Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs

https://doi.org/10.14219/jada.2014.44Get rights and content

ABSTRACT

Background and Overview

Xerostomia, also known as “dry mouth,” is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue.

Conclusions and Practice Implications

Initial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.

Section snippets

FUNCTIONS OF SALIVA

In addition to its role in digestion, saliva serves several protective functions, including cleansing the oral cavity, facilitating oral processing and swallowing of food, protecting oral tissues against physical and microbial insults, maintaining a neutral pH and preventing demineralization.

The antimicrobial properties of saliva are due to a wide variety of immune and nonimmune salivary proteins that inhibit the adherence and growth of viruses and bacteria.8 Salivary proteins and mucins

Systemic diseases

Box 110, 11, 12 presents medical conditions that may cause dry mouth. An estimated 4 million people in the United States have Sjögren syndrome (SS), an autoimmune disease commonly associated with hyposalivation. SS is a chronic inflammatory disease characterized by lymphocytic infiltration of the salivary and lacrimal glands, resulting in xerostomia and dry eyes.13 Approximately 90 percent of those with SS are women, and patients often experience associated symptoms such as fatigue and joint

SIGNS AND SYMPTOMS

Box 3 presents clinical signs and symptoms of hyposalivation. Patients with dry mouth often have atrophic and erythematous oral mucosa, loss of papillae on the tongue29 and lips that peel and crack. Traumatic lesions may be visible on the buccal mucosa and the lateral borders of the tongue. Dentures may become loose, causing painful ulcerations.30 Patients also may describe the need to sip fluids, especially when eating, or may need to drink water when awakened from sleep.19, 31

Cervical or root

History and examination

Appropriate evaluation and patient assessment, including a comprehensive medical and dental history, are essential for diagnosing SGH. A positive response to any of the following questions has been associated with reduced saliva, even in patients who have not expressed complaints of xerostomia34:

  • Does the amount of saliva in your mouth seem to be too little?

  • Does your mouth feel dry when eating a meal?

  • Do you sip liquids to aid in swallowing dry food?

  • Do you have difficulty swallowing?

A

MANAGEMENT

Treatment planning to alleviate dry-mouth symptoms should be tailored to the individual patient. A multidisciplinary model of care for xerostomia and SGH should include the following components:

  • patient education—a patient-centered process emphasizing daily oral hygiene, regular dental visits, use of topical fluoride, tobacco-use cessation counseling and other interventions;

  • management of systemic conditions and medication use in consultation with the patient's physician, oncologist or

CONCLUSIONS

Dentists are often challenged when diagnosing and treating patients with xerostomia and SGH, which can have potentially devastating effects on the oral cavity. Early detection, comprehensive evaluation and diagnostic testing may prevent significant oral disease and lead to multidisciplinary care that includes collaboration with physicians.

Patient education, management of systemic conditions associated with salivary dysfunction and implementation of preventive measures to reduce oral disease are

References (65)

  • I von Bültzingslöwen et al.

    Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2007)
  • I Al-Hashimi et al.

    Oral amyloidosis: two unusual case presentations

    Oral Surg Oral Med Oral Pathol

    (1987)
  • R Solans-Laqué et al.

    Risk, predictors, and clinical characteristics of lymphoma development in primary Sjögren's syndrome

    Semin Arthritis Rheum

    (2011)
  • CH Shiboski et al.

    Management of salivary hypofunction during and after radiotherapy

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2007)
  • SB Jensen et al.

    A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

    Support Care Cancer

    (2010)
  • F Salaffi et al.

    Ultrasonography of salivary glands in primary Sjögren's syndrome: a comparison with contrast sialography and scintigraphy

    Rheumatology (Oxford)

    (2008)
  • P Dirix et al.

    The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer

    Support Care Cancer

    (2008)
  • SB Jensen et al.

    A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life

    Support Care Cancer

    (2010)
  • WM Thomson et al.

    The impact of xerostomia on oral-health-related quality of life among younger adults

    Health Qual Life Outcomes

    (2006)
  • V de Almeida Pdel et al.

    Saliva composition and functions: a comprehensive review

    J Contemp Dent Pract

    (2008)
  • H Mese et al.

    Salivary secretion, taste and hyposalivation

    J Oral Rehabil

    (2007)
  • C Scully

    Drug effects on salivary glands: dry mouth

    Oral Dis

    (2003)
  • M Navazesh et al.

    Xerostomia: prevalence, diagnosis, and management

    Compend Contin Educ Dent

    (2009)
  • M Ramos-Casals et al.

    Treatment of primary Sjögren syndrome: a systematic review

    JAMA

    (2010)
  • JB Epstein et al.

    Quality of life and oral function following radiotherapy for head and neck cancer

    Head Neck

    (1999)
  • JJ Napeñas et al.

    Diagnosis and treatment of xerostomia (dry mouth)

    Odontology

    (2009)
  • Elsevier/Gold Standard

    Clinical Pharmacology (database)

  • BW Neville et al.

    Oral & Maxillofacial Pathology

    (2009)
  • A Villa et al.

    Risk factors and symptoms associated with xerostomia: a cross-sectional study

    Aust Dent J

    (2011)
  • BP Rai et al.

    Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults

    Cochrane Database Syst Rev

    (2012)
  • E Forte et al.

    The use of anti-spasmodics in the treatment of irritable bowel syndrome: focus on otilonium bromide

    Eur Rev Med Pharmacol Sci

    (2012)
  • R Katzenschlager et al.

    Anticholinergics for symptomatic management of Parkinson's disease

    Cochrane Database Syst Rev

    (2003)
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    Disclosure. None of the authors reported any disclosures.

    1

    Dr. Plemons is a professor, Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas.

    2

    Dr. Al-Hashimi is a professor and the director, Salivary Dysfunction Clinic and Stomatology Research Laboratory, Department of Periodontics, Texas A&M University Baylor College of Dentistry, Dallas.

    3

    Dr. Marek is an associate professor, Department of Oral Pathology, Radiology and Medicine, College of Dentistry, The University of Iowa, Iowa City.

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