What is xerostomia?

From the Guidelines

Xerostomia is a condition characterized by a reduced salivary flow rate, typically less than 0.1 mL/min, which can be caused by various factors including medications, medical treatments, and certain diseases. This condition can occur due to various causes, including medications (such as antihistamines, decongestants, antidepressants, and blood pressure medications), medical treatments like radiation therapy for head and neck cancers, certain diseases like Sjögren's syndrome or diabetes, and aging 1. Management typically involves addressing the underlying cause when possible, staying hydrated by drinking water frequently, using sugar-free gum or lozenges to stimulate saliva production, and avoiding alcohol, caffeine, and tobacco which can worsen dryness.

Key Points to Consider

• Xerostomia can be caused by several disorders, including salivary gland hypofunction and rheumatoid arthritis 1.
• Radiation therapy to the head and neck can cause xerostomia and salivary gland dysfunction, increasing the risk of dental caries and its sequelae 1.
• Intensity-modulated radiation therapy (IMRT) and salivary gland sparing techniques can help reduce the risk of xerostomia and dental caries 1.
• Proper management of xerostomia is important to prevent complications such as tooth decay, gum disease, oral infections, and difficulty with speaking, chewing, and swallowing.

Recommendations for Management

• Stay hydrated by drinking water frequently to help stimulate saliva production and reduce dryness.
• Use sugar-free gum or lozenges to stimulate saliva production.
• Avoid alcohol, caffeine, and tobacco, which can worsen dryness.
• Consider prescription medications like pilocarpine (Salagen) or cevimeline (Evoxac) to stimulate saliva production, as recommended by the most recent and highest quality study 1.

From the Research

Definition of Xerostomia

• Xerostomia is defined as the complaint of oral dryness, which is a symptom, not a disease 2, 3.
• It is characterized by a reduction in salivary flow, resulting in perpetual dry and sticky mucosa or sticky, stringy saliva 2.

Causes of Xerostomia

• Xerostomia can be caused by various factors, including:
  • Medications: several hundred medications can cause or exacerbate xerostomia 2, 4.
  • Systemic diseases: such as autoimmune diseases, cancer, and bone marrow transplants 2, 5, 4.
  • Radiation therapy: particularly to the head and neck 5, 4.
  • Aging: xerostomia is more prevalent among older adults 5, 3.

Effects of Xerostomia

• Xerostomia can lead to various complications, including:
  • Digestive problems 2.
  • Weight loss 2.
  • Accelerated dental decay 2, 4.
  • Difficulty with speech and swallowing 5.
  • Impaired quality of life 5, 3.

Diagnosis and Treatment of Xerostomia

• Diagnosis of xerostomia can be confirmed using sialometry 5.
• Treatment of xerostomia aims to increase salivary flow or provide oral moisture by other means 5, 4.
• Medications such as cevimeline and pilocarpine can be used to stimulate salivary secretion 6.
• A comprehensive review of the differential diagnosis, evaluation, and management of xerostomia is essential for prompt diagnosis and treatment 3.