Psychological state: Ahidden factor that influences the management of hyposalivation

Introduction: An association between psychological state and saliva production has been identified. Here we report a case of hyposalivation in a patient with anxiety disorder managed through a collaborative treatment with a clinical psychologist. Case Report: A 29-year-old female presented with a 6-month history of dry mouth. She was healthy and did not smoke, consume alcohol, or take medications. The patient complained of dry lips. At clinical examination, good oral hygiene with thick pooling saliva and shiny oral mucosa was detected. Hyposalivation was confirmed (unstimulated salivary flow rate (SFR) < 0.1 mL/min). The patient was asked to increase fluid intake, chew xylitol gum, and use 0.9% sodium chloride mouthwash. During a follow-up visit, the patient reported psychological stress in the previous year. She was referred to a clinical psychologist who diagnosed an anxiety disorder and provided nonmedication therapy. After 1 month, significant improvement was seen, as shown by an increase in the SFR to 0.3 mL/min, and all subjective complaints ceased. Conclusion: Saliva production was probably limited by the anxiety disorder-induced anticholinergic activity. Collaboration between the dentist and clinical psychologist successfully reduced the hyposalivation. Evaluating and managing a patient's psychological state could be important for successful management of hyposalivation.