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Wednesday, September 21, 2011

Management of Treatment-Associated Dry Mouth

Oral Medicine clinicians at Penn Medicine are managing patients who experience dry mouth as a result of treatment for a variety of conditions, including cancer, autoimmune diseases such as Sjogren’s syndrome and lupus, sinus disease and allergic disorders. Side effects from commonly used drugs including antihistamines, antidepressants and tranquilizers are also a major cause of dry mouth.

Dry mouth is a condition marked by the abnormal reduction of saliva, and is the leading treatment-related side effect in the oral cavity. Symptoms of dry mouth include difficulty eating and swallowing, inflammation of the lining of the mouth, mucosal fissures, hoarseness and an increase in tooth decay and gum disease.

Patients with cancer are especially susceptible to dry mouth, because of radiation therapy, radioactive iodine therapy (for thyroid cancer) and chemotherapy, all of which can cause profound, persistent hyposalivation.

In the general population, dry mouth is typically the result of medication use; more than 400 drugs report dry mouth as an adverse event. Mouth breathing, obesity and other physical conditions have also been associated with dry mouth.

Penn oral medicine clinicians approach the management of dry mouth on an individual basis, depending upon the originating condition or circumstance. Patients with salivary glands damaged by radiation therapy, for example, may receive a combination of sialogogues—pharmacologic salivary stimulants—oral moisturizers and salivary substitutes.

Case Study

Mr. G, a 57-year-old man with a history of non-Hodgkin’s lymphoma of the neck, was referred to the Division of Oral Medicine of the Department of Oral and Maxillofacial Surgery for an evaluation after he experienced profound hyposalivation following radiation therapy. In addition to chapped and cracked lips, mucosal fissures
and difficulty swallowing, Mr. G’s tongue became cracked,
swollen and inflamed (Figure 1).

He reported that he had difficulty swallowing and speaking and that the constant perception of dryness was a great source of anxiety and irritation. After an evaluation, Mr. G was prescribed pilocarpine, a sialogogue, and a combination of polyvinylpyrrolidone and hyaluronic acid to hydrate and soothe his oral mucosa. At his follow-up visit, Mr. G reported a substantial improvement in symptoms and improved quality of life.

Faculty Team

The Department of Oral and Maxillofacial Surgery at Penn Medicine includes a group of multidisciplinary specialists who provide medical, surgical and specialty dental services. Penn’s oral and maxillofacial team specializes in non-surgical and surgical treatment of diseases, disorders, injuries and esthetic aspects of the mouth, teeth, jaws and face.

Treating Dry Mouth at Penn Medicine

Thomas P. Sollecito, DMD
Chief, Oral Medicine Division
Professor of Oral Medicine

Martin S. Greenberg, DDS
Professor of Oral Medicine

Eric T. Stoopler, DMD
Director, Oral Medicine Residency Program
Associate Professor of Oral Medicine


Oral and Maxillofacial Surgery
Hospital of the University of Pennsylvania
5 White
3400 Spruce Street
Philadelphia, PA 19104

Penn Medicine Radnor
250 King of Prussia Road
Radnor, PA 19087

To refer a patient to Penn Medicine, please contact Penn PhysicianLinkTM here or at 877-937-7366.

Download a pdf of this Clinical Briefing.


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