Dry mouth - Causes, symptoms and treatment. MF.
Dry mouth( xerostomia) - dryness of the oral mucosa, due to a decrease or cessation of the secretion of the salivary glands. With chronic dryness of the oral mucosa it is difficult for a person to speak, chew, swallow and taste, all this in general makes life rather uncomfortable.
Typical signs of this condition are:
- Sensation of "stickiness" and dryness in the oral cavity
- Intensified thirst
- Areas of irritation in the mucous membrane of the oral cavity;cracks in the lips and in the corners of the mouth
- Sensation of dryness in the throat
- Burning or itching in the mouth( especially in the tongue)
- Language turns red, becomes dry and rough
- Speech, mouthfeel, chewing and swallowing
- Hoarseness, dryness of the mucosanasal passages, sore throat
- Bad breath odor
The oral mucosa can respond to various pathological processes and functional disorders in many body systems.
Causes of dry mouth, not associated with the disease
1. Insufficient drinking regimen( with water shortage, in hot weather, when eating highly salted foods).
2. The use of a significant number of different drugs( antitumor, atropine, psychotropic drugs, diuretics, group of sympathomimetics, etc.) has such a side effect as dry mouth. Even hypotensive, vasoconstrictive and antihistamines help to reduce the production of saliva.
3. When breathing through the mouth( in the elderly at night during sleep with an open mouth due to weakness of the muscles that lead the lower jaw to the upper, with obstructed nasal breathing due to polyps of a curved nasal septum, etc.).
4. Frequent unreasonable mouth rinses.
5. Smoking.
6. Alcohol intoxication.
7. Menopause.
Diseases in which dry mouth is observed
1. Salivary gland diseases ( mumps, sialadenitis, sialolithiasis, sialostasis, Mikulich's disease).Common signs for each of these pathologies is the violation of saliva, up to complete cessation, the pain of the gland, its enlargement, salivary colic( pain in the salivary gland during eating), swelling in the salivary gland.
2. Infectious diseases .Dryness in the oral cavity occurs as a result of increased body temperature and sweating( influenza, angina, etc.), and due to a significant loss of fluid with vomit and feces( cholera, dysentery, etc.).
3. Endocrine diseases .Diabetes mellitus is a disease that is based on the absolute or relative insufficiency of insulin in the body, causing a violation of carbohydrate and other metabolic processes in the body. Characteristic symptoms of overt diabetes are thirst, dry mouth, weight loss, weakness and polyuria( increased amount of excreted urine).The amount of urine released per day can be 3-6 liters and more. Thirst and dry mouth are associated with a decrease in fluid in the body and suppression of the salivary gland function.
Thyrotoxicosis is a pathological condition of the body that develops as a result of high levels of thyroid hormones in the blood. Thyrotoxicosis is a complication of diffuse toxic goiter, thyrotoxic adenoma, multinodular hyperthyroidism. Patients complain of feelings of fear, increased irritability, sleep disturbances, tremors in the arms and whole body, tachycardia, sweating, frequent diarrhea, vomiting, dry mouth, decreased appetite. Xerostomia occurs due to the violation of metabolic processes and increased excretion of fluid from the body.
4. Neoplasms of the oral cavity ( malignant and benign).Parotid and submandibular salivary glands are most often affected. Benign tumors are more often located in the gland tissue, but can also be superficial. They are painless formations with a smooth or coarse-grained surface, a dense elastic consistency, with a clearly expressed capsule. Malignant tumors are a dense, painless node or an infiltrate in the gland, with no clear boundaries. With the progression of the disease, pain appears. The tumor quickly spreads to surrounding tissues and organs and gives regional metastases. When parotid gland is affected, paralysis of mimic muscles occurs. Dryness of the oral cavity can be observed both as a result of the presence of the tumor itself( destruction, compression of the gland tissue and its ducts), and as a complication of radiotherapy for oncological processes in the maxillofacial region due to the direct action of ionizing radiation on the neurosecretory apparatus and gland tissue.
Parotid salivary gland cancer
5. Deficiency of retinol ( vitamin A) is manifested with pallor and dry skin, its peeling, a tendency to pustular lesions. Dry and dull hair, dry mouth, photophobia, conjunctivitis, blepharitis, frequent respiratory tract diseases, fragility and striation of the nails, cracks in the corner of the mouth, hyperkeratosis( increased keratinization) of the oral mucosa are observed. Insufficiency of vitamin A leads to severe disorders of the epithelium, in which a change in the course of physiological regeneration( recovery) occurs and its atrophy develops. Increased debridement of the newly formed epithelium of excretory ducts of the salivary glands leads to their blockage and the formation of retention cysts. The secretion of saliva is slowed down, although the gland tissue itself is not affected.
6. Pathological processes leading to increased loss of fluid : external and internal bleeding, massive burns, fever, frequent persistent diarrhea and vomiting, increased sweating.
7. Surgical removal of salivary glands is performed with extensive injuries, oncological processes, with chronic inflammatory diseases, if other methods of treatment were ineffective.
8. Injuries of large salivary glands. Dry mouth is noted when the parotid, submaxillary, sublingual areas are injured. Trauma can lead to rupture of the tissue and ducts of the gland, which can cause disruption of the formation and salivation in the oral cavity.
9. Nerve damage to ( mainly glossopharyngeal and facial craniocerebral nerves) that contribute to the salivary gland or salivary center( the core of the facial and glossopharyngeal nerves in the medulla oblongata).
10. Anemia .Iron deficiency anemia is characterized by pallor of the skin and mucous membranes, weakness, physical fatigue and mental fatigue, shortness of breath during movements, frequent dizziness, tinnitus, dry mouth, taste distortion( addiction to chalk, coal, lime).
11. Nervous overexcitation .Excitement, stress, high psycho-emotional loads sometimes cause the appearance of dryness in the mouth in people with increased nervous excitability. Dry mouth goes together with symptoms of stress.
12. Systemic diseases .
Systemic scleroderma is a polysyndromic disease manifested by progressive fibrosis of the skin, internal organs( heart, lungs, gastrointestinal tract, kidneys) and vascular pathology such as obliterating endarteritis with widespread vasospasticheskih( reducing the lumen of the vessels by reducing the smooth muscles of their walls) violations. The clinic reflects a specific skin lesion that changes the appearance of the patient( masky face, sclerodactyly) and various body systems( polyarthralgia, esophagitis, peptic ulcers, pneumosclerosis, cardiosclerosis, glomerulonephritis, etc.), the symptoms progress with time. A common symptom is osteolysis of the nail phalanges, which leads to a shortening and deformation of the fingers and toes. The defeat of the mucous membranes is manifested by dryness in the oral cavity, thickening and shortening of the tongue bridle. Scleroderma often combines with Sjogren's syndrome.
Sjogren's disease is a systemic autoimmune disease characterized by dry mucous membranes caused by lymphoid proliferation of endocrine glands.
Sjogren's syndrome is a symptom complex characterized by a combination of signs of the defeat of the glands of external secretion( more often salivary and lacrimal) with a number of autoimmune diseases.
The course of the disease and Sjogren's syndrome are identical. However, the disease occurs as an independent disease, and the syndrome occurs in combination with rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma and other diseases. Manifestations of pathology can be conditionally divided into systemic lesions( recurrent non-erosive arthritis, myositis, interstitial nephritis, etc.) and symptoms associated with hypofunction of the glands of external secretion( dryness of the mucous membranes of the oral cavity, nasopharynx, trachea, eyes, vagina, gastrointestinaltract).Patients complain of itching, burning, pain of the eyelids, photophobia. A recurrent bacterial conjunctivitis may develop. The defeat of the salivary glands leads to the development, most often, of chronic mumps, accompanied by pain, swelling of the salivary gland tissue, an increase in body temperature to 38 - 40oC.In the late stages there is a sharp dryness in the mouth, the inability to speak, swallow food without the addition of liquid.
Cystic fibrosis is a hereditary disease characterized by systemic damage to the glands of external secretion, manifested by a serious disorder of the respiratory system, gastrointestinal tract and a number of other organs and systems. The disease manifests itself in the period of newborn. With good appetite, children do not gain weight, there is a paroxysmal cough, dryness of the mucous membrane of the mouth, saliva is viscous. There is constant shortness of breath and cyanosis.
Diagnosis for dry mouth
When examining a patient, clarify the children's diseases( mumps), what drugs are taking now, bad habits. Examine and feel the area of the salivary glands. Based on the data already received, the doctor makes a presumptive diagnosis and determines the tactics for further examination.
Laboratory-instrumental examination for dry mouth
1. general blood test( reduction of hemoglobin and number of erythrocytes in iron deficiency anemia, scleroderma, increase in leukocytes in inflammatory diseases);
2. general urine analysis - microhematuria( appearance of erythrocytes in urine), proteinuria( protein in urine), cylindruria, leukocyturia with systemic scleroderma;
3. blood glucose( norm 3,3-5,5 mmol / l, rising of a level of a glucose testifies to a possible diabetes);
4. Blood on thyroid hormones: T3, T4, TTG.With thyrotoxicosis, the level of T3, T4 rises and TSH decreases;
5. Biochemical blood test: retinol in case of vitamin A deficiency below 100 mcg / l, carotene - below 200 mcg / l;
6. ELISA( enzyme immunoassay) - antinuclear antibodies in scleroderma;
7. Serological analysis: rheumatoid factor in the titer of 1:80 with Sjogren's disease;
8. Ultrasound is used to determine the size of the salivary glands, the presence of stones, tumors, cysts, neuritis, etc.;
9. Sialoscintigraphy - allows you to judge not only the secretory function of the salivary glands in general, but also about each phase of saliva formation separately;
10. Review radiography - the method is used for sialolithiasis( salivary stone disease), with the possibility of foreign bodies of the salivary glands, with damage to the jaw and facial bones;
11. Sialadenolymphography - is used for suspected metastases in the salivary glands;
12. Sialometry - is performed when it is necessary to evaluate the excretory capacity of the salivary glands. Normal parameters: 1.0 ml of saliva for 7-20 minutes;
13. Probing the ducts of the salivary glands is used to assess their patency;
14. Biopsy and cytology of saliva and obtained bioptate - used in the presence of neoplasms of the salivary glands;
15. CT( computed tomography) - the method is effective for diagnosing neoplasms in the salivary glands;
16. MRI( magnetic resonance imaging) reveals the cause of the pathology of salivary glands, neuralgia of the glossopharyngeal and facial nerves;
17. If it is necessary to study the qualitative composition of saliva, it is possible to determine the level of immunoglobulins, proteolytic enzymes, amylase, macro- and microelements, etc.
Treatment of dry mouth
Treatment should be comprehensive, coordinated with the doctor and include:
1. Treatment of the underlying disease that caused dryness in the oral cavity.
2. Abandonment of bad habits( smoking).
3. If dryness in the mouth is caused by medications, then, on the advice of a doctor, try to reduce the dose.
4. Do not eat too much salted food.
5. If necessary, drink abundantly.
6. Avoid alcohol-containing mouthwashes.
7. It is possible to use drugs that replace saliva.
Than dry mouth is dangerous
Dryness of the oral cavity can be one of the first symptoms of many systemic diseases. Therefore, if possible, in the shortest possible time, consult a doctor for examination. Dry mouth increases the risk of gingivitis( inflammatory gum disease), caries and various infections of the oral cavity( for example, thrush).Also, dry mouth can make it difficult to wear dentures.
To which doctor to handle when dry in the mouth
Therapist, endocrinologist, rheumatologist, dentist.
Doctor therapist Klentkina Yu. V.