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Xerostomia following radiotherapy — Clinical Guidelines

Overview

Xerostomia, or dry mouth, is a common condition often induced by radiotherapy, particularly affecting the oral cavity and significantly impacting quality of life through difficulties in swallowing, speaking, and maintaining oral hygiene 1 2 11 21.

Diagnosis

Clinical Assessment: Subjective reporting of dry mouth sensation 1 2 11.

Salivary Flow Measurement: Use of stimulated salivary flow tests to quantify hyposalivation 6 26.

Medication Review: Evaluate polypharmacy and identify potential xerogenic medications 6 13 18.

Grading: Utilize scales like the Xerostomia Inventory (XI) for severity grading 4 18.

Management

Non-pharmacological Interventions: Saliva stimulants (e.g., sugar-free gum), frequent sips of water 1 17.

Salivary Stimulants: Thyme honey mouth rinse shown to be effective in some studies 1.

Adjunct Therapies: Use of mucin-containing oral sprays or lozenges for symptomatic relief 15 23.

Avoidance of Aggravating Agents: Limit use of antiseptic mouthwashes that may worsen xerostomia 12.

Acupuncture: Considered as a viable adjunctive treatment for symptom management in hospice patients 16.

Special Populations

Elderly: Higher prevalence due to polypharmacy and age-related changes 3 6 9 10 13 20.

Comorbidities: Management should consider interactions with existing conditions like hypertension and diabetes 3 4 18.

Key Recommendations

Regular Salivary Flow Monitoring: Assess salivary flow rates to diagnose and monitor severity (Evidence: Moderate 6 26).

Review and Optimize Medication Regimens: Evaluate and adjust medications to minimize xerostomia risk (Evidence: Moderate 6 13).

Implement Non-pharmacological Interventions: Encourage use of saliva stimulants and hydration strategies (Evidence: Moderate 1 17).

Consider Alternative Therapies: Explore adjunctive treatments like mucin sprays or acupuncture for symptom relief (Evidence: Weak 15 16).

Educate Patients on Oral Hygiene: Provide guidance to mitigate complications despite xerostomia (Evidence: Expert opinion 17).

References

1 Ibrahim SS, Tadry NN, Ezzatt OM, Hussein RR. The efficacy of thyme honey mouth rinse on polypharmacy-induced xerostomia: A randomized controlled clinical trial with a biochemical assessment. Journal of stomatology, oral and maxillofacial surgery 2026. link 2 Hafsah S, Syam S. Association of xerostomia and polypharmacy - A case-control study. Community dental health 2025. link 3 Mascarenhas MK, Cademartori MG, Borges RDC, Gonzalez MC, Bielemann RM, Thomson WM et al.. Prevalence and Associations of Xerostomia in Older Adults in Southern Brazil. Gerodontology 2025. link 4 Ramírez L, Sánchez I, González-Serrano J, Muñoz M, Martínez-Acitores ML, Garrido E et al.. Factors influencing xerostomia and oral health-related quality of life in polymedicated patients. Gerodontology 2024. link 5 Saito T, Murotani K, Ito K, Nakamura N, Oya N. Bias due to statistical handling of death and reirradiation in the assessment of duration of response after palliative radiotherapy: a scoping review and analysis of clinical data. The British journal of radiology 2023. link 6 Laugisch O, Holtfreter B, Pink C, Samietz S, Völzke H, Kocher T. Polypharmacy and saliva volumes in the northeast of Germany - The Study of Health in Pomerania. Community dentistry and oral epidemiology 2022. link 7 Thomson WM, Ferguson CA, Janssens BE, Kerse NM, Ting GS, Smith MB. Xerostomia and polypharmacy among dependent older New Zealanders: a national survey. Age and ageing 2021. link 8 Barbe AG. Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management. Drugs & aging 2018. link 9 Viljakainen S, Nykänen I, Ahonen R, Komulainen K, Suominen AL, Hartikainen S et al.. Xerostomia among older home care clients. Community dentistry and oral epidemiology 2016. link 10 Tiisanoja A, Syrjälä AM, Komulainen K, Hartikainen S, Taipale H, Knuuttila M et al.. Sedative load and salivary secretion and xerostomia in community-dwelling older people. Gerodontology 2016. link 11 Thomson WM. Dry mouth and older people. Australian dental journal 2015. link 12 Chevalier M, Sakarovitch C, Precheur I, Lamure J, Pouyssegur-Rougier V. Antiseptic mouthwashes could worsen xerostomia in patients taking polypharmacy. Acta odontologica Scandinavica 2015. link 13 Singh ML, Papas A. Oral implications of polypharmacy in the elderly. Dental clinics of North America 2014. link 14 Villa A, Polimeni A, Strohmenger L, Cicciù D, Gherlone E, Abati S. Dental patients' self-reports of xerostomia and associated risk factors. Journal of the American Dental Association (1939) 2011. link 15 Kharevich O, Shipman B, Goldman BM, Nahon M. Salese to buffer saliva in elderly patients with xerostomia: a pilot study. Journal of prosthodontics : official journal of the American College of Prosthodontists 2011. link 16 Meidell L, Holritz Rasmussen B. Acupuncture as an optional treatment for hospice patients with xerostomia: an intervention study. International journal of palliative nursing 2009. link 17 Friedman PK, Isfeld D. Xerostomia: the "invisible" oral health condition. Journal of the Massachusetts Dental Society 2008. link 18 Wolff A, Zuk-Paz L, Kaplan I. Major salivary gland output differs between users and non-users of specific medication categories. Gerodontology 2008. link 19 Ship JA, McCutcheon JA, Spivakovsky S, Kerr AR. Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth. Journal of oral rehabilitation 2007. link 20 Ikebe K, Nokubi T, Sajima H, Kobayashi S, Hata K, Ono T et al.. Perception of dry mouth in a sample of community-dwelling older adults in Japan. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2001. link 21 Bivona PL. Xerostomia. A common problem among the elderly. The New York state dental journal 1998. link 22 Nederfors T, Isaksson R, Mörnstad H, Dahlöf C. Prevalence of perceived symptoms of dry mouth in an adult Swedish population--relation to age, sex and pharmacotherapy. Community dentistry and oral epidemiology 1997. link 23 Sweeney MP, Bagg J, Baxter WP, Aitchison TC. Clinical trial of a mucin-containing oral spray for treatment of xerostomia in hospice patients. Palliative medicine 1997. link 24 Nederfors T. Xerostomia: prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists. Swedish dental journal. Supplement 1996. link 25 McDonald E, Marino C. Dry mouth: diagnosing and treating its multiple causes. Geriatrics 1991. link 26 Yamagiwa M, Takeuchi K, Harada T, Sakakura Y. A simple measurement of parotid salivary flow using material quick absorber. American journal of otolaryngology 1991. link90005-z)

Xerostomia following radiotherapy