Recent Update on Management of Xerostomia: A Narrative Review
DOI:
https://doi.org/10.61172/511phg61Keywords:
Xerostomia, Hyposalivation, Diagnosis, Treatment, Conventional, Novel, Methods,Abstract
Background: Xerostomia is a multifactorial condition with significant consequences for oral function and quality of life. While conventional diagnostic and treatment strategies remain essential, rapid advances in salivary diagnostics, imaging technologies, artificial intelligence, and regenerative therapies have expanded the clinical landscape. However, the clinical utility and translational readiness of these emerging approaches remain incompletely synthesised.
Objectives: To review conventional and emerging diagnostic and therapeutic approaches for xerostomia and evaluate their clinical utility, translational readiness, and limitations.
Methods: A narrative literature review was conducted using Google Scholar, MEDLINE, and PubMed databases. English-language publications from 2000 to 2025 were retrieved using combinations of keywords related to xerostomia, diagnosis, management, biomarkers, imaging, and emerging therapies. Clinical studies, systematic reviews, meta-analyses, and relevant narrative reviews were included.
Results: Conventional diagnostic methods, including symptom assessment, clinical examination, and sialometry, remain essential but have limitations. Emerging approaches such as salivary biomarkers, advanced imaging, wearable sensors, and artificial intelligence show improved diagnostic potential. Traditional treatments focus on symptom relief and salivary stimulation, while novel therapies—including acupuncture, low-level laser therapy, intraoral devices, and regenerative approaches—demonstrate promising outcomes. However, their clinical application is limited by cost, accessibility, and insufficient validation.
Conclusion: Conventional and emerging approaches should be viewed as complementary rather than competing strategies in xerostomia management. Although novel technologies offer substantial promise for improving diagnostic precision and therapeutic outcomes, further clinical validation and long-term evidence are required before widespread integration into routine practice.
Keywords: Xerostomia; Hyposalivation; Salivary gland dysfunction; Diagnosis; Salivary biomarkers; Emerging therapies
Article Metrics
Downloads
References
1. Khalid A, Elah S, Qurban A, Atif S. Xerostomia diagnosis—A narrative review. Journal of the Pakistan Dental Association. 2022;31(1):49-54.
2. Sardellitti L, Bortone A, Filigheddu E, Serralutzu F, Milia EP. Xerostomia: from pharmacological treatments to traditional medicine—an overview on the possible clinical management and prevention using systemic approaches. Current Oncology. 2023;30(5):4412-4426.
3. Pedersen AML, Sørensen CE, Proctor GB, Carpenter GH, Ekström J. Salivary secretion in health and disease. Journal of Oral Rehabilitation. 2018;45(9):730-746.
4. Kilian M, Chapple I, Hannig M, et al. The oral microbiome–an update for oral healthcare professionals. British Dental Journal. 2016;221(10):657-666.
5. do Nascimento ML, de Farias ABS, Carvalho AT, et al. Impact of xerostomia on the quality of life of patients submitted to head and neck radiotherapy. Medicina Oral, Patología Oral y Cirugía Bucal. 2019;24(6):e770.
6. Kim Y-J. Xerostomia and its cellular targets. International Journal of Molecular Sciences. 2023;24(6):5358.
7. Mumtaz M, Abdullah Alsuwaiket A, Raza S, et al. Prevalence of xerostomia and associated systemic risk factors in Riyadh, Saudi Arabia: a cross-sectional study. 2021.
8. Villa A, Abati S. Risk factors and symptoms associated with xerostomia: a cross‐sectional study. Australian Dental Journal. 2011;56(3):290-295.
9. Ghalwash D, El-Gawish A, Abou-Bakr A. Prevalence and impact of xerostomia on quality of life: a clinical-based cross-sectional study in Egypt. The Egyptian Journal of Otolaryngology. 2025;41(1):224.
10. Agostini BA, Cericato GO, Silveira ERd, et al. How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Brazilian Dental Journal. 2018;29(6):606-618.
11. Krajewski Jr MP, Mo Q, Lu C-H, et al. Medication use among patients reporting xerostomia of an academic dental clinic. Journal of Pharmacy Technology. 2022;38(5):264-271.
12. National Cancer Institute. Oral Complications of Cancer Therapies (PDQ®) Health Professional Version.
13. Challacombe S, Osailan S, Proctor G, Carpenter G. Dry mouth: a clinical guide on causes, effects and treatments. Groeningen: Springer Berlin Heidelberg; 2015.
14. Villa A, Connell CL, Abati S. Diagnosis and management of xerostomia and hyposalivation. Therapeutics and Clinical Risk Management. 2014:45-51.
15. Zhang M. Salivary flow measurement for xerostomia diagnosis using a Schirmer based algorithm. Clinical Journal for Medicine, Health and Pharmacy. 2025;3(3):32-45.
16. Izrailov А, Antonova I. Modern approaches to diagnosis of xerostomia. Periodontology. 2023;28(3):235-246.
17. Löfgren CD, Wickström C, Sonesson M, Lagunas PT, Christersson C. A systematic review of methods to diagnose oral dryness and salivary gland function. BMC Oral Health. 2012;12(1):29.
18. Goto T, Kishimoto T, Iwawaki Y, et al. Reliability of screening methods to diagnose oral dryness and evaluate saliva secretion. Dentistry Journal. 2020;8(3):102.
19. Berti-Couto SdA, Couto-Souza PH, Jacobs R, et al. Clinical diagnosis of hyposalivation in hospitalized patients. Journal of Applied Oral Science. 2012;20:157-161.
20. Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Annals of Medical and Health Sciences Research. 2014;4(4):503-510.
21. Samia E. Common drugs causing xerostomia. J Infect Dis Travel Med. 2022;28:1-4.
22. Choo PJ, Taing M-W, Teoh L. A retrospective study of drugs associated with xerostomia from the Australian Database of Adverse Event Notifications. International Journal of Pharmacy Practice. 2022;30(6):548-553.
23. Assy Z, Jager D, Mashhour E, Bikker F, Brand H. Regional differences in perceived oral dryness as determined with a newly developed questionnaire, the Regional Oral Dryness Inventory. Clinical Oral Investigations. 2020;24(11):4051-4060.
24. Thomson WM, van der Putten G-J, de Baat C, et al. Shortening the xerostomia inventory. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2011;112(3):322-327.
25. Pourjahanshah D, Nekouei AH, Kakoei S, Haghdoost A. Estimating the cut-off point of Xerostomia Inventory questionnaire score to diagnose dry mouth based on non-stimulating saliva test: a diagnostic sensitivity and specificity study. BMC Oral Health. 2025;25(1):365.
26. Ansari Chaharsoughi S, Rezaee M, Alaee A. The correlation between the modified Fox questionnaire and the modified Schirmer test in measuring oral dryness: a cross-sectional study. Journal of Dental Advances in Clinical Sciences. 2025;1(1):3-9.
27. Gil-Montoya J-A, Silvestre F-J, Barrios R, Silvestre-Rangil J. Treatment of xerostomia and hyposalivation in the elderly: a systematic review. Medicina Oral, Patología Oral y Cirugía Bucal. 2016;21(3):e355.
28. Kalk W, Vissink A, Spijkervet F, et al. Sialometry and sialochemistry: diagnostic tools for Sjögren's syndrome. Annals of the Rheumatic Diseases. 2001;60(12):1110-1116.
29. Sacon MB, Esteves CV, Florezi GP, et al. Comparison of two methods for sialometry: weighing and volume techniques. Clinical and Laboratorial Research in Dentistry. 2017.
30. Mütevelizade G, Bozdemir BÇ, Aydın N, et al. Radiation-induced xerostomia: evaluation with ¹⁸F-FDG PET/CT. Molecular Imaging and Radionuclide Therapy. 2025;34(3):213.
31. Duong S, Youssef J, Pimenta P, et al. An imaging‐based approach to the evaluation of xerostomia. Lasers in Surgery and Medicine. 2012;44(6):482-489.
32. Liquidato BM, Soler RdC, Bussoloti Filho I. Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients. Revista Brasileira de Otorrinolaringologia. 2006;72:116-119.
33. Chisholm DM. Labial salivary gland biopsy in Sjögren's disease. Journal of Clinical Pathology. 1988;21:656-660.
34. Seyal E, Akaa J, O'Dea D, et al. Real-world diagnostic value of integrating oral and ocular dryness testing in suspected Sjögren's disease. Frontiers in Medicine. 2025;12:1594270.
35. Lee Y-H, Auh Q-S, Park H-K. Determination of xerostomia with cutoff value for salivary flow rate using machine learning algorithm. 2023.
36. Constantin V, Luchian I, Goriuc A, et al. Salivary biomarkers identification: advances in standard and emerging technologies. Oral. 2025;5(2):26.
37. Atif S, Abdul Wahab N, Ghafoor S, et al. Salivary aquaporin-3 as a screening biomarker for xerostomia in patients with periodontal disease and the effects of xerostomia on oral health-related quality of life. PLOS ONE. 2023;18(4):e0283995.
38. Park Y. Xerostomia and its impact on oral health. In: Salivary Analysis—Biomarkers, Clinical Applications, and Emerging Technologies. 2025:79.
39. Khabazian A, Koopaie M, Khabazian T, et al. Evaluation of salivary nitric oxide levels and anxiety in multiple sclerosis patients with and without xerostomia: correlation with clinical variables. BMC Oral Health. 2025;25(1):507.
40. Gao B, Luo J, Nong X, Yao Z, Wang H. Combined analysis of salivary metabolomics and microbiota in type 1 diabetics with xerostomia: a pilot study. Journal of Oral Pathology & Medicine. 2025.
41. Nakajima R, Patel SG, Katabi N, et al. Diagnostic and prognostic utility of ¹⁸F-FDG PET/CT in recurrent salivary gland cancers. American Journal of Roentgenology. 2021;216(5):1344-1356.
42. Mahdani FY, Ayuningtyas NF. Current approaches of salivary glands regeneration for management of xerostomia and hyposalivation: a narrative review. Indonesian Journal of Dental Medicine. 2023;6(1):43-46.
43. Hu J, Andablo‐Reyes E, Mighell A, Pavitt S, Sarkar A. Dry mouth diagnosis and saliva substitutes—a review from a textural perspective. Journal of Texture Studies. 2021;52(2):141-156.
44. Kalgeri SH, Doddawad VG, Shivakumar AT, et al. Xerostomia: current advancements and insights in biomedical and biotechnology research. Biomedical and Biotechnology Research Journal. 2024;8(1):1-12.
45. Visvanathan V, Nix P. Managing the patient presenting with xerostomia: a review. International Journal of Clinical Practice. 2010;64(3):404-407.
46. Escobar A, Aitken-Saavedra JP, Escobar A, Aitken-Saavedra J. Xerostomia: an update of causes and treatments. In: Salivary Glands—New Approaches in Diagnostics and Treatment. 2019:15-37.
47. Saleh J, Figueiredo MAZ, Cherubini K, Salum FG. Salivary hypofunction: an update on aetiology, diagnosis and therapeutics. Archives of Oral Biology. 2015;60(2):242-255.
48. Navarro Morante A, Wolff A, Bautista Mendoza GR, López‐Jornet P. Natural products for the management of xerostomia: a randomized, double‐blinded, placebo‐controlled clinical trial. Journal of Oral Pathology & Medicine. 2017;46(2):154-160.
49. Fisic A, Aras HC, Almhöjd U, Almståhl A. Dental care professionals' awareness of oral dryness and its clinical management: a questionnaire-based study. BMC Oral Health. 2024;24(1):45.
50. Tanaka A, Kellesarian SV, Arany S. Xerostomia and patients' satisfaction with removable denture performance: systematic review. Quintessence International. 2021;52(1).
51. Gómez-Moreno G, Guardia J, Aguilar-Salvatierra A, et al. Effectiveness of malic acid 1% in patients with xerostomia induced by antihypertensive drugs. Medicina Oral, Patología Oral y Cirugía Bucal. 2012;18(1):e49.
52. Gómez‐Moreno G, Aguilar‐Salvatierra A, Guardia J, et al. The efficacy of a topical sialogogue spray containing 1% malic acid in patients with antidepressant‐induced dry mouth: a double‐blind, randomized clinical trial. Depression and Anxiety. 2013;30(2):137-142.
53. Charalambous A. Seeking optimal management for radioactive iodine therapy-induced adverse effects. Asia-Pacific Journal of Oncology Nursing. 2017;4(4):319-322.
54. Alhejoury HA, Mogharbel LF, Al-Qadhi MA, et al. Artificial saliva for therapeutic management of xerostomia: a narrative review. Journal of Pharmacy and Bioallied Sciences. 2021;13(Suppl 2):S903-S907.
55. Barbieri T, Costa KCd, Guerra LdFC. Current alternatives in the prevention and treatment of xerostomia in cancer therapy. RGO-Revista Gaúcha de Odontologia. 2020;68:e20200016.
56. Mercadante V, Jensen SB, Smith DK, et al. Salivary gland hypofunction and/or xerostomia induced by nonsurgical cancer therapies: ISOO/MASCC/ASCO guideline. Journal of Clinical Oncology. 2021;39(25):2825-2843.
57. Vives-Soler A, López-López J, Jané-Salas E. Xerostomía y radioterapia de cabeza y cuello: actualización. Revista Colombiana de Cancerología. 2017;21(1):26-32.
58. Kapourani A, Kontogiannopoulos KN, Barmpalexis P. A review on the role of pilocarpine on the management of xerostomia and the importance of the topical administration systems development. Pharmaceuticals. 2022;15(6):762.
59. Galaniha LT, Nolden AA. The role of saliva in taste dysfunction among cancer patients: mechanisms and potential treatment. Oral Oncology. 2022;133:106030.
60. Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary secretory disorders, inducing drugs, and clinical management. International Journal of Medical Sciences. 2015;12(10):811.
61. Almansoori AA, Hariharan A, Cao UM, Upadhyay A, Tran SD. Drug therapeutics delivery to the salivary glands: intraglandular and intraductal injections. Cell Biology and Translational Medicine, Volume 20: Organ Function, Maintenance, Repair in Health and Disease. 2023:119-130.
62. Nayani S, Mustafa OG. Management of diabetes in people undergoing dental treatment in primary care. Primary Dental Journal. 2020;9(2):38-46.
63. Taga T, Ito K, Takamatsu K, et al. Menopausal symptoms are associated with oral sensory complaints in perimenopausal women: an observational study. BMC Women's Health. 2021;21(1):262.
64. Goulart JD, de Almeida JC, da Silva Leardini JM, et al. Xerostomia e suas causas na Odontologia. Revista Eletrônica Acervo Saúde. 2016;(3):99-103.
65. Ghazzaoui SF, Romano LTC, Gonnelli FAS, Palma LF. Acupuntura para xerostomia e hipofluxo salivar: revisão de literatura. Revista Brasileira de Odontologia. 2016;73(4):340.
66. Jiang Q, Zhang H, Pang R, et al. Acupuncture for primary Sjögren syndrome (pSS) on symptomatic improvements: study protocol for a randomized controlled trial. BMC Complementary and Alternative Medicine. 2017;17(1):61.
67. Ni X, Tian T, Chen D, et al. Acupuncture for radiation-induced xerostomia in cancer patients: a systematic review and meta-analysis. Integrative Cancer Therapies. 2020;19:1534735420980825.
68. Tariq A, Jamshaid M, Majeed I. Xerostomia: post-radiation management strategies. International Journal of Pharmaceutical Research & Allied Sciences. 2015;4(3).
69. Ribeiro LN, de Vasconcelos Carvalho M, de Oliveira Limirio JPJ, et al. Impact of low-level laser therapy on the quality of life of patients with xerostomia undergoing head and neck radiotherapy: a systematic review. Supportive Care in Cancer. 2024;32(2):118.
70. Saleh J, Figueiredo MAZ, Cherubini K, Braga-Filho A, Salum FG. Effect of low-level laser therapy on radiotherapy-induced hyposalivation and xerostomia: a pilot study. Photomedicine and Laser Surgery. 2014;32(10):546-552.
71. Gonnelli FAS, Palma LF, Giordani AJ, et al. Laser de baixa potência para prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. Radiologia Brasileira. 2016;49:86-91.
72. de Oliveira Silva IJ, Almeida ARP, Falcão NC, et al. Hipossalivação: etiologia, diagnóstico e tratamento. Journal of Dentistry & Public Health. 2016;7(2).
73. Terlević Dabić D, Jurišić S, Vučićević Boras V, et al. The effectiveness of low-level laser therapy in patients with drug-induced hyposalivation: a pilot study. Photomedicine and Laser Surgery. 2016;34(9):389-393.
74. Alajbeg I, Falcão DP, Tran SD, et al. Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2012;113(6):773-781.
75. Jeon KJ, Park Y, Jeong H, et al. Parotid gland evaluation of menopausal women with xerostomia using the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) method of MRI: a pilot study. Dentomaxillofacial Radiology. 2023;52(4):20220349.
76. Alghanem S, Dziurkowska E, Ordyniec-Kwaśnica I, Sznitowska M. Intraoral medical devices for sustained drug delivery. Clinical Oral Investigations. 2023;27(12):7157-7169.
77. Pringle S, Maimets M, van der Zwaag M, et al. Human salivary gland stem cells functionally restore radiation damaged salivary glands. Stem Cells. 2016;34(3):640-652.
78. Jain N, Jain S, Kaur A, et al. Incidence of xerostomia in locally advanced head-and-neck cancers in elderly patients treated with intensity-modulated radiotherapy. Journal of Cancer Research and Therapeutics. 2022;18(1):81-83.
79. Bilal MU, Alvi S, Humayune F, et al. Advances in gene therapy for xerostomia: current perspectives and future directions: a narrative review. Health Science Reports. 2026;9(5):e72295.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Olawande Adebayo, Funmilola Eunice Adewinle, Elijah Olufemi Oyetola
This work is licensed under a Creative Commons Attribution 4.0 International License.
Open Access Statement
- We became fully Open Access since January 2023.
- Our new and archived materials are available free of charge on open basis and under a Creative Commons license as stated below.
Copyright statement
Copyright © 1999 The authors. This work, Nigerian Dental Journal by Nigerian Dental Association is licensed under Creative Commons Attribution 4.0 International License.