Welcome to Dr Roger K.A. Allen’s Blog

INTRODUCTION

A very common symptom of sarcoidosis is dry eye and dry mouth. Dry mouth is called xerostomia (Greek meaning “dry” and “mouth” and is due to granulomas damaging the salivary glands. As an aside, there is a syndrome in sarcoidosis called Heerfordt’s syndrome which consists of parotid gland enlargement, fever and uveitis which is inflammation of the eye. The parotid glands are those which you see enlarged in mumps and which makes you look like a chipmunk.

We take saliva for granted when we have it.  There is a joke about lung transplants in the same vein.

Question: What’s the worst thing about a lung transplant?

Answer: Coughing up someone else’s sputum.

Imagine if we had salivary gland transplants. We won’t go there.  Thus, producing sputum, saliva and gastric juices is a wonderful thing.

WHAT ELSE CAUSES IT?

Another condition which affects salivary glands is Sjogren’s syndrome which is an autoimmune condition a bit like lupus (SLE). There are many other causes but sometimes no cause can be found. It just happens. Radiotherapy is a common cause but the reference below does not mention sarcoidosis.

HOW DO WE TREAT IT?

1. Treating the sarcoidosis early before it causes irreversible damage to the salivary glands is the best thing to do.
2. Sugar-free gum can help stimulate salivary flow without which we end up with holes in our teeth, gum disease and even losing teeth to decay. SalivaSure *(lozenge containing xylitol) is a salivary stimulant. Omni Theragum and Theramints *(contains xylitol) and Dentiva *(slow dissolving soft lozenge) (American Dental Association, 2006) (all ameircan brands – Wrigley’s extra is a sugar free gum)
3. There are saliva replacements as well but these are really lubricants and need to be administered regularly. Oral-Lube, Biotene Oral-Balance (mouthwash, sprays, toothpaste, gel, gum), GC Drymouth Gel and Tooth Mosse, Oral 7 (mouthwash, toothpaste,gel), Oasis* (moisturizing mouthwash), Salivart Synthetic Saliva Omni Theraspray * (contains xylitol).
4. Pilocarpine is a drug which can stimulate salivary flow but has too many side-effects to be universally useful (see the reference below).
5. Xerostomia can be a very distressing problem.  See your dentist regularly and you would qualify for subsidy from the Federal Government now for a medical condition requiring regular dental care.
6. Early recognition is important. If you think your mouth is dry all the time, tell your doctor and get help early.
7. Avoid other causes. Finally, some drugs can cause dry mouth eg the tricyclic antidepressants so always check that this is not a cause. Keeping yourself well hydrated is important and observed good dental hygiene eg brush and floss after meals and use mouth rinses and  ToothMousse.

It is important that patients try a variety of products (gels, toothpastes, mouthwashes etc) as individuals respond differently to each treatment.

Acknowledgements:

I wish to thank Dr Yoram Chaiter on the BMJ website doc2doc for his input into this subject and for the listing of some of the medications he uses.  I go under the name, Odysseus on this site.

References:

http://www.australianprescriber.com/magazine/29/4/97/8/