Xerostomia is the subjective feeling of mouth dryness, which may be caused or not by function lowering of salivary glands, or with decrease of saliva quality or quantity.
It is a frequent symptom in palliative care patients; its prevalence is referred to be 60% to 88% in advanced and progressive oncological disease patients.
Saliva plays an important role in maintaining the best physiological conditions of mouth. Besides humidifying the oral cavity tissues, its lubricating properties help swallowing and talking, and prevents other damages caused by mechanical and noxious microbiological agents.
Decreased salivation can lead to oral pain; accelerated dental morbidity; oral infections, fissures, and ulcerations; halitosis; alteration in taste and enjoyment of food; chewing and swallowing difficulties; nutritional impairment; trouble producing intelligible speech; and denture-related problems.
Etiologies
- Medications with anticholinergic activity are the most common pharmacologic causes of xerostomia. These include many antiemetics, antihistamines, antipsychotics, antispasmodics, antidepressants (especially the tricyclics), and bronchodilators. Alpha-blockers (e.g., terazosin), alpha-2 agonists (e.g. ,clonidine), beta-blockers (e.g., metoprolol), opioids and benzodiazepines may also be responsible for xerostomia.
- Radiation for head and neck malignancies.
- Comorbidities: HIV/AIDS, diabetes, renal failure, and mood and anxiety disorders.
- Dehydration from any cause, including drug-induced.
Treatment
Address underlying causes. Eliminate unnecessary drugs, substitute less drying ones, or titrate to lowest effective dose.
Stimulate residual gland function.
- Sugarless gums and candies can stimulate salivary reflexes.
- Cholinergic agonists, such as pilocarpine and cevimeline.
Use saliva substitutes. Most have limited efficacy; frequent sips of water are more useful and convenient. Topical products containing olive oil, betaine, and xylitol are effective for medication-induced xerostomia.
Encourage oral hydration. Humidifiers, especially during sleep, may also be helpful.
Optimize oral hygiene.
Use antimicrobial mouthwashes (alcohol-free): chlorhexidine gluconate oral rinse.
Avoid toothpaste products contain the surfactant sodium lauryl sulfate, which can irritate dry mucosa.
A soft diet must be advised; avoid hard and dry food, tobacco, and alcoholic beverages.
See reference for more information. Adapted from Reisfield GM, Rosielle DA and Wilson GR. Palliative Care Network of Wisconsin. Fast facts and concepts #182. Xerostomia. Internet. Accessed on December 19, 2017.