How is xerostomia treated?

Treatment of Xerostomia

The treatment of xerostomia should focus on alcohol-free rinses, maintaining a low-sucrose diet, avoiding caffeine, spicy and acidic foods, tobacco, and ensuring adequate hydration with fluoridated water, while considering pharmacologic options like pilocarpine for severe cases. 1

General Management Strategies

Lifestyle Modifications

• Hydration

  • Encourage drinking fluoridated tap water regularly
  • Explain that while water consumption helps, it will not completely eliminate xerostomia 1
  • Avoid dehydration, particularly important for elderly patients 2

• Dietary Adjustments

  • Consume a low-sucrose diet
  • Avoid caffeine, which can worsen dry mouth
  • Eliminate spicy and highly acidic foods
  • Minimize intake of sticky and/or sugar-containing food and drinks 1
  • Avoid alcohol, including mouthwash containing alcohol 1

• Tobacco Cessation

  • Counsel patients to avoid tobacco products, which worsen xerostomia 1

Oral Care Products

• Mouth Rinses

  • Use alcohol-free rinses exclusively 1
  • Consider specialized rinses formulated for dry mouth

• Dental Hygiene

  • Brush with remineralizing toothpaste
  • Use dental floss regularly
  • Consider prescription 1.1% sodium fluoride toothpaste as a dentifrice or in customized delivery trays 1
  • Maintain close follow-up with dental professionals 1

Pharmacologic Interventions

Saliva Substitutes

• Artificial Saliva Products
  • Provide immediate, temporary relief
  • Useful for patients with severe salivary gland hypofunction 3
  • May be less preferred by some patients compared to mechanical stimulation methods 4

Salivary Stimulants

• Pilocarpine
  • FDA-approved for xerostomia in Sjögren's syndrome and post-radiation patients
  • Dosage: 5-7.5 mg four times daily
  • Shown to significantly improve global assessments of dry mouth, ability to speak without liquids, and reduce need for supplemental oral comfort agents 5
  • Common side effects include sweating, nausea, rhinitis, and diarrhea
  • Contraindicated in patients with certain cardiovascular conditions, asthma, or narrow-angle glaucoma

Mechanical Stimulation

• Sugar-free Chewing Gum

  • Increases salivary flow through mechanical stimulation
  • Often preferred by patients over artificial saliva 4
  • Should be sugar-free to prevent dental caries

• Pastilles/Lozenges

  • Polysaccharide-containing pastilles can significantly increase salivary flow rate 6
  • Provide both mechanical stimulation and gustatory effects

Special Considerations

Xerostomia in Cancer Survivors

• Monitor for xerostomia as part of regular follow-up care
• Consider more aggressive interventions for radiation-induced xerostomia
• Amifostine may be considered as a radioprotectant during radiation therapy to reduce the risk of developing xerostomia 1

Medication-Induced Xerostomia

• Review patient's current medications
• Consider alternatives to medications with anticholinergic effects when possible 3
• Common culprits include anxiolytics, antidepressants (particularly tricyclics), antimuscarinics, antihistamines, and antipsychotics 1

Follow-up Care

• Regular dental evaluations at least every 6 months, or more frequently for those with severe xerostomia 1
• Monitor for development of dental caries, oral infections, or candidiasis
• Assess effectiveness of current management strategies and adjust as needed

Pitfalls and Caveats

• Simply increasing water intake will not resolve xerostomia, though it helps with symptoms
• Untreated xerostomia can lead to increased dental caries, oral discomfort, and difficulties with speaking and eating
• Patients with polypharmacy are at higher risk for xerostomia and may require more comprehensive management 1
• Elderly patients with xerostomia are at risk for malnutrition due to difficulties with chewing and swallowing 3