What are the treatment options for dry mouth (xerostomia)?

From the Guidelines

Treatment of dry mouth (xerostomia) should start with non-pharmacological glandular stimulation, using gustatory stimulants (sugar-free acidic candies, lozenges, xylitol) and/or mechanical stimulants (sugar-free chewing gum), as recommended by the EULAR guidelines 1.

Non-Pharmacological Interventions

• Increasing fluid intake throughout the day
• Avoiding dehydrating substances like caffeine, alcohol, and tobacco
• Using sugar-free gum or candies containing xylitol to stimulate saliva production
• Utilizing saliva substitutes such as Biotène, XyliMelts, or Mouth Kote for immediate relief

Pharmacological Interventions

• Prescription medications like pilocarpine (Salagen, 5-10mg three times daily) or cevimeline (Evoxac, 30mg three times daily) may be prescribed to stimulate salivary glands for patients with moderate glandular dysfunction 1
• Baseline evaluation of salivary gland function is recommended before starting treatment for oral dryness, and the therapeutic approach should be driven by the baseline measurement of salivary glandular function 1

Additional Recommendations

• Regular dental check-ups are essential as dry mouth increases the risk of tooth decay
• If dry mouth is medication-induced, the doctor might adjust dosages or switch medications
• For underlying conditions like Sjögren's syndrome, treating the primary disease is crucial, and a multidisciplinary approach involving various health professionals is essential 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. 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 Patients’ assessments of specific dry mouth symptoms such as severity of dry mouth, mouth discomfort, ability to speak without water, ability to sleep without drinking water, ability to swallow food without drinking, and a decreased use of saliva substitutes were found to be consistent with the significant global improvement described

The treatment options for dry mouth (xerostomia) include pilocarpine hydrochloride tablets. The recommended dosage is 5 mg four times a day (20 mg/day) for 6 weeks, which can be increased to 7.5 mg q.i.d..

• Key benefits of pilocarpine hydrochloride tablets include:
  • Global improvement of dry mouth
  • Reduction in severity of dry mouth
  • Improvement in mouth discomfort
  • Ability to speak without water
  • Ability to sleep without drinking water
  • Ability to swallow food without drinking
  • Decreased use of saliva substitutes 2 2

From the Research

Treatment Options for Dry Mouth (Xerostomia)

• The treatment options for dry mouth include medication, topical therapies, and lifestyle changes.
• Medications such as pilocarpine 3, 4, 5, 6 and cevimeline 4 are commonly used to stimulate salivary secretion and relieve symptoms of xerostomia.
• Topical therapies such as saliva substitutes, lozenges, sprays, mouthrinses, gels, oils, chewing gum, and toothpastes may also be effective in reducing dry mouth symptoms 7.
• Oxygenated glycerol triester (OGT) saliva substitute spray has shown evidence of effectiveness compared to an electrolyte spray 7.
• Chewing gum may increase saliva production in those with residual secretory capacity, but there is no evidence that it is more or less effective than saliva substitutes 7.
• Integrated mouthcare systems and oral reservoir devices may be helpful, but further research is required to confirm their effectiveness 7.

Medication-Induced Xerostomia

• Medication-induced xerostomia is a common issue, especially in older adults, and can be caused by various medications, including anticholinergics, antihistamines, and decongestants 4.
• Changing medications or reducing doses may help alleviate dry mouth symptoms 4.
• Healthcare professionals should investigate dry mouth symptoms in their patients and consider multidisciplinary, preventive care-oriented approaches to manage xerostomia 4.

Radiation-Induced Xerostomia

• Radiation therapy to the head and neck region can cause xerostomia, and pilocarpine has been shown to be moderately effective in relieving symptoms 3, 6.
• Pilocarpine may also help reduce the severity of xerostomia when administered during radiation therapy, but further investigation is needed 3.