Dry Mouth Syndrome or Xerostomia

Dry Mouth Syndrome and Oral Cancer

Dry Mouth Syndrome or Xerostomia as it is known by the medical profession is very often the result of cancer treatment for oral cancer. Oral cancer is also known as head and neck cancer. There are three ways that cancer therapy can adversely affect the production of saliva in your mouth. One is from radiation therapy. The second is from chemotherapy. The third is from drugs used to treat symptoms brought on by cancer treatments as many medications are known to effect saliva production.

Dry Mouth and Radiation Therapy

Radiation treatment for your head and neck can effect or even damage the glands which produce saliva themselves. This will of course cause a significant decrease in the amount of saliva produced. Unlike chemotherapy, this can be either temporary or permanent. The amount of saliva made by the glands usually starts to decrease within a week after starting therapy to the head or neck. It will continue to decrease as treatment continues over time. The severeness of the dryness will depend on the dose or amount of radiation and the number of salivary glands that receive radiation.

When this is temporary, it is because the radiation has caused changes in certain cells of the salivary glands, resulting in a reduction in saliva as well as thicker saliva. A common complain heard from those starting to undergo radiation therapy is thick or sticky saliva. Sometimes, over a period of time, the glands will start to function again, but they will rarely return to normal if they have been damaged by receiving direct radiation.

When this is a permanent condition, it can lead to other problems over the course of your life. They may partly recover during the first year after radiation therapy ends. Salivary glands that did not receive radiation may start making more saliva to compensate for the ones that can no longer produce for you. When this condition is permanent, it happens because of certain factors such as the area of the gland exposed to radiation, and the amount of radiation used.

Dry Mouth and Chemotheapy

Chemotherapy drugs can change both the amount of saliva produced, as well as the saliva itself. There are drugs which affect the sebaceous glands of the body, including salivary glands. During or after the process of chemotherapy, there may be an enlargement of the salivary glands. This inflammation reduces the amount of saliva produced and thereby causes dry mouth. Although this will not completely get rid of all of your saliva, it can be significantly reduced. Certain chemotherapy drugs are worse than others for causing dry mouth. Also, some drugs affect saliva production differently depending on the size and frequency of the doses.

For Chemotherapy, normal salivary flow usually will return after treatment has been completed. It may take a few weeks or a few months though.

Dry Mouth and Cancer Drugs

Some drugs used to treat problems arising from cancer treatments can cause a dry mouth as a result of their own side effects. Some of these include painkillers such as morphine, medicines used to treat high blood pressure, anti-depressants and antisickeness drugs. A dry mouth is a common side effect of a wide variety of medicines. As the number of side effects from cancer treatment can also be great, you will likely be given other treatments in addition to just the cancer treatments themselves.

Dry Mouth Syndrome in General

Here is a more scientific explanation from Dr. Jerry Gin, Ph.D.

Xerostomia or dry mouth is a condition or symptom usually consisting of insufficient saliva in the mouth (hyposalivation) and usually accompanied by a difference in composition of the saliva (amount of minerals and proteins). Salivary gland hypofunction has been defined as any objectively demonstrable reduction in whole and/or individual gland flow rates. An unstimulated whole saliva flow rate in a normal person is 0.3-0.4 ml per minute whereas below 0.1 ml per minute is abnormal. Reduction of 50% of saliva production usually results in the sensation of dry mouth.In the US, about 70 million suffer from it. One out of three persons over the age of 45 has dry mouth.

Dry mouth causes a whole host of problems. There is difficulty in swallowing and eating. Dry vocal chords cause difficulty in speaking. Thirst is a common complaint. There is soreness of throat and mouth. Coatings occur on the tongue. Cracked lips, parched tongue, and parched mouth, bad breath are additional complaints.

Without adequate saliva, a host of oral health problems occur. Cavities increase because of the lack of saliva to wash away bacteria and to neutralize the acids that are produced by bacteria. Gingivitis (inflamed and bleeding gums) is a major problem - which can lead to inflammation in the rest of the body since the mouth is the gateway to the blood stream. Inflammation in the arteries lead to coronary problems (heart attacks). Periodontitis, the next higher level of gum inflammation, lead to loss of teeth. Mouth sores and fungal infections of the gums become more common. Thus, dry mouth is a very serious condition.

There are a number of common causes of dry mouth. The number one cause is medications: 75% of prescription drugs and many over-the-counter drugs have dry mouth as a side effect (1,800 medications result in dry mouth). Older Americans who take multiple drugs will experience dry mouth. Diseases such as Sjogren's syndrome and diabetes cause dry mouth. Head and neck injuries which damage nerves to the salivary glands result in dry mouth. Treatment for head and neck cancers will result in dry mouth due to the damage caused by radiation and chemotherapy. Tobacco use is often associated with dry mouth. Drug addiction to methamphetamine will result in "meth mouth".

Over-the-counter medications for colds, allergy and pain are often implicated in dry mouth (e.g., Benadryl, Claritin, Imodium, Rolaids, Motrin, Zantac). Prescription drugs for many medical problems result in dry mouth: pain, osteoporosis, anxiety, high blood pressure, arthritis, asthma, depression, allergies, cholesterol, ulcer, urinary incontinence, diabetes, prostate, ADD/ADHD.

Medications which cause Dry Mouth or Xerostomia

Drugs affecting these problems associated with dry mouth are:

Anorexiant
Antiacid/Gastric ulcers
Antiacne
Antianxiety
Anticholineric/Antispasmodic
Anticonvulsant
Antidepressant
Antidiarrheal
Antiemetic
Antihistamine
Antihypertensive
Anti-inflammatory
Analgesic
Anti-nauseant
Anti-Parkinson
Bronchodilator
Cholesterol Reducing
Decongestant
Diuretic
Hormone therapy
Muscle Relaxant
Narcotic Analgesic/anti-inflammatory
Sedative

Medical problems associated with medications causing dry mouth include pain, osteoporosis, anxiety, high blood pressure, arthritis, asthma, depression, allergies, cholesterol, ulcer, urinary incontinence, diabetes, prostate problems, and ADD/ADHD. There are various typical remedies for dry mouth. This includes drinking water or liquids - which are temporary relief and necessitates carrying around water and frequent trips to the bathroom. Sugar-free gum and candy help to some extent. The most common remedies include lubricating mouth rinses which offer temporary relief. The difficulty is the inconvenience of carrying around a mouth rinse and finding a place to use it. Lubricating sprays is another alternative; however, sprays offer only temporary relief. There are prescription drugs such as pilocarpine or cevimeline which can stimulate saliva production if the salivary glands are still functional.