Xerostomia in Systemic Disorders | Autoimmune Diseases | Diabetes

Many types of systemic disorders cause decreased salivary flow, which lead to development of dry mouth syndrome or xerostomia. Some diseases such as autoimmune diseases, diabetes mellitus, hypertension, neurological disorders, and depression cause progressive destruction of parenchyma often irreversibly. Other times there may be affected nerves or vessels causing temporary effects and reversibility. Autoimmune diseases, which induce dry mouth or xerostomia, are Sjögren’s syndrome, lupus erythematosus, rheumatoid arthritis, and scleroderma. Common clinical features in all these diseases can be observed as oral mucosa dryness as well as dryness of ocular, vaginal, pharyngeal, laryngeal, and nasal mucous membranes. Out of all these disorders, Sjögren's syndrome is the one that most affects the mucous membranes. Sjögren’s syndrome is a chronic inflammatory autoimmune disease characterized by progressive replacement of the parenchyma of the lacrimal glands and salivary by an inflammatory infiltrate. It can be seen alone as primary Sjögren syndrome or in association with other autoimmune disorders like lupus erythematosus, rheumatoid arthritis, scleroderma, primary biliary cirrhosis, and vasculitis.

When a dentist suspects the presence of dry mouth syndrome or xerostomia, the patient is referred for a biopsy of the salivary glands to be performed under the lower lip. The patient also undergoes special serological tests like IgG antibodies, anti Ro/SS-A and anti Ro/SS-B34, and rheumatoid factor.

Another disease that commonly causes xerostomia is diabetes. According to recent research conducted on diabetic and nondiabetic patients, it has been found that the total saliva of diabetic patients not controlled is approximately one third to half the amount of saliva of non-diabetics. The uncontrolled diabetic patients may have some clinical manifestations of disease namely polydipsia, polyphagia, polyuria causing the sensation of dry mouth. What occurs in uncontrolled diabetic patients who have xerostomia is progressive destruction of parenchyma, which can also sometimes affect blood vessels and nerves.

The above factors modify the secretion of salivary flow by different mechanisms including the interruption of autonomic nerve function, interference with ductal cells of salivary glands, cytotoxicity causing indirect effects such as vasoconstriction or vasodilation, and disturbance of fluid and electrolyte balance. These can also cause physical trauma to the salivary glands and nerves.

Now read some Tips on Dealing with Xerostomia or Dry Mouth Syndrome