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The lower image is a section through the submaxillary gland.
This is a higher resolution image (more of a "closeup") than the
other two images, and a different staining technique has been used
in its preparation. The base stain is red instead of purple.
However, the mucous secreting aceni are again clear and are shown to
be in close approximation to the serous secreting aceni which stain
red. The submandibular gland secretes a mixture of both
types of saliva.
What causes xerostomia?
Xerostomia happens when the three sets of saliva glands
described above are forced to decrease the output of saliva. There are two
basic reasons why the saliva glands might cease to function at full capacity:
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Certain drugs which may be taken for various reasons
and for various medical conditions may cause the saliva glands to reduce
their output. The following is a partial list of broad drug categories
that may do this. If you think you may be taking a drug that is
causing dry mouth, then check with your physician:
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antihistamines (the older types like
Benedryl)
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Pseudoephederine (also called Sudafed®
but found in many other brands)--the
only generic decongestant now available over the counter.
-
antidepressants (old style types like Elavil,
Flexaryl etc)
-
anticholinergics (often used as decongestants as
well as surgical drying agents like atropine and scopolamine.)
-
anorexiants (diet pills)
-
antihypetensives (blood pressure meds)
-
antipsychotics (psychiatric drugs)
-
anti-Parkinson agents, diuretics
("water pills")
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sedatives (sleeping pills)
-
Certain illegal recreational drugs
-
Methamphetamines
-
Cocaine
-
Ecstasy
-
Some medical conditions or treatment modalities may destroy
the parenchymal acini which actually produce the saliva . These
include:
-
Radical radiotherapy (therapeutic x-ray
treatments) for the treatment of head and neck cancer. Radiation
to the head and neck area causes damage to the blood vessels and also
kills off cells that are actively dividing, including saliva producing
cells in the salivary glands.
-
Chemotherapy for cancer. The dry mouth
caused by chemotherapy is generally temporary, but can become a more
chronic problem if the chemo is prolonged.
-
Uncontrolled diabetes
-
Sarcoidosis
-
Systemic Lupus Erythematosis
-
Sjörgren's syndrome (an autoimmune disease which
attacks all fluid producing glands in the body, including saliva and
tear producing glands.
-
Rheumatoid
arthritis and systemic lupus erythematosis
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Persons suffering xerostomia often also
suffer from bad breath. Halitosis is
a separate problem which has its own diagnostic and treatment
protocols. Persons wishing to understand their bad breath,
and how to treat it may consult my dedicated page on
Halitosis |
How can xerostomia be treated?
Unfortunately, xerostomia is a condition that currently has no
definitive means for treatment. However, palliative treatments (treatments
designed to improve
symptoms without actually treating the underlying disease) and inductive
treatments (treatments designed to induce the remaining salivary tissue
to produce more saliva) are available.
Palliative treatment methods are useful in all cases of
xerostomia, including those in which there is little remaining salivary tissue.
These treatments involve non-prescription methods to stimulate remaining
parenchymal tissues to produce more saliva, and some will supply missing
naturally occurring enzymes and saliva-like moisture to the mouth.
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Drink lots of sugarless fluids.
When you drink water, it is always absorbed into the
bloodstream. In an effort to restore normal osmotic body
chemistry, the body will excrete the excess water in any way
possible. Most of the excess water is absorbed through the
kidneys and ends up as urine, but all excretory functions are
increased, including saliva production. Sugar should be
avoided because people with dry mouth are more prone to tooth
decay and sugar is the prime villain when it comes to decayed
teeth.
-
Chew gums and suck on mints or candy
sweetened with xylitol. Chewing or sucking on a candy that
does not promote decay stimulates saliva production.
Any sugarless candy or gum is good for theis purpose, but
xylitol is an artificial sweetener that has been shown to
inhibit bacterial growth in the oral cavity.
Biotene products (Laclede) are
highly recommended by dentists for patients with dry mouth.
You can buy less expensive mints and candies sweetened with
xylitol over the internet (Google
search). Below is a list of some that you may
find in supermarkets or drug stores:
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Gums
(manufacturer)
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Mints / lozenges / candies
(manufacturer)
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Biotene Dry Mouth Gum
(Laclede
Research Labs)
ElimiTaste
(Zapp Gum)
Ricochet Gum
(Emerald
Forest)
Therabreath ZOX Mints
(TheraBreath)
TheraGum
(Omnii)
Trident Gum with Xylitol
(Warner-Lambert)
Xponent Xylitol Gum (Global Sweet
Polyois)
Xylitol Gum Power Bite
(Rocky Mountain
Herbals)
Carefree Koolerz
(Hershey)
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Mini Mints, various flavors
(Solaray)
Ricochet Fruit Sours & Mints
(Emerald
Forest)
Spry Mints
(Xlear)
Thayers Sugar-Free Citrus Dry
Mouth Lozenges
(Thayers)
TheraMints
(Omnii)
Xylichew Mints
(Xylichew)
Xylitol Mints ( Nature’s
Sweet Life)
Xylitol Mints
(Xponent)
Xylitol Peppermint Mints
(BioGenesis
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Saliva substitutes such as Rosane, Salavart or
Optimoist, when used over at least a two week period not only helps to
restore moisture, but also tends to stimulate remaining parenchymal tissues
to produce more saliva on their own.
-
Neutral Sodium Fluoride toothpaste (Prevident 5000
Google search)
Prevident is a high fluoride toothpaste, often prescribed by dentists
for patients suffering from generalized tooth sensitivity or rampant decay.
It has the added benefit of stimulating saliva production if used several
times a day regularly. It is applied to the teeth after brushing and
flossing (with regular toothpaste and floss). Apply a small amount to
the brush and brush teeth without water. Spit out, but do not rinse.
Do not swallow. This is an especially recommended type of treatment
since persons suffering xerostomia are also prone to rampant tooth decay,
and the high fluoride content of this toothpaste inhibits the plaque
organisms that cause decay, and helps to remineralize areas of tooth decay.
Inductive treatment options involve prescription drugs
which, when taken as directed, will help to induce remaining parenchymal
salivary tissues to produce the maximum amount of saliva possible. The
patient needs to be under the care of a dentist or physician to get a
prescription for these drugs.
-
Salagen (pilocarpine 5 mg tablets) The dentist
prescribes 45 tablets. The patient takes a half tablet three times a
day (every 8 hours) for the first month and then increases the dose slowly
to the maximum 5 mg dose three times per day as tolerated. This drug
works quite well, but there are some side effects which effect a minority of
patients taking it. These side effects include excessive sweating,
gastrointestinal disturbance, increased lung secretions, blurred vision, and
rarely slow or fast heart rate. Excessive sweating is reported as the
most common side effect, the others being reported rarely. This
drug should not be taken by persons suffering narrow angle glaucoma.
-
Evoxac (cevimeline HCl, 30 mg tablets) Evoxac is
taken three times a day, just like Salagen. It is reported to have
fewer side effects than Salagen because it exerts its primary effect on
receptors found on salivary parenchymal cells. This drug should not be
taken by persons suffering narrow angle glaucoma.
Non traditional treatment modalities:
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Acupuncture relies on stimulating trigger points in
the head and neck region with the goal of parasympathetic stimulation of
functioning salivary tissues. This is accomplished by using a series
of small needles of varying size inserted just under the skin in the area of
the trigger points. Studies have shown that the effects of acupuncture
provided relief for individuals with Sjorgrens syndrome for up to six months
after treatment.
-
Acupuncture-like TENS therapy. TENS stands for
Transcutaneous Electric Nerve Stimulation. This is quite similar to
Acupuncture, but relies on low voltage electrical stimulation of the
acupuncture trigger points instead of using needles. One study showed
that patients who had suffered xerostomia after radiation therapy for head
or neck cancer showed significant improvement when treated using TENS
therapy twice per week for six weeks. An innovative product
involving continuous stimulation of intraoral tissues that (apparently)
involves having a dentist take an impression of your teeth, and having a
custom built radio controlled unit that fits on the lower teeth fabricated,
can be seen by clicking
here.
Future treatment modalities
-
Gene Transfer recombinant DNA technology is a new,
cutting edge technology which shows promise in curing chronic xerostomia.
Gene transfer technology uses a "cold" virus (an adenovirus) which has been
modified to contain a gene encoding for a specific functional protein.
The patient is infected with this virus and the virus transfers
the gene to duct cells in the non-functioning salivary glands causing them
to begin secreting again. This treatment modality is still in the
animal-testing stage.
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Guided tissue regeneration (GTR) is also a new,
cutting edge technology which uses tissue cells cultured and grown outside
of the human body, and then implanted in a patient using a polyglycolic acid
polymer scaffold which is seeded with the cultured cells to recreate a
functioning human organ. This technology is still in the experimental
stage.
Tooth decay and
xerostostomia
Persons with dry mouth syndrome are prone to a much
more virulent form of tooth decay characterized by "rampant
ectopic caries". Rampant means that it tends to occur all
over the mouth, "ectopic" means that the tooth decay occurs on parts
of the teeth that are not usually involved with decay.
In the case of dry mouth, The bacterial floral
pattern shifts toward organisms which produce a great deal of acid
when exposed to sugar, and persons with dry mouth are more prone to
sucking on hard candies in order to produce more saliva in their
mouth. This combination produces very fast and serious decay
in areas of the teeth that are not protected by enamel, namely the
exposed root surfaces.
Excessive exposures of the teeth to sugar causes
decay in normally hydrated mouths too, but the decay generally
happens in areas of the teeth protected by enamel, mostly in on the
top surfaces (occlusal surfaces) of the back teeth, and in between
the teeth where the teeth make contact with each other
(interproximal surfaces). It happens at the point of
contact between adjacent teeth because the teeth rub together at
that point, and the buildup of plaque in the triangular space below
the point of contact creates a constant supply of acid which works
quickly on the enamel which is under assault from the constant
rubbing. This type of caries is clearly seen on the x-ray
image below:
In the case of dry mouth, however, the concentration
of acid is much greater, and it begins dissolving the root surfaces
which, though not under abrasive attack, are much softer than the
enamel-protected contact areas:
In the image above, the root caries are indicated by
the red arrow, and the blue arrow indicates the position in which
normal interproximal caries is more prone to happen.
Good oral hygiene, including proper brushing
and floss (or
Stimudents) along with
avoidance of sugar will reduce or eliminate the likelihood of the
rampant decay associated with xerostomia. The use of
xylitol candy or mints not only stimulates saliva production, but also reduces the
bacteria count in the mouth helping to further prevent tooth decay.
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