What is the treatment for dry mouth in the Emergency Department (ED)?

Treatment for Dry Mouth in the Emergency Department

For dry mouth in the Emergency Department, use carboxymethylcellulose-based oral moisturizers applied 3-4 times daily as needed, with more frequent application for severe symptoms. 1

First-Line Interventions

Immediate Relief Measures

• Topical moisturizers:

  • Carboxymethylcellulose-based oral moisturizers (first choice) 1
  • Sprays of cold sterile water 2
  • Swabs of cold sterile water 2
  • Mouth and lip moisturizer 2

• Hydration techniques:

  • Frozen gauze pads with normal saline or ice (more effective than wet gauze) 2
  • Drinking fluoridated water frequently 1

Important Cautions

• AVOID lemon-glycerin swabs as they:
  • Produce acidic pH 2
  • Dry oral tissues 2
  • Cause irreversible enamel softening and erosion 2
  • Exhaust salivary mechanisms over time, leading to increased xerostomia 2

Second-Line Interventions

Saliva Stimulants

• Pilocarpine hydrochloride:

  • Dosage: 5 mg three to four times daily 1
  • Particularly effective for moderate to severe xerostomia 1
  • FDA-approved for Sjögren's syndrome with demonstrated efficacy in clinical trials 3
  • Shows statistically significant improvement in dry mouth symptoms 3

• Non-pharmacological stimulants:

  • Sugar-free gum (if patient has residual salivary capacity) 1, 4
  • Sugar-free lozenges 1

Treatment Algorithm Based on Severity

Mild Dry Mouth

1. Carboxymethylcellulose-based oral moisturizers
2. Cold water sprays/swabs
3. Increased hydration
4. Sugar-free gum/lozenges if appropriate

Moderate to Severe Dry Mouth

1. More frequent application of oral moisturizers
2. Consider pilocarpine 5 mg three to four times daily if no contraindications
3. Combination of moisturizers and stimulants for enhanced effect 1

Special Considerations

For Patients on High-Flow Oxygen

• Use heated humidifiers rather than bubble humidifiers to significantly reduce mouth and throat dryness 2

For Patients with Sjögren's Syndrome

• Consider more aggressive treatment with pilocarpine as these patients show significant response 3
• Oxygenated glycerol triester (OGT) spray may be more effective than aqueous electrolyte sprays 4

Family Involvement

• Family members can assist with providing simple mouth care when appropriate 2
• This can have positive effects for both patients and family members 2

Efficacy Expectations

• Most topical treatments provide short-term relief only 4, 5
• Saliva stimulants like pilocarpine may provide more sustained relief in patients with residual salivary function 3
• Integrated approaches (combining moisturizers and stimulants) may be more effective than single interventions 4

The evidence suggests that while no treatment completely resolves dry mouth, a structured approach using moisturizers first and adding stimulants for more severe cases provides the best symptomatic relief for patients in the ED setting.