Salivary flow and its relation with oral symptoms in terminally ill patients

BACKGROUND. Patients with terminal malignant disease commonly report hyposa livation or xerostomia. This leads to "dry mouth," fungal infection, and mu cosal abnormalities. To the authors' knowledge oral symptomatology and find ings have not been correlated previously with accurate salivary flow measur ements. METHODS. Measurement of stimulated parotid salivary now rate and clinical r ecording of oral symptoms within 24 hours from the time of hospital admissi on were obtained in 48 terminally ill cancer patients. Subjective reporting of symptoms by patients, parotid salivary flow rate, clinical recording of dental status, presence of candidiasis, angular cheilitis, and dryness of the floor of the mouth were obtained. RESULTS. A clinical diagnosis of oral candidiasis was made tentatively in 9 4% of patients, and 50% of the patients were found to have angular cheiliti s. Thirty-one of 45 evaluable patients (68%) reported a sensation of oral d ryness. Sixteen of the 48 patients (33%) had no saliva at the floor of the mouth. Analysis of individual salivary flow rates was stratified into 3 lev els of secretion: 0, < 0.2, and greater than or equal to 0.2 mL/minute. Sym ptoms were found to correlate with salivary flow rates. CONCLUSIONS, In the current study, symptoms were found to be most severe in the patients with xerostomia followed by those patients with hyposalivatio n. Treatment should be directed individually to each group of patients usin g either salivary substitutes or stimulants. The rate of incidence of oral pathologic findings may be higher than formerly recognized. (C) 2000 Americ an Cancer Society.