Xerostomia in patients on chronic hemodialysis: An update.

Xerostomia, or dryness of oral cavity, is relatively common in patients on chronic hemodialysis and significantly impairs their quality of life. Xerostomia is often the consequence of reduced salivary flow resulting from atrophy and fibrosis of the salivary glands, an event that is of uncertain origin. Many medications commonly used in dialysis patients may also cause or exacerbate xerostomia. Its consequences may be serious and disturbing and include difficulties in chewing, swallowing, tasting, and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries, and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in the quality of life. Therapeutically, stimulation of the salivary glands to increase the production of saliva mechanically by chewing-gum, mouthwash, acupressure, or transcutaneous electrical stimulation has had modest success. However, the long-term effectiveness of such treatments still needs to be investigated and defined. Xerostomia remains a frustrating and disturbing symptom for patients on hemodialysis. Further efforts should be made to find the causes and the mechanisms of the reduced salivary flow observed in patients on chronic hemodialysis.