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

Treatment Options for Dry Mouth (Xerostomia)

The most effective treatment approach for dry mouth includes non-pharmacological interventions as first-line therapy for mild symptoms, with pilocarpine (5 mg three to four times daily) recommended for moderate to severe cases when functioning salivary tissue remains. 1, 2

Assessment and Treatment Algorithm

Step 1: Determine Severity and Cause

• Measure unstimulated and stimulated salivary flow rates 3
• Identify potential causes:
  • Medication side effects (most common cause) 4
  • Sjögren's syndrome
  • Head and neck radiation
  • Dehydration
  • Systemic diseases

Step 2: Treatment Based on Severity

Mild Dry Mouth

• Non-pharmacological interventions:
  • Sugar-free gum or lozenges to stimulate saliva 1
  • Frequent water intake 1
  • Humidifiers to increase environmental moisture 1
  • Avoiding aggravating factors (alcohol, caffeine, tobacco) 1

Moderate to Severe Dry Mouth

• Saliva substitutes:

  • Oxygenated glycerol triester (OGT) sprays show better effectiveness than electrolyte sprays 5
  • Products containing xylitol may help reduce dental caries risk 4

• Pharmacological stimulants:

  • Pilocarpine: 5 mg three times daily for radiation-induced xerostomia; 5 mg four times daily for Sjögren's syndrome 2
  • Dosage may be adjusted between 5-7.5 mg based on response and side effects 2
  • Significant improvement in global dry mouth symptoms typically seen after 6 weeks of treatment 2

Special Considerations

Dental Protection

• Prescribe fluoride rinse or gel for dentate patients to prevent caries 3
• Regular dental check-ups are necessary to prevent complications 1

Monitoring for Side Effects

• Common adverse effects of pilocarpine include sweating, nausea, rhinitis, diarrhea, and dizziness 2
• Sweating is the most common reason for discontinuation (12% at higher doses) 2

Pitfalls to Avoid

• Don't overlook medication review: The most common cause of dry mouth in older adults is medication use, particularly those with anticholinergic effects 4
• Don't rely solely on saliva substitutes: While helpful for symptom relief, they have short duration of effect and don't provide the protective functions of natural saliva 6
• Don't delay treatment: Chronic dry mouth increases risk for dental caries, periodontal disease, and oral infections 4
• Don't expect immediate results: Pharmacological treatments may take several weeks to show significant improvement 2

Emerging Approaches

Newer technologies such as self-assembly systems, emulsions, liposomes, and microgels are being developed as potential saliva substitutes with better moistening and lubrication properties, though these remain investigational 7

While many treatment options exist, the evidence supporting topical therapies is generally weak, with only OGT spray showing clear superiority over electrolyte sprays in controlled trials 5. Pilocarpine remains the best-supported pharmacological option for moderate to severe dry mouth when functioning salivary tissue remains 2.