Secretory process: the role of age, autoimmunity and endocrinopathy

Xerostomia is a common occurrence in older people, impairing their quality of life. When salivary gland function goes below 50%, patients show oral mucosal dryness and consequent problems on speaking and eating. They present oral health impairment. Their quality of life is compromised too. The prevalence of xerostomia is reported to be approximately 30% in people over 65 years old. Drug-induced xerostomia is the most common cause of dry mouth in elderly, because many older adults are taking at least one medication that causes salivary dysfunction. Among the autoimmune disease that can cause xerostomia, Sjögren’s syndrome (SS) is the most representative one in elderly. Dryness of oral mucosa and eyes is the main symptom of the disease. The “Elderly onset primary Sjogren’s Syndrome” (EopSS) is a common disease in Caucasian population, with a global incidence of 3% but a geographic variability. Patients with SS are frequently misdiagnosed, and physicians treat each symptom individually, unaware of underlying systemic disease. The control of symptoms with substitution of saliva and tears is recommended; therapies with anti-CD20 and Interferon-α are useful in patients with residual glandular function and salivary flow. Among the endocrinopathies, diabetes mellitus (DM) is the most common cause of xerostomia in older patients. Hyposalivation increases in diabetic patients with low metabolic control, which can cause more severe side effects in relation to oral health. Xerostomia may be produced by changes in salivary composition (caused by diabetes complications such as neuropathy, angiopathy, and metabolic failure) instead of changes in salivary quantity. Treating diabetes itself, maintaining good glycaemic values, can allay xerostomia in those patients. Doctors and dentists have to be aware of the various oral manifestations of diabetes in order to make an early diagnosis and treatment, avoiding further complications.