Introduction

Recent clinical evidence suggests that Xerostomia in Multiple Sclerosis is a significant complaint that adversely affects oral health, nutritional intake, and overall quality of life. This dry mouth condition often results from neuroendocrine and autonomic dysregulation inherent to the disease. While many clinicians previously linked these symptoms to anxiety, a new comparative study explores the specific role of salivary cortisol as a physiological stress biomarker.

The Role of Salivary Cortisol

Researchers conducted a comparative cross-sectional study involving 39 patients with multiple sclerosis. They divided the group into 23 patients with xerostomia and 16 without. The team used enzyme-linked immunosorbent assay (ELISA) to quantify unstimulated whole saliva cortisol levels. Furthermore, they assessed xerostomia severity using the Abslang test and the Short Xerostomia Inventory (SXI).

The results showed that patients with xerostomia had significantly higher salivary cortisol levels compared to the control group. Specifically, levels were 8.5 ± 1.8 ng/mL in the xerostomia group versus 4.7 ± 2.2 ng/mL in those without the condition. Surprisingly, the xerostomia group reported significantly lower anxiety scores than the controls. Consequently, this suggests that salivary cortisol levels reflect physiological neuroendocrine stress or autonomic dysregulation rather than subjective anxiety alone.

Managing Xerostomia in Multiple Sclerosis

Since the study highlights a lack of association between dry mouth and self-reported anxiety, clinicians must look beyond psychological factors. Salivary cortisol emerges as a potential biological marker to assist in oral health assessments. Therefore, integrating biological stress markers into routine check-ups could improve the management of Xerostomia in Multiple Sclerosis.

Early identification of salivary gland dysfunction allows for proactive interventions. Dentists and neurologists should collaborate to monitor these patients, as high cortisol may indicate underlying physiological stress that warrants specific therapeutic strategies. Although this cross-sectional design cannot confirm causality, it supports the importance of neuroendocrine monitoring in neurodegenerative care.

Frequently Asked Questions

How common is xerostomia in Multiple Sclerosis?

Xerostomia is a frequent clinical complaint in MS patients, often stemming from medication side effects or autonomic nervous system dysregulation associated with the disease.

Why is salivary cortisol higher in MS patients with dry mouth?

Higher cortisol levels likely reflect physiological stress or dysregulation of the neuroendocrine system, specifically the hypothalamic-pituitary-adrenal (HPA) axis, which influences salivary gland function.

Does anxiety cause dry mouth in MS?

While anxiety can contribute to dry mouth, this study found that MS patients with severe xerostomia actually had lower anxiety scores, indicating that biological factors often outweigh subjective stress.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Khabazian T et al. Salivary cortisol as a neuroendocrine stress biomarker for xerostomia in multiple sclerosis patients: a comparative cross-sectional study. BMC Oral Health. 2026 Apr 07. doi: 10.1186/s12903-026-08280-z. PMID: 41947123.