What are the treatments for dry mouth (xerostomia)?

From the Guidelines

Treatments for dry mouth (xerostomia) should prioritize lifestyle changes, including increasing fluid intake and using a humidifier, as well as medications like pilocarpine or cevimeline, as recommended by the most recent guidelines 1. To manage dry mouth, it is essential to increase fluid intake by sipping water frequently throughout the day and using a humidifier at night. Avoiding alcohol, caffeine, tobacco, and salty or spicy foods that can worsen dryness is also crucial. For symptom relief, trying over-the-counter saliva substitutes like Biotène or XyliMelts, or using sugar-free gum or candies containing xylitol to stimulate saliva production can be beneficial. Some key points to consider when managing dry mouth include:

• Increasing fluid intake and using a humidifier to prevent dryness
• Avoiding irritants like alcohol, caffeine, and tobacco
• Using saliva substitutes or stimulants like sugar-free gum or xylitol
• Practicing good oral hygiene, including brushing twice daily with fluoride toothpaste and using alcohol-free mouthwash
• Considering prescription medications like pilocarpine (Salagen) 5-10mg three times daily or cevimeline (Evoxac) 30mg three times daily if symptoms persist, as recommended by recent guidelines 1. It is also important to note that dry mouth can be a symptom of an underlying condition, such as Sjögren's syndrome, or a side effect of certain medications, and if symptoms persist despite these measures, consulting a healthcare provider is necessary 1.

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. In both studies, some patients noted improvement in the global assessment of their dry mouth, speaking without liquids, and a reduced need for supplemental oral comfort agents A 12-week, randomized, double-blind, parallel-group, placebo-controlled study was conducted in 256 patients (14 men, 242 women) whose mean age was 57 years with a range of 24 to 85 years. 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.

The treatment for dry mouth (xerostomia) is pilocarpine hydrochloride tablets. The dosage is 5 mg four times a day (20 mg/day). Pilocarpine has been shown to provide statistically significant global improvement of dry mouth compared to placebo 2, 2, 2.

• Key benefits of pilocarpine include:
  • Improvement in global assessment of dry mouth
  • Ability to speak without liquids
  • Reduced need for supplemental oral comfort agents
  • Improvement in specific dry mouth symptoms such as severity of dry mouth, mouth discomfort, ability to sleep without drinking water, and decreased use of saliva substitutes.

From the Research

Treatments for Dry Mouth (Xerostomia)

• Topical therapies such as lozenges, sprays, mouthrinses, gels, oils, chewing gum, or toothpastes can be used to treat dry mouth symptoms 3
• Saliva stimulants and saliva substitutes are two broad categories of interventions, with oxygenated glycerol triester (OGT) saliva substitute spray showing evidence of effectiveness compared to an electrolyte spray 3
• Chewing gum can increase saliva production in those with residual secretory capacity, but there is no evidence that gum is more or less effective than saliva substitutes 3
• Integrated mouthcare systems and oral reservoir devices may be helpful, but further research is required to confirm this 3

Non-Pharmacological Interventions

• Acupuncture may result in a small increase in saliva production in patients with dry mouth following radiotherapy, but there is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms 4
• Electrostimulation devices have insufficient evidence to determine their effects on dry mouth symptoms or saliva production in patients with Sjögren's Syndrome 4
• A newly developed pastille containing four polysaccharides can increase the salivary flow rate and relieve symptoms of dry mouth 5

Pharmacological Interventions

• Salagen and Evoxac are FDA-approved salivary stimulants that can be effective in treating dry mouth symptoms, but require awareness of their indications, contraindications, potential adverse effects, and patient tolerance 6
• Oral pilocarpine can improve symptoms of xerostomia after radiation therapy in about 50% of patients, but has limited efficacy, adverse effects, and high cost 7