From the Guidelines
Dry mouth should be treated with dietary modifications and topical measures, such as saliva substitutes and mouth rinses, as recommended by the NCCN panel for all patients with dry mouth (sicca syndrome) 1.
Treatment Approaches
The treatment of dry mouth depends on its cause and severity. For mild cases, simple measures like sipping water frequently throughout the day, chewing sugar-free gum, or using alcohol-free mouthwash can provide relief.
- Over-the-counter saliva substitutes such as Biotène, Mouth Kote, or Oasis are effective for temporary relief.
- For medication-induced dry mouth, speaking with a doctor about adjusting dosages or switching medications is recommended.
- Prescription options include pilocarpine (Salagen) 5-10mg three times daily or cevimeline (Evoxac) 30mg three times daily, which stimulate saliva production 1.
Management of Symptoms
Using a humidifier at night, avoiding caffeine, alcohol, and tobacco, and limiting salty or spicy foods can help manage symptoms.
- Good oral hygiene is essential, including brushing twice daily with fluoride toothpaste, flossing daily, and using alcohol-free fluoride rinses to prevent tooth decay.
- Dry mouth occurs when salivary glands don't produce enough saliva, often due to medications, radiation therapy, certain diseases like Sjögren's syndrome, or aging.
Underlying Cause
Treating the underlying cause while managing symptoms is the most effective approach for long-term relief.
- For patients with moderate or severe symptoms, prednisone and systemic sialagogues (such as cevimeline or pilocarpine) are options, and referral to rheumatology and dentistry is recommended 1.
- In severe cases, inpatient care can be considered, and holding immunotherapy is recommended until symptoms become grade 1 1.
From the FDA Drug Label
INDICATIONS AND USAGE 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 ... 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.
Treatment for dry mouth is pilocarpine hydrochloride tablets, which have been shown to provide statistically significant improvement in mouth dryness and global improvement of dry mouth in patients with salivary gland hypofunction caused by radiotherapy for cancer of the head and neck, and in patients with Sjogren’s Syndrome, at doses of 5 mg and 10 mg 2.
From the Research
Treatment Options for Dry Mouth
- Saliva substitutes containing xylitol can help reduce symptoms and complications of dry mouth 3
- Prescription cholinergic agonists, such as cevimeline, can stimulate salivary secretion and provide relief from xerostomia symptoms 4
- Good oral hygiene methods, such as regular brushing and flossing, can help prevent oral conditions associated with dry mouth 3, 5
- Altering medications with anticholinergic properties can help manage dry mouth symptoms 6
- Salivary stimulants, such as pilocarpine, can be more beneficial than salivary substitutes in patients with residual salivary gland function 6
Non-Pharmacological Interventions
- Educating patients on oral health practices and the importance of good oral hygiene can help prevent dry mouth complications 3, 7
- Encouraging patients to stay hydrated and avoid dehydration can help reduce dry mouth symptoms 3, 6
- Avoiding alcohol and caffeine intake can help reduce dry mouth symptoms 3