Xerostomia symptoms and treatment strategies associated with salivary flows

Objectives We sought to analyze the types and quantity of dry mouth products patients use as well as the reported dry mouth symptom severity and frequency in relation to salivary flows. We hypothesized that respondents with higher stimulated flow would report better responses to products that stimulate flow. Methods Patients with complaints of dry mouth who had documented unstimulated and stimulated whole salivary flows (UWS and SWS, respectively) completed a questionnaire to assess dry mouth products used, current symptoms, and response to therapy. Statistical analyses included descriptive analyses and associations between dichotomized (low/normal) salivary flow levels, and symptom severity was assessed using nonparametric Wilcoxon rank-sum tests. Results Eighty-seven patients completed the questionnaire; 38 patients had a diagnosis of Sjogren syndrome. More than half of patients (55%; n = 48) reported using 4 or more dry mouth products. The most common product used was water (n = 78), followed by rinses (n = 54) and lozenges (n = 48). Twenty-five patients (29%) reported use of parasympathomimetics. More than half (56%) of patients using parasympathomimetics reported that their mouth felt “much better” compared with less than one-third of patients using other methods: water (29%), gum (23%), lozenges (27%), candies (4%), rinse (26%), spray (24%), or gel (20%). Among parasympathomimetic users with normal SWS, 71% reported their mouth felt “much better” compared with 36% of those with low SWS. For water, gum, lozenges, candies, and sprays, greater than 50% of respondents reported improvement lasting less than 1 hour. Regarding rinses, gels, and parasympathomimetics, greater than 50% of respondents reported improvement lasting greater than or equal to 1 hour. The dichotomized level of UWS rate was not associated with any measures of symptom severity, whereas the low SWS rate was associated with the following measures: dryness of the mouth (P = .004), difficulty speaking due to dryness (P = .03), and difficulty swallowing due to dryness (P = .004). Conclusions Different treatment categories for dry mouth symptoms provided varying degrees of relief. Patients with normal vs low stimulated flow who used parasympathomimetics reported the greatest treatment response and longest relief of dry mouth symptoms. Assessment of salivary flow levels may be a useful guide for more targeted recommendations of dry mouth products.