The Most Common Cause of Xerostomia in the Elderly — And Why Is It Important?

Xerostomia, the self-perception of dry mouth, affects about 20% of the general global population and at least 30% of the population aged 65+. According to a study entitled, “Common Precipitating Factors of Xerostomia in the Elderly,” the most common cause of xerostomia in the elderly is medication, typically gastrointestinal, psychotropic, and antihypertensive drugs. But why is this important to know? 

Let’s dig a little deeper.

Background

Saliva plays a crucial role in oral health, protecting from harmful bacteria and fungi, transporting nutrients and digestive enzymes, and facilitating chewing, swallowing, and speaking. There are three major salivary glands: parotid, submandibular, and sublingual. There are hundreds of other minor salivary glands, but the main three are responsible for 95% of saliva production.

When salivary glands don’t produce enough saliva (known as hyposalivation), it can lead to xerostomia, the self-perception of dry mouth, which has many adverse effects, not only on oral health but on overall quality of life. 

Dry mouth symptoms include:

• Halitosis (bad breath)
• Impaired chewing and swallowing
• Cracked lips, tongue
• Difficulties wearing dentures
• Digestive problems
• Weight loss
• Candidiasis (fungal infection)
• Cough
• Oral complications such as periodontitis and tooth decay

Xerostomia can be diagnosed by your medical provider by taking a detailed medical history, coupled with an oral examination and/or saliva measurement. Health professionals with elderly patients should be aware that xerostomia is common in the elderly and often a result of/related to:

• Anxiety, stress, depression
• Radiation therapy and chemotherapy
• Systemic disease
• Polypharmacy or certain drugs
• Aging

Discerning the Main Cause of Xerostomia in the Elderly

The above factors are known to cause or be related to xerostomia, but what’s the main culprit of this uncomfortable, painful condition among the elderly? That’s what researchers from Universitas Airlangga in Indonesia set out to determine. 

The researchers set out to perform a comprehensive sweep of recent medical literature on xerostomia. They put forth several inclusion criteria for their review of the medical literature in databases from PubMed and Scopus:

• Original articles
• Research on factors predisposing the elderly to xerostomia
• Research published in English 
• Population, context, and concept
• Research published between July 1991 and September 2021, discussing dry mouth either from the consumption of xerostomia drugs or other possibilities
• Keywords: Dry Mouth OR Xerostomia AND Elderly OR Geriatric) OR (“Dry Mouth” AND “Elderly”) OR (“Dry Mouth” AND “Geriatric”) OR (“Xerostomia” AND “Elderly”) OR (“Xerostomia” AND “Geriatric”)

Study Results

The initial search of both databases yielded 27,441 references. After the first filter, the results were narrowed down to 4,604 papers. During the review of the titles and abstracts of these papers, the researchers discarded those that did not match the discussion, as well as any duplicates. They classified the papers based on full text and further narrowed the results down to 12 papers. 

Nine studies used subjective measurements such as the Xerostomia Inventory (XI), Bother Index (BI), FOX questionnaire, and simple questions about xerostomia. Two studies used objective measurements including sialometry and Clinical Oral Dryness Score (CODS).

Concurrently, nine of the 12 studies included populations in which xerostomia was drug-induced. Four studies included populations in which xerostomia was due to systemic diseases, rheumatic disease, radiation therapy to the head/neck region, nutrition, and psychological factors.

According to the analysis of the 12 selected papers, the main causative factor of xerostomia in the elderly is the use of drugs. Over 400 drugs can cause xerostomia and affect the function of the salivary glands. The most common drug categories that cause xerostomia are antacids and gastrointestinal drugs, psychotropic drugs, antihypertensive drugs, and hypnotics.

Non-pharmacological factors that cause xerostomia in the elderly are stress, social support, malnutrition, and systemic conditions.

Head and neck cancer therapy are also leading causes of xerostomia in the elderly. Nearly half of patients diagnosed with head and neck cancer are over the age of 65. Radiotherapy is one treatment, and salivary glands are often exposed to it due to their location and the location of the cancer. If the dose is high, radiotherapy can cause irreversible damage to the salivary gland (and if the dose is lower, the damage is typically temporary and reversible).

Why is Xerostomia Research Important?

Xerostomia is a condition that affects the general population, but especially the elderly. Why is research so important? Why is it so important to understand the causes and correlations between lifestyle, medications, and other conditions?

Xerostomia significantly decreases the quality of life for those who suffer from it, as it can lead to oral health problems and make it difficult to speak, chew, swallow, and sleep. Research — determining and understanding the most common causes of xerostomia — ultimately helps identify prevention, treatment, and management strategies. 

Xerostomia research also helps advance all of the above strategies. Through understanding the causes of xerostomia, scientists, doctors, and medical researchers can seek new and improved treatments and interventions to alleviate the discomfort and health risks associated with xerostomia.

The Best Xerostomia Remedies Available Today

Xerostomia presents differently in every person, so each treatment plan must be customized with one’s doctor in order to achieve the best results. While medication might be the main culprit behind xerostomia in the elderly, many of these medications are life-saving or crucial and cannot be cut out. So what treatments remain for the elderly who suffer from xerostomia?

There are several general paths healthcare professionals recommend, and these paths are often customized and fine-tuned to suit the individual.

Generally, anyone who suffers from dry mouth is recommended to implement several lifestyle changes. These include:

• Drinking more water
• Cutting out alcohol, nicotine, and caffeine 
• Learning techniques to ensure nose breathing at night (as opposed to mouth breathing, which can dry out one’s mouth)
• Using a humidifier at night to keep moisture in the air
• Regular visits to a dentist or oral health specialist

In terms of medical dry mouth treatment, there are three main options, some of which can be implemented at the same time.

The best treatments for dry mouth include:

• Electrostimulation: The SaliPen (FDA-approved) is a small handheld device that administers gentle, painless electrical impulses to the mouth, stimulating the salivary glands to naturally produce more saliva.
• Medication: Sialogogues are medications that chemically stimulate the salivary glands to produce more saliva. 
• Saliva substitutes: Throat lozenges, oral sprays, gums, and mouthwashes (prescription or over-the-counter) provide artificial saliva to alleviate dry mouth discomfort. These substitutes don’t stimulate the salivary glands but they do offer temporary relief from the discomfort of dry mouth symptoms. 

To learn more about xerostomia and its treatments, read our blog or contact us today. 

FAQS

What is xerostomia?

Xerostomia is the self-perception of dry mouth, which can present as dry, cracked lips, sore throat, increased dental cavities and oral infections, and digestive problems. Xerostomia can also make chewing, eating, swallowing, and speaking difficult.

What is the main cause of xerostomia in the elderly?

According to a study entitled, “Common Precipitating Factors of Xerostomia in the Elderly,” the most common cause of xerostomia in the elderly is medication, typically gastrointestinal, psychotropic, and antihypertensive drugs. 

Why is xerostomia research important?

Xerostomia research impacts prevention, treatment, and management solutions for this painful condition. It also helps to advance treatment solutions so people who suffer from xerostomia can get the best possible treatment. 

How do I know which xerostomia treatment is best for me?

There are several xerostomia treatments available, including electrostimulation, prescription medication, and artificial saliva. Talk with your doctor, dentist, or oral health specialist to decide upon a treatment path that’s best for you.