From the Guidelines
Xerostomia, or dry mouth, should be managed with a combination of symptomatic relief using topical therapies, such as artificial tears and saliva substitutes, and systemic therapies, including pilocarpine or cevimeline, to stimulate saliva production and improve quality of life. The treatment approach should be individualized based on the severity of symptoms and the underlying cause of xerostomia. For mild cases, staying hydrated, chewing sugar-free gum, and using alcohol-free mouthwashes can provide relief [ 1 ]. Over-the-counter saliva substitutes like Biotène or XyliMelts can temporarily moisturize the mouth.
For medication-induced xerostomia, consulting a healthcare provider about adjusting dosages or switching medications is essential. Prescription options include pilocarpine (Salagen) 5-10mg three times daily or cevimeline (Evoxac) 30mg three times daily, which stimulate saliva production by activating muscarinic receptors in salivary glands [ 1 ]. However, these medications may cause side effects like sweating and digestive issues.
Patients should also practice meticulous oral hygiene, avoid alcohol, tobacco, caffeine, and spicy foods that can worsen dryness, and attend regular dental check-ups, as xerostomia increases the risk of tooth decay and oral infections due to reduced saliva's protective functions [ 1 ]. Untreated xerostomia can significantly impact quality of life, causing difficulties with speaking, eating, and swallowing, while increasing the risk for oral health complications.
In cases of severe xerostomia, particularly in patients with Sjögren's syndrome, a multidisciplinary approach involving various health professionals is essential, with a central role for specialists in autoimmune diseases [ 1 ]. The first therapeutic approach to dryness should be symptomatic relief using topical therapies, and systemic therapies may be considered for the treatment of active systemic disease.
Overall, the management of xerostomia requires a comprehensive approach that addresses the underlying cause, manages symptoms, and improves quality of life, with the most recent and highest quality study [ 1 ] guiding the treatment approach.
From the Research
Xerostomia Treatment Options
- Xerostomia, also known as dry mouth, can be treated with various medications, including pilocarpine, cevimeline, and bethanechol 2, 3, 4.
- These medications are cholinergic agonists that stimulate salivary secretion, increasing salivary flow rates and reducing symptoms of xerostomia 2, 5.
Comparison of Treatment Options
- A study comparing pilocarpine and cevimeline found that both medications increased salivary secretion, but there was no significant difference between the two 3.
- Another study found that bethanechol increased stimulated saliva more than pilocarpine, and cevimeline had fewer side effects than pilocarpine 4.
- Cevimeline has been shown to have a longer-lasting salivation effect than pilocarpine, with fewer adverse events 5.
Administration and Delivery
- Oral administration of pilocarpine and cevimeline has been shown to be effective in increasing salivary flow rates and reducing symptoms of xerostomia 2, 5.
- Local delivery of saliva-stimulating agents, such as oral disintegrating tablets, may provide rapid onset of action and reduce systemic side effects 6.