Salivation, decreased
Typically a common but minor complaint, diminished production or excretion of saliva (dry mouth) usually results from mouth breathing. However, this symptom can also result from salivary duct obstruction, Sjögren’s syndrome, the use of an anticholinergic or other drug, and the effects of radiation. Also known as xerostomia, dry mouth can even result from vigorous exercise or autonomic stimulation — for example, as the result of fear.
History
Evaluate the patient’s complaint of dry mouth by asking pertinent history questions: When did he first notice the symptom? Was he exercising at the time? Is he currently taking any medications? Is his sensation of dry mouth intermittent or continuous? Is it related to or relieved by a particular activity? Ask about related symptoms, such as burning or itching eyes, or changes in sense of smell or taste.
Physical assessment
Inspect the patient’s mouth, including the mucous membranes, for any abnormalities. Observe his eyes for conjunctival irritation, matted lids, and corneal epithelial thickening. Perform simple tests of smell and taste to detect impairment of these senses. Check for enlarged parotid and submaxillary glands. (See Examining salivary glands and ductal openings.) Palpate for tender or enlarged areas along the neck, too.
Medical causes
Dehydration
Decreased saliva production causes dry oral mucous membranes. Skin turgor is also decreased, and urine output may be low. Vital signs may reveal hypotension, tachycardia, and a low-grade fever.
Facial nerve paralysis
With facial nerve paralysis, a diminished saliva production occurs along with decreased sense of taste and facial muscle movement. The affected side of the face may sag and appear masklike.
Salivary duct obstruction
Usually associated with a salivary stone, salivary duct obstruction causes reduced salivation and local pain and swelling of the face or neck. The symptoms are most noticeable when eating or drinking.
Sjögren’s syndrome
Diminished secretions from the lacrimal, parotid, and submaxillary glands produce the hallmarks of Sjögren’s syndrome: decreased or absent salivation and dry eyes with a persistent burning, gritty sensation. The patient may also experience dryness that involves the nose, respiratory tract, vagina, and skin.
Related oral signs and symptoms include difficulty chewing, talking, and swallowing as well as ulcers and soreness of the lips and mucosa. The parotid and submaxillary glands may be enlarged. Nasal crusting, epistaxis, fatigue, lethargy, nonproductive cough, abdominal discomfort, and polyuria may be present. These signs and symptoms may occur alone or with rheumatoid arthritis or another connective tissue disorder.
Other causes
Drugs
Anticholinergics, antihistamines, tricyclic antidepressants, phenothiazines, clonidine, and opioid analgesics can cause decreased salivation, which disappears after discontinuation of therapy.
Radiation
Excessive irradiation of the mouth or face from chemotherapeutic treatments or dental X-rays may cause transient decreased salivation due to salivary gland atrophy, which can lead to difficulty swallowing, discomfort, and gum disease.
Special considerations
If markedly reduced salivation interferes with speaking, eating, or swallowing, allow the patient extra time for these activities.
Pediatric pointers
Mouth breathing and anticholinergic therapy are the primary causes of decreased salivation in children.
Patient counseling
To relieve dry mouth, encourage the patient to increase his fluid intake during meals and to chew gum or tart sugarless mints between meals. To reduce the risk of cavities, advise him to brush his teeth, floss, use mouthwash, and avoid sugary desserts, candies, and drinks. Routine dental visits and fluoride treatments may also be beneficial.
Pilocarpine (5 to 10 mg orally three times daily) can relieve symptoms of dry mouth, but it must be used regularly.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Dry mouth
Read excerpts from these other book chapters related to Dry mouth:
Medical Books Excerpts
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Throat pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Throat pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Sore Throat
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Dry mouth
» Next page: Sore Throat (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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