Diuretics
• Drugs- Cyclobenzaprine, Haloperidol
• Infections with high fever
• Lithium
• MAOIs
• Neuroleptics
• Psychogenic
• Radiation therapy
• Salivary gland surgery
• Tricyclic antidepressants

Treatment

Treatment involves finding any correctable causes and fixing those if possible. In many cases it is not possible to correct the xerostomia itself, and treatment focuses on relieving the symptoms and preventing cavities. Patients who have endured chemotherapy usually suffer from this post- treatment. Patients with xerostomia should avoid the use of decongestants and antihistamines, and pay careful attention to oral hygiene. Sipping sugarless fluids frequently, chewing xylitol-containing gum, and using a carboxymethyl cellulose saliva substitute as a mouthwash may help. Aquoral may be prescribed to treat xerostomia. Non-systemic relief can be found using an oxidized glycerol triesters treatment used to coat the mouth.

External links

• Oral Cancer Foundation
• University of Illinois at Chicago
• NIH
• Sjögren's Syndrome Foundation page on Dry Mouth