Under the hyposalivation, the medical profession understands the lack of secretion of saliva. The oral mucosa reddens in this phenomenon, it hurts and is sometimes inflamed. Therapeutic procedures such as the administration of saliva substitutes can be used to combat dry mouth.
What is hyposalivation?
Hyposalivation is known as the lack of secretion of saliva. The opposite is the higher than average secretion of saliva, also known as hypersalivation. When salivary flow is reduced by half of normal, medicine also refers to xerostomia or dry mouth. Thus, xerostomia is a special form of hypersalivation in which the entire oral mucosa is no longer moistened with sufficient amounts of saliva. In addition to moistening the oral mucosa, saliva also has functions in food intake that are no longer satisfactorily fulfilled in the case of insufficient saliva secretion. From diseases to hormonal changes or medications, various causes are possible as triggers of hyposalivation or dry mouth. In a healthy organism, the salivary gland secretes about one milliliter of saliva per minute. This value is reduced to less than 0.5 milliliters in dry mouth.
Causes
The most common cause of hyposalivation, or dry mouth, is physiologic aging. Thus, with advanced age, salivary secretion naturally decreases as the salivary glands become less active. In addition, after a certain age, many people take medications that can reduce salivary flow. These medications include, for example, antihypertensives, anticholinergics, tricyclic antidepressants, antihistamines, and cytostatics. More than 400 drugs describe hyposalivation in their side effects. Amphetamines can have an equally depressing effect on salivary secretion. However, lack of fluid intake and dehydration also cause the mouth to dry out. Apart from this, psychological factors such as stress can minimize saliva production. Radiation therapy is an equally common cause. Causative diseases include Zagari’s disease, Sjögren’s or Heerfordt’s syndrome, as well as AIDS and sepsis. In addition, inflammation and tumors of the salivary glands can result in hyposalivation.
Symptoms, complaints, and signs
When hyposalivation is present, saliva loses its buffering function. This means that the oral mucosa is reddened and becomes vulnerable to inflammation. Sometimes bleeding gums set in. Pain in the mouth is therefore a common side effect of hyposalivation. A burning sensation on the tongue in particular characterizes the clinical picture. The risk of caries also increases with reduced salivary secretion. Harmful acids in the mouth are hardly neutralized by the lack of saliva. Bad breath sets in. After a longer period of time, the entire oral mucosa atrophies. Chewing is difficult in many cases. The same applies to the swallowing movement. In addition, the sense of taste can be affected. Patients often have above-average thirst. Instead of a clear liquid, the oral fluid becomes foamy. Sometimes patients can barely speak with extreme dry mouth.
Diagnosis and course of the disease
Diagnosis for hyposalivation is usually made by palpation. To do this, the physician uses a glove that sticks to the oral mucosa when there is a lack of salivary secretion in the vestibule of the mouth. When he tries to palpate the salivary glands, the glands do not release any salivary secretion as a result. On visual diagnosis, reddened areas and possibly inflammation as well as caries lesions are indicative of hyposalivation. The medical history can also provide important clues to the lack of secretion. To initiate a course of therapy, the physician must determine the cause of the hyposalivation. The prognosis is also decided with the cause. A good prognosis exists, for example, with medications that only have to be taken for a certain period of time. Dry mouth due to minimal fluid intake is also prognostically favorable. Diseases of the salivary glands are less favorable.
Complications
Hyposalivation results primarily in oral discomfort. This involves reddening of the mucous membrane and pain and inflammation.In most cases, hyposalivation also prevents the patient from taking in normal amounts of food and fluids, so that the patient usually suffers from being underweight or from various deficiency symptoms. It is also not uncommon to experience a burning sensation on the tongue and bleeding gums. The bleeding on the gums is very unpleasant and leads to pain. Likewise, tooth decay and other diseases of the teeth often occur. Patients also complain of a strong and unpleasant bad breath, which can also have a negative effect on the environment. This can lead to social discomfort or exclusion. Furthermore, those affected suffer from swallowing difficulties, which can lead to pain, especially when thirst is increased. The oral cavity is severely dried out and the affected person can hardly speak. In most cases, hyposalivation can be treated relatively easily and quickly. This does not lead to further complications. The treatment is causal and depends on the underlying disease. Life expectancy is not limited by hyposalivation.
When should one go to the doctor?
Symptoms such as repeated bleeding gums and a burning sensation on the tongue indicate hyposalivation. A visit to the doctor is indicated if the symptoms persist over a long period of time and no clear cause can be determined. If other symptoms such as bad breath or difficulty swallowing develop, medical advice is required. Caries or a generally unpleasant feeling in the mouth also indicate problems with saliva formation that need to be clarified by a doctor. People who regularly take medication are particularly susceptible to the development of hyposalivation. Radiation therapy, stress and diseases such as AIDS and sepsis are also possible triggers. Those who are among the at-risk groups should seek medical attention if the above symptoms and complaints occur. Children who suddenly refuse to eat should be taken to a pediatrician immediately. Bleeding on the gums and pain are also complaints that indicate hyposalivation in the child and should be clarified immediately. In addition to the general practitioner, the dentist may also be called in.
Treatment and therapy
Treatment of hyposalivation is based on the cause. If simply too little fluid was taken in, then the deficiency can be easily regulated. If the lack of saliva results from the patient sleeping with the mouth open at night, then the nose must be opened to allow nasal breathing to replace mouth breathing. If the decreased salivary secretion is a symptom of another condition that may not have a cure, saliva substitutes are given to the patient. Administration of these agents may symptomatically relieve the symptoms. The use of sugar-free chewing gum is often recommended because it can stimulate salivary flow. Instead of chewing gum, certain medications can also stimulate the glands to secrete saliva. If necessary, medicinal saliva stimulation via the substance pilocarpine can be used. Patients with hyposalivation are also often advised to maintain good oral hygiene. The reduced salivary flow otherwise increases the risk of inflammatory reactions and caries. If medications are responsible for hyposalivation, the benefits and risks of these medications are discussed. Because hyposalivation is usually the lower risk compared with not taking a particular medication, discontinuing the medication is not normally recommended.
Prevention
Most causes of hypersalivation or dry mouth cannot be counteracted. Hyposalivation resulting from dehydration can be prevented by drinking at least 1.5 liters of fluid daily. Dry mouth due to mouth breathing during sleep can be prevented by removing the adenoids, if necessary.
Follow-up care
For aftercare for hyposalivation, doctors often recommend sugar-free chewing gums. These increase salivary flow, which decreases the risk of inflammation and tooth decay. Depending on how much salivary stimulation is impaired, medications may also be used. However, for patients suffering from the condition due to other medications, doctors usually advise against further medication. The focus of follow-up treatment is therefore more on good oral hygiene.This, together with the normal flow of saliva, reduces the risk of inflamed areas inside the mouth. To counteract dry mouth, it often helps to drink more. At least 1.5 liters a day should be consumed by patients to avoid the special type of dehydration. If the problems do not improve over a longer period of time, a detailed investigation of the cause takes place. Among other things, mouth breathing during sleep may be responsible for the reduced saliva flow. It may help to surgically remove the polyps. Other measures against unconscious mouth breathing can also improve the situation. In some cases, it already helps not to lie on the back, but on the side. For acute dry mouth, patients should have chewing gum handy. Sugar-free chewing gums, which do not attack dental health, are best.
What you can do yourself
In the case of hyposalivation, there are some self-help options available to the affected person, so it is not necessary to see a doctor in every case. In most cases, hyposalivation occurs due to an insufficient intake of fluids. If the affected person consumes little fluid, this habit must be changed. As a rule, the patient should drink about two liters of fluid per day. Sleeping with the mouth open can also promote hyposalivation and should be avoided. In the case of an acute lack of saliva in the mouth, this can also be stimulated relatively well by chewing gum. Sugar-free chewing gum is particularly suitable for this purpose, so as not to damage the teeth. Some medications can also promote the condition. They can also be discontinued in consultation with a doctor or replaced by others. However, a doctor should always be consulted first. If the symptoms cannot be treated by means of self-help, the affected person is usually dependent on a visit to the doctor.
