Evaluation, differential diagnosis, and treatment of xerostomia

The salivary component of Sjögren's syndrome (SS) is defined as xerostomia (dry mouth). However, xerostomia is a common symptom associated with quantitative and qualitative changes in saliva, which are generally referred to as salivary hypofunction. This can be caused by various systemic diseases (including SS), anticholinergic effects of many drugs, psychological conditions, and physiological changes. Chronic salivary hypofunction is clinically significant because it can cause oral dysfunction, dental destruction, and mucosal infection. Evaluating patients complaining of xerostomia requires particular attention to their current medications and physical examination of the major salivary glands, teeth, and oral mucosa. Based on that information and the differential diagnosis of salivary hypofunction, appropriate tests can then be selected to develop a final diagnosis. Effective treatment of patients with chronic salivary hypofunction requires a combination of: (1) ongoing dental decay prevention and treatment supervised by their dentist; (2) salivary flow stimulation; (3) recognition and treatment of chronic oral candidiasis; (4) selective use of saliva substitutes; and (5) prescription drug review.