Sialolithiasis Secondary to Xerostomia: A Complication of Chronic Antipsychotic and Anticholinergic Use

Xerostomia, a common adverse effect of psychotropic medications, often results from the use of antipsychotics and anticholinergic agents, which inhibit M3 muscarinic receptors on salivary glands, reducing saliva production. Chronic xerostomia predisposes patients to complications such as sialolithiasis and sialadenitis, yet it is frequently underreported and underdiagnosed. This case report highlights a 72-year-old female with a 45-year history of postpartum-onset psychiatric illness treated with trifluoperazine and trihexyphenidyl. Long-term use of these medications led to persistent xerostomia, which progressed to recurrent submandibular sialadenitis and sialolithiasis. Despite experiencing significant discomfort, the patient did not seek timely intervention, ultimately requiring surgical removal of sialoliths. This case underscores the importance of regular oral health assessments in patients on long-term psychotropic therapy. Early recognition and management of xerostomia can prevent severe complications. Clinicians should explore alternative treatment strategies to minimize the need for anticholinergics, such as using atypical antipsychotics with lower extrapyramidal side effect profiles.