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References

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Xerostomia. Part 1: aetiology and oral manifestations

From Volume 49, Issue 10, November 2022 | Pages 840-846

Authors

Farima Mehrabi

BDS, MFDS, RCSEd PgCertMedEd

Dental Foundation Trainee

Articles by Farima Mehrabi

Dáire Shanahan

BA BDentSc, MBBCh, MFDRCSI

Specialist Trainee in Oral Medicine, University of Bristol Dental Hospital

Articles by Dáire Shanahan

Gemma Davis

BDS, MFDSRCS (Eng), PgCertTLHP

Specialty Registrar in Oral Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

Articles by Gemma Davis

Abstract

Xerostomia is the subjective sensation of a dry mouth. It can negatively impact oral health and quality of life. The underlying aetiology consists of both local and systemic factors. This two-part series aims to comprehensively review the aetiology and oral manifestations involved with xerostomia.

CPD/Clinical Relevance: Early recognition and management of xerostomia is important to limit the adverse effects of this condition

Article

Xerostomia is the subjective sensation of a dry mouth, a common complaint with a variety of causes. Dry mouth is most frequently associated with salivary gland hypofunction, where either the quantity or quality of saliva is altered. In some cases, the perception of dryness can also occur in the presence of normal salivary gland function.

The prevalence of a persistent dry mouth ranges from 1% to 68% of the population,1,2,3 with an increased prevalence in women (~30%) and the elderly (~50%).1 This great variability is due to a lack of global consensus regarding the definition of xerostomia, a lack of standardized assessment tools and outcome measures used in research, as well as the different populations investigated.4

Daily salivary output in a healthy adult is approximately 1.5 litres, of which 90% is contributed from the parotid, sublingual and submandibular glands. The remaining 10% is produced by minor salivary glands.5 At rest, secretion can range between 0.25 ml/min and 0.35 ml/min, which is mostly contributed by the submandibular and sublingual glands.6 When there has been mechanical, electrical and/or sensory stimuli, the secretion rate can increase to 1.5 ml/min.6 The highest volume produced is usually around mealtimes and will reach a maximum peak at around midday, reducing considerably during sleep, following a circadian rhythm.6,7 Studies have suggested that the salivary glands may contain a circadian clock that regulates the amount, type and content of saliva.7,8 Research has shown that clock genes regulate circadian gene expression and, in turn, daily physiological function.8 Abnormalities of clock genes have been found in patients with reduced salivary flow; however, more research is needed to support these claims.8

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