A 67-year-old man with Parkinson disease has experienced an increasingly dry mouth for the past 3 months, and this interferes with eating and swallowing. He has noted dry eyes as well. On physical examination he has minimal tremor at rest; there are no other abnormal findings. Laboratory studies show no detectable autoantibodies. Which of the following is the most likely cause for his findings?
The most common cause for dry mouth (xerostomia) and dry eyes (xerophthalmia) is a medication effect. Anticholinergics such as trihexyphenidyl to treat the parkinsonian tremor can be implicated, as well as antidepressants, antipsychotics, and antihistaminics. Alcohol and tobacco use are risks for precancerous lesions and squamous cancers of the oral cavity. The lack of saliva is unlikely to be associated with infection, which tends to be focal. Sialadenitis is unlikely to involve all salivary glands, except in the setting of Sjogren syndrome, which is associated with SS-A and SS-B autoantibodies, and may be associated with some pain with inflammation.
Alcohol ingestion
Anticholinergic drug use
Candidiasis
Sialadenitis with blockage of salivary duct
Head & Neck