What is it?

Xerostomia is not a disease in itself, but rather a symptom of two important disorders of the salivary glands:

• Aptyalism, which is the total absence of saliva secretion, where the salivary glands have been severely and irreversibly damaged by disease or medical treatment.

• Hyposalivation, which is a reduction in saliva production by the salivary glands.

Having a dry mouth in the morning upon waking, or after physical activity, is not abnormal and should not lead to a diagnosis of xerostomia. It is only when the sensation of dry mouth persists throughout the day, despite adequate hydration, that xerostomia may be considered.

The best way to establish a diagnosis is to consult a dentist, who will carry out a clinical examination, a medical history assessment, and an objective test to measure saliva deficiency.

What are the causes?

The causes of xerostomia can be divided into two categories. On the one hand, there are so-called iatrogenic causes, meaning those “caused by medical intervention”. In this case, dry mouth is a consequence of drug therapy or radiotherapy treatment.

On the other hand, there are non-iatrogenic causes, which are not related to medical treatment.

In order to treat dry mouth effectively, it is important to identify the cause, as the first line of treatment is to eliminate the underlying cause of xerostomia.

What are the consequences?

The first impact of xerostomia on daily life is a significant reduction in quality of life. Dry mouth leads to pain, altered taste, chewing and swallowing difficulties, making eating much slower and more difficult. It also causes speech problems, which in the long term may lead to social isolation.

However, dry mouth also affects oral health. Complications may arise because saliva no longer fulfils its antibacterial and pH-buffering roles. As a result, it is not uncommon for people with hyposalivation or aptyalism to experience:

• Bacterial complications, such as dental caries, periodontal disease, oral ulcers, or intolerance to dental prostheses.

• Fungal infections, including recurrent candidiasis. This condition is caused by a fungus, Candida albicans, which proliferates in the mouth and leads to membrane formation, a burning sensation in the mouth, erythema of the underlying tissue, and the impression that the tongue lacks papillae.

How is it diagnosed?

The diagnosis of xerostomia is made in three stages:

1. Medical history assessment – The individual is asked to answer questions such as:
   “Have you experienced a daily sensation of dry mouth for more than three months?”,
   “Do you have a dry mouth when eating or speaking?”,
   “Do you have difficulty swallowing certain foods?”

2. Oral cavity examination – This involves assessing the consequences of dry mouth on saliva (is it scarce, fibrous, thick, or even absent?), on the mucous membranes (are they red and dry?), on the tongue (is it depapillated and shiny?), and on the corners of the mouth (are there fissures?).

3. Objective salivary flow test – This is carried out by placing a sugar cube on the tongue. The time required for it to dissolve is an objective indicator of reduced saliva secretion.

Is there treatment?

If the salivary glands have not been irreversibly destroyed, dry mouth can be treated. In this way, it is possible to regain a certain level of comfort and prevent the complications associated with xerostomia.