, Volume 97, Issue 2, pp 76–83 | Cite as

Diagnosis and treatment of xerostomia (dry mouth)

  • Joel J. Napeñas
  • Michael T. Brennan
  • Philip C. FoxEmail author
Review Article


Xerostomia (dry mouth) is a common complaint with widespread implications such as impaired quality of life, oral pain, and numerous oral complications. There are a variety of salivary and nonsalivary causes of xerostomia, the most frequent being medication side effects and systemic disorders. A systematic approach should be employed to determine the etiology of this condition, with distinctions made between patients with subjective complaints of xerostomia alone and those with measurable salivary gland dysfunction. Management is multidisciplinary and multimodal. This review summarizes the current literature on the etiology, diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.

Key words

Saliva Xerostomia Dry mouth 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jensen SB, Pedersen AM, Reibel J, Nauntofte B. Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 2003;11:207–25.PubMedGoogle Scholar
  2. 2.
    Nieuw Amerongen AV, Veerman EC. Saliva — the defender of the oral cavity. Oral Dis 2002;8:12–22.CrossRefGoogle Scholar
  3. 3.
    Baum BJ. Principles of saliva secretion. Ann N Y Acad Sci 1993;694:17–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Kaplan MD, Baum BJ. The functions of saliva. Dysphagia 1993;8:225–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc 1987;115:581–4.PubMedGoogle Scholar
  6. 6.
    Thomson WM, Chalmers JM, Spencer AJ, Williams SM. The Xerostomia Inventory: a multi-item approach to measuring dry mouth. Community Dent Health 1999;16:12–7.PubMedGoogle Scholar
  7. 7.
    Dawes C. Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res 1987;66:648–53.PubMedGoogle Scholar
  8. 8.
    Orellana MF, Lagravere MO, Boychuk DG, Major PW, Flores-Mir C. Prevalence of xerostomia in population-based samples: a systematic review. J Public Health Dent 2006;66:152–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Ship JA, Pillemer SR, Baum BJ. Xerostomia and the geriatric patient. J Am Geriatr Soc 2002;50:535–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Fox PC. Autoimmune diseases and Sjogren’s syndrome: an autoimmune exocrinopathy. Ann N Y Acad Sci 2007;1098:15–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Shiboski CH, Hodgson TA, Ship JA, Schiodt M. Management of salivary hypofunction during and after radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:S66. e1-19.PubMedCrossRefGoogle Scholar
  12. 12.
    Fox PC. Differentiation of dry mouth etiology. Adv Dent Res 1996;10:13–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Atkinson JC, Fox PC. Salivary gland dysfunction. Clin Geriatr Med 1992;8:499–511.PubMedGoogle Scholar
  14. 14.
    Bertram U, Kragh-Sorensen P, Rafaelsen OJ, Larsen NE. Saliva secretion following long-term antidepressant treatment with nortriptyline controlled by plasma levels. Scand J Dent Res 1979;87:58–64.PubMedGoogle Scholar
  15. 15.
    Mandel ID, Katz R, Zengo A, Kutscher AH, Greenberg RA, Katz S, Scharf R, Pintoff A. The effect of pharmacologic agents on salivary secretion and composition in man. I. Pilocarpine, atropine and anticholinesterases. J Oral Ther Pharmacol 1967;4:192–9.PubMedGoogle Scholar
  16. 16.
    Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, Jenkins CD, Klerman GL, Williams GH. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986;314:1657–64.PubMedGoogle Scholar
  17. 17.
    Ben-Aryeh H, Schiller M, Shasha S, Szargel R, Gutman D. Salivary composition in patients with essential hypertension and the effect of pindolol. J Oral Med 1981;36:76–8.PubMedGoogle Scholar
  18. 18.
    Mandel ID, Katz R. The effect of pharmacologic agents on salivary secretion and composition. II. Isoproterenol, alpha and beta adrenergic blockers. J Oral Ther Pharmacol 1968;4:260–9.PubMedGoogle Scholar
  19. 19.
    Maier H, Antonczyk G, Schindler JG, Heidland A. Effect of verapamil on ionized calcium excretion in human parotid saliva. Eur J Clin Pharmacol 1979;16:7–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Atkinson JC, Shiroky JB, Macynski A, Fox PC. Effects of furosemide on the oral cavity. Gerodontology 1989;8:23–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Mattes RD, Christensen CM, Engelman K. Effects of therapeutic doses of amiloride and hydrochlorothiazide on taste, saliva and salt intake in normotensive adults. Chem Senses 1988;13:33–44.CrossRefGoogle Scholar
  22. 22.
    von Bültzingslöwen I, Sollecito TP, Fox PC, Daniels T, Jonsson R, Lockhart PB, Wray D, Brennan MT, Carrozzo M, Gandera B, Fujibayashi T, Navazesh M, Rhodus NL, Schiødt M. Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:S57.e1-15.Google Scholar
  23. 23.
    Jonsson R, Kroneld U, Backman K, Magnusson B, Tarkowski A. Progression of sialadenitis in Sjögren’s syndrome. Br J Rheumatol 1993;32:578–81.PubMedCrossRefGoogle Scholar
  24. 24.
    García-Carrasco M, Ramos-Casals M, Rosas J, Pallarés L, Calvo-Alen J, Cervera R, Font J, Ingelmo M. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine 2002;81:270–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Kassan SS, Thomas TL, Moutsopoulos HM, Hoover R, Kimberly RP, Budman DR, Costa J, Decker JL, Chused TM. Increased risk of lymphoma in sicca syndrome. Ann Intern Med 1978;89:888–92.PubMedGoogle Scholar
  26. 26.
    Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern Med 2005;165:2337–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Helenius LM, Meurman JH, Helenius I, Kari K, Hietanen J, Suuronen R, Hallikainen D, Kautiainen H, Leirisalo-Repo M, Lindqvist C. Oral and salivary parameters in patients with rheumatic diseases. Acta Odontol Scand 2005;63:284–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Brun JG, Madland TM, Jonsson R. A prospective study of sicca symptoms in patients with rheumatoid arthritis. Arthritis Rheum 2003;49:187–92.PubMedCrossRefGoogle Scholar
  29. 29.
    Jensen JL, Bergem HO, Gilboe I-M, Husby G, Axéll T. Oral and ocular sicca symptoms and findings are prevalent in systemic lupus erythematosus. J Oral Pathol Med 1999;28:317–22.PubMedGoogle Scholar
  30. 30.
    Rhodus NL, Johnson DK. The prevalence of oral manifestations of systemic lupus erythematosus. Quintessence Int 1990;21:461–5.PubMedGoogle Scholar
  31. 31.
    Grennan DM, Ferguson M, Williamson J, Mavrikakis M, Dick WC, Buchanan WW. Sjogren’s syndrome in SLE: Part 1. The frequency of the clinical and subclinical features of Sjogren’s syndrome in patients with SLE. N Z Med J 1977;86:374–6.PubMedGoogle Scholar
  32. 32.
    Tsuneyama K, Van De WJ, Yamazaki K, Suzuki K, Sato S, Takeda Y, Ruebner B, Yost BA, Nakanuma Y, Coppel RL, Gershwin ME. Primary biliary cirrhosis an epithelitis: evidence of abnormal salivary gland immunohistochemistry. Autoimmunity 1997;26:23–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Janin A, Gosselin B, Gosset D, Hatron PY, Sauvezie B. Histological criteria of Sjogren’s syndrome in scleroderma. Clin Exp Rheumatol 1989;7:167–9.PubMedGoogle Scholar
  34. 34.
    Carrozzo M, Gandolfo S. Oral diseases possibly associated with hepatitis C virus. Crit Rev Oral Biol Med 2003;14:115–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Moore PA, Guggenheimer J, Etzel KR, Weyant RJ, Orchard T. Type I diabetes mellitus, xerostomia, and salivary flow rates. Oral Surg Oral Med Oral Pathol 2001;92:281–91.Google Scholar
  36. 36.
    Mira JG, Wescott WB, Starcke EN, Shannon IL. Some factors influencing salivary function when treating with radiotherapy. Int J Radiat Oncol Biol Phys 1981;7:535–41.PubMedGoogle Scholar
  37. 37.
    Mira JG, Fullerton GD, Wescott WB. Correlation between initial salivary flow rate and radiation dose in the production of xerostomia. Acta Radiol Oncol 1982;21:151–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Shannon IL, Trodahl JN, Starcke EN. Radiosensitivity of the human parotid gland. Proc Soc Exp Biol Med 1978;157:50–3.PubMedGoogle Scholar
  39. 39.
    Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999;45:577–87.PubMedGoogle Scholar
  40. 40.
    Cheng VS, Downs J, Herbert D, Aramany M. The function of the parotid gland following radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1981;7:253–8.PubMedGoogle Scholar
  41. 41.
    Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A. Parotid and submandibular/sublingual salivary flow during high dose radiotherapy. Radiother Oncol 2001;61:271–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Franzen L, Funegard U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck. A consecutive study of salivary flow and patient discomfort. Eur J Cancer 1992;28:457–62.PubMedCrossRefGoogle Scholar
  43. 43.
    Chaillet MP, Cosset JM, Socie G, Pico JL, Grimaud E, Dubray B, Alapetite C, Girinsky T. Prospective study of the clinical symptoms of therapeutic whole body irradiation. Health Phys 1993;64:370–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Scott J, Bodner L, Baum BJ. Assessment of age-related changes in the submandibular and sublingual salivary glands of the rat using stereological analysis. Arch Oral Biol 1986;31:69–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Ghezzi EM, Wagner-Lange LA, Schork MA, Metter EJ, Baum BJ, Streckfus CF, Ship JA. Longitudinal influence of age, menopause, hormone replacement therapy, and other medications on parotid flow rates in healthy women. J Gerontol A Biol Sci Med Sci 2000;55:M34–42.PubMedGoogle Scholar
  46. 46.
    Baum BJ, Costa PT, Izutsu KT. Sodium handling by aging human parotid glands is inconsistent with a two-stage secretion model. Am J Physiol Regul Integr Comp Physiol 1984;246:R35–9.Google Scholar
  47. 47.
    Finkelstein MS, Tanner M, Freedman ML. Salivary and serum IgA levels in a geriatric outpatient population. J Clin Immunol 1984;4:85–91.PubMedCrossRefGoogle Scholar
  48. 48.
    Baum BJ, Kousvelari EE, Oppenheim FG. Exocrine protein secretion from human parotid glands during aging: stable release of the acidic proline-rich proteins. J Gerontol 1982;37:392–5.PubMedGoogle Scholar
  49. 49.
    Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc 2007;138:15S–20S.PubMedGoogle Scholar
  50. 50.
    Spielman AI. Interaction of saliva and taste. J Dent Res 1990;69:838–43.PubMedGoogle Scholar
  51. 51.
    Atkinson JC, Wu AJ. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc 1994;125:409–16.PubMedGoogle Scholar
  52. 52.
    Navazesh M. Methods for collecting saliva. Ann N Y Acad Sci 1993;694:72–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH; European Study Group on Classification Criteria for Sjögren’s Syndrome. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002;61:554–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Heintze U, Birkhed D, Björn H. Secretion rate and buffer effect of resting and stimulated whole saliva as a function of age and sex. Swed Dent J 1983;7:227–38.PubMedGoogle Scholar
  55. 55.
    Kohn WG, Ship JA, Atkinson JC, Patton LL, Fox PC. Salivary gland 99-mTc-scintigraphy: a grading scale and correlation with major salivary gland flow rates. J Oral Pathol Med 1992;21:70–4.PubMedCrossRefGoogle Scholar
  56. 56.
    Luyk NH, Doyle T, Ferguson MM. Recent trends in imaging the salivary glands. Dentomaxillofac Radiol 1991;20:3–10.PubMedGoogle Scholar
  57. 57.
    Zbaren P, Ducomun JC. Diagnosis of salivary gland disease using ultrasound and sialography: a comparison. Clin Otolaryngol Allied Sci 1989;14:189–97.PubMedCrossRefGoogle Scholar
  58. 58.
    Daniels TE. Labial salivary gland biopsy in Sjögren’s syndrome. Arthritis Rheum 1984;27:147–56.PubMedCrossRefGoogle Scholar
  59. 59.
    Nieuw Amerongen AV, Veerman EC. Current therapies for xerostomia and salivary gland hypofunction associated with cancer therapies. Support Care Cancer 2003;11:226–31.PubMedGoogle Scholar
  60. 60.
    Bernardi R, Perin C, Becker FL, Ramos GZ, Gheno GZ, Lopes LR, Pires M, Barros HM. Effect of pilocarpine mouthwash on salivary flow. Braz J Med Biol Res 2002;35:105–10.PubMedCrossRefGoogle Scholar
  61. 61.
    Hamlar DD, Schuller DE, Gahbauer RA, Buerki RA, Staubus AE, Hall J, Altman JS, Elzinga DJ, Martin MR. Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma. Laryngoscope 1996;106:972–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Frydrych AM, Davies GR, Slack-Smith LM, Heywood J. An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia. Aust Dent J 2002;47:249–53.PubMedCrossRefGoogle Scholar
  63. 63.
    Scully C. Drug effects on salivary glands: dry mouth. Oral Dis 2003;9:165–76.PubMedCrossRefGoogle Scholar
  64. 64.
    Bots CP, Brand HS, Poorterman JH, van Amerongen BM, Valentijn-Benz M, Veerman EC, ter Wee PM, Nieuw Amerongen AV. Oral and salivary changes in patients with end stage renal disease (ESRD): a two year follow-up study. Br Dent J 2007;202:E3.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of The Nippon Dental University 2009

Authors and Affiliations

  • Joel J. Napeñas
    • 1
  • Michael T. Brennan
    • 1
  • Philip C. Fox
    • 1
    • 2
    Email author
  1. 1.Department of Oral MedicineCarolinas Medical CenterCharlotteUSA
  2. 2.PC Fox ConsultingSpello (PG)Italy

Personalised recommendations