Dry mouth: why is your mouth dry?

Dry mouth is a common reason for consultation in dental and oral medicine. It may be discovered during a clinical examination for any other reason, as the patient may be unaware of it. It is caused by a qualitative and quantitative deficiency in saliva. Saliva’s most important function is its antibacterial activity, which limits the multiplication of microorganisms and slows down pathogenic mechanisms. It facilitates chewing, swallowing, and speech; it is essential for maintaining a neutral pH in the oral cavity.

Clinical signs

The patient presents with difficulty speaking, chewing, or swallowing; they feel the need to moisten their mouth or suck on candy. Sometimes certain patients tolerate or ignore their hyposialia. Conversely, some patients complain of a dry mouth even though their saliva quantity is normal: these are psychogenic oropharyngeal paresthesias.

Patient history: Common to all patients: age, gender and lifestyle, occupation, medication use.

Certain pathologies or physiological states affect the salivary center: various exacerbated emotions (fear, stress, excitement), endogenous neuroses, depression, and brain tumors.

Others affect the salivary pathways: encephalitis, brain tumors, cerebrovascular accidents, and neurosurgical operations.

Others affect the function of the salivary gland: Sjögren’s syndrome, lithiasis (stones), infection, tumors, aplasia, or excision or irradiation of the gland.

Certain general pathologies alter the electrolyte balance: prolonged dehydration (vomiting, diarrhea, sweating, hemorrhage), various types of diabetes, heart failure, uremia, edema, hypertension, hormonal disorders, Parkinson’s disease, anemia, certain viral infections (HIV), and certain occupational exposures (lead or silica).

The patient is asked about how the symptom appeared:

• An abrupt onset is more often associated with an iatrogenic etiology.
• A gradual onset is more often associated with a systemic disease.

The patient history helps to estimate the discomfort caused regarding chewing and swallowing, phonation, and whether there is dysgeusia, halitosis, or sialomegaly.

One looks for other localizations: ocular, digestive, or genital. The existence of oral hyperesthesia in the form of burning sensations is noted.

Examination of the oral cavity:

• Extraoral: makes it possible to objectify any potential swelling of the salivary glands or facial paralysis.
• Intraoral: Appearance of red, dry mucous membranes; the tongue is depapillated, glazed, and sticks to the mirror; the saliva is thick, stringy, or non-existent. Dental signs: polycaries with cavities located at the cervical margin, significant increase in dental plaque and periodontal disease; bone resorption and sometimes tooth loss. Mucosal signs: frequent candidiasis and ulcerations.

Diagnostic tests: They are numerous but not very specific.

• The sugar test: the simplest, at the dental chair, in a sitting position; a No. 4 sugar cube placed under the tongue should melt in three minutes; it is a good screening test.
• Measurement of intraoral pH: If there is dryness, the acidic pH is below 6.5; it is measured on the tongue with pH paper.

Other examinations

Radiological examination:

• Panoramic and occlusal radiographs allow for the search for lithiasis.
• Sialography, which uses a contrast agent and thus allows for the highlighting of functional gland disorders.
• Ultrasound.

Biological examinations that look for a systemic etiology: CBC, ESR, Ig.

Ophthalmological examination: Schirmer test to assess dry eyes.

Anatomopathological examination: biopsy of accessory salivary glands: specific lesions in Sjögren’s syndrome, sarcoidosis, and sometimes amyloidosis; the sample is taken from the mucosa of the lower lip.

Etiological diagnosis

There are 5 main causes of dry mouth:

• Iatrogenic hyposialia, by far the most frequent: sialoprivic medications, radiotherapy for head and neck cancers.
• Sjögren’s syndrome: multidisciplinary diagnosis.
• Senescence: diagnosis reached by exclusion.

Psychogenic dry mouth

Sialoprivic medications: These are responsible for 80% of salivary deficits; certain medications have an inhibitory effect on salivation centers: psychotropic drugs, anti-arrhythmics, antihypertensives, antispasmodics, antihistamines, anti-Parkinsonian drugs, anti-emetics, muscle relaxants, centrally acting analgesics, and anorectics.

In general, all sympathomimetics, atropine-like drugs, and antihistamines.

Cervicofacial radiotherapy: Irradiations for head and neck cancers deliver 65 Grays to the oral cavity; hyposialia occurs with the appearance of radiomucositis after one week of treatment; it worsens until complete xerostomia, which can be permanent.

The diagnosis is obvious: dental complications can be significant with an increase in cavities and the need for fluoride prophylaxis from the start of radiotherapy, which must be continued afterward.

It is necessary to restore the oral cavity to good health before starting radiotherapy.

Sjögren’s syndrome combines several criteria: dry mouth, dry eyes, and involvement of accessory salivary glands; clinically, parotidomegaly is observed in 1/3 of cases.

The syndrome can be primary (idiopathic) or secondary associated with connective tissue diseases (most often rheumatoid arthritis or more or less severe cutaneous vasculitis, lymphoid interstitial pneumonia, or multiple neuritis).

The biological workup includes CBC, ESR, protein electrophoresis, cryoglobulinemia, Ag, HCV antibodies with multiple antibody screenings.

Most sialoses are accompanied by dry mouth; sarcoidosis can be diagnosed via an accessory salivary gland biopsy. Amyloidosis can also cause dry mouth.

Senescence is a diagnosis of exclusion: a frequent deficiency in women around menopause; also check for mouth breathing and insufficient fluid intake.

Psychogenic dry mouth: clinical examination is normal while the patient complains of a sensation of thick, sticky saliva; the mucous membranes seem to burn and tingle. The patient has the impression that their tongue and lips are swollen. These pains are described as intermittent at first, then daily; they are at their worst in the evening and disappear at night; they are relieved during meals. 60% involve patients in a pre-depressive state or represent the expression of anxiety or a stress state in a normal patient. 30% of cases are the expression of the decompensation of a long-standing organized psychopathological state; finally, 10% are the expression of manic-depressive psychosis.

Treatments

Generally not very effective; the easiest approach is to treat the cause, for example by reducing sialoprivic medications.

In terms of preventing oral manifestations: motivation for oral hygiene, prescription of fluoride trays to avoid cavities and the use of fluoride toothpastes; disinfection of dentures, periodontal treatment, and the use of bicarbonate mouthwashes to avoid candidiasis.

Sea buckthorn, a natural and effective remedy thanks to Omega 7

Omegas 7 are fatty acids that come from a shrub called sea buckthorn, native to temperate zones in Europe and Asia. Omegas 7 are produced by our body, but unfortunately in very small quantities, which is therefore not sufficient to fight dry mouth.

Our capsules are made from cold-pressed sea buckthorn oil, naturally rich in Omega 7. It is distinguished by its contribution of fatty acids, particularly Omega 7.

Thanks to the combined action of the four omegas 3, 6, 7, 9 and natural antioxidants (vitamin E and carotenoids), our capsules improve the hydration of your skin and mucous membranes.

For maximum effectiveness, it is advisable to take one sea buckthorn oil capsule with each meal: morning, noon, and evening. Be aware that a daily dosage of approximately 270mg of Omega 7 (which is actually palmitoleic acid) is required. Sea buckthorn is widely recognized in the field of pharmacopoeia for its healing properties, both for the skin and for skin hydration.