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Diagnosing Xerostomia

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Early Diagnosis of Dry Mouth

Many patients will eventually seek help from their dentist, doctor or pharmacist for dry mouth symptoms. Unfortunately, by the time they notice dry mouth symptoms, saliva flow could already be down by 50%.

For early diagnosis of dry mouth, health professionals will play a vital role by proactively screening patients for dry mouth symptoms using a simple four-step process:

  1. Ask if their medical history includes conditions such as diabetes or Sjögren’s Syndrome.

  2. Askif they are taking any medication. More than 400 drugs include dry mouth as a possible side-effect.

  3. Ask(i) Do they have difficulty swallowing? (ii) Does their mouth feel dry when eating? (iii) Do they have to sip liquids when swallowing dry foods? (iv) Do they have a feeling that there is too little saliva in their mouths?

  4. Conduct a clinical assessment for dry mouth symptoms. This should include:

    • The Mirror ‘Stick’ Test: Place a mirror against the buccal mucosa and tongue. If it adheres to the tissues, then salivary secretion may be reduced.
    • Does saliva pool in the floor of the mouth?
    • Have there been changes in caries and presentation, for example in unusual sites, such as incisal, cuspal and cervical caries?

Measuring Salivary Flow Rates to Detect Dry Mouth Symptoms

Salivary flow rates are classified as stimulated whole mouth saliva (SWMS) or unstimulated whole mouth saliva (USWMS) and can be measured by asking the patient to drool and then spit into a collecting vessel for five minutes. Unstimulated is where nothing has been in the mouth for 90 minutes.

The accepted definition of hyposalivation is:

  • An USWMS rate below 0.1ml/minute, measured over 15 minutes, or
  • A SWMS rate below 0.7ml/minute, measured over 5 minutes.

Dry Mouth: A “Breeding Ground” for Dental Problems

Chronic dry mouth symptoms can lead to:

  1. Enamel demineralization
  2. Increased caries
  3. Periodontal disease
  4. Infections
  5. Mucositis
  6. Halitosis

Patients with medication-induced dry mouth symptoms reported:

  • 2.89 times greater risk for coronal caries
  • 3.27 times greater risk for root caries


Undiagnosed or untreated dry mouth could lead to a significant impact on quality of life. If recognized and treated early, dry mouth oral health effects may be minimized.