Xerostomia of Various Etiologies: A Review of the Literature Tanasiewicz, Marta; Hildebrandt, Tomasz; Obersztyn, Izabela
Advances in clinical and experimental medicine : official organ Wroclaw Medical University,
2016 Jan-Feb, Volume:
25, Issue:
1
Journal Article
Peer reviewed
Open access
This paper presents the etiopathogenesis, symptomatology, evaluation and treatment of mouth dryness. Xerostomia affects 1-29% of the population, mostly women. It is observed in geriatric patients and ...in individuals using certain medications, those subjected to radiotherapy of the head and neck region or affected with autoimmune conditions. The main signs of xerostomia include the impression of a dry mouth, problems with food ingestion and dryness of the oral mucosa and skin. Evaluation is based on structured interviews (the Fox test) and determinations of unstimulated and stimulated salivary volume. The signs of xerostomia can be attenuated with saliva substitutes, cevimeline or malic acid. Only palliative treatment of this condition is available at present. Untreated xerostomia significantly impairs the quality of life, which can potentially lead to depression.
Highlights • Salivary dysfunctions have a negative impact on the quality of life of patients. • We investigated diagnosis methods and risk factors for salivary dysfunctions. • Therapeutic modalities ...to restore salivary function were also discussed. • New therapeutic modalities have been studied and involve stem cells transplantation.
Dry mouth and older people Thomson, WM
Australian dental journal,
March 2015, 2015-Mar, 2015-03-00, 20150301, Volume:
60, Issue:
S1
Journal Article
Peer reviewed
Open access
Dry mouth is more common among older people than in any other age group. Appropriate definition and accurate measurement of dry mouth is critical for better understanding, monitoring and treatment of ...the condition. Xerostomia is the symptom(s) of dry mouth; it can be measured using methods ranging from single questions to multi‐item summated rating scales. Low salivary flow (known as salivary gland hypofunction, or SGH) must be determined by measuring that flow. The relationship between SGH and xerostomia is not straightforward, but both conditions are common among older people, and they affect sufferers’ day‐to‐day lives in important ways. The major risk factor for dry mouth is the taking of particular medications, and older people take more of those than any other age group, not only for symptomatic relief of various age‐associated chronic diseases, but also in order to reduce the likelihood of complications which may arise from those conditions. The greater the number taken, the greater the associated anticholinergic burden, and the more likely it is that the individual will suffer from dry mouth. Since treating dry mouth is such a challenge for clinicians, there is a need for dentists, doctors and pharmacists to work together to prevent it occurring.
Objectives
Though xerostomia is a frequent oral symptom, there is no validated disease‐specific questionnaire in German. The purpose of this study was to translate and validate versions of the ...Xerostomia Inventory and the Summated Xerostomia Inventory in a German‐speaking population.
Participants and Methods
Thirty‐nine patients including 18 patients suffering from radiation‐induced xerostomia enrolled in this study. Both questionnaires were translated into German language according to international accepted guidelines. For validation, we evaluated reliability, validity, and responsiveness using the COSMIN manual for cross‐cultural adaptation.
Results
Cronbach's α was 0.92 for XI and 0.91 for SXI, showing both high internal consistency. Patients suffering from xerostomia showed significantly higher average scores demonstrating its discriminant validity. Confirmatory factor analysis showed excellent “goodness‐of‐fit” values for SXI and good to moderate values for XI, confirming the assumed factor structures. The Xerostomia Inventory and its summated version both showed excellent test–retest reliability in the non‐xerostomia group (ICC = 0.85 and 0.84).
Conclusions
The XI and SXI in their cross‐cultural adapted versions are the first validated self‐report assessments for xerostomia in German language. They are characterized by practical design and can be easily interpreted by the treating physician.
Introduction
Radiotherapy-induced xerostomia (RIX) is one of the most common adverse effects of radiotherapy (RT) in head and neck cancer patients (HNC) and a major determinant of survivors’ quality ...of life. The primary objective was to evaluate the reduction of patients’ xerostomia symptoms after the utilisation of a sodium-hyaluronate mouthwash compared to a placebo solution. The secondary objectives were to evaluate the improvement of quality of life and to evaluate the patients’ satisfaction.
Methods
The protocol was approved by the ethical committee (Ref. 50,053/19) and registered at ClinicalTrials.gov (ID: NCT05103124). The study was a double-blind randomised clinical trial (RCT) with a crossover design and was conducted at the Fondazione Policlinico Universitario A. Gemelli, Rome.
Results
Thirty-two patients completed the study protocol. Lower values of the modified Xerostomia Questionnaire (XQ) were retrieved when comparing the baseline scores to the ones after the treatment, when compared with placebo (Mann–Whitney
U
test = 0.01); higher values of patients’ satisfaction (Likert scale) and modified XQ were retrieved for the sodium-hyaluronate mouthwash (Mann–Whitney
U
test = 0.001).
Conclusions
This RCT highlights the advantages of treating RIX with the sodium-hyaluronate mouthwash since it seems to be clinically effective in reducing its symptoms, without any reported adverse events.
ClinicalTrials.gov: NCT05103124 in 17/10/2021.
Xerostomia, also known as "dry mouth," is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction, which is the objective measurement of reduced ...salivary flow. Patients with dry mouth exhibit symptoms of variable severity that are commonly attributed to medication use, chronic disease and medical treatment, such as radiotherapy to the head and neck region. Chronic xerostomia significantly increases the risk of experiencing dental caries, demineralization, tooth sensitivity, candidiasis and other oral diseases that may affect quality of life negatively. This article presents a multidisciplinary approach to the clinical management of xerostomia, consistent with the findings of published systematic reviews on this key clinical issue.
Initial evaluation of patients with dry mouth should include a detailed health history to facilitate early detection and identify underlying causes. Comprehensive evaluation, diagnostic testing and periodic assessment of salivary flow, followed by corrective actions, may help prevent significant oral disease. A systematic approach to xerostomia management can facilitate interdisciplinary patient care, including collaboration with physicians regarding systemic conditions and medication use. Comprehensive management of xerostomia and hyposalivation should emphasize patient education and lifestyle modifications. It also should focus on various palliative and preventive measures, including pharmacological treatment with salivary stimulants, topical fluoride interventions and the use of sugar-free chewing gum to relieve dry-mouth symptoms and improve the patient's quality of life.
There are no effective treatments for radiation-induced xerostomia (RIX), a common side effect of head and neck radiation. Mesenchymal stromal cells (MSCs) exhibit regenerative effects and may ...represent an effective cell therapy for the treatment of RIX. Here we present the updated primary safety and secondary efficacy endpoints of a first-in-human pilot study of IFNγ-stimulated refreshed autologous bone marrow- derived MSCs MSC(M) for the treatment of RIX.
Methods: We conducted a single-center clinical trial (NCT04489732) investigating the safety and tolerability of autologous IFNγ-stimulated MSC(M) under an FDA-IND. Patients underwent bone marrow aspiration, MSC(M) were then cultured, stimulated with IFNγ, and cryopreserved. Banked IFNγ-stimulated MSC(M) were thawed, allowed to recover, and then 10 × 106 MSC(M) were injected into the right submandibular gland. The primary objective was safety and tolerability determined by dose-limiting toxicity (DLT) defined as submandibular pain > 5 on a standard 10-point pain scale or any serious adverse event (SAE) within one month after injection. Secondary objectives included analysis of efficacy as measured by salivary quantification and validated quality of life instruments.
Six patients with RIX who had completed radiation at least 2 years earlier were enrolled. The median age was 71 (61-74), 5 (83%) patients were male. Three patients (50%) reported a pain score of 1 after submandibular gland injection, all pain resolved within 4 days. No DLTs occurred and no SAEs were reported up to 12 months after injection. The analysis of secondary endpoints demonstrated a trend of increased salivary production, with the 2 responders having persistent increased saliva production at 1 year. The mean unstimulated saliva was 0.13 mL/min (SEM 0.07) at baseline and increased to 0.18 mL/min (SEM 0.08) at 12 months after injection. There was additionally a trend in improved quality of life.
Injection of autologous IFNγ-stimulated MSC(M) into the submandibular gland of patients with RIX is safe and well tolerated. A trend towards an improvement in secondary endpoints of salivary quantity and quality of life was observed. This first-in-human pilot study provides support for further investigation into IFNγ-stimulated MSC(M) as a potentially curative remedy to treat RIX. A phase I dose-escalation study injecting into bilateral submandibular glands is currently accruing at our institution (NCT05820711).
Objectives
Medication-induced salivary gland dysfunction (MISGD) causes significant morbidity resulting in decreased quality of life. This systematic review assessed the literature on the prevalence, ...diagnosis, treatment, and prevention of MISGD.
Materials and methods
Electronic databases were searched for articles related to MISGD through June 2013. Four independent reviewers extracted information regarding study design, study population, interventions, outcomes, and conclusions for each article. Only papers with acceptable degree of relevance, quality of methodology, and strength of evidence were retained for further analysis.
Results
There were limited data on the epidemiology of MISGD. Furthermore, various methods were used to assess salivary flow rate or xerostomia. Preventive and therapeutic strategies included substitution of medications, oral, or systemic therapy with sialogogues, use of saliva substitutes or of electro-stimulating devices. Although there are promising approaches to improve salivary gland function, most studies are characterized by small numbers and heterogeneous methods.
Conclusions
Physicians and dentists should identify the medications associated with xerostomia and salivary gland dysfunction through a thorough medical history. Preferably, health care providers should measure the unstimulated and stimulated whole salivary flow rates of all their patients so that these values can be used as a baseline to rate the complaints of patients who subsequently claim to experience xerostomia or salivary gland dysfunction as well as the possibilities of effectively treating this condition.
Clinical relevance
MISGD remains a major burden for the population. This systematic review provides a contemporary in-depth description of the diagnosis and treatment of MISGD.
Dry mouth: A critical topic for older adult patients Han, Phuu; Suarez-Durall, Piedad; Mulligan, Roseann
Journal of prosthodontic research,
January 2015, 2015-Jan, 2015-01-00, 20150101, Volume:
59, Issue:
1
Journal Article
Peer reviewed
Diminished salivary flow, or dry mouth impacts the oral health of many older adults, dentate and edentulous. As a result typical oral conditions can prove more challenging to both the patient's ...comfort and home care and the treatment selected by the clinician. This paper will review issues of dry mouth from a clinical and symptomatic perspective and will include the condition's causes, treatment and prevention.
We performed a review of PubMed using the words: older adults, dry mouth, xerostomia, radiation-induced xerostomia, and salivary gland hypofunction. We selected 90 articles with a clinical application perspective.
When it comes to treatment of dry mouth conditions, either objective or subjective, there are no easy answers as to the best course of action for a specific individual. While most of the cited studies have examined the most difficult cases of dry mouth (e.g. Sjögren's syndrome, and that seen during and post head and neck cancer treatments), there are many older adults who demonstrate dry mouth from the use of multiple medications. This paper presents a summary of the etiology, diagnosis, prevention, and pharmacological and non-pharmacological treatment of dry mouth (salivary hypofunction and xerostomia in older adults).
It is important to understand the causes of dry mouth and to educate our patients. Starting a prevention program as early as possible considering the most practical, cost effective and efficient treatments with the best risk-benefit ratio will help to diminish dry mouth symptoms and sequelae.
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