Pathology · patient case question
Each of the following is contributing to this patient's xerostomia EXCEPT one. Which is the EXCEPTION?
Patient case: Generalised deep pockets in type 2 diabetes
Patient: Male, 49 years old
Chief complaint: “I'm here for my check-up.”
History: Type 2 diabetes mellitus, hypertension, fatty liver. Medications: metformin, valsartan, atorvastatin. Wears a maxillary removable partial denture.
Findings: Generalised bleeding on probing with pocket depths of 5–8 mm in all four quadrants. Reports a persistently dry mouth.
Show answer and explanation
Correct answer: A. The removable partial denture
- A. CORRECT as the exception. A removable partial denture does not reduce salivary output. It may make a dry mouth FEEL worse, because retention depends on a salivary film and a dry denture becomes uncomfortable and unstable, but the prosthesis is not a cause of hyposalivation — it is a casualty of it.
- B. Antihypertensives are among the commonest drug causes of xerostomia. Diuretics reduce fluid volume, and several classes have anticholinergic or sympatholytic effects on salivary flow.
- C. Uncontrolled diabetes causes xerostomia by two mechanisms: osmotic diuresis from glycosuria produces dehydration, and diabetic autonomic neuropathy impairs salivary gland stimulation.
- D. Mouth breathing dries the mucosa directly, and reduced fluid intake compounds the dehydration.
Note: When you meet an 'all cause xerostomia EXCEPT' item, run the four categories: drugs, systemic disease (diabetes, Sjögren, HIV), radiation to the head and neck, and dehydration. Whatever falls outside those four is your answer.