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Diagnosis and management of xerostomia and hyposalivation

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Therapeutics and Clinical Risk Management
Authors:
  • Miami Cancer Institue
  • Università Vita-Salute San Raffaele, Milano, Italy

Abstract and Figures

Xerostomia, the subjective complaint of dry mouth, and hyposalivation remain a significant burden for many individuals. Diagnosis of xerostomia and salivary gland hypofunction is dependent upon a careful and detailed history and thorough oral examination. There exist many options for treatment and symptom management: salivary stimulants, topical agents, saliva substitutes, and systemic sialogogues. The aim of this review is to investigate the current state of knowledge on management and treatment of patients affected by xerostomia and/or hyposalivation.
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http://dx.doi.org/10.2147/TCRM.S76282
Diagnosis and management of xerostomia and
hyposalivation
Alessandro Villa1,2
Christopher L Connell3
Silvio Abati4
1Division of Oral Medicine and
Den tis try, B righam and Wom en’s
Hospital, Boston, MA, USA;
2Department of Oral Medicine,
Infection and Immunity, Harvard
School of Dental Medicine, Boston,
MA, USA; 3Department of General
Dentistry, Boston University Henry M
Goldman School of Dental Medicine,
Boston, MA, USA; 4Dental Clinic,
Department of Health Sciences,
University of Milan, Milano, Italy
Abstract: Xerostomia, the subjective complaint of dry mouth, and hyposalivation remain a
significant burden for many individuals. Diagnosis of xerostomia and salivary gland hypofunc-
tion is dependent upon a careful and detailed history and thorough oral examination. There exist
many options for treatment and symptom management: salivary stimulants, topical agents,
saliva substitutes, and systemic sialogogues. The aim of this review is to investigate the current
state of knowledge on management and treatment of patients affected by xerostomia and/or
hyposalivation.
Keyword: saliva stimulation, dry mouth, saliva substitutes, sialogogues
Introduction
Xerostomia is defined as the subjective complaint of dry mouth.1 Interestingly,
patients complaining of xerostomia frequently do not show any objective sign of
hyposalivation and their symptoms may be secondary to qualitative and/or quantita-
tive changes in the composition of saliva.2,3 The normal stimulated salivary flow rate
averages 1.5–2.0 mL/min while the unstimulated salivary flow rate is approximately
0.3–0.4 mL/min.4,5 A diagnosis of hyposalivation is made when the stimulated salivary
flow rate is #0.5–0.7 mL/min and the unstimulated salivary flow rate is #0.1 mL/min.5–7
Xerostomia in patients with objective hyposalivation is diagnosed when the rate of
saliva flow is less than the rate of fluid absorption across the oral mucosa plus the rate
of fluid evaporation from the mouth.8
Chronic xerostomia remains a significant burden for many individuals. In particular,
it may affect speech, chewing, swallowing, denture-wearing, and general well-being.9
Xerostomia secondary to hyposalivation may also result in rampant dental caries, oral
fungal infections (eg, candidiasis), taste changes, halitosis, or burning mouth.5,10,11
The most frequent cause of hyposalivation is the use of certain medications (such as
anticoagulants, antidepressants, antihypertensives, antiretrovirals, hypoglycemics,
levothyroxine, multivitamins and supplements, non-steroidal anti-inflammatory drugs,
and steroid inhalers) (Villa et al, unpublished data, 2014), followed by radiotherapy
to the head and neck, and Sjögren’s syndrome.12 Other factors include depression,
anxiety and stress, or malnutrition.13
The prevalence of xerostomia in the population ranges from 5.5% to 46%. Studies
have shown differences in the prevalence between the sexes and xerostomia appears
to increase with increasing age. A possible explanation is that older individuals take
several xerogenic drugs for their chronic conditions and this may lead to an overall
reduction of the unstimulated salivary flow rate.1,10,12,14–18 Xerostomia remains an unre-
solved common complaint especially among the geriatric population, despite seeking
medical or dental consultation.19 The aim of this review is to explore the current state
Correspondence: Alessandro Villa
Division of Oral Medicine and Dentistry,
Brigham and Women’s Hospital, 1620
Tremont Street, Suite BC-3-028,
Boston, MA 02120, USA
Tel +1 617 732 5517
Fax +1 617 232 8970
Email avilla@partners.org
Journal name: Therapeutics and Clinical Risk Management
Article Designation: Review
Year: 2015
Volume: 11
Running head verso: Villa et al
Running head recto: Diagnosis and management of xerostomia and hyposalivation
DOI: http://dx.doi.org/10.2147/TCRM.S76282
This article was published in the following Dove Press journal:
Therapeutics and Clinical Risk Management
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Villa et al
of knowledge on management and treatment of patients
affected by xerostomia and hyposalivation.
Diagnosis of xerostomia and salivary
gland hypofunction
The diagnosis of xerostomia and salivary gland hypofunc-
tion requires a thorough medical history. Particular attention
should be given to the reported symptoms, medication use,
and past medical history.
Patients with salivary gland hypofunction typically com-
plain of dry mouth, difficulty swallowing and/or speaking;
they hardly tolerate spicy, acidic, and crunchy food and often
times report taste changes or difficulty wearing dentures.20
Several questionnaires have been proposed to identify
patients with xerostomia and hyposalivation. Fox et al
developed a questionnaire on the severity of dry mouth,
which may predict true hyposalivation (Table 1).21 A positive
answer to all the questions was associated with low saliva
flow rates. A few years later, Thomson et al created an
eleven-item summated rating scale on the severity of chronic
xerostomia (Xerostomia Inventory).22 Each response was
scored and summed to give a final score. van der Putten et al
shortened the Xerostomia Inventory and proposed the Sum-
mated Xerostomia Inventory-Dutch. Only five items were
included.2 In the questionnaire developed by Sreebny and
Valdini, the question “does your mouth usually feel dry” was
found to have had a sensitivity of 93%, a specificity of 68%,
a negative predictive value of 98%, and a positive predictive
value of 54% for hyposalivation.23 Eisbruch et al studied the
grade of xerostomia through a validated scale made of three
Table 1 Questionnaires to assess dry mouth
Authors Questions/statements Response/scoring
Fox et al21 1) Does the amount of saliva in your mouth seem to
be too little, too much, or you do not notice it?
2) Do you have any difculty swallowing?
3) Does your mouth feel dry when eating a meal?
4) Do you sip liquids to aid in swallowing dry food?
Yes/no
Thomson et al22 1) My mouth feels dry
2) I have difculty in eating dry foods
3) I get up at night to drink
4) My mouth feels dry when eating a meal
5) I sip liquids to aid in swallowing food
6) I suck sweets or cough lollies to relieve dry mouth
7) I have difculties swallowing certain foods
8) The skin of my face feels dry
9) My eyes feel dry
10) My lips feel dry
11) The inside of my nose feels dry
Never = scoring 1
Hardly ever = scoring 2
Occasionally = scoring 3
Fairly often = scoring 4
Very often = scoring 5
van der Putten et al21) My mouth feels dry when eating a meal
2) My mouth feels dry
3) I have difculty in eating dry foods
4) I have difculties swallowing certain foods
5) My lips feel dry
Never = scoring 1
Occasionally = scoring 2
Ever = scoring 3
Eisbruch et al24 Subjective grade 1= no disability
Subjective grade 2= dryness requiring additional uids
for swallowing
Subjective grade 3= dryness causing dietary alterations
or interference with sleep, speaking, or other
activities
Not applicable
Pai et al25 1) Rate the difculty you experience in speaking due
to dryness
2) Rate the difculty you experience in swallowing
due to dryness
3) Rate how much saliva is in your mouth
4) Rate the dryness in your mouth
5) Rate the dryness in your throat
6) Rate the dryness of your lips
7) Rate the dryness of your tongue
8) Rate the level of your thirst
100 mm horizontal scale
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47
Diagnosis and management of xerostomia and hyposalivation
grades (Table 1).24 Finally, Pai et al proposed an eight-item
visual analogue scale with which patients were asked to score
their xerostomia.25
One of the major risk factors for xerostomia and hypos-
alivation is the use of certain medications. In addition,
polypharmacy has been shown to significantly influence
patients’ saliva flow.10,26 “Xerogenic” medications associ-
ated with a low unstimulated saliva flow are: psycholeptics,
psychoanaleptics (particularly selective serotonin reuptake
inhibitors), oral antidiabetics (mainly sulfonylureas),
respiratory agents, quinine, antihypertensive agents (such
as thiazides and calcium channel blockers), urinary anti-
spasmodics, glucosamine, non-steroidal anti- inflammatory
drugs, opioids, ophthalmologicals, and magnesium
hydroxide.7,27 Clinicians should review the drug history
carefully in order to identify medications that can reduce
the saliva flow in patients complaining of xerostomia.
Finally, a thorough medical history should be obtained in
order to identify other known causes of xerostomia such
as Sjögren’s syndrome, radiation treatment of the head
and neck region, and other systemic diseases (particularly
hypertension, asthma, diabetes mellitus, hematological
diseases, thyroid diseases, rheumatic diseases, psychiatric
diseases, and eating disorders).
A careful oral examination is fundamental to identify
clinical signs pathognomonic for hyposalivation. Several
helpful signs have been proposed by Osailan et al: 1) sticking
of an intraoral mirror to the buccal mucosa or tongue;
2) frothy saliva; 3) no saliva pooling in floor of mouth;
4) loss of papillae of the tongue dorsum; 5) altered/smooth
gingival architecture; 6) glassy appearance to the oral mucosa
(especially the palate); 7) lobulated/deeply fissured tongue;
8) cervical caries (more than two teeth); and/or 9) mucosal
debris on palate (except under dentures).28
Measurement of salivary ow rates
Most of the methods to measure the salivary flow are easy
to perform and require little time. Salivary flow rates are
usually measured for at least 5 minutes after an overnight
fast or 2 hours after a meal.29 Unstimulated whole salivary
flow rate is assessed with the patient seated in an upright
position. Patients are asked to constantly drain saliva from
the lower lip into a graduated container for 15 minutes
(draining method).30 Leal et al proposed to collect saliva with
preweighed cotton rolls placed at the orifices of the ducts of
the major salivary glands and then reweigh them after the
collection time.14 The saliva can also be collected using a
graduated absorbent strip placed on the floor of the mouth
(readings at 1, 2, and 3 minutes).31 Other methods to assess
the unstimulated whole salivary flow rate include the spitting
method and the suction method.14,30 Stimulated salivary flow
rate is measured after the patient has chewed an unflavored
gum base or paraffin wax (1–2 g) for 1 minute.32 Otherwise,
saliva production can be stimulated with a solution of 2%
citric acid placed on the sides of the tongue at intervals of 30
seconds. The saliva is then collected into a graduated cylinder
for 5 minutes. Salivary flow (both stimulated and unstimu-
lated) can also be measured selectively from one major
salivary gland or minor salivary gland. The parotid gland
secretion is typically collected by using a suction device
and placing a cup (the Lashley or Carlson–Crittenden cup)
over the Stensen duct.33 The submandibular gland salivary
flow rate can be measured by incannulation of the Wharton’s
duct.34 A similar system to measure the salivary flow rates
for both the sublingual and submandibular glands has been
developed by Wolff et al.35 Minor salivary gland salivary flow
can be measured with micropipette and absorbent filter paper
(the Periotron® method; ProFlow™ Inc, Amityville, NY,
USA).36 Flow rates can be calculated in units of μL/min/cm2
of mucosal area.37
Management and treatment of
xerostomia
Several treatment strategies for the management of xeros-
tomia have been proposed in the past years and they all
aim to reduce patients’ symptoms and/or increase salivary
flow. Easy remedies are proper hydration; increase in
humidity at night-time; avoidance of irritating dentifrices
and crunchy/hard foods; and use of sugar-free chewing
gums/candy.38 Medications include mucosal lubricants, saliva
substitutes, and saliva stimulants.
Systemic sialogogues
Pilocarpine and cevimeline are two systemic US Food and
Drug Administration-approved sialogogues for treatment of
dry mouth. Their effect depends on the presence of functional
glandular tissue. Oral pilocarpine is a parasympathomi-
metic medication with muscarinic action.39,40 Cevimeline
is a salivary gland stimulant with a stronger affinity for M3
muscarinic receptors.41–44 Pilocarpine and cevimeline provide
a similar benefit in patients with dry mouth.45 Pilocarpine
is typically administered at a dose of 5 mg three times a
day for at least 3 months and cevimeline is prescribed at
a dose of 30 mg three times a day for at least 3 months.46
Side effects include: excessive sweating, cutaneous vaso-
dilatation, emesis, nausea, diarrhea, persistent hiccup,
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Villa et al
bronchoconstriction, hypotension, bradycardia, increased
urinary frequency, and vision problems. Both pilocarpine
and cevimeline are relatively contraindicated in patients with
uncontrolled asthma or chronic pulmonary disease and in
β-adrenergic blocker users, and should be used with caution
in patients with active gastric ulcers or uncontrolled hyper-
tension. Pilocarpine is also contraindicated in individuals
with narrow-angle glaucoma and iritis, and should be used
with caution in individuals with chronic pulmonary disease,
asthma, or cardiovascular diseases.40
Other sialogogues
Anethole trithione is a cholagogue that has been shown to
improve oral symptoms and increase the salivary flow in
patients with xerostomia and hyposalivation.47 More stud-
ies are necessary to prove the efficacy of this medication.
Patients who were treated with psychotropic drugs (tricyclic
antidepressants or neuroleptics) and were suffering from
xerostomia benefited from yohimbine use, an alpha 2 adre-
noceptor antagonist.48
Intraoral topical agents
Intraoral topical agents are among the most common
recommended treatments for the management of xeros-
tomia. These include chewing gums, saliva stimulants,
and substitutes. A topical sialogogue spray containing 1%
malic acid has recently shown its efficacy in managing
symptoms of xerostomia in patients with antidepressant- or
antihypertensive-induced dry mouth;49,50 however, this has
the potential to cause mild enamel erosion. Commercially
available sugar-free chewing gums and candies can also
be used to simulate salivary flow.51 In particular, chewing
gums have been shown to increase saliva secretion and
decrease oral mucosal friction.52 In addition to chewing
gum, saliva stimulants and substitutes (eg, gel, mouthwash,
and toothpaste) provide over-the-counter alternatives
for salivary gland hypofunction management. Other oral
sprays, specifically oxygenated glycerol tri-ester, serve
as an alternative treatment for dry mouth and have been
proven to be more effective than other commercially avail-
able saliva substitutes.53 Saliva substitutes aim to increase
viscosity and mimic natural saliva without altering the
salivary flow.54 These agents contain minerals (eg, fluoride,
calcium, and phosphate ions), carboxymethylcellulose or
hydroxyethylcellulose, flavoring agents, and preservatives
(eg, propyl or methyl paraben).38 Other efficacious remedies
include mucoadhesive lipid-based bioerodible tablets55 or
mucin spray, although their efficacy for management of
xerostomia remains controversial.51,56–59 Mucin-containing
lozenges provided benefit for the treatment of xerostomia
when compared to a placebo.60 Other topical agents (tooth-
paste, mouth rinse, mouth spray, and gel) containing olive
oil, betaine, and xylitol may be effective in improving
xerostomia secondary to medication use.61 Of note, saliva
substitute spray containing carboxymethylcellulose,62
xanthan gum-containing spray,63 or buffered Profylin gel64
did not seem to improve dry mouth symptoms. Also lemon
lozenge use in individuals with xerostomia did not show
any increase in salivary flow when compared to baseline
paraffin-stimulated mean flow rate and the gum-stimulated
flow rates.65 Of interest, Regelink et al reported that saliva
substitutes are not effective in patients with reasonable
stimulated salivary flow.66
The saliva substitute Saliva Orthana, a mucin-con-
taining oral spray, was tested in a double-blind, single-
phase, placebo-controlled trial for patients complaining of
xerostomia.59 The results of this study did not show any
significant improvement when compared to the placebo.
When oral lubricants are considered, the gel formulation
appears to be the most efficient and appreciated by patients.67
Patients taking oral lozenges of anhydrous crystalline malt-
ose showed an increase in saliva production and a decrease
in perceived symptoms of xerostomia.68 Patients applying
the anticholinesterase physostigmine on the oral mucosa to
stimulate salivary production from the minor glands reported
great benefit, and this could be a valid alternative to systemic
treatment.69
Changes in medications
Although the evidence available is limited, with patients
on medications known to induce salivary gland hypofunc-
tion, a treatment alternative includes decreasing the dosage
of the medications or potentially replacing the medica-
tions with less xerogenic drugs.70 Studies have shown that
xerostomia became more manageable through medication
dose reduction and medication replacement.71,72 Any
change in medication should be discussed with the refer-
ring physician.
Others
Other remedies have been proposed for the management of
xerostomia. Intraoral electrostimulation has also been tested
to increase salivary flow.73,74 Furthermore, reports have
shown that intraoral appliances, such as the saliva stimula-
tion device Saliwell Crown or the electrostimulating device
GenNarino, have been effective in reducing dry mouth and
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Diagnosis and management of xerostomia and hyposalivation
increasing the production of saliva.75 Acupuncture may be
a useful adjunct for the stimulation of salivary flow in some
patients with xerostomia and in patients with irradiation-
induced xerostomia. However, additional larger studies are
necessary to confirm these findings.76,77
Finally, patients who undergo radiation of the head and neck
region may benefit from the use of intensity-modified radiation
therapy and/or of amifostine (cytoprotective agent).78
Conclusion
Xerostomia and hyposalivation remain a debilitating con-
dition for many individuals. This review summarizes the
diagnostic and therapeutic approaches to manage xerostomia
and hyposalivation. Clinicians with a patient complaining of
xerostomia have the opportunity to identify patients with true
salivary gland hypofunction with effective diagnostic criteria
and functional tests, and therefore prevent secondary effects.
Although no standard treatment guidelines are available,
many treatment options exist for the management of xeros-
tomia and hyposalivation: topical agents to alleviate and/or
prevent xerostomia, systemic therapy, or newer devices.
While systemic agents such as pilocarpine or cevimeline
have been largely studied, new medical devices require large
well-designed clinical trials.
Disclosure
The authors report no conflicts of interest in this work.
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51
Diagnosis and management of xerostomia and hyposalivation
77. O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of
acupuncture in the treatment of irradiation-induced xerostomia in
patients with head and neck cancer: a systematic review. Acupunct
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and neck cancer patients treated with radiotherapy: a systematic review
and meta-analysis based on randomized controlled trials. PLoS One.
2014;9(5):e95968.
... No definitive intervention remains available for RT-induced xerostomia and hyposalivation [7,9]. Although dietary modifications, salivary stimulants such as sugar-free gum and salivary substitutes in the form of lozenges, sprays, gels, and mouthwashes can be helpful but with temporal benefit [10]. When local measures prove ineffective, medications like pilocarpine and cevimeline may be preferred [11]. ...
... This study was a prospective case series of 10 The inclusion criteria were individuals aged 18 years and above, could read and understand Arabic and had recently received an RT prescription dose of > 50 Gy for head and neck cancer (mouth, ear, nose, throat and salivary glands) [19,20]. Furthermore, patients who were clinically diagnosed with hyposalivation (unstimulated salivary flow rate of ≤ 0.1 mL/min) or presently experiencing subjective oral dryness (xerostomia) due to recent radiation therapy for SCC of the head and neck were included [19]. ...
Article
Full-text available
It is not uncommon for individuals receiving radiotherapy for head and cancers to experience dry mouth sensation (xerostomia), salivary hypofunction (hyposalivation) and taste changes. The present study aimed to evaluate the short-term effectiveness of biweekly photobiomodulation therapy (PBMT) in managing these radiotherapy-induced adverse effects and its impact on oral health-related quality of life. Ten patients who developed xerostomia and hyposalivation secondary to radiotherapy for head and neck cancer were included. The study assessments included clinician-based [the stimulated (SSF) and unstimulated salivary flow (USSF) and taste change questionnaire] and patient-based measures [Shortened Xerostomia Inventory (SXI) and Oral Health Impact Profile (OHIP-5)]. The 10 participants (males = 5, females = 5) had a mean age of 52 (± 15) years. Half were diagnosed with nasopharyngeal squamous cell carcinoma. From visits 1 to 8, 80% showed increased USSF and/or SSF, but these were limited and not significant (p > 0.05). Nevertheless, 80% of the patients had lower xerostomia scores, 60% had less dryness frequency, and 40% showed taste improvement. Improvement in oral health-related quality of life was only observed in 30% of the participants. Strong proportional correlations were found between USSF and SSF as well as SXI and OHIP-5 at study visits 1 and 8 (p < 0.05). The findings showed the usefulness of PBMT in reducing xerostomia and taste changes and possibly increasing salivary flow over a 4-week duration. However, randomised clinical trials are needed to assess the long-term effectiveness of PBMT compared to other management options. Clinical study registration: The study was prospectively registered with the US National Library of Medicine’s clinical trial registry on 13 September 2022 [ClinicalTrials.gov ref: NCT05538169].
... In addition, 131 I reduces the levels of prostaglandin, which is responsible for salivation, and causes plaque formation, gingivitis and periodontal disease [3,5,6]. Recent evidences reported that there is a bidirectional association between thyroid diseases and periodontal disease [7,8] and the chanching microbiota and inflammatory cytokines may increase pro-inflammatory environment among differentiated thyroid carcinoma patients with xerostomia after 131 I therapy [8,9]. ...
Article
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Objectives To evaluate the impact of oral health problems on oral health-related quality of life (OHRQoL) among female patients received Radioactive iodine (¹³¹I) therapy. Materials and methods This unmatched case-control study was conducted on 40 female patients (20 cancer free controls and 20 patients treated with ¹³¹I therapy). Data were collected via clinical examination, self reported questionnaire including the Oral Health Impact Profile-14 (OHIP-14), salivary tests, socio-demographic and behavioural characteristics. Data were analyzed using descriptive, bivariate and multivariate statistics. Results There were significant differences in the total number of decayed, missing and filled surfaces, stimulated and unstimulated salivary flow rates, and periodontal indices between the study and control groups in the unadjusted analysis. Age adjusted analysis revealed significant differences in the stimulated and unstimulated salivary flow rates, periodontal indices, physical pain domain scores between groups. No significant differences were observed between groups in the xerostomia severity and OHRQoL. In study group, the score for the OHIP-14 psychological discomfort domain was negatively correlated with both stimulated and unstimulated salivary flow rates. The total OHIP-14 score and its domain scores of physical pain and psychological disability were correlated positively with the severity of xerostomia, but negatively correlated with number of the repeated ¹³¹I therapy. Conclusions Due to xerostomia, patients reported worse OHRQoL in the domains of physical pain, psychological discomfort and disability. They had worse periodontal status and tooth brushing habits than healthy controls. Clinical relevance The findings of this study may provide a valuable insight on the oral health problems and needs of target group when planning a a team-based care.
... Yet, little is known as to why dry mouth receives so little attention as a symptom. The perceived sensation of dry mouth is called xerostomia [17,18]. Xerostomia may be present even when there is no evidence of reduced salivary flow on oral examination [19]. ...
Article
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Background The prevalence of dry mouth in the palliative care population is well documented and increases due to polypharmacy, radiotherapy and systemic conditions. Saliva as a lubricant for the mouth and throat has implications for swallowing, chewing, and speech. The literature about the experience of xerostomia (perceived feeling of dry mouth) in palliative care is scarce. Clinical evidence suggests that xerostomia has a negative impact on people’s comfort, however, no recent studies explored this impact in detail. This new knowledge is paramount to adhere to the principles of palliative care. Aims To evaluate the impact of xerostomia on the lives of people receiving palliative care with particular reference to eating and speaking. Design A qualitative descriptive study (interview design). Thematic analysis was used for data analysis. Setting A single specialist palliative care centre in Ireland. Results The majority of participants (35/40) had cancer. Xerostomia was reported to have multiple physical, psychological, and daily life consequences. Participants provided insights into the impact of xerostomia on sleeping, eating, talking, denture wearing, and they described in detail their intra-oral sensations associated with xerostomia. The negative effect of xerostomia on speech was reported as the most significant to participants. Conclusion Xerostomia has a profound impact on the daily lives of people receiving palliative care, including physical and psychological consequences. Speaking is often affected, which can impede the person’s ability to communicate. There needs to be increased awareness of the impact of xerostomia and more research is required to understand how best to manage xerostomia in a palliative care setting.
... mL/min, and normal SFR is 1.5-2.0 mL, while hyposalivation is diagnosed when UFR is under 0.1 mL/min or SFR is under 0.7 mL/min [20]. Normal salivary pH is between 6.7-7.3, and abnormal salivary pH is under 6.3 [21]. ...
Article
The aim of the study is to analyse and discuss the main mucosal, dental and cutaneous manifestations in the oral area associated with anorexia in adolescent patients, in order to raise awareness among healthcare providers and caregivers about the specific oral health challenges faced by this population and to highlight the need for early intervention and tailored dental care strategies. Methods: We performed a systematic search on the PubMed and Embase databases from their inception to March 2024 using specific key-words: [“anorexia”] AND [“adolescent” OR “paediatric” OR “children”] AND [“oral manifestations” OR “oral lesion” OR “oral complication” OR “oral disorder” OR “oral mucosa” OR “oral mucosal disease” OR “teeth”]. Results: Oral manifestations in adolescents with anorexia include mucosal, dental, periodontal and gingival tissues manifestations, as well as salivary glands alterations. These manifestations are indicative of nutritional deficiencies and poor oral hygiene practices commonly seen in individuals with anorexia. Conclusions: Adolescents with anorexia nervosa often experience a wide range of oral health complications. Regular dental check-ups and proper nutrition are essential in managing oral health issues in this population. Collaboration between healthcare professionals, such as dentists, nutritionists, and mental health specialists, is crucial in providing comprehensive care for these cases.
Article
Background Oral frailty in older adults can affect their eating efficiency, prolonging meal times, which can compromise food flavour. Objective This study explored the association between cooking methods and chewing‐to‐swallowing time on the basis of different oral functions in older adults. Methods This cross‐sectional study involved 65 community‐dwelling individuals aged ≥ 65 years. Chewing‐to‐swallowing time was measured as participants tested the textures of two ingredients—chicken breast and baby Chinese cabbage—prepared using four cooking methods (boiling, sous vide , confit and high‐pressure). Oral frailty was determined by the following items: tooth count, bite force, saliva secretion rate, swallowing, tongue‐lip motor function and oral hygiene. Regression models analysed the correlation between cooking methods and chewing‐to‐swallowing time under various oral functions. Results No differences in chewing‐to‐swallowing time were found for chicken prepared using the various cooking methods among older adults with oral frailty (all p > 0.05). However, for older adults without oral frailty had a shorter chewing‐to‐swallowing time for both sous vide ( β = −1.06, p < 0.001) and confit chicken (β = −1.79, p = 0.003) than for boiled chicken. For older adults with oral frailty had a shorter chewing‐to‐swallowing time for sous vide ( β = −0.06, p < 0.001) and high‐pressure methods ( β = −1.16, p < 0.001) than for boiled vegetable. For older adults without oral frailty had a shorter chewing‐to‐swallowing time for high‐pressure methods ( β = −0.83, p < 0.001) than for boiled vegetable. Conclusion Under different oral functional conditions, cooking methods are associated with the chewing and swallowing times of older adults.
Article
Objectives This study investigated the prevalence and associations of xerostomia in older adults in southern Brazil. Methods A cross‐sectional study was carried out in Pelotas, Brazil, during 2014. A representative sample of the city's older adult population (60+) was selected. The dependent variable was self‐reported feeling of dry mouth in the past 6 months. Covariates included socio‐economic status, schooling, gender, age, tobacco and alcohol consumption, polypharmacy, hypertension, diabetes, arthritis, depression, dentition status and use of removable dental prostheses. Descriptive analysis was carried out, and Poisson regression was used to obtain prevalence ratios and 95% confidence intervals. Analyses used STATA 15.1. Results Most of the 1451 participants were female (63.3%). The prevalence of xerostomia was 36.7% (95% CI 34.3–39.1). Adjusted analysis showed that xerostomia was significantly more common among females (PR 1.44, 95% CI 1.22–1.74), those with less schooling (PR 1.31, 95% CI 1.10–1.51), those exposed to polypharmacy (PR 1.22, 95% CI 1.05–1.37), people with arthritis (PR 1.42, 95% CI 1.23–1.61) and those with depression symptoms (PR 1.45, 95% CI 1.23–1.70). Conclusion Xerostomia is common among older adults. Health workers need to pay attention to its associated factors for early identification and promotion of appropriate interventions, particularly the rational use of medicines.
Article
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Introduction: The elderly population is increasing both globally and nationally, including in Dumai City, Riau Province. The older they get, the more health problems they complain about, and xerostomia is one of the most common issues. There are only a few studies that examine the problem of xerostomia in the elderly. Therefore, the purpose of this study is to examine how xerostomia relates to gender, age, and overall health among elderly people in Dumai City, Riau Province. Methods: This study used a cross-sectional design approach. The survey included data on gender, age, and subjective assessment of xerostomia using the Summated Xerostomia Inventory in Indonesian (SXI-ID) questionnaire, consisting of 5 questions with answer options: never, rarely, sometimes, often, and always. In addition, the standard xerostomia question, "How often does the mouth feel dry?" has four answer options: never, sometimes, often, and always. Sampling was done by the accidental sampling technique; 247 respondents met the requirements and participated in the study completely. Results: The study showed that more respondents of the male gender (18.6 ± 2.7) suffered from xerostomia than women (17.4 ± 4.4), which was statistically significant (p<0.05). The results of the Spearman Rank correlation test between the age variable and the xerostomia condition showed statistically significant results (p<0.05), namely that the older the age, the greater the potential for xerostomia in the elderly. Conclusion: The incidence of xerostomia is more prevalent in men and as individuals age. Promotive and preventive efforts for the oral health of the elderly need to be strengthened to minimize oral health problems due to xerostomia.
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Perioperatives Durstgefühl von Intensivpatienten ist ein bislang vernachlässigtes Thema – dabei geben viele Patienten Mundtrockenheit und Durstgefühl als postoperative Beschwerden an. Der folgende Beitrag identifiziert die Auslöser und Risikofaktoren, zeigt, wie die Symptome gemessen werden können, und gibt Empfehlungen, wie sich Abhilfe schaffen lässt. Der Beitrag hat beim 27. Intensiv-Pflegepreis den 5. Platz belegt.
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Changes in subjective sensations due to xerostomia before and after administration of Xialine®, a xanthan gum-based saliva substitute, were evaluated in 30 patients with radiation-induced xerostomia using the QLQ-H&N35. Xerostomia in general decreased with both Xialine® and placebo to almost the same degree. A trend was seen for Xialine® to improve problems with speech and senses.
Article
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One of the major side effects of medications prescribed to elderly patients is the qualitative and quantitative alteration of saliva (salivary hypofunction). Saliva plays a pivotal role in the homeostasis of the oral cavity because of its protective and functional properties, including facilitating speech, swallowing, enhancing taste, buffering and neutralizing intrinsic and extrinsic acid, remineralizing teeth, maintaining the oral mucosal health, preventing overgrowth of noxious microorganisms, and xerostomia. With salivary hypofunction, a plethora of complications arise, resulting in decreased quality of life. The anticholinergic effects of medications can be overcome, and the oral cavity can be restored to normalcy.
Chapter
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The various functions of saliva—among them digestive, protective and trophic ones—not just limited to the mouth, and the relative contribution of the different types of gland to the total volume secreted as well as to various secretory rhythms over time are discussed. Salivary reflexes, afferent and efferent pathways, as well as the action of classical and non-classical transmission mechanisms regulating the activity of the secretory elements and blood vessels are in focus. Sensory nerves of glandular origin and an involvement in gland inflammation are discussed. Although, the glandular activities are principally regulated by nerves, recent findings of an “acute” influence of gastro-intestinal hormones on saliva composition and metabolism, are paid attention to, suggesting, in addition to the cephalic nervous phase, both a regulatory gastric and intestinal phase. The influence of nerves and hormones in the long-term perspective as well as old age, diseases and consumption of pharmaceutical drugs on the glands and their secretion are discussed with focus on xerostomia and salivary gland hypofunction. Treatment options of dry mouth are presented as well as an explanation to the troublesome clozapine-induced sialorrhea. Final sections of this chapter describe the families of secretory salivary proteins and highlight the most recent results obtained in the study of the human salivary proteome. Particular emphasis is given to the post-translational modifications occurring to salivary proteins before and after secretion, to the polymorphisms observed in the different protein families and to the physiological variations, with a major concern to those detected in the pediatric age. Functions exerted by the different families of salivary proteins and the potential use of human saliva for prognostic and diagnostic purposes are finally discussed.
Article
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Background: Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent. Methods: By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software. Results: Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade 3-4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54-0.95; p<0.00001), Grade 2-4 acute xerostomia (RR,0.70; 95%CI,0.52-0.96; p = 0.02), or late xerostomia (RR,0.60; 95%CI,0.49-0.74; p<0.00001) and Grade 3-4 dysphagia (RR,0.39; 95%CI,0.17-0.92; p = 0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade 3-4 mucositis (RR,0.97; 95% CI,0.74-1.26; p = 0.80), Grade 2-4 acute xerostomia (RR,0.35; 95%CI,0.02-5.44; p = 0.45), or late xerostomia (RR,0.40; 95%CI,0.13-1.24; p = 0.11) and Grade 3-4 dysphagia (RR,0.23; 95%CI,0.01-4.78; p = 0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89-1.17; p = 0.76) and partial response (RR,0.90; 95%CI, 0.56-1.44; p = 0.66). For the hematologic side effect, no statistical difference of Grade 3-4 leucopenia (RR,0.60; 95%CI,0.35-1.05; p = 0.07), anemia (RR,0.80; 95%CI, 0.42-1.53; p = 0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16-1.15; p = 0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3-4) of 5%, 6%, 4% and 4% respectively. Conclusion: This systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.
Article
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Saliva has multiple essential functions in relation to the digestive process taking place in the upper parts of the gastrointestinal (GI) tract. This paper reviews the role of human saliva and its compositional elements in relation to the GI functions of taste, mastication, bolus formation, enzymatic digestion, and swallowing. The indirect function of saliva in the digestive process that includes maintenance of an intact dentition and mucosa is also reviewed. Finally, pathophysiological considerations of salivary dysfunction in relation to some GI functions are considered.
Article
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Objectives: Assessing the clinical effectiveness of a topical sialogogue on spray (malic acid, 1%) in the treatment of xerostomia induced by antihypertensive drugs. Study Design: This research has been carried out through a randomized double-blind clinical trial. 45 patients suffering from hypertensive drugs-induced xerostomia were divided into 2 groups: the first group (25 patients) received a topical sialogogue on spray (malic acid, 1%) whereas the second group (20 patients) received a placebo. Both of them were administered on demand for 2 weeks. Dry Mouth Questionnaire (DMQ) was used in order to evaluate xerostomia levels before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after application, were measured. All the statistical analyses were performed by using SPSS software v17.0. Different DMQ scores at the earliest and final stage of the trial were analysed by using Mann-Whitney U test, whereas Student’s T-test was used to analyse salivary flows. Critical p-value was established at p<0.05. Results: DMQ scores increased significantly (clinical recovery) from 1.21 to 3.36 points (p<0.05) after malic acid (1%) application whereas DMQ scores increased from 1.18 to 1.34 points (p>0.05) after placebo application. After two weeks of treatment with malic acid, unstimulated salivary flow increased from 0.17 to 0.242 mL/min whereas the stimulated one increased from 0.66 to 0.92 mL/min (p<0.05). After placebo application unstimulated flow ranged from 0.152 to 0.146 mL/min and stimulated flow increased from 0.67 to 0.70 mL/min (p>0.05). Conclusions: Malic acid 1% spray improved antihypertensive-induced xerostomia and stimulated the production of saliva. Key words:Xerostomia, hyposialia, malic acid, antihypertensive drugs.
Article
The purpose of this study was to assess patient preference and product efficacy of three non-prescription products for the symptomatic relief of xerostomia. The study group consisted of 80 individuals with a complaint of chronic (> six months) xerostomia and an unstimulated salivary flow rate of < 0.1 mL/min. The three products - a sorbitol/xylitol-sweetened chewing gum, a sorbitol-sweetened sour lemon lozenge, and a sorbitol/xylitol-sweetened artificial saliva substitute spray - were assigned in a permuted block randomization scheme. Each product was used for two weeks with an interval of one week between trials. The study did not identify any product to be statistically significant in terms of patient preference. Kruskal-Wallis testing revealed no statistical significance (P > 0.589) among the products. No product demonstrated marked efficacy in stimulating salivary output. ANOVA analysis followed by Tukey HSD testing revealed no significant difference between the baseline paraffin-stimulated mean flow rate and the gum- and lozengestimulated flow rates.
Article
Background: One of the most important antidepressants side effects is dry mouth. The aim of this study was to evaluate the clinical efficacy of a topical sialogogue spray containing 1% malic acid on patients affected by dry mouth caused by antidepressants drug. Materials and methods: This research took the form of a double-blind, randomized clinical trial at Faculty of Dentistry of University of Granada (Spain). Seventy participants with antidepressant-induced dry mouth were divided into two groups: for the first "intervention group" (35 subjects) a topical sialogogue spray (1% malic acid) was applied, while for the second "control group" (35 subjects), a placebo spray was applied; for both groups, the sprays were applied on demand during 2 weeks. The dry mouth questionnaire (DMQ) was used to evaluate dry mouth symptoms before and after product/placebo application. Unstimulated and stimulated salivary flows rates, before and after application, were measured. Results: Dry mouth symptoms improved after 1% malic acid topical spray application (p < .05). After 2 weeks of 1% malic acid application, unstimulated and stimulated salivary flows rates increased significantly (p < .05). Conclusions: A sialogogue spray containing 1% malic acid improved dry mouth feeling of the patients suffering antidepressant-induced dry mouth and increased unstimulated and stimulated salivary flows rates.
Article
Investigated the conditions which influence the secretion of the parotid gland directly or indirectly. A series of experiments were conducted, in which the secretion was recorded by counting the drops as they fell from the drainage tube. Eight Ss between 8 to 38 yrs of age were involved. Concludes that direct reflexes of the parotid gland were excited by the mechanical, chemical, and protopathic stimulation of the oral mucosa. The secretion produced when a foreign body is chewed involved a specific reaction to a complex group of stimuli. The presence of food in the stomach excited secretion and erotic emotion reduced the quantity of secretion. Reflex secretion was excited by the sight and odor of food, but was conditioned by hunger. Parotid secretion was inhibited by violent muscular activity. There was no direct reflex to olfactory, visual, auditory or tactile stimulations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)