Xerostomia is not diagnosed promptly in most cases. This is usually because each person perceives dry mouth differently and some scientific studies indicate that we may lose 50% of our salivary flow without noticing that we have dry mouth. Therefore, many people who have dry mouth do not realize that this is a problem until symptoms become more severe.
Other times, although the patient reports having dry mouth symptoms, the doctor cannot find any definite signs of dry mouth, and patients have to go to different medical specialists to be properly diagnosed.
Clinical history
To diagnose xerostomia or dry mouth, the doctor will ask the patient the amount of water he/she drinks each day, his/her type of diet, alcohol intake, smoking habits, oral hygiene habits, diseases, and metabolic disorders, medications, and whether the patient has followed a radiotherapeutic treatment.
The doctor will also assess the symptoms the patient reports considering that the threshold of sensitivity is subjective. Patients should report any signs or symptoms of dry mouth, even if they are only mild.
The most frequent symptoms and signs of dry mouth are viscous and frothy saliva, difficulty speaking, chewing and swallowing, constant thirst, burning mouth, parched and dry tongue, cracked lips, small sores at the corners of the lips, mouth sores, burning throat, halitosis, tooth decay on the root surface (this is one of the main signs of xerostomia), and periodontal diseases such as gingivitis.
Exploration
The doctor will perform a physical exam of the mouth and mucosa in order to look for signs such as paleness and loss of color of the oral mucosa, candidiasis, cavities ion the roots of the teeth, cracked tongue, etc.
He also will palpate the head and neck region where major salivary glands are located to check their consistency.
The doctor may need to order blood tests to detect autoimmune disorders.
Additional tests to diagnose dry mouth
The salivary glands produce between 1 and 5 liters of saliva per day. Dry mouth occurs when the amount of saliva decreases by half (underflow to 0.5 ml / min) both at rest and with stimulation.
There are various tests to examine the salivary flow, but the most frequently used are:
–Sialometry: It measures the amount of saliva at rest and during stimulus (patients with teeth: paraffin pastilles; and patients without teeth: gustatory chemical stimulation with 10% citric acid).
–Sialography (radiosialography): the secretion rate and the possible calcifications may be observed by a radiographic examination of the salivary glands with contrast medium.
–Scintigraphy: This imaging test allows observation of the functionality of the glands to determine if they are working properly.
–Ultrasound.
–Magnetic resonance.
–Computed tomography (CT).
–Biopsy of the salivary glands to observe inflammation and destruction of the glandular tissue. A biopsy of the minor salivary glands and a blood test to detect antibodies should be performed if it is suspected that the patient has Sjögren’s syndrome.