What are the salivary changes in the elderly?

Did you know that over 400 medications can potentially cause dry mouth, a common symptom of salivary changes in older adults? Understanding what are the salivary changes in the elderly is crucial for identifying underlying issues and maintaining proper oral hygiene.

Quick Summary

Salivary changes in the elderly involve decreased flow and altered composition, often resulting in dry mouth (xerostomia), primarily caused by systemic diseases or medications rather than just age alone, though glandular structure does change over time.

Key Points

• Not a Normal Part of Aging: While some minor salivary changes occur with age, significant dry mouth (xerostomia) is most often caused by other factors like medications or systemic diseases.

• Medications Are a Major Cause: Hundreds of common drugs taken by seniors, including those for high blood pressure, depression, and allergies, can have dry mouth as a side effect.

• Systemic Diseases Play a Role: Conditions such as Sjögren's syndrome, diabetes, and Alzheimer's disease can impair salivary gland function.

• Reduced Saliva Leads to Oral Health Risks: Lower saliva production increases the risk of tooth decay, gum disease, and oral infections like thrush due to compromised protection.

• Management is Multifaceted: Strategies include reviewing medications, staying hydrated, using saliva substitutes, and maintaining excellent oral hygiene to mitigate symptoms and prevent complications.

• Glandular Structure Changes: Histological changes, like reduced acini and increased fibrous tissue in salivary glands, contribute to diminished function, especially under unstimulated conditions.

The Multifactorial Nature of Salivary Changes in Older Adults

While it's a common misconception that dry mouth is a normal part of aging, the truth is more complex. True xerostomia, or salivary gland hypofunction, is often the result of multiple interacting factors, including physiological changes, medications, and systemic diseases common in older adults. Saliva plays a critical role in oral health, from aiding digestion and lubrication to providing defense against oral infections. A decrease in its quantity or quality can have significant consequences for a senior's overall well-being.

How Aging Physiologically Affects Salivary Glands

Even in healthy aging, there are subtle physiological shifts in the salivary glands, although they may not be significant enough on their own to cause severe dryness. Research has shown that the secretory acini, the parts of the gland that produce saliva, can decrease in volume with age. Simultaneously, the proportion of fatty and fibrous connective tissue within the glands increases. This can lead to a slight reduction in saliva production, particularly under minimal or unstimulated conditions.

Furthermore, studies have indicated a potential reduction in the synthesis of certain proteins and a decline in antioxidant enzymes within the saliva of older individuals. This change in saliva composition can compromise the mouth's natural defense mechanisms, making the oral tissues more susceptible to environmental factors and infections. It's a combination of these microscopic changes that can make the elderly more vulnerable to conditions that cause noticeable salivary problems.

The Impact of Common Medications

For many older adults, the most significant cause of salivary changes is polypharmacy, or the use of multiple medications. Hundreds of both prescription and over-the-counter drugs have a side effect of reducing salivary flow. Some of the most common include:

• Anticholinergics: Found in some medications for incontinence, allergies, and Parkinson's disease.
• Antidepressants and Antipsychotics: Many of these interfere with the nervous system's signaling to the salivary glands.
• Diuretics: These 'water pills' cause dehydration, which affects saliva production.
• Antihypertensives: Certain blood pressure medications can impact salivary function indirectly.
• Antihistamines: Used for allergies and often included in sleep aids, they have a drying effect.

Because many seniors take multiple drugs to manage various chronic conditions, the cumulative effect can drastically reduce saliva, leading to noticeable dry mouth symptoms. A detailed review of all medications by a healthcare provider or dentist is a critical first step in managing xerostomia.

Systemic Diseases and Their Influence

Several chronic health conditions common in the elderly can directly impact salivary gland function and flow, causing or worsening dry mouth. Some of these include:

• Sjögren's Syndrome: An autoimmune disease that specifically attacks the glands that produce tears and saliva, leading to severe dry mouth and eyes.
• Diabetes: Poorly controlled blood sugar levels can damage nerves that stimulate saliva production and increase the risk of oral infections like candidiasis.
• Alzheimer's and Parkinson's Disease: Neurological conditions can impair the signals required for proper salivation.
• Head and Neck Radiation: Cancer treatments in this area can permanently damage salivary glands, leading to long-term or permanent salivary hypofunction.

Consequences of Reduced Saliva

When saliva flow and composition are compromised, the oral environment loses its primary protective agent. This can lead to a cascade of oral health problems that significantly impact quality of life.

• Increased Risk of Dental Caries: Saliva neutralizes acids and washes away food particles. Without it, plaque and bacteria thrive, dramatically increasing the risk of new and recurrent cavities, especially at the tooth root.
• Periodontal Disease: The antibacterial properties of saliva are diminished, allowing harmful bacteria to flourish and contribute to gum disease.
• Difficulty Chewing and Swallowing (Dysphagia): Saliva is necessary to form a food bolus. Dry mouth can make eating dry or solid foods difficult, potentially leading to poor nutrition and unintended weight loss.
• Oral Infections: Reduced immune protection in saliva makes seniors more susceptible to oral infections, particularly yeast infections like candidiasis (oral thrush).
• Ill-fitting Dentures: A lack of lubrication can cause dentures to rub against the gums, leading to painful sores and making it harder to wear and tolerate them.

Managing Salivary Changes in the Elderly

Thankfully, there are several strategies to manage the symptoms and consequences of altered saliva. A comprehensive approach, often involving a doctor, dentist, and pharmacist, is most effective.

• Stay Hydrated: Sip water throughout the day to keep the mouth moist. Avoid caffeine and alcohol, which can further dehydrate the mouth.
• Stimulate Saliva Flow: Chew sugarless gum or suck on sugarless candies containing xylitol. The act of chewing can stimulate saliva production.
• Use Saliva Substitutes: Over-the-counter sprays, lozenges, and gels can provide temporary relief by mimicking the moisturizing effects of natural saliva.
• Optimize Oral Hygiene: Maintain excellent oral hygiene with regular brushing and flossing. Use fluoride toothpaste and consider a fluoride mouth rinse to protect against cavities.
• Nighttime Humidifier: Using a humidifier while sleeping can help alleviate dryness caused by mouth breathing.
• Medical Review: Ask a doctor or dentist to review medications for potential alternatives with fewer dry mouth side effects.

Comparison: Healthy Aging vs. Aging with Xerostomia

Feature	Healthy Elderly	Elderly with Xerostomia
Salivary Flow Rate	Minor, often non-symptomatic reduction in unstimulated flow; stimulated flow remains stable.	Significant reduction in both unstimulated and stimulated flow rates.
Saliva Composition	Slight age-related changes in certain proteins (e.g., sIgA, mucins).	Altered electrolyte levels, reduced antioxidants, and lower mucin levels.
Glandular Tissue	Acini volume slightly decreases; replaced by fibrous/adipose tissue.	More pronounced acini atrophy and structural degeneration.
Oral Symptoms	Generally, no subjective sensation of dryness or discomfort.	Frequent thirst, sticky feeling, mouth sores, cracked lips, burning tongue.
Oral Health Risk	Standard risk level, but immune defenses slightly lower.	Significantly increased risk of dental caries, candidiasis, and periodontal disease.

Conclusion

The question of what are the salivary changes in the elderly requires a deeper look beyond simple aging. While natural changes occur, the most impactful issues are often caused by medications, systemic illnesses, and lifestyle factors. Fortunately, a proactive and collaborative approach to management can help seniors address these issues effectively. By working with healthcare providers and adopting appropriate lifestyle adjustments, it is possible to mitigate the negative effects of altered saliva and protect oral and overall health. For more detailed guidance, consulting with a dental professional is always recommended.

For more information on dry mouth and older adults, visit the National Institute of Dental and Craniofacial Research website.

Frequently Asked Questions

Is feeling a dry mouth simply a normal sign of getting older?

No, while some minor changes in salivary flow can occur, the sensation of significant dry mouth, known as xerostomia, is not an inevitable part of aging. It is more commonly a symptom of medications, underlying health issues, or other factors.

Which specific types of medications cause salivary changes in the elderly?

Many medications can cause dry mouth. Common culprits include diuretics, antihistamines, antidepressants, antipsychotics, and certain blood pressure medications. If you suspect a medication is the cause, consult your doctor or dentist.

What health problems are linked to reduced saliva in older adults?

Reduced saliva is linked to a higher risk of dental caries (cavities), periodontal (gum) disease, oral candidiasis (thrush), and difficulty with chewing and swallowing, which can affect nutrition.

How can dry mouth be managed at home?

Home management strategies include sipping water frequently, using a humidifier at night, chewing sugar-free gum with xylitol, and avoiding dehydrating agents like caffeine, alcohol, and tobacco.

Does dry mouth affect dentures?

Yes, a dry mouth can cause dentures to fit poorly and lead to painful sores. Saliva acts as a natural lubricant and adhesive, so its reduction can cause significant discomfort for denture wearers.

Can systemic diseases like diabetes cause salivary changes?

Yes, systemic conditions like diabetes, Sjögren's syndrome, and Alzheimer's disease can directly affect salivary gland function and contribute to xerostomia.

Is it still necessary to see a dentist regularly if you have dry mouth?

Yes, regular dental visits are crucial. A dentist can help diagnose the cause of your dry mouth, recommend specific management strategies, and provide extra preventive care, such as high-fluoride treatments, to protect your teeth.

What is the difference between dry mouth and salivary gland hypofunction?

Dry mouth, or xerostomia, is the subjective sensation of dryness. Salivary gland hypofunction is the objective reduction in saliva flow rate. While often related, a person can feel dry even with normal flow, or have low flow without feeling it.