Recognition and treatment of salivary induced conditions

Salivary problems, particularly in the aged, are frequent but often not well recognized. Symptomatic dryness (xerostomia) is accompanied by objective evidence of reduced salivary secretion in about half the cases. Dry mouth is not an age change but most often follows salivary gland disturbance of external origin or due to systemic disease. It may herald the presence of widespread symptoms of exocrine gland hypofunction. Resting and stimulated salivary flow rates are useful measures of dryness. Xerostomia may be accompanied by an increase in caries rate, candidosis, cheilitis, dysgeusia or dysphagia. Prominent causes of salivary gland hypofunction are drugs, irradiation, organic diseases, psychogenic factors and decreased mastication. However, a cause cannot always be found and even when identified its effects cannot always be reversed, e.g. in Sjögren's syndrome. Locally acting stimulants of salivary flow or saliva substitutes may alleviate symptoms but systemically acting sialogogues need to be used with caution. The dentist has an important role in identifying xerostomia, an identification that can lead to the diagnosis of previously unrecognized disease.