Xerostomia: insufficient saliva, dry mouth and fissured tongue

Sufficient saliva is necessary to have a favorable bacterial oral balance as well as for healthy teeth and oral tissue. If the responsible glands release insufficient or no saliva, extreme dryness can persist for a long time. The tongue dries out, cracks and wounds develop, making eating and talking difficult. What does xerostomia mean, what causes it and what can be done about it?

Xerostomia

• Influence of saliva
• Where are the glands located?
• Drought
• Causes of xerostomia
• Sjögren’s syndrome
• How to treat?

Influence of saliva

Having sufficient saliva flow maintains the mouth. The tongue and palate remain in good condition, and a favorable pH value also applies. In other words, with sufficient saliva you will have a healthy oral environment. Saliva provides the initial digestion of food to obtain energy. When we chew food with saliva, starch is converted into glucose, which is absorbed through the tongue pores. Insufficient or non-existent saliva therefore directly affects human nutrition. How does xerostomia affect the functioning of the mouth and what else can be done?

Where are the glands located?

Having enough saliva means that the glands are working properly. There are a series of pipe exits in the mouth, where the glands supply saliva to the mouth. This concerns the following glands (lit.1):

• parotid gland: this is the largest gland and is located in front of the ear in the cheek. The fluid is released into the mouth next to the rear upper teeth;
• submandibular salivary gland: this gland is located in the soft part of the neck under the jawbone. It opens behind the lower front teeth in two small salivary bumps;
• sublingual gland: it is located under the tongue, with a series of exits in a row under the tongue. Together with the submandibular gland outlet on either side of the tongue, it looks like a V-shaped elevation behind the lower teeth, which widens from front to back.

In addition, it involves a series of small glands, which release saliva here and there in the mouth. But what if one or a few glands do not work properly, what causes this and what can be done about it?

Drought

Sleeping with your mouth open or having long conversations can cause temporary dryness. However, it can also happen that the palate, mouth, tongue and throat are continuously too dry. This affects the bacterial condition of the mouth. The teeth are affected, with the tooth neck emerging more quickly. The tongue shows fissures and cracks, as well as black spots on the tongue caused by hairy tongue. In addition, dryness and cracks can lead to additional inflammation and wounds, causing the condition of the mouth to quickly deteriorate. The person’s ability to eat becomes increasingly poor, and speaking, breathing and sleeping become more difficult. People will also make clicking or smacking sounds with the tongue more often. It occurs relatively often, and the nuisance can have varying degrees. It affects a third of people over sixty, but it is also assumed that a tenth of younger generations are affected to some extent (lit.2).

Causes of xerostomia

The glands produce saliva, after which it is guided and released into the mouth via the salivary ducts. There may be a disease of the salivary gland. Consider a deformity or inflammation, which disrupts the production of the fluid. Cells are also damaged as we age, meaning that the older person can produce less and less saliva. An obstruction or inflammation may also occur in the drain pipes. In addition, it may be due to the transmission of electrical nerve information. The brain stem controls this basic function, so that saliva is produced when one is triggered to do so. Think of smelling delicious food. If the signal does not come across, production will not occur. It may be due to nerve degeneration (such as in Multiple Sclerosis), but also due to antidepressants or Parkinson’s medication. In the latter case, levodopa is taken to reduce the influence of acetylcholine. It results in fewer muscle-stimulating substances, so that vibrations decrease. This can also influence the production of suppletion, because the influence of signaling substances decreases. Naturally, in addition to this example, there are various medications and diseases that can have a negative influence on the glands.

Sjögren’s syndrome

If you have an inflammation of the salivary glands, this may include Sjögren’s syndrome. This can also affect the tear glands, causing the person to have excessively dry eyes. The inflammation can be caused by various reasons. In addition to standard inflammation, the immune system can structurally damage the gland cells. It is often combined with another autoimmune disease. Think of rheumatoid arthritis, rheumatic scleroderma, GPA, Myasthenia Graves, and so on. This syndrome has also been found to be related to Non-Hodgkin lymphoma. One in sixteen people (6.3%) with the syndrome have a chance of developing this type of cancer in the long term (between 3 and 27 years), and this always concerns women (lit.3).

How to treat?

Usually nothing can be done about it, except for a different lifestyle. It is important to keep it well wet, in addition to stimulating the still working salivary glands to work. Think of saliva-stimulating chewing gum. In addition, good oral hygiene should be practiced. Brush your teeth at least twice a day with antibacterial toothpaste, rinse your mouth and floss regularly. In addition, one should avoid spicy food, smoking, gassy drinks and alcohol. If you have a certain illness, it should of course be treated with good medication. A change in medication may be able to alleviate oral problems.

Follow your dental hygienist’s tips to minimize the impact of dry mouth.

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• Too much saliva production when seeing or smelling food
• Severe swelling in the mouth, salivary gland cyst and ranula