Top Clin Nutr

Vol. 32, No. 4, pp. 340–349

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PRACTICE PROJECTS
Drug-Induced Xerostomia in
Hemodialysis Patients and Its
Implications in Oral Health
Roxana Torres, MHSN, RDN, LDN;
Luigi Brunetti, PharmD, MPH;
Ellis Morrow, MS, RDN, CSD, LD;
Jane Ziegler, DCN, RDN, LDN

Xerostomia or dry mouth occurs when there is decreased production of saliva. This condition
can lead to oral health complications (eg, dental caries, oral lesions), chewing and swallowing
problems, and reduced quality of life. Hemodialysis patients are at increased risk of developing
xerostomia because of polypharmacy, fluid restriction, salivary gland dysfunction, oral breath-
ing, and systemic diseases. Drug-induced xerostomia increases the risk of oral diseases in these
patients. The health care team needs to assess the symptoms of xerostomia in the hemodial-
ysis population and to apply the latest recommendations for its management. This article de-
scribes the risks of drug-induced xerostomia in oral health and its management in patients on HD.
Key words: drug-induced xerostomia, dry mouth, hemodialysis, oral health, xerostomia

X EROSTOMIA or dry mouth is caused by

a reduction or absence of saliva produc-
tion in the mouth.1 This condition can lead to
health complications, such as dental caries,
difficulty in speaking and swallowing, halito-
sis, oral candidiasis, and decreased quality of
life.1-3 The prevalence of xerostomia in nor-
mal adults is approximately 10% to 46% and is
more common in older adults and women.3,4
Author Affiliation: Graduate Programs in Clinical
Nutrition, Department of Nutritional Sciences,
School of Health Related Professions, Rutgers, The
State University of New Jersey, Newark.
The authors have disclosed that they have no signif-
icant relationships with, or financial interest in, any
commercial companies pertaining to this article.
Correspondence: Roxana Torres MHSN, RDN, LDN,
Graduate Programs in Clinical Nutrition, Depart-
ment of Nutritional Sciences, School of Health Re-
lated Professions, Rutgers, The State University of
New Jersey, 65 Bergen St 157, Newark, NJ 07107
(roxana.torres@shp.rutgers.edu).
DOI: 10.1097/TIN.0000000000000119
Some of the causes of this condition are sys-
temic diseases (eg, diabetes, renal disease, and
thyroid disease), drugs, salivary gland dysfunc-
tion, and radiation therapy of the head and
neck regions.1-3
End-stage renal disease (ESRD) is a con-
dition in which the kidneys are no longer
able to maintain fluid and electrolyte (sodium,
potassium, calcium, phosphate, and bicarbon-
ate) homeostasis. This causes an increase of
plasma creatinine, blood urea nitrogen, and
uremia level.5 Hemodialysis (HD), one of the
most common treatments available for ESRD,
reduces the uremic toxin concentration and
fluid excess and corrects metabolic abnor-
malities such as hyperkalemia and acidosis.6
In 2015, more than 660 000 Americans
were treated for ESRD, of whom 468 000
received HD treatment.7 Polypharmacy is
highly prevalent in these patients, and sev-
eral of these medications such as antihyper-
tensives, antidepressants, antiemetics, antihy-
perlipidemics, and some dietary supplements

340

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 Drug-Induced Xerostomia and Its Implications
(eg, Ma Huang-Guarana, vitamin D synthetic,
and St John’s wort) cause dry mouth as a side
effect.6,8,9
Dry mouth can increase thirst, which can
lead to increased interdialytic weight gain
(IWG) and potentially fluid overload. In ad-
dition, xerostomia increases risk of oral dis-
eases, which can lead to other health compli-
cations in HD patients such as chewing and
swallowing problems, and a higher risk of
infection.10,11 People treated with HD, with
or without xerostomia, are at an increased risk
to develop dental caries, oral infections, and
edentulism, which can also affect the ability
of patients to eat and their quality of life.6,12
There are several pharmacological and non-
pharmacological interventions for the man-
agement of xerostomia in HD patients.13,14
The dialysis health care team should assess
the risk for and presence of xerostomia and
be familiar with the drugs associated with this
condition to prevent or manage it. The aim
of this article is to describe the risk of drug-
induced xerostomia in oral diseases and its
management in HD patients.
XEROSTOMIA: PATHOPHYSIOLOGY AND
ETIOLOGY
Xerostomia or the sensation of dry mouth
can be assessed by questioning individuals
directly.3,15 Xerostomia can be caused by
salivary gland hypofunction, resulting in a
decreased salivary flow rate (SFR), and can
be assessed through objective techniques
(eg, sialometry, scintigraphy).6 The parotid,
submandibular, and sublingual glands, and
hundreds of minor salivary glands secrete
saliva.3,16 Saliva is composed of water (99%),
electrolytes, glycoproteins, mucus, enzymes,
bacteria, among other inorganic and organic
compounds.15 The functions of saliva are to
prepare food for mastication and swallowing,
protect the soft and hard tissues of the mouth,
provide antibacterial activity, antifungal and
antiviral properties, maintain oral cavity pH
and tooth integrity, and assist with normal
taste sensation.3
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341
The flow of the saliva can be described
in terms of unstimulated (resting) and
stimulated (external factors promoting the
secretory mechanism).3 The parasympathetic
and sympathetic nervous systems control
the stimulation of saliva secretion. The
parasympathetic system stimulates the wa-
tery secretions, while the sympathetic system
stimulates a more viscous and reduced salivary
flow.3 Anxiety and stress stimulate the sympa-
thetic system, leading to higher sensation of
dryness. Oral dryness occurs by dehydration
of the oral mucosa due to decreased saliva
output from the salivary glands and a reduced
layer of saliva in the oral mucosa.3 Adults
have an average SFR of 0.3 to 0.5 mL/min
(range: 0.008-1.850 mL/min) amounting to
a daily salivary output of approximately
1 L.3 In salivary gland hypofunction, the SFR
decreases as the unstimulated SFR is less than
0.1 to 0.2 mL/min, and the stimulated whole
saliva flow rate is less than 0.7 mL/min.4
The signs and symptoms of xerostomia
include soreness, burning or difficulty with
swallowing, mild depapillation of the sides
of the tongue, thick saliva, and dry lips.1,3
This condition can be caused by different
mechanisms, including medications, age,
Sjögren syndrome, radiation therapy, and sys-
temic diseases (eg, human immunodeficiency
virus, diabetes, and kidney disease).1,17 A
meta-analysis comparing SFRs in younger and
older adults concludes that the aging process
is associated with decreased SFR, which is
independent of medication usage.18 Similarly,
a meta-analysis in patients with diabetes
reported a 46.1% prevalence of xerostomia
and a strong association between xerostomia
and diabetes (odds ratio: [OR] = 3.15; 95%
confidence interval [CI], 2.11; P < .001).19
XEROSTOMIA IN HD PATIENTS
People with ESRD who receive HD treat-
ment are affected by several factors that in-
crease the risk for xerostomia and reduce
the SFR. The prevalence of xerostomia in HD
patients ranges from 28.2% to 66.7%.6 The
342 TOPICS IN CLINICAL NUTRITION/OCTOBER–DECEMBER 2017
common causes of xerostomia experienced
by HD patients are related to drug toxicity
and polypharmacy, older age, salivary gland
atrophy and fibrosis, fluid restriction, and sys-
temic diseases such as diabetes and ESRD.6,20
Marques and colleagues21 performed a
cross-sectional study that assessed the factors
associated with reduced SFR in HD patients.
Saliva samples were collected to determine
the SFR; the Xerostomia Inventory and the
dialysis thirst inventory were administered to
determine the prevalence and severity of xe-
rostomia. The authors found that 35.9% of
the participants reported hyposalivation and
serum urea before the HD session was nega-
tively associated with SFR (r = −0.333; P =
.007).21 Calcium-phosphorous product (r =
−0.233; P = .033), use of sevelamer (phos-
phate binder) (r = −0.345; P = .002), and the
number of medications were negatively asso-
ciated with SFR. Also, they found a negative
association between dental caries and SFR (r
= −0.228; P = .011), and a tendency between
periodontal index (r = −0.185; P = .061) and
SFR was found.21
In the same way, Postorino and
colleagues20 studied the frequency of al-
teration in the salivary secretion in HD
patients. They found a high prevalence
of xerostomia (68%) in HD patients while
significant salivary secretion reduction was
observed in uremic subjects compared with
healthy subjects (3.30 ± 1.32 vs 4.09 ±
1.31 g/2 min; P < .02).20 They also reported
an association between reduced salivary
secretion with age and salivary gland atrophy.
Xerostomia increases thirst, which may
lead to an excess in daily fluid consumption
and increased IWG, that can cause fluid over-
load and cardiac complications.22,23 Bruzda
and colleagues23 analyzed whether hypos-
alivation is related to increased thirst and
weight gain in HD patients. They found that
in patients with hyposalivation (unstimulated
whole saliva <0.1 mL/min), the IWG was
higher than that in the no-hyposalivation
group (3.65 ± 1.78 vs 3.0 ± 1.4; P =
.042). Also, in all HD patients, IWG was posi-
tively correlated with xerostomia (r = 0.341;
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
P = .038) and thirst (r = 0.2; P = .041). An-
other cross-sectional study analyzed the clin-
ical significance and factors associated with
thirst and xerostomia.22 They found that thirst
was significantly associated with xerostomia
(r = 0.654; P = .000) and IWG was positively
correlated with thirst (r = 0.315; P = .042).
Also, they reported that xerostomia and thirst
negatively affect the patient’s health-related
quality of life.22
Xerostomia can affect food intake in HD
patients and can impact the ability to swal-
low, taste, and chew foods.24,25 In addition,
since HD patients have increased caloric and
protein requirements, they are at higher risk
of developing malnutrition.21 The prevalence
of protein-energy malnutrition or protein-
energy wasting is approximately 18% to 75%
in dialysis patients, which is characterized by
losses in protein and energy stores associated
with cachexia, increased hospitalization, and
mortality.26 Protein-energy wasting is caused
by a combination of factors, such as decreased
protein and energy intake (eg, due to alter-
ations in organs involved in nutrient intake,
depression, and anorexia), hypermetabolism
(eg, increased resting energy expenditure,
persistent inflammation, hormonal disorders,
and metabolic acidosis), comorbidities (eg,
diabetes, heart failure, and anemia), lifestyle
(eg, sedentarism), and dialysis procedure (eg,
due to nutrient losses into dialysate, dialysis-
related hypermetabolism, and loss of resid-
ual renal function).27 Adequate nutrition is
an important component to treat and prevent
protein-energy wasting. Hence, it is important
to understand how xerostomia and other oral
diseases may indirectly impact these patients’
nutritional status.
Chen and colleagues28 studied the relation-
ship between periodontal disease, malnutri-
tion, and inflammation in HD patients. They
found a significant association between the
malnutrition indicator used (serum albumin
level <3.6 g/dL) and inflammation (hsCRP
level >3.0 mg/dL) in participants with severe
periodontitis (35.3%; P = .005). Xerostomia
promotes the growth of bacteria and plaque
on teeth, increasing the risk of periodontal
 Drug-Induced Xerostomia and Its Implications
diseases.1,3 This may lead to tooth loss and
chewing and swallowing problems that can
impact the patient’s food intake and nutri-
tional status.
A population-based cross-sectional study
found that dry mouth interferes with the
food preferences and food selection of older
adults but is not associated with poor diet
quality.25 Another study that assessed the vari-
ables associated with xerostomia in HD pa-
tients found that xerostomia was significantly
associated with old age, poor appetite, activ-
ities of daily living, and the Charlson Comor-
bidity Index.22 Therefore, early detection and
management of xerostomia in HD patients can
help prevent the development of oral diseases
and other complications such as nutritional
disorders.
DRUG-INDUCED XEROSTOMIA
There are 400 to 1500 drugs that impact
the salivation process and have xerostomia
as a side effect.16,29 Some of these drugs
include anticholinergics/antimuscarinics, di-
uretics, antihypertensives, antiarrhythmics,
antidepressants and antipsychotics, antihis-
tamines, sedatives, anxiolytics, muscle relax-
ants, opioids, analgesics, and nonsteroidal
anti-inflammatory agents.29,30 These drugs
impact the salivary flow or secretion in
different pathways, including inhibition of
parasympathetic activity (anticholinergic ac-
tion), stimulation of the sympathetic nervous
system (sympathomimetic action), reduction
of blood volume (diuretics), antihypotensive
effect, and modulation in nerve transmission
within the central nervous system.16
Dose, duration, and the number of medica-
tions increase the risk of xerostomia.6,18 Xe-
rostomia is most prevalent in older people and
in people with polypharmacy such as the HD
patient.6,18 The prevalence of HD is higher in
elderly patients (84.8%, 75+ years of age) than
in younger patients (45-64 years of age, 59.7%,
and 65-74 years of age, 68.8%); which is prob-
ably related to longer progression of ESRD and
presence of 2 or more chronic diseases. 31,32
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343
Patients on HD commonly have other chronic
diseases that require prolonged drug ther-
apy, such as diabetes, hypertension, hyper-
lipidemia, and depression.33 The HD patients
take approximately 10 to 12 different medica-
tions per day, sometimes twice per day, which
can lead to an average of 19 pills per day.33
Table 1 summarizes some of the most com-
monly prescribed medications in HD patients
that may lead to dry mouth. In addition, the
presumed mechanism is provided.6,34,35,37
Villa and colleagues38 studied a group of
dental patients 18 years of age and older
with self-reported xerostomia. They found
an overall prevalence of xerostomia of 7%,
with higher odds of reporting dry mouth in
adults 51 years of age or older compared with
younger participants (OR = 1.6, 95% CI: 1.5-
1.8 vs OR = 0.5, 95% CI: 0.4-0.6; P < .04).
They reported that the prevalence of xeros-
tomia increased with the number of medica-
tions that patients were reportedly using (2-5
medications per day, OR = 2.6, 95% CI: 2.5-
2.9; P < .01).38 Polypharmacy in HD patients
appears to increase the risk of xerostomia.1
Xerostomia is an independent factor for oral
diseases and decreased quality of life.2,38,24
ORAL DISEASE AND XEROSTOMIA
The functions of saliva in the mouth in-
clude protection against bacteria and fungi,
transportation of nutrients and enzymes, rem-
ineralization of teeth, and lubrication of the
oral cavity, and as previously discussed, assists
with chewing and swallowing.4 Alterations in
these functions occurring secondary to xeros-
tomia or salivary gland hypofunction can re-
sult in oral diseases, such as lesions in the oral
mucosa, gingiva, and tongue; dental caries;
periodontal diseases; candidiasis; and bacte-
rial or fungal infections.6,39 Hopcraft and Tan4
suggest that drug-induced xerostomia affects
oral health through 2 pathways. The first path-
way is by reducing the salivary flow, resulting
in lower buffering of plaque acids.4 The sec-
ond pathway is by using strategies to man-
age xerostomia such as consuming cariogenic
344 TOPICS IN CLINICAL NUTRITION/OCTOBER–DECEMBER 2017

Table 1. Mechanism of Xerogenic Effect for Some Common Medications Used by Patients in
Hemodialysis Treatment3,8,30,34,35,36

Mechanism
of Xerogenic
drugs Drug Class Drug Name

Anticholinergic Antidepressants • Tricyclic antidepressants (eg, amoxapine,

action doxepin, clomipramine, amitriptyline)
Antiemetics • Ondansetron
• Haloperidol
• Metoclopramide
Sympathomimetic Antidepressants/ • Serotonin reuptake inhibitors (eg, setraline,
actions Antianxiety citalopram)
• Serotonin agonist (eg, loxapine, risperidone)
• Benzodiazepine
• Alprazolam
Antihypertensives • β-Blocker (eg, atenolol, metoprolol)
Proton pump inhibitors • Omeprazole
• Lansoprazole
• Pantoprazole
Opioids • Tramadol
• Morphine
Antihyperlipidemic • HMG Co-A reductase inhibitors (eg,
simvastatin, atorvastatin)
Bronchodilators/ • Albuterol
decongestants • Ephedrine
Other xerogenic Diuretics • Loop diuretics (eg, furosemide, bumetanide,
mechanism torsemide)
• Thiazide diuretics (eg, hydrochlorothiazide)
Antihypertensives • Calcium channel blocker (eg, amlodipine,
nifedipine)
• ACE inhibitors (eg, lisinopril, ramipril,
enalapril, perindopril, losartan, irbesartan)
Other • Synthetic vitamin D (eg, calcitriol,
paricalcitol)
• Anticonvulsant (eg, gabapentin)
• Antihistamines
• Muscle relaxant agents

foods and drinks that can lead to increased
demineralization, resulting in dental caries.4
People in HD treatment have a higher
risk of infections because of their vulnera-
ble immune function.10 In addition, they may
have other systemic diseases, such as dia-
betes, hyperparathyroidism, and cardiovascu-
lar diseases, that increase the inflammatory
process in the body, which has an impact
on the immune function.10 Therefore, they
are at a higher risk for the development of
oral diseases. The more common oral dis-
eases and oral symptoms documented for
dialysis patients are xerostomia, taste distur-
bances, uremic odor, tongue coating, mucosal
petechial/ecchymosis, mucosal inflammation,
periodontitis, and oral ulceration.40 Immune
dysfunction secondary to defects in lympho-
cyte and monocyte function and malnutrition
have been suggested as possible reasons for

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 Drug-Induced Xerostomia and Its Implications
poor oral health in uremic patients.40 Mal-
nutrition can lead to reduced synthesis of
antibodies in these patients.28 In the same
way, a long length of time since the initiation
of dialysis might increase gingival inflamma-
tion, while secondary hyperparathyroidism
has been suggested as a possible cause of pe-
riodontal disease in dialysis patients.11,40
A study in uremic patients with and with-
out diabetes on HD treatment evaluated
the oral manifestations and salivary pH in
this population.10 They found a significantly
higher incidence of caries (6.36 ± 3.09; P
< .001), periodontal risk (23.4%; P < .015),
and a lower salivary pH (17%; P < .056)10
in the uremic group with diabetes compared
with the group without diabetes. However,
other studies have found a low prevalence
of dental caries in chronic kidney disease pa-
tients on HD treatment due to increased sali-
vary pH.41,42 In these patients, the urea level
in saliva increases, interfering with the acid
formation by cariogenic bacteria, thereby de-
creasing the cariogenic activity.41,42 The HD
treatment reduces the salivary urea concen-
tration by 60%.42 However, the level is still
higher than in a healthy person.41
Another case-control study of 128 patients
with and without diabetes in HD treatment
examined the dental condition and oral man-
ifestations of these patients.43 Subjects with
diabetes compared with those without had a
higher prevalence of caries (Decayed, Miss-
ing, and Filled Teeth index, 19.93 ± 8.19
vs 14.26 ± 9.16; P = .001), Community Pe-
riodontal Index (3 or more missing teeth
20.9% vs 3.5%; P = .055), dry mouth (5.07
± 1.56 vs 4.24 ± 1.73; P = .40), taste changes
(5.48 ± 2.56 vs 3.72 ± 2.44; P = .004), and
tongue/mucosa pain (5.36 ± 1.99 vs 4.22 ±
2.00; P = .018).43 Another study of patients
in HD did not find an association between
HD and periodontal disease; however, they
reported a higher incidence of difficulty in
biting or chewing (62.8%), eating discomfort
(60.5%), swallowing problems (58.1%), de-
creased taste sensation (90.8%), unsatisfying
diets (93.0%), and fair or poor self-perceived
health (72.7%).44 These findings highlight the
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345
challenges that xerostomia may represent in
patients on HD treatment. Thus, it is impor-
tant for health care providers to be aware of
the available treatments or interventions for
the management of this condition.
MANAGEMENT OF XEROSTOMIA IN HD
PATIENTS
Management of xerostomia in HD patients
can be determined by the severity of the symp-
toms, etiology, and patients’ preferences.45
There are several strategies and treatments
that have shown effectiveness in the manage-
ment and prevention of this problem.13,14,45
The interventions recommended for HD pa-
tients can be divided into 3 areas: stimu-
lation of the salivary glands, saliva substi-
tutes, and the restoration of salivary function.6
However, if the cause of xerostomia is drug-
induced, the recommendation is to identify
the drugs with dry mouth as a side effect
and adjust or modify the pharmacological
therapy.30
The interventions to stimulate the salivary
secretion include chewing sugar-free gum,
acupressure, electrostimulation, use of pilo-
carpine and cevimeline, and drugs that target
angiotensin II.6,13,14,30 Chewing sugar-free fla-
vored gum helps stimulate the salivary flow
as a response to gustatory and mechanical
stimuli.13 A randomized crossover trial in a
group of HD patients evaluated the efficacy
of using sugar-free (with xylitol and sorbitol)
chewing gum or a saliva substitute on thirst,
xerostomia, and IWG for 6 weeks.46 The use
of chewing gum significantly decreased the
level of xerostomia (from 29.9 ± 9.5 to 28.1
± 9.1; P = .005) and thirst (from 16.6 ± 5.1
to 15.4 ± 4.8; P = .005), while the saliva sub-
stitute only had the effect of decreasing thirst
(from 16.6 ± 5.1 to 15.5 ± 5.0, P = .005).
The effect of chewing gum or using the saliva
substitute did not have a significant effect on
the IWG in these participants.46
There are a variety of salivary substitutes
(ie, artificial saliva) based on hydroxyethyl
cellulose, mucin, carboxymethyl cellulose,
346 TOPICS IN CLINICAL NUTRITION/OCTOBER–DECEMBER 2017
xanthan gum, or polyethylene glycol.6 The
mechanism of action of these substitutes is
to restore/replace saliva, lubricate, moisten,
clean, and provide a coating on oral mucosa.6
A randomized double-blind trial on adults with
dry mouth symptoms divided subjects into
3 experimental groups (artificial saliva, cit-
ric acid, and distilled water control group) to
compare the efficacy of saliva substitute and
citric acid in long-term therapy for dry mouth
and drug-induced xerostomia.47 The partici-
pants used the therapy 4 times a day for 30
days, 1 hour after eating and brushing their
teeth; they also had to keep a journal to moni-
tor the symptoms and efficacy of the therapy.
The use of saliva substitute and the citric acid
relieved dry mouth significantly after 15 min-
utes (67.83 and 61.67 vs 34.89; P < .0001)
and after 1 hour (54; P = .0004 and 66.39;
P < .001 vs 30.94) but citric acid provided a
longer effect.47
Similarly, Salom and colleagues48 evaluated
the efficacy, safety, and acceptability of a new
saliva substitute with the same composition as
eggs (same proteins: ovalbumin, ovotransfer-
rin, ovomucoid, ovomucin, ovostatin, and en-
zymes) that helps build a gel to restore saliva
viscosity and provide a balanced environment
(Novasial, UNITHER Pharmaceuticals, Amiens
Cedex, France). They compared this saliva
equivalent with an oxygenated glycerol tri-
ester oral spray (Aequasyal Eisai, Montesson,
France) and a moisturizing spray (Biotene
GlaxoSmithkline Santé Grand Public, Evreux,
France). They found that Novasial was most
effective in decreasing oral dryness (19.5%,
P < .0001) when compared with Aequasyal
(10%) and with Biotene (13%). Also, they re-
ported a better adherence to Novalsial.48 Al-
ternatively, there are some suggested natural
salivary substitutes, such as milk, olive oil, aloe
vera, and marshmallow root but there is lim-
ited research documenting their safe use or
efficacy in patients with xerostomia.49
The restoration of salivary function is the
process when the salivary function is re-
stored by salivary gland regeneration, tis-
sue engineering of salivary glands, and gene
therapy.6,30 However, these therapies are still
Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
in the early experimental stages and more
studies are necessary to determine the effi-
cacy and safety in HD patients. Other alterna-
tive therapies are emerging but more studies
are needed. For example, De Rosi et al50 evalu-
ated a natural formulation containing tea cate-
chins in patients with xerostomia and Sjögren
syndrome. They found that participants in the
intervention group had an increase in the stim-
ulated and unstimulated SFR through all the
intervention (8 weeks).50 Another interven-
tion in patients with xerostomia explored the
effect of a device that delivers electrostimula-
tion to the lingual nerve for an 11-month pe-
riod. The device resulted in an improvement
of xerostomia and salivary output in these
subjects.51 Alternatively, acupressure stimu-
lates the autonomic nervous system secreting
neurotransmitters and neuromodulations that
increase saliva production.6 This alternative
therapy has shown some benefits in decreas-
ing dry mouth, but sufficient data about long-
term use are not available.6,14 Pilocarpine, ce-
vimeline, and angiotensin-converting enzyme
inhibitors have shown some benefits in de-
creasing dry mouth symptoms, but the studies
available are inconclusive.6,30
CONCLUSION AND IMPLICATIONS
Xerostomia is a common oral disease in
HD patients and affects different aspects of
their health and quality of life. The most com-
mon cause for xerostomia in this population is
drug-induced due to polypharmacy. Xerosto-
mia can lead to serious health problems, such
as oral diseases, malnutrition, and fluid over-
load, and these can increase the mortality and
morbidity risk in HD patients and decrease
their quality of life. There are several strate-
gies for the management of xerostomia that
target different aspects of this condition.
Health care providers should assess for xe-
rostomia symptoms in their routine checks of
HD patients. They should combine objective
with subjective strategies to detect this con-
dition. Also, they should be aware of the va-
riety of treatments and interventions that are
 Drug-Induced Xerostomia and Its Implications
available for the management of this condi-
tion. Registered dietitian nutritionists play an
important role in the early detection, preven-
tion, and management of xerostomia. Regis-
tered dietitian nutritionists in the clinical set-
ting can include oral health screening as part
of the nutrition care process (nutrition screen-
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