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

From the Guidelines

The most effective treatment for xerostomia (dry mouth) involves a combination of non-pharmacological stimulation, saliva substitutes, and prescription medications, with the goal of improving comfort and preventing complications like dental caries and oral infections.

Treatment Options

The treatment of xerostomia involves both addressing underlying causes and managing symptoms.

• Identify and treat any contributing factors such as medications, systemic diseases, or radiation therapy.
• For symptomatic relief, encourage frequent sips of water, sugar-free gum or candies to stimulate saliva production, and avoiding alcohol, caffeine, and tobacco which worsen dryness.
• Over-the-counter saliva substitutes like Biotène, Mouth Kote, or Oasis can provide temporary moisture.
• For more severe cases, prescription medications that stimulate saliva production include pilocarpine (Salagen) 5-10mg three times daily or cevimeline (Evoxac) 30mg three times daily, as recommended by the British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines 1.

Non-Pharmacological Interventions

Non-pharmacological glandular stimulation is recommended as the preferred first-line therapeutic approach for patients with mild glandular dysfunction, using gustatory stimulants (sugar-free acidic candies, lozenges, xylitol) and/or mechanical stimulants (sugar-free chewing gum) 1.

Oral Hygiene and Prevention

Good oral hygiene is essential, including regular dental check-ups, fluoride treatments, and using alcohol-free mouthwash.

• Humidifiers can help maintain moisture in the environment, especially during sleep.
• For radiation-induced xerostomia, acupuncture has shown some benefit.
• Dental/oral evaluation and management can help decrease dental caries and associated problems, such as dentoalveolar infection and osteoradionecrosis 1.

Individualized Treatment

Treatment should be individualized based on the cause and severity of symptoms, with the goal of improving comfort and preventing complications like dental caries and oral infections.

• Patients with severe xerostomia should be given oral hygiene advice to prevent the development of dental caries and clinicians should also be vigilant of the risk of oral candidiasis in patients with severe xerostomia 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, placebo-controlled study in 207 patients was conducted in patients whose mean age was 58. 5 years with a range of 19 to 77; the racial distribution was Caucasian 95%, Black 4%, and other 1%. In this population, a statistically significant improvement in mouth dryness occurred in the 5 mg and 10 mg pilocarpine hydrochloride tablet treated patients compared to placebo treated patients 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 options for xerostomia (dry mouth) include:

• Pilocarpine hydrochloride tablets for the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck
• Pilocarpine hydrochloride tablets for the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome
• Doses of 5 mg and 10 mg of pilocarpine hydrochloride tablets have been shown to be effective in improving mouth dryness and global improvement of dry mouth compared to placebo 2
• A dose of 5 mg of pilocarpine hydrochloride tablets has been shown to be effective in improving global improvement of dry mouth compared to placebo 2 2

From the Research

Treatment Options for Xerostomia

The treatment of xerostomia involves addressing the underlying cause, followed by the use of salivary substitutes and/or salivary stimulants 3. The following are some of the treatment options available:

• Salivary stimulants: These are more beneficial than salivary substitutes in patients with residual salivary gland function 3.
• Salivary substitutes: These can provide symptomatic relief, but need to be carefully adapted to each patient's situation in terms of usability and practicability 4.
• Medication changes: Changing medications with anticholinergic properties to those with fewer xerogenic side effects or reducing the dose can help manage xerostomia 3, 4.
• Topical agents: Various topical agents, such as malic acid spray and betaine-based mouthwash, can improve the dry mouth sensation and oral health-related quality of life 5.
• Sialogogues: Pilocarpine and cevimeline are pharmaceutical treatment options that can stimulate salivation, but may have cholinergic side effects that need to be supervised by healthcare professionals 4.
• Preventive measures: Preventive therapeutic measures, such as chewing and administering gustatory substances, can help stimulate saliva production 6.

Management of Xerostomia

The management of xerostomia should be based on patient symptoms, as there is little correlation between patient symptoms and objective tests of salivary flow 3. A multidisciplinary approach, including the involvement of dentists, is essential for the treatment of xerostomia, especially in residents with dry mouth 7. The treatment plan should focus on prevention, maintenance, oral comfort, and emergency treatment, and should be non-invasive whenever possible 7.