What is xerostomia (dry mouth)?

From the Guidelines

Xerostomia, also known as dry mouth, is a condition where the salivary glands do not produce enough saliva to keep the mouth moist, and it can result from various causes including medication side effects, radiation therapy to the head and neck, certain diseases like Sjögren's syndrome, diabetes, or HIV/AIDS, and natural aging processes. This condition can lead to a range of symptoms, including a sticky, dry feeling in the mouth, frequent thirst, cracked lips, sores in the mouth, difficulty speaking or swallowing, hoarseness, and bad breath. According to the most recent evidence, treatment depends on the underlying cause but may include sipping water frequently, using sugar-free gum or lozenges to stimulate saliva production, avoiding tobacco, alcohol, and caffeine which can worsen dryness, using a humidifier at night, and in severe cases, prescription medications like pilocarpine (Salagen) or cevimeline (Evoxac) that stimulate saliva production 1.

Some key points to consider in the management of xerostomia include:

• The importance of adequate saliva for oral health, as it helps neutralize acids, limit bacterial growth, wash away food particles, and aid in digestion 1
• The potential for xerostomia to lead to increased dental problems if left untreated, highlighting the need for prompt and effective management 1
• The use of non-pharmacological stimulation, such as gustatory stimulants and mechanical stimulants, as a first-line therapeutic approach for mild glandular dysfunction 1
• The consideration of pharmacological stimulation with muscarinic agonists, such as pilocarpine and cevimeline, for patients with moderate glandular dysfunction 1

Overall, the management of xerostomia requires a comprehensive approach that takes into account the underlying cause of the condition, as well as the individual patient's needs and preferences. By prioritizing the most recent and highest-quality evidence, healthcare providers can provide effective and personalized care for patients with xerostomia.

From the FDA Drug Label

“Global improvement” is defined as a score of 55 mm or more on a 100 mm visual analogue scale in response to the question, “Please rate your present condition of dry mouth (xerostomia) compared with your condition at the start of this study. Patients’ assessments of specific dry mouth symptoms such as severity of dry mouth, mouth discomfort, ability to speak without water, ability to sleep without drinking water, ability to swallow food without drinking, and a decreased use of saliva substitutes were found to be consistent with the significant global improvement described

Xerostomia, also known as dry mouth, is a condition characterized by:

• Severity of dry mouth
• Mouth discomfort
• Difficulty speaking without water
• Difficulty sleeping without drinking water
• Difficulty swallowing food without drinking
• Increased use of saliva substitutes 2 2

From the Research

Definition and Causes of Xerostomia

• Xerostomia, also known as dry mouth, is a condition characterized by a reduction in salivary flow or a sensation of dryness in the mouth 3, 4, 5, 6, 7.
• The most common causes of xerostomia include the use of certain systemic medications, high doses of radiation, and certain diseases such as Sjogren's syndrome 3, 4, 6, 7.
• Other causes of xerostomia may include dehydration, diabetes, and therapeutic radiation to the head and neck region 6.

Symptoms and Complications of Xerostomia

• Xerostomia is associated with difficulties in chewing, swallowing, tasting, or speaking, and can result in poor diet, malnutrition, and decreased social interaction 3.
• Patients with xerostomia are at increased risk of developing dental caries, candidiasis, and other oral diseases that may affect quality of life negatively 3, 4, 5, 6, 7.
• Xerostomia can cause oral discomfort, especially for denture wearers, and may lead to ill-fitting dentures, taste alterations, and fungal infections 3, 7.

Diagnosis and Treatment of Xerostomia

• A thorough intraoral and extra-oral clinical examination is important for the diagnosis of xerostomia 3.
• Treatment may include the use of salivary substitutes, salivary stimulants such as pilocarpine, ongoing dental care, caries prevention, and a review of the current prescription drug regimen 3, 5, 7.
• A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use 5.