Established and Novel Approaches for the Management of Hyposalivation and Xerostomia

Abstract

Hyposalivation, often symptomatically manifested as xerostomia (dry mouth sensation) may indicate the presence of altered salivary gland function and places patients at a higher risk for oral complications. Diverse symptoms and consequences have been associated with hyposalivation, such as difficulties with speaking, swallowing and tasting and a significant increase in dental caries and other oral infections. Although hyposalivation may be caused by a variety of conditions (head and neck radiotherapy, Sjogren's syndrome, medications, etc.), its hallmark symptom, xerostomia, is common to all such disorders, and varies only in intensity. Therefore, treatment is generally non-specific, and similar therapeutic approaches are used in all cases. In the present paper, available palliative oral care in the form of saliva substitutes, such as mouthwashes or gels, is detailed. Also salivary flow stimulants, such as certain pharmaceutical or gustatory preparations, acupuncture and electrostimulation are reviewed. Finally, other approaches, currently under investigation, such as biological and gene therapies, are discussed. The degree of evidence of the best known methods and their intended use are analyzed.

Root caries: a periodontal perspective

“…diet modification, fluoride delivery and improved oral hygiene . In patients with impaired salivary gland function, due to aging, radiotherapy, diseases or medications, the administration of salivary substitutes to buffer the acidic environment and inhibit adhesion and growth of bacteria might also be of help .…”

Sjögren's syndrome – an update for dental practitioners

“…Factors involved may be the loss of salivary buffering capacity and the imbibition of cariogenic drinks to relieve symptoms of xerostomia. 11 Even with excellent levels of oral hygiene, caries and premature tooth loss have been found in some studies where patients have a higher DMFT (decayed/ missing/filled teeth) score compared to control individuals. 12 It is unclear whether patients with SS are at an increased or indeed reduced risk of periodontal attachment loss compared to a non-SS population, as current evidence is conflicting.…”

Interventions for the management of radiotherapy-induced xerostomia and hyposalivation: A systematic review and meta-analysis

“…Topical application of salivary substitutes can offer some benefit by providing a moistureretaining coating onto the oral mucosa [6]. Other interventions, such as acupuncture, have also been used to increase saliva production, possibly by enhancing peripheral blood flow [7]. However there is currently little robust evidence to inform the management of hyposalivation and xerostomia in this population.…”