Ağız Kuruluğu: Nedenleri, Tanısı ve Tedavisi

Öz

Ağız kuruluğu (kserostomi), ağızda kuruluk hissinin subjektif olarak algılanmasıyla karakterize edilen ve sıklıkla tükürük akış hızının azalması veya tükürük içeriğindeki değişikliklerle ilişkili olan bir klinik durumdur. Tükürük ise lubrikasyon, tamponlama, antimikrobiyal savunma ve remineralizasyon gibi temel fonksiyonlarıyla ağız homeostazının korunmasında önemli rol oynar. Bu nedenle, tükürük sekresyonundaki bozukluklar, ağız sağlığı ve sistemik sağlık üzerinde ciddi sonuçlara yol açabilmektedir. Ağız kuruluğu, diş çürükleri, oral enfeksiyonlar, mukozal hassasiyet, yutma güçlüğü ve tat alma bozuklukları gibi problemlere neden olarak bireylerin yaşam kalitesini olumsuz yönde etkilemektedir. Ağız kuruluğunun etiyolojisi multifaktöriyeldir ve sistemik hastalıklar, kserojenik ilaç kullanımı, Sjögren sendromu gibi otoimmün hastalıklar ile baş-boyun radyoterapisi, kemoterapi, hormonal değişiklikler, psikolojik faktörler ve yaşlanma gibi birçok faktörü içermektedir. Ağız kuruluğunun tanısında ayrıntılı anamnez, klinik muayene, Xerostomia Inventory gibi subjektif değerlendirme ölçekleri ile tükürük akış hızı ölçümleri, ultrasonografi ve sialografi gibi görüntüleme yöntemlerini kapsayan bütüncül bir yaklaşım gerekmektedir. Ağız kuruluğunun tedavisi, öncelikle altta yatan nedenin belirlenmesine ve giderilmesine yönelik olup, semptomatik yaklaşımlarla desteklenmektedir. Tedavi seçenekleri arasında yaşam tarzı düzenlemeleri, farmakolojik ajanlar, tükürük uyarıcı ve yerine koyucu preparatlar ile düşük düzey lazer tedavisi ve transkutanöz elektriksel sinir uyarımı gibi güncel yaklaşımlar yer almaktadır. Bu derleme, ağız kuruluğunun nedenleri, tanı yöntemleri ve tedavi yaklaşımlarını kapsamlı bir şekilde ele almakta ve doğru tanı ile bireye özgü tedavi planlamasının önemini vurgulamayı amaçlamaktadır.

Anahtar Kelimeler

• Ağız kuruluğu
• kserostomi
• hiposalivasyon
• tükürük bezi disfonksiyonu

Teşekkür

Bu makale, Sabriye Sevim Mertoğlu’nun İstanbul Kent Üniversitesi Diş Hekimliği Fakültesi Bitirme Tezi esas alınarak oluşturulmuştur.

Xerostomia: Causes, Diagnosis and Treatment

Öz

Xerostomia is a common clinical condition characterized by the subjective sensation of oral dryness, often associated with reduced salivary flow or alterations in salivary composition. Saliva plays a crucial role in maintaining oral homeostasis through its lubricating, buffering, antimicrobial, and remineralizing functions. Therefore, disturbances in salivary secretion may lead to significant oral and systemic complications. Xerostomia adversely affects patients’ quality of life and is associated with an increased risk of dental caries, oral infections, mucosal discomfort, dysphagia, and taste disturbances. The etiology of xerostomia is multifactorial and includes systemic diseases, xerogenic medications, autoimmune disorders such as Sjögren’s syndrome, head and neck radiotherapy, chemotherapy, hormonal changes, psychological factors, and aging. Diagnosis of xerostomia requires a comprehensive approach involving detailed medical history, clinical examination, subjective assessment tools such as the Xerostomia Inventory, salivary flow rate measurements, and imaging modalities including ultrasonography and sialography. Management of xerostomia focuses on identifying and treating the underlying cause, along with symptomatic relief. Therapeutic strategies include lifestyle modifications, pharmacological agents, salivary stimulants and substitutes, as well as emerging treatment modalities such as low-level laser therapy and transcutaneous electrical nerve stimulation. This thesis aims to provide a comprehensive overview of the causes, diagnostic methods, and current treatment approaches for xerostomia, emphasizing the importance of accurate diagnosis and individualized management to improve patient outcomes and quality of life.

Anahtar Kelimeler

• Xerostomia
• dry mouth
• salivary gland dysfunction
• hyposalivation

Kaynakça

1. Abouseif, N., Jaber, M. and Abdelsayed, R.B. (2025) ‘Salivary Gland Sarcoidosis: Systematic Review of Case Reports and Case Series’, Journal of Clinical Medicine, 14(21), article 7539. https://doi.org/10.3390/jcm14217539
2. Agostini, B.A., Cericato, G.O., Silveira, E.R. da, Nascimento, G.G., Costa, F.D. dos Santos, Thomson, W.M. and Demarco, F.F. (2018) ‘How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates’, Brazilian Dental Journal, 29(6), pp. 606–618. https://doi.org/10.1590/0103-6440201802302. Akol Görgün, E., Çağlayan, F. and Tohumcu, A. (2024) ‘Sağlıklı bireylerde kuru ağız subjektif semptomlarının görülme sıklığının değerlendirilmesi’, Current Research in Health Sciences, 1(2), pp. 48–51.
3. Aoun, G., Nasseh, I., and Berberi, A. (2016) ‘Evaluation of the oral component of Sjögren's syndrome: An overview’, Journal of International Society of Preventive and Community Dentistry, 6(4), pp.278–284. https://doi.org/10.4103/2231-0762.186802
4. Blitzer, G.C., Glazer, T., Burr, A., Gustafson, S., Ganz, O., Meyers, R., McDowell, K.A., Nickel, K.P., Mattison, R.J., Weiss, M., Chappell, R., Rogus-Pulia, N.M., Galipeau, J. and Kimple, R.J. (2023) ‘Marrow-derived autologous stromal cells for the restoration of salivary hypofunction (MARSH): A pilot, first-in-human study of interferon gamma-stimulated marrow mesenchymal stromal cells for treatment of radiation-induced xerostomia’, Cytotherapy, 25(11), pp. 1139–1144. https://doi.org/10.1016/j.jcyt.2023.07.009
5. Dawes, C., Pedersen, A.M.L., Villa, A., Ekström, J., Proctor, G.B., Vissink, A., Aframian, D., McGowan, R., Aliko, A., Narayana, N., Sia, Y.W., Joshi, R.K., Jensen, S.B. and Wolff, A. (2015) ‘The functions of human saliva: A review sponsored by the World Workshop on Oral Medicine VI’, Archives of Oral Biology, 60(6), pp. 863–874. https://doi.org/10.1016/j.archoralbio.2015.03.004.
6. de Vries, S.A.G., Tan, C.X.W., Bouma, G., Forouzanfar, T., Brand, H.S. and de Boer, N.K. (2018) ‘Salivary function and oral health problems in Crohn's disease patients’, Inflammatory Bowel Diseases, 24(6), pp. 1361–1367. https://doi.org/10.1093/ibd/izy017.
7. Dhillon, M., Raju, S.M., Mohan, R.S. and Tomar, D. (2016) ‘Efficacy of TENS on parotid saliva flow’, Journal of Dentistry (Shiraz), 17(3), pp. 164–170.
8. Dirix, P., Nuyts, S., & Van den Bogaert, W. (2006) ‘Radiation-induced xerostomia’, Cancer, 107(11), pp.2525–2534. https://doi.org/10.1002/cncr.22302.

9. Faruque, M.R.J., Wanschers, M., Ligtenberg, A.J.M., Laine, M.L. and Bikker, F.J. (2022) ‘A review on the role of salivary MUC5B in oral health’, Journal of Oral Biosciences, 64(4), pp. 392–399. https://doi.org/10.1016/j.job.2022.09.005.
10. Fantozzi, P.J., Pampena, E., Di Vanna, D., Pellegrino, E., Corbi, D., Mammucari, S., Alessi, F., Pampena, R., Bertazzoni, G., Minisola, S., Mastroianni, C.M., Polimeni, A., Romeo, U. and Villa, A. (2020) ‘Xerostomia, gustatory and olfactory dysfunctions in patients with COVID-19’, American Journal of Otolaryngology, 41(6), article 102721. https://doi.org/10.1016/j.amjoto.2020.102721.
11. Furness, S., Worthington, H. V., Bryan, G., Birchenough, S., and McMillan, R. (2011) ‘Interventions for the management of dry mouth: Topical therapies’, Cochrane Database of Systematic Reviews, 2011(12), Article CD008934. https://doi.org/10.1002/14651858.CD008934.pub2
12. Gholami, N., Hosseini Sabzvari, B., Razzaghi, A., and Salah, S. (2017) ‘Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia’, Journal of Dental Research, Dental Clinics, Dental Prospects, 11(4), pp. 247–252. https://doi.org/10.15171/joddd.2017.043
13. Gil-Montoya, J.A., Silvestre, F.J., Barrios, R. and Silvestre-Rangil, J. (2016) ‘Treatment of xerostomia and hyposalivation in the elderly: A systematic review’, Medicina Oral Patología Oral y Cirugía Bucal, 21(3), pp. e355–e366. https://doi.org/10.4317/medoral.20969.
14. Herlofson, B.B. and Barkvoll, P. (1996) ‘Oral mucosal desquamation caused by two toothpaste detergents in an experimental model’, European Journal of Oral Sciences, 104(1), pp. 21–26. https://doi.org/10.1111/j.1600-0722.1996.tb00041.x.
15. Jacob, L.E., Krishnan, M., Mathew, A., Mathew, A.L., Baby, T.K. and Krishnan, A. (2022) ‘Xerostomia – A comprehensive review with a focus on mid-life health’, Journal of Mid-life Health, 13(2), pp. 100–106. https://doi.org/10.4103/jmh.jmh_91_21
16. Jager, D. H. J., Karagozoglu, K. H., Maarse, F., Brand, H. S., and Forouzanfar, T. (2016) ‘Recent advances in salivary gland imaging in Sjögren's syndrome’, Oral Diseases, 22(5), pp.367–377. https://doi.org/10.1111/odi.12429
17. Jedel, E. (2005) ‘Acupuncture in xerostomia: A systematic review’, Journal of Oral Rehabilitation, 32(6), pp.392–396. https://doi.org/10.1111/j.1365-2842.2005.01445.x
18. Jensen, S. B., Pedersen, A. M., Vissink, A., Andersen, E., Brown, C. G., Davies, A. N., Dutilh, J., Fulton, J. S., Jankovic, L., Lopes, N. N., Mello, A. L., Muniz, L. V., Murdoch-Kinch, C. A., Nair, R. G., Napeñas, J. J., Nogueira-Rodrigues, A., Saunders, D., Stirling, B., von Bültzingslöwen, I., ... Weikel, D. S. (2010) ‘A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: Prevalence, severity and impact on quality of life ’, Supportive Care in Cancer, 18(8), 1039–1060. https://doi.org/10.1007/s00520-010-0827-8
19. Kandula, S., Nagi, R., & Nagaraju, R. (2023) ‘Sialography: A pictorial review’, Oral Radiology, 39(2), 225–234. https://doi.org/10.1007/s11282-022-00668-1
20. Kapourani, A., Kontogiannopoulos, K.N., Manioudaki, A.-E., Poulopoulos, A.K., Tsalikis, L., Assimopoulou, A.N. and Barmpalexis, P. (2022) ‘A review on xerostomia and its various management strategies: The role of advanced polymeric materials in the treatment approaches’, Polymers, 14(5), article 850. https://doi.org/10.3390/polym14050850.
21. Kim, J. Y., An, C. H., Kim, J. Y., and Jung, J. K. (2020). ‘Experimental animal model systems for understanding salivary secretory disorders’, International Journal of Molecular Sciences, 21(22), 8423. https://doi.org/10.3390/ijms21228423
22. López-Pintor, R.M., Casañas, E., González-Serrano, J., Serrano, J., Ramírez, L., de Arriba, L. and Hernández, G. (2016) ‘Xerostomia, hyposalivation, and salivary flow in diabetes patients’, Journal of Diabetes Research, 2016, article 4372852. https://doi.org/10.1155/2016/4372852.
23. Malicka, B., Kaczmarek, U. and Skośkiewicz-Malinowska, K. (2014) ‘Prevalence of xerostomia and the salivary flow rate in diabetic patients’, Advances in Clinical and Experimental Medicine, 23(2), pp. 225–233. https://doi.org/10.17219/acem/37067.
24. Mardani, H., Ghannadi, A., Rashnavadi, B., & Kamali, R. (2017) ‘The effect of ginger herbal spray on reducing xerostomia in patients with type II diabetes’, Avicenna Journal of Phytomedicine, 7(4), 308–316. https://doi.org/10.22038/ajp.2017.8755
25. Marín, C., Díaz-de-Valdés, L., Conejeros, C., Martínez, R., & Niklander, S. (2021) ‘Interventions for the treatment of xerostomia: A randomized controlled clinical trial’, Journal of Clinical and Experimental Dentistry, 13(2), e104–e111. https://doi.org/10.4317/jced.57924
26. Mhatre, S., Srichand, R., Sethumadhavan, J., Mishra, P.B., Patil, S. D., Chavan, R.S., Joshi, M., and Shetty, U. (2024) ‘Dry mouth dilemma: A comprehensive review of xerostomia in complete denture wearers’, Cureus, 16(4), e58564. https://doi.org/10.7759/cureus.58564
27. Mishra, N., Iqbal, J., Sabir, S., Singh, P., Singh, N., Sharma, A.K. (2022) ‘Role of saliva in oral health’, IP Indian Journal of Conservative and Endodontics, 7(3), 109–112. https://doi.org/10.18231/j.ijce.2022.024
28. Mortazavi, H., Baharvand, M., Movahhedian, A., Mohammadi, M. and Khodadoustan, A. (2014) ‘Xerostomia due to systemic disease: A review of 20 conditions and mechanisms’, Annals of Medical and Health Sciences Research, 4(4), pp. 503–510. https://doi.org/10.4103/2141-9248.139284.
29. Mravak-Stipetic, M. (2012) ‘Xerostomia: Diagnosis and treatment’, Rad514 Medical Sciences, 38(2012), pp.69–91. Nair, G. R., Naidu, G. S., Jain, S., Nagi, R., Makkad, R. S., and Jha, A. (2016) ‘Clinical effectiveness of aloe vera in the management of oral mucosal diseases: A systematic review’, Journal of Clinical and Diagnostic Research, 10(8), ZE01–ZE07. https://doi.org/10.7860/JCDR/2016/18142.8222
30. Navazesh, M. (1993) ‘Methods for collecting saliva’, Annals of the New York Academy of Sciences, 694, pp.72–77. Pina, G.M.S., Mota Carvalho, R., Silva, B.S.F. and Almeida, F.T. (2020) ‘Prevalence of hyposalivation in older people: A systematic review and meta-analysis’, Gerodontology, 37(4), pp. 317–331. https://doi.org/10.1111/ger.12497.
31. Pinna, R., Campus, G., Cumbo, E., Mura, I., and Milia, E. (2015) ‘Xerostomia induced by radiotherapy: An overview of the physiopathology, clinical evidence, and management of the oral damage’, Therapeutics and Clinical Risk Management, 11, 171–188. https://doi.org/10.2147/TCRM.S70652
32. Prinz, J. F., & Lucas, P. W. (2009) ‘Swallowing and oral processing’, Journal of Texture Studies, 40(1), 54–69. https://doi.org/10.1111/j.1745-4603.2008.00181.x
33. Sardellitti, L., Bortone, A., Filigheddu, E., Serralutzu, F., and Milia, E. P. (2023) ‘Xerostomia: From pharmacological treatments to traditional medicine: An overview on the possible clinical management and prevention using systemic approaches’, Current Oncology, 30(5), pp.4412–4426. https://doi.org/10.3390/curroncol30050336
34. Shimazaki, Y., Fu, B., Yonemoto, K., Akifusa, S., Shibata, Y., Takeshita, T., Ninomiya, T., Kiyohara, Y., and Yamashita, Y. (2017) ‘Stimulated salivary flow rate and oral health status’, Journal of Oral Science, 59(1), pp. 55–62. https://doi.org/10.2334/josnusd.16-0372
35. Spiegelberg, L., Braks, J. A. M., Djasim, U. M., Farrell, E., van der Wal, K.G.H., and Wolvius, E.B. (2014) ‘Effects of hyperbaric oxygen therapy on the viability of irradiated soft head and neck tissues in mice’, Oral Diseases, 20(3), e111–e119. https://doi.org/10.1111/odi.12162
36. Sugiya, H. (2014). Xerostomia. In Reference Module in Biomedical Sciences. Elsevier. https://doi.org/10.1016/B978-0-12-801238-3.00036-2
37. Sultana, N., and Sham, E. M. (2011) ‘Xerostomia overview’, International Journal of Dental Clinics, 3, pp.58–61. Sumita, Y., Liu, Y., Khalili, S., Maria, O.M., Xia, D., Key, S., Cotrim, A.P., Mezey, E., and Tran, S.D. (2011) ‘Bone marrow-derived cells rescue salivary gland function in mice with head and neck irradiation’, International Journal of Biochemistry & Cell Biology, 43(1), pp.80–87. https://doi.org/10.1016/j.biocel.2010.09.023
38. Suzuki, N., Fujimoto, A., Yoneda, M., Watanabe, T., Hirofuji, T. and Hanioka, T. (2016) ‘Resting salivary flow independently associated with oral malodor’, BMC Oral Health, 17(1), article 23. https://doi.org/10.1186/s12903-016-0255-3.
39. Talacko, A. A., & McGurk, M. (2000). Imaging of salivary gland disease. British Journal of Oral and Maxillofacial Surgery, 38(1), 1–6.
40. Thomson, W.M., Chalmers, J.M., Spencer, A.J. and Williams, S.M. (1999) ‘The Xerostomia Inventory: a multi-item approach to measuring dry mouth’, Community Dental Health, 16(1), pp. 12–17.
41. Tsibouklis, J., Middleton, A.M., Patel, N. and Pratten, J. (2013) ‘Toward mucoadhesive hydrogel formulations for the management of xerostomia: The physicochemical, biological, and pharmacological considerations’, Journal of Biomedical Materials Research Part A, 101(11), pp. 3327–3338. https://doi.org/10.1002/jbm.a.34626.
42. Varadarajan, V.V., & Dziegielewski, P.T. (2017). Surgical management of salivary gland disease. In S. Cha (Ed.), Salivary Gland Development and Regeneration. Springer. https://doi.org/10.1007/978-3-319-43513-8_13
43. Villa, A., Connell, C.L. and Abati, S. (2015) ‘Diagnosis and management of xerostomia and hyposalivation’, Therapeutics and Clinical Risk Management, 11, pp. 45–51. https://doi.org/10.2147/TCRM.S76282.
44. Vivino, F.B., Al-Hashimi, I., Khan, Z., LeVeque, F.G., Salisbury, P.L. III, Tran-Johnson, T.K., Muscoplat, C.C., Trivedi, M., Goldlust, B. and Gallagher, S.C. (1999) ‘Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: A randomized, placebo-controlled, fixed-dose, multicenter trial’, Archives of Internal Medicine, 159(2), pp. 174–181. https://doi.org/10.1001/archinte.159.2.174
45. Widmaier, E. P. ve Vander, A. J. (2018) İnsan fizyolojisi. Ankara: Güneş Tıp
46. Xin, W., Leung, K.C.M., Lo, E.C.M., Mok, M.Y. and Leung, M.H. (2016) ‘A randomized, double-blind, placebo-controlled clinical trial of fluoride varnish in preventing dental caries of Sjögren’s syndrome patients’, BMC Oral Health, 16(1), article 102. https://doi.org/10.1186/s12903-016-0296-7.
47. Yilmaz, F., Carti Dorterler, O., Eren Halici, S., Kasap, B. and Demirbas, A. (2024) ‘The effects of pregnancy on oral health, salivary pH and flow rate’, BMC Oral Health, 24(1), article 1286. https://doi.org/10.1186/s12903-024-05057-0.
48. Zhang, C.-Z., Cheng, X.-Q., Li, J.-Y., Zhang, P., Yi, P., Xu, X., and Zhou, X.-D. (2016) ‘Saliva in the diagnosis of diseases’, International Journal of Oral Science, 8(3), 133–137. https://doi.org/10.1038/ijos.2016.38 Zhao, H., Ran, S., Huo, W., Gan, K. and Li, W. (2025) ‘Xerostomia correlates with pain sensitivity in burning mouth syndrome patients’, Scientific Reports, 15(1), article 13191. https://doi.org/10.1038/s41598-025-97048-6.