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Treating Xerostomia Patients
DISEASES that can CONTRIBUTE
to salivary flow dysfunction
• Sjögren-Larsson syndrome – systemic
autoimmune disease; immune cells attack and
destroy the exocrine glands that produce tears
and saliva. Pronounced SHOW-grins, this disease
is common in those with fibromyalgia and chronic
fatigue syndrome.
• Lupus – collection of autoimmune diseases;
a hyperactive immune system attacks normal,
healthy tissues and can affect the joints, skin,
kidneys, blood cells, heart, and lungs
• Erythema multiforme – condition of the skin and
oral mucous membrane ranging from a mild rash
to life-threatening rash. Usually follows an infection
or drug exposure. Peak incidence occurs in the
second and third decades of life.
• Von Recklinghausen’s disease
(neurofibromatosis) – genetic disease in
which patients develop multiple soft tumors
(neurofibromas). Tumors occur under the skin
sand throughout the nervous system.
• Sialolithiasis – formation of calculus, or stones,
in the salivary glands
• Bell’s palsy – disorder of the nerve that controls
movement of facial muscles. Damage to this nerve
causes weakness or paralysis of these muscles.
Cannot use muscles due to paralysis.
• Stroke – rapid loss of brain function due to
disturbance in the blood supply to the brain
The submandibular salivary glands are located in the
submandibular fossa of the mandible, or cleft, on both sides.
Their ducts go into the ventral side of the oral cavity on
either side of the mouth. It is very important for the surgeon
who places implants not to drill their osteotomy into this
area. Of course we’re using guided surgery with CT scans
now, so those things are definitely less of an occurrence.
All three sets of salivary glands are the main salivary glands
that allow us to chew our food in our mouth. There are
minor ones, too, some of which are called molar glands, but
these are the three sets of two that are the most important.
BB: We’ve talked about the causes of xerostomia, and we just
reviewed the anatomy of the three sets of salivary glands. Can
you tell us a little bit about the ways of diagnosing xerostomia?
CT: That’s very important because you have to treat the
patient who has xerostomia a little differently — a lot of
the diagnoses come from the patients’ symptoms. One of
the most important things, especially with women, is that
they come in with lipstick on their teeth. Women who have
lipstick on their teeth usually are experiencing a lack of
salivary flow — there is no saliva there to rinse the lipstick
off their teeth. That’s one of the first things I notice.
The next thing I notice obviously is a dry mouth. Maybe
thick and ropey saliva, almost a mucous-like saliva. Sore
throats. Difficulty talking. Sometimes they’ll complain about
a tongue that’s really sore all the time, and feeling thick —
those kind of symptoms. And I ask specific questions in the
initial consultation when the patient is sitting in my chair.
Lots of them — especially, again, postmenopausal women —
say they have a lot of these symptoms. It’s a tough nut
to crack.
BB: Are there other things you can detect from your patients,
such as taste, or a malodor?
CT: That’s correct. A lot of times there are specific causes
of bad breath. Now, obviously, bad breath can be the result
of periodontal disease or caries caused by salivary gland
dysfunction. Because the saliva has certain bactericidal
properties, bad breath, malodor, and a bad taste in their
mouth can be symptoms of gland dysfunction.
BB: And then you mentioned caries, lack of salivary flow can
obviously affect that, right?
CT: Tremendously, especially near the gingival tissues and
the areas of the CEJ (cementoenamel junction) of the teeth.
They become rampant caries, and it can be very difficult to
treat. You have to go with certain preventive measures, such
as using PreviDent ® (Colgate; New York, N.Y.) or some kind
of fluoride rinse, drink water a lot, and so forth.
BB: So if they have cervical lesions, does that become part of
the differential diagnosis as to what’s causing that?
CT: Correct. That is definitely one of the major pop-up
symptoms.
BB: As far as developing fungal and other infections, you
mentioned the bactericidal properties of saliva. What are some
other things that can show up?
CT: It isn’t necessarily specifically from salivary gland
dysfunction, but those people who have autoimmune
problems or who are taking medications can have candida
problems all throughout their body, especially the ladies. So
what happens is they get candidiasis in their mouths, and
a lot of the people I treat have to wear prostheses — either
fixed or removable prostheses — and that can be a problem
when you do get candida because it’s tough to keep treating
it with Nystatin or Monistat ® (Insight Pharmaceuticals;
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