Management of Xerostomia in older adults: A systematic review

Background: Xerostomia (dry mouth) is a common adverse effect of many medications and can severely diminish quality of life for older adults. Objective: To assess the effectiveness of 3 categories of interventions used to manage drug-induced xerostomia and xerostomia secondary to Sjögren syndrome and radiation treatment for head and neck cancer in older adults: saliva substitutes, saliva stimulants, and topical fluoride. Data Sources: The Cochrane Library, PubMed, EMBASE (to July 2009) and CINAHL (to February 2010) were searched for randomized or quasi-randomized studies involving older adults with drug- or radiation-induced xerostomia or Sjögren syndrome. Study Selection and Data Extraction: An updating search focusing on systematic reviews (to June 2012) was conducted prior to publication. Outcomes included perceived dryness of the mouth, reduced sialometry, or increased root caries. Duplicate study selection and data extraction were conducted. Risk of bias was assessed. A random effects meta-analysis was employed. Data Synthesis: Four studies of saliva substitutes (N = 116), 3 studies of saliva stimulants (N = 361), and 1 of fluoride treatment (N = 334) met selection criteria. Saliva substitutes were more effective than other treatments at improving perceived dryness of the mouth as determined on a 10-point visual analog scale (weighted mean difference [WMD] -1.91 [95% CI -2.54 to -1.29]) but less effective than placebo (WMD 0.26 [95% CI 0.51-1.02]). Parasympathetic stimulants were more effective than placebo in improving oral dryness (OR = 0.37 [95% CI 0.19-0.72]). Due to lack of data, quantitative synthesis of results for topical fluoride was not possible. Conclusions: There is evidence to suggest that saliva substitutes improve symptoms but the clinical significance is minimal. The evidence more strongly supports the effect of saliva stimulants, although the quality of evidence is poor and adverse effects from these medications cannot be overlooked. Evidence demonstrating efficacy of topical fluoride in disease prevention was inconclusive. Addressing underlying causes of xerostomia, including drug choices, may help mitigate the burden of illness and effects on quality of life.