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Mouth Dryness (Xerostomia) in Seniors


Mouth dryness is a common ailment experienced by the elderly. It is often due to age-related changes in the salivary glands but more significantly it is caused by common chronic medication often used by seniors. In many cases mouth dryness is ignored by physicians as the need for these chronic drugs outweighs the discomfort caused by a dry mouth. However, there are several possible complications that can arise with a persistently dry mouth. Furthermore, mouth dryness can sometimes be due to other underlying diseases and should therefore not be taken for granted in seniors.

Xerostomia, the medical term for mouth dryness, is a condition characterized by decreased saliva production or alteration in saliva. Sometimes a person may feel that the mouth is persistently dry yet saliva production is normal – these cases are not true xerostomia. Constant dryness can make it difficult to eat and swallow and increases the risk for conditions like mouth ulcers and oral thrust. A loss of sense of taste, usually only partial, may also be experienced thereby removing the pleasure from eating tasty foods. This also has an impact on the person – usually a psychological impact.

Symptoms of a Dry Mouth

Mouth dryness is a symptom and not a condition on its own. Not every person realizes that they have mouth dryness but other symptoms may point to a lower than normal quantity of saliva in the mouth. The initial symptoms include difficulty in lubricating foods. The patient may complain of difficulty in swallowing or eating. The consistency of the saliva often changes and in xerostomia it appears to have a thick, ropey and foam-like appearance. The tongue has a leathery appearance and shows loss of papillae. The loss of papillae can lead to decreased or altered taste sensation.

Patients with xerostomia often develop oral thrush, a fungal infection caused by Candida albicans. As the saliva contains antimicrobial agents and has a cleansing action against microbes, lack of saliva leads to a definite increase in oral infections. Periodontal diseases are more aggressive in cases with xerostomia. As a result of various infections and increased bacterial count in the oral cavity, patients with xerostomia often develop halitosis or foul odor to the breath. Dental caries (tooth cavities) is more rampant and severe in patient with xerostomia.

Causes of Mouth Dryness

Xerostomia has multiple causes. It is associated with systemic disorders, use of certain drugs and local factors.

The systemic diseases that are associated with xerostomia include Sjögren’s syndrome and uncontrolled diabetes mellitus. These conditions are more common in seniors. Sjögren’s syndrome is the most commonly associated disease leading to xerostomia. Other less commonly involved systemic factors includes HIV infections, Mikulicz disease, Lambert-Eaton syndrome and age-related changes in saliva regulation.

The drugs leading to xerostomia as a side effect include certain chemotherapeutic agents, antidepressants, antihistamines, antihypertensives and amphetamines. Diuretics, which increase fluid loss, are one of the leading causes of drug-induced dehydration and mouth dryness is a common symptom.

Excessive smoking and chronic alcohol consumption also predisposes an individual to develop xerostomia. Local factors causing xerostomia include mouth breathing and trauma to the salivary gland duct. Tumors of the salivary glands can block the outflow of saliva as well as the presence of salivary gland stones. Shrinking of the gland can also occur and it sometimes becomes non-functional.


Treatment of xerostomia is primarily directed at treating the underlying disease. Habits such as mouth breathing should be corrected. Alcohol consumption and cigarette smoking should be minimized or discontinued. Drugs that may be causing a dry mouth should not be discontinued unless advised by a medical professionals.

Drugs like pilocarpine can be prescribed to increase the flow of saliva. Drinking fluids and chewing sugar free gum is also recommended. Saliva substitutes such as carboxymethyl cellulose can also be prescribed. Oxidized glycerol trimesters can be used to coating the oral mucosa and provide relief for many of the symptoms associated with xerostomia.

Patients with xerostomia are advised to maintain proper oral hygiene and undergo periodontal therapy periodically to avoid oral infections. All cavities should be restored and preventive measures should be taken to avoid development of new lesions of dental caries.

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