Homoeopathic management of xerostomia.

Dr Rahul V. Sutariya MD(Hom)

Introduction:
Xerostomia is dryness of the mouth and it is reported by the patient as a subjective symptom which resulted from diminished saliva production. It causes oral discomfort, difficulty in speech and swallowing, loss or absence of taste and teeth carries.

Keywords: Xerostomia, anti-muscarinic, GY, Paclitaxel and Rehabilitation.

Causes:

• Drugs- anti-muscarinic (use for allergies, asthma, bradycardia, tachycardia, motion sickness and Parkinson’s disease), antidepressants, opioids, diuretics, etc.
• Radiation therapy- in head neck cancer patients 24-26 GY radiation can lead xerostomia. Now latest radiotherapy types are very prevalent to save parotid and salivary gland exposure during radiation.
• Dehydration
• Mouth breathing
• Candidiasis
• Anxiety and other psychiatric ailments

Diagnosis:
Clinically xerostomia can be diagnosed during oral examination. Oral parts like tongue, buccal mucosa, etc seems dry and rough. During patient history it is noted as subjective symptoms with other symptoms like dryness f mouth and discomfort.

Education and prevention:                                                                                                           

• Keep mouth as moist as possible – like frequent sips of water.
• Treat underlying cause
• Medication review if possible than hold medications.
• Oral care and hygiene
• Artificial saliva products
• Avoid tobacco and alcohol

Management:

Home remedies

• Rehydration
• Suckling ice cubes, frozen fruits.
• Salted lime pickles, or salivation producing sour foods.
• Chewing gums, candies
• Application of homemade lubricants like ghee or oil preparation, rinsing mouth with sun flower oil etc.

Homoeopathic management:

• In Phatak repertory

Mouth, Dry-

Bell, Aco, Ars, Nux.v, Phos.ac, Phos, Sep, Sulph, Berb, Bry, Chin, Lach, Lyc, Mur.ac, Nat.m, Rhus.t, Stram, Stront.c, Sul-I, Tub, Verat and Verat.v.

• In select your remedy-

GUMS, MOUTH, TEETH AND TONGUE, MOUTH-Dryness, there are medicines like Ars.alb, Bryonia, Nux mosch, Lachesis, Alumen, Nux vom, Pulsatilla, Aurum m, Arum triph, Capsicum, Hyscyamus, Baryta mur, Merc papis, Acid phos, Uran nit, Salicylic acid and Verat alb.

• Sarkar sir recommends medicines like- (06)

Post radio side effects-
Cadmium salts, Radium metallicum and Radium bromatum, Cobaltum salts, Strontium salts, X- ray, Paclitaxel, Diospyros kaki and Helianthus annus.

Medicine	Dryness	tongue	Thirst	Inflammation	Associate symptom
Arsenic album	Dryness and burning heat	Tongue dry, clean and red, stitching and burning pain in tongue.	Small-frequent	Swollen, edematous, constricted, burning, unable to swallow.	Burning
Bryonia alba	Dryness all mucous membranes	Dryness of tongue, tongue coated, yellowish, dark brown, bitter taste.	Large-long interval		Agg. motion better by rest.
Nux moschata	Great/ extreme dryness	So dry, adheres to roof of mouth, saliva like cotton	thirst less		Better by hard pressure
Lachesis	Dryness of mouth	Unable to protrude his tongue. Cracked, red, dry tongue burns and trembles.		Aphthous, gums swollen, soreness throat, swallowing agg.	Hungry Empty swallowing agg.
Alumen	Dryness of mouth, throat and tongue		Thirst for icy cold water		Mouth burning ulcerated, dirty and spongy
Nux vom		Gums swollen and bleeding.		Jaw contracted, pharynx constricted.	Breath offensive after meals or in the morning
Aurum met		Taste putrid or bitter.	Thirst increased	Ulcerations of gums, mastoid and other facial bones inflammation. Carries of palate.	Breath offensive in girls at puberty
Arum triph		Tongue red, sore and burning.		Mouth raw at roof and palate. Saliva acrid and corroding. corner of mouth sore and cracked.	Picking of lips until they bleed.
Hyoscyamus	Dry mouth, tongue, dry as burnt leather	Tongue dry, red, cracked, stiff and immovable, protrude with difficulty.			Taste as leather. Speech impaired. lower jaw drops.
Baryta mur	Dry mouth	Cracked			Offensive odour, bleeding gums, viscid mucus fills the mouth.
Merc per	Dryness in mouth even sugar refuses to melt				Eating aggravates dryness. Breath is hot and dries the lips
Apis mel	Dryness	Tongue fiery red, swollen, sore and raw with vesicles. tongue feels scalded and hot. Cancer of tongue	Thirst less	Lips swollen especially upper, gums swollen. Throat and uvula swollen.	Craving for milk. Edema of cellular tissues and mucous membranes.
Acid phos	Dryness	Tongue swollen, dry with viscid, frothy mucus. Bites tongue involuntarily.	Thirst for a cold milk.	Bleeding gums.	Diabetes. debility mental first than physical.
Uraium nit	Dryness				Diabetes
Salicylic acid	Dry mouth with burning tongue				Fetid breath, soreness and cancers
Verat alb		Tongue pale, cold, cool sensation as if peppermint.	Thirst for cold water but vomited as soon as swallowed.		Perspiration. Aversion to warm food.
Pulsatilla	Dry mouth, wants frequent wash.	Yellow white tongue with tenacious mucus.	Without thirst.		Breath offensive in the evening or at night Aversion to rich food.

Conclusion:
Xerostomia or dry mouth is burning troubleshooting in cancer rehabilitation with limited effective therapies. Post radiation or post-surgical head and neck cancer patient majorly suffer from this common complaint. many patient and doctors consider it as accessory symptom so don’t take care or serious actions against it. But changing oncological scenario and latest protocols enough focuses on this complaint. It’s a rehabilitation issue so it needs much more care and management for quality life of cancer survivors. Homoeopathic management provides very simple solutions with basic remedies. This is an area which required scientific researches and trials for authentic declarations.

Bibliography:

• Website: https://www.ncbi.nlm.nih.gov/
• Textbook for certificate course in essentials of palliative care, 5^th edition, published by Indian association of palliative care.
• T IPC 5, Introducing palliative care, economy edition for Indian subcontinent and Africa 5^th edition published by Institute of palliative medicine, pain and palliative care society, Calicut, India.
• R. Phatak repertory
• Select your remedy by Dr.Bishamber Das,16^th edition published in 1994.
• Just you think vol-2 by Dr.Sunirmal Sarkar published by Homoeopathic medical publishers in 2019.
• Pocket manual of homoeopathic materia medica and repertory by Dr. Willium Boericke, MD 21^st edition

Dr.Rahul V. Sutariya M. D. (Homoeopathy)
Associate Professor, Dept. of Materia Medica, Smt. AJSHMC & RI, Mehsana, (Gujarat)