When should I consider referring a patient with xerostomia to a specialist for further evaluation?

Consider referring a patient with xerostomia to a specialist for further evaluation if:

• There is doubt about the diagnosis or management of the oral dryness or related oral problems.
• Oral problems are causing a decrease in oral intake or there are concerns about nutrition.
• There are persistent severe symptoms not adequately relieved by initial management measures such as saliva stimulants or substitutes.
• There are signs suggestive of serious underlying conditions such as oral lumps, persistent ulceration, or red or red and white patches in the oral cavity, which may indicate malignancy and require urgent referral.
• There is suspicion of an underlying systemic condition (e.g., Sjögren’s syndrome) contributing to xerostomia.

Initial management should include addressing reversible causes (e.g., drug side effects, dehydration, anxiety, candida infection) and simple saliva stimulatory measures. If these are insufficient or if any of the above concerns arise, specialist referral is warranted NICE CKS,NICE NG12.