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In a recent communication, Little3 discussed the psychodynamics of xerostomia, or more appropriately hyposalivation, as xerostomia refers to the absence of salivary flow. His report is based on the case history of a woman seen first in supportive treatment and then in psychoanalytic treatment. Little provides convincing evidence of the role of oral dynamics in the etiology of the patient's symptoms. One is left with the impression that hyposalivation is purely a psychogenic disorder, based on the content of his communication and lack of indication that the patient had a definitive medical work-up. The purpose of this brief communication is to correct this impression by indicating some common physiological causes of hyposalvation and to suggest the possibility of somatic compliance in Little's patient.
Hyposalivation occurs in a variety of conditions where a physiological mechanism is known to exist or likely to exist and where the symbolic meaning of dry mouth does not appear to be a causative factor. The autonomic nervous system mediates changes in salivary flow rate in patients experiencing marked to severe anxiety, fear, and depression.4 Changes in adrenocortical activity probably also influence salivary flow.4, 9 Hormonal changes commonly contribute to hyposalivation in postmenopausal women.2 Hyposalivation can be a symptom of a systematic disease and is a side effect of many common pharmacological agents. Disease processes associated with hyposalivation include cystic fibrosis, Sjögren's syndrome, diabetes mellitus, and hypertension.8 Drugs that cause hyposalivation as an unwanted side effect include the major and minor tranquillizers, muscle relaxants, sedatives, antihistamines, and antihypertensive drugs. Autonomic mechanisms have been alluded to in the report of a