From the Guidelines
Xerostomia treatment should prioritize non-pharmacological stimulation, such as using sugar-free gum or lozenges to stimulate saliva production, and avoiding alcohol, caffeine, and tobacco, as recommended by the EULAR guidelines 1. For patients with mild glandular dysfunction, non-pharmacological glandular stimulation is the preferred first-line therapeutic approach, using gustatory stimulants and/or mechanical stimulants, as it can stimulate glandular function 1. In patients with moderate glandular dysfunction, pharmacological stimulation with muscarinic agonists, such as pilocarpine or cevimeline, may be considered, although the evidence is limited and the safety profile is unfavorable 1. Key aspects of xerostomia management include:
- Identifying and addressing underlying causes, such as medications or medical conditions
- Increasing water intake and using sugar-free gum or lozenges to stimulate saliva production
- Avoiding alcohol, caffeine, and tobacco, which worsen dryness
- Using over-the-counter saliva substitutes, such as Biotène or XyliMelts, for temporary moisture
- Practicing meticulous oral hygiene, including regular dental check-ups, fluoride treatments, and using alcohol-free mouthwash, to prevent tooth decay and oral infections 1. The treatment approach should be tailored to the severity of symptoms and underlying cause, with combination therapy often providing the best relief, and humidifiers at night can help prevent nighttime dryness.
From the FDA Drug Label
Pilocarpine hydrochloride tablets are indicated for 1) the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; and 2) the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome. A 12 week randomized, double-blind, placebo-controlled study in 207 patients was conducted in patients whose mean age was 58. 5 years with a range of 19 to 77; the racial distribution was Caucasian 95%, Black 4%, and other 1%. In this population, a statistically significant improvement in mouth dryness occurred in the 5 mg and 10 mg pilocarpine hydrochloride tablet treated patients compared to placebo treated patients After 6 weeks of treatment, statistically significant global improvement of dry mouth was observed compared to placebo After 12 weeks of treatment, statistically significant global improvement of dry mouth was observed at a dose of 5 mg compared with placebo.
Xerostomia Treatment: Pilocarpine hydrochloride tablets are indicated for the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck and for the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome.
- The recommended dose is 5 mg, four times a day 2.
- Statistically significant improvement in mouth dryness was observed in patients treated with 5 mg and 10 mg of pilocarpine hydrochloride tablets compared to placebo treated patients 2.
- Global improvement of dry mouth was observed at a dose of 5 mg compared with placebo 2.
From the Research
Xerostomia Treatment Options
Xerostomia, or dry mouth, is a condition that can be caused by various factors, including certain medications, radiation, and diseases such as Sjogren's syndrome 3, 4, 5. The treatment of xerostomia depends on the underlying cause and the functionality of the salivary glands 4.
Treatment Modalities
Some of the treatment modalities available for xerostomia include:
- Saliva substitutes, such as Biotene 3
- Salivary stimulants, such as pilocarpine 3, 4, 6
- Mouth rinses 6
- Sugar-free candy 6
- Ongoing dental care and caries prevention 3
- Review of the current prescription drug regimen and possible elimination of drugs having anticholinergic effects 3
Role of Advanced Polymeric Materials
Advanced polymeric materials play a crucial role in the treatment of xerostomia, particularly in the development of saliva substitutes and novel drug delivery systems 5. These materials can function as thickening and lubricating agents, or as mucoadhesive polymers that prolong the treatment effect 5.
Importance of Dental Care
Dental care is essential for individuals with xerostomia, as they are at increased risk of developing dental caries and other oral health problems 3, 7. A thorough intraoral and extra-oral clinical examination is important for diagnosis, and ongoing dental care can help prevent complications associated with xerostomia 3.