Research from Denmark: Do Mouth Sores Indicate the Presence and Severity of Xerostomia?
Oral mucosal lesions affect up to 64.7% of people around the world. Some of the most common are oral lichen planus (OLP), oral lichenoid lesions (OLL), and stomatitis — all of these affect the mucous membranes of the mouth and can be very painful.
Researchers sought to examine whether the severity of xerostomia (dry mouth) and saliva flow rates could be used as diagnostic tools in discriminating between patients with OLP, OLL and generalized stomatitis with and without contact allergy.
Their hypothesis was that patients with OLP, OLL and generalized stomatitis and concomitant contact allergies have:
- A higher frequency of xerostomia
- More severe xerostomia
- Lower saliva flow rates
than patients with OLP, OLL and stomatitis WITHOUT contact allergies; and healthy age- and gender-matched control subjects. To test their hypothesis, they conducted a survey of ___ patients with the above mucosal lesions. They published their findings in a paper entitled, Oral symptoms and salivary findings in oral lichen planus, oral lichenoid lesions and stomatitis.
Below is a synopsis of what they uncovered.
What is Xerostomia?
Xerostomia is the subjective feeling of dry mouth, which occurs due to malfunctioning salivary glands. Salivary glands may malfunction for any number of reasons:
- Autoimmune diseases like Sjrogen’s syndrome and diabetes
- Head, neck or thyroid cancer treatments like chemotherapy and radiation
- Medications used to manage different symptoms
Studies have also found that polypharmacy, taking several medications at the same time, increases the risk of xerostomia.
While xerostomia is often caused when the salivary glands don’t produce enough saliva, it can also occur in the presence of an apparently normal salivary secretion. In these cases, while the apparent amount of saliva is sufficient, the quality is often sub-par, indicating that not only quantity but also quality of saliva is of importance to the feeling of oral comfort.
What are Oral Lichen Planus and Oral Lichenoid Lesions?
Oral lichen planus is a chronic inflammatory condition that affects mucous membranes in the mouth. It typically presents as white, lacy patches, red, swollen tissues, or open sores on the insides of the cheeks, gums, tongue, inner lip tissue, and palate.
These lesions cause significant pain, burning, and discomfort. OLP is one of the most common types of oral lesions,affecting up to 2% of the adult population, typically middle-aged and elderly people. It is more common in women than men.
OLP isn’t contagious. It’s a chronic disorder that occurs when the immune system attacks cells of the oral mucous membranes, but the reason they attack is unknown.
Oral lichenoid lesions (OLL) are very similar to OLP, but these occur as a reaction to certain systemic medications, dental materials, and oral hygiene substances, like flavorings.
OLP and OLL are so similar that even clinicians may have a hard time discerning one from the other.
Previous research has shown an association between OLP/OLL and xerostomia (as well as diseases known to cause xerostomia, including Sjögren’s syndrome, hepatitis C, type 1 diabetes and more).
One study showed that 45% of patients with specific types of OLP also suffer from xerostomia and a sensation of very viscous saliva. The researchers previously found that only 15% of the 45% OLP patients who complained about xerostomia actually had hyposalivation (reduced saliva production), which may be related to cardiovascular medications.
However, there has been no conclusive evidence regarding whether xerostomia is caused by OLP/OLL or if it reflects a pathogenic association to systemic autoimmune diseases.
Denmark Researchers Examine Relationship Between Xerostomia and OLP/OLL
Researchers in Denmark examined the relationship between patients with OLP/OLL and concomitant contact allergy and the severity and frequency of xerostomia — compared to cases without contact allergy and healthy controls.
134 patients with symptoms of oral mucosal diseases were referred to the researchers in the University of Copenhagen. Some patients were excluded due to diagnoses other than OLP, OLL, and stomatitis, or because their symptoms were suspected to be caused by medication. 49 patients completed the study.
The researchers administered a questionnaire to these 49 patients — 42 women, within 10 years of age 61 — and 29 healthy age and gender-matched subjects. The questionnaire included standardized questions about general oral health, xerostomia, clinical exams, sialometry, mucosal biopsy, and contact allergy testing.
Out of the 49 patients:
- 19 had oral lichen planus
- 19 had oral lichenoid lesions
- 11 had generalized stomatitis
- 38.8% had contact allergy
Prior to inclusion in the study, clinicians took an oral smear from participants in order to exclude oral candidiasis, as it may mimic other mucosal lesions. 11 patients had oral candidiasis and were treated with nystatin for 4 weeks, prior to inclusion. The treatment had no impact on their
oral symptoms, but according to a repeated smear, the hyphae and spores were eliminated.
All patients underwent a mucosal biopsy and were referred for patch testing for contact allergy, which was done according to the European baseline series, a toothpaste series, and a dental material series. All participants also had their serum levels of thyroid stimulating hormone (TSH) checked.
Study Findings
According to the questionnaire, 46.9% showed significantly more common and severe xerostomia symptoms than the healthy controls. Interestingly, saliva flow rates didn’t differ.
Researchers found no differences in the frequency of xerostomia between patients with OLP, OLL and stomatitis and patients with and without a concomitant contact allergy (p = 0.30). However, the unstimulated whole saliva (UWS) saliva flow rates tended to be lower in patients with OLP/OLL and concomitant contact allergy than in those without contact allergy (p = 0.05).
Based on the results, the researchers concluded that they had no conclusion. They found that xerostomia is prevalent in patients with oral lichen planus, lichenoid lesions, and generalized stomatitis — however, these conditions are not associated with salivary gland hypofunction, numbers of systemic diseases or medications, contact allergy, age, or gender. In other words, more research is necessary to fully understand the relationship between oral mucosal lesions, xerostomia, and contact allergies.
FAQS
What is xerostomia?
Xerostomia, also known as dry mouth is the chronic subjective feeling of dry mouth. People with xerostomia may have trouble chewing, swallowing, and speaking. They may have oral sores, increased cavities, dry and cracked lips, halitosis, sore throat, and other symptoms.
What are the best dry mouth treatments?
Dry mouth treatments range from oral electrostimulation, such as the Salipen, to medications to artificial saliva. People who suffer from dry mouth should consult an oral care specialist to determine the best course of treatment.
Why is xerostomia research important?
Xerostomia is a painful and life-altering condition that affects people on a daily basis. The more scientists understand it and its relationship with other medical conditions, the better they can achieve advancements in patient care and treatment.
Even a study like the one conducted by University of Copenhagen researchers — which did not yield conclusive results — is a step forward in xerostomia research. While the findings were inconclusive regarding OLP/OLL, xerostomia, and contact allergy, the study did indicate a relationship and that further research should be conducted.
What is the relationship between Levothyroxine and dry mouth?
One of the main conditions associated with dry mouth is thyroid disease. Levothyroxine is a medication used to treat hypothyroidism, one of the main types of thyroid disease. While it’s an effective medication, one of its main side effects is dry mouth. People with thyroid disease who suffer from Levothyroxine-induced dry mouth should speak to their healthcare provider about dry mouth remedies like electrostimulation and artificial saliva substitutes.
