Evaluation and management of dry mouth and its complications in rheumatology practice

ABSTRACT

Introduction

The symptom of dry mouth has multiple potential etiologies and can be a diagnostic clue to the presence of common systemic diseases encountered in rheumatology practice. The presence of decreased saliva flow (i.e. salivary hypofunction) defines a subset of dry mouth patients in whom there may be reversible drug effects, an iatrogenic insult such as head and neck irradiation, or a disease that directly involves the salivary glands (e.g. Sjögren’s disease). The assessment of salivary hypofunction includes sialometry, salivary gland imaging, salivary gland biopsy, and an assessment for relevant systemic diseases. Optimal management of dry mouth requires accurate definition of its cause, followed by general measures that serve to alleviate its symptoms and prevent its complications.

Areas covered

Through a literature search on xerostomia and salivary hypofunction, we provide an overview of the causes of dry mouth, highlight the potential impact of salivary hypofunction on oral and systemic health, detail routine evaluation methods and treatment strategies, and emphasize the importance of collaboration with oral health care providers.

Expert opinion

Our Expert Opinion is provided on unmet needs in the management of dry mouth and relevant research progress in the field.

KEYWORDS:

• Xerostomia
• salivary hypofunction
• Sjögren’s disease
• oral candidiasis
• dry mouth

Article highlights

• Salivary hypofunction refers to an objective decrease in saliva flow and is found in only a minority of those who experience the symptom of dry mouth (xerostomia).

• The morbidity of salivary hypofunction is high and includes an increased risk of dental caries, oral candidiasis, gastrointestinal disturbances, and impaired quality of life.

• There is a broad differential diagnosis for xerostomia and salivary hypofunction.

• Measurement of salivary flow is a useful tool in the diagnostic evaluation but is rarely done.

• Salivary gland biopsy, typically from the labial submucosa, is important for diagnosing Sjögren’s or other systemic diseases involving the salivary glands.

• Laboratory tests, including anti-SSA/Ro, anti-SSB/La, and antinuclear antibodies (ANA), can identify conditions like Sjögren’s disease underlying dry mouth.

• Comprehensive evaluations, including referring the patient to a dental care provider, is essential for evaluation, diagnosis, and treatment planning, emphasizing the importance of dental hygiene.

• Management of dry mouth includes use of artificial saliva and oral rinses, pharmacologic and non-pharmacologic sialagogues, scrupulous dental hygiene, minimizing the dose or use of drugs with xerogenic side effects, and treatment of intervening oral fungal infections.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Clinical photos and clinical images provided herein were collected with the patient’s written consent. NIDCR subjects were consented to clinical research protocols NIH IRB 15-D-0051 and NIH IRB 11-D-0172 (PI-Warner) before any study procedures were conducted.

Additional information

Funding

This work was supported by the following awards and mechanisms: 1UC2DE032254-01 (PIs: ANB, BMW) from the Division of Extramural Research (DER) and Division of Intramural Research (DIR) Programs of the National Institutes of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH); Z01-DE000704 (PI: BMW) of the DIR of the NIDCR, NIH; and the Jerome L. Greene Foundation (ANB) U.S. Department of Health and Human Services > National Institutes of Health, 1UC2DE032254-01, Z01-DE000704.