Salivation, decreased [Xerostomia]
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 other drug, and the effects of radiation. It can even result from vigorous exercise or autonomic stimulation—for example, as the result of fear.
History and physical examination
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 sense of smell in or taste.
Next, 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, page 698.) 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.
Facial nerve paralysis
A diminished saliva production occurs along with decreased sense of taste and facial muscle movement.
Salivary duct obstruction
Usually associated with a salivary stone, this obstruction causes reduced salivation and local pain and swelling.
Sjögren’s syndrome
Diminished secretions from the lacrimal, parotid, and submaxillary glands produce the hallmarks of this disorder: 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 hydrochloride, 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 hydrochloride (5 to 10 mg orally three times daily) can relieve symptoms of dry mouth, but it must be used regularly.
Pictures
![Salivation, decreased [Xerostomia] - 2713.png](/bookimages/8/2713.png)
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 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)
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- 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: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Dry mouth
» Next page: Sore Throat (Field Guide to Bedside Diagnosis)
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