Polypharmacy, salivary function, and oral health outcomes in institutionalized older adults: A scoping review

Polypharmacy is common in long-term care facilities (LTCFs) and may contribute to xerostomia, hyposalivation, and oral disease. However, evidence specific to LTCF populations has not been comprehensively mapped. Objective: To map the available evidence on the association between polypharmacy or medication burden and salivary dysfunction and oral health outcomes in institutionalized older adults.

This scoping review was conducted in accordance with Joanna Briggs Institute guidance and reported following PRISMA-ScR. PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and LILACS via BVS were searched from 1 January 2005 to 23 January 2026. To identify potentially relevant grey literature, Google Scholar and ClinicalTrials.gov were also searched. Screening was performed in Rayyan, data were extracted using a piloted charting form, and findings were synthesized narratively.

Eight studies published between 2010 and 2025 were included. Seven used a cross-sectional design and one was a randomized controlled trial, all conducted in LTCF settings in Europe and Asia. Polypharmacy, commonly defined as the use of five or more medications, was highly prevalent. Measures of xerogenic or anticholinergic burden identified associations with xerostomia or reduced salivary flow more consistently than medication count alone. Dry mouth was frequent, and where oral outcomes were assessed, substantial oral morbidity was also reported.

In institutional care settings, salivary dysfunction and oral disease are common and appear to be more closely associated with xerogenic or anticholinergic burden than with medication number alone. Preventive oral care protocols integrated with xerogenic risk-informed medication review and standardized outcome assessment should be prioritized in future LTCF research and care.