Treatment of Medication-Induced Xerostomia (Dry Mouth)
For medication-induced xerostomia, treatment should include a combination of non-pharmacological interventions such as frequent water sips, sugar-free gum, and artificial saliva products, along with pharmacological options like pilocarpine 5 mg three times daily in severe cases. 1
Non-Pharmacological Management (First-Line)
Hydration and Oral Care
- Frequent sips of water throughout the day to maintain oral moisture
- Room humidification to prevent further drying of oral mucosa
- Oral sprays or gels with neutral pH containing fluoride and electrolytes 1
- Bland oral rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) several times daily 2
- Avoid club soda due to carbonic acids 2
- Avoid commercial mouthwashes with alcohol or astringent properties 2
Saliva Stimulation
- Sugar-free chewing gum (preferably containing xylitol)
- Sugar-free acidic candies or lozenges to stimulate saliva production
- Artificial saliva products as substitutes for natural saliva 1
Oral Hygiene Protocol
- Brushing: Use ultra-soft-headed toothbrush with prescription-strength fluoride toothpaste; brush within 30 minutes after eating and before bed 2
- Flossing: At least once daily using waxed floss to minimize gingival trauma 2
- Moisturizing: Apply water-based lubricants after cleaning, at bedtime, and as needed 2
- Lip care: Use animal or plant-based oils (beeswax, cocoa butter, lanolin) instead of petroleum-based products 2
Pharmacological Management (For Moderate to Severe Cases)
Severity-Based Approach
| Severity | Management Approach |
|---|---|
| Mild | Non-pharmacological interventions only |
| Moderate | Add saliva substitutes (oral sprays preferred) |
| Severe | Add pilocarpine 5 mg three times daily |
Pilocarpine (For Severe Cases)
- Dosage: 5 mg three times daily
- Mechanism: Muscarinic agonist that stimulates salivary gland function
- Evidence: Significantly improves global assessment of dry mouth, speaking without liquids, and reduces need for supplemental oral comfort agents 3
- Common side effects: Sweating, nausea, rhinitis, diarrhea, chills, flushing, urinary frequency, dizziness 3
- Caution: Dose may need adjustment based on side effects; sweating is the most common adverse event causing treatment discontinuation (≤1% at 5 mg TID) 3
Special Considerations
What to Avoid
- Lemon-glycerin swabs: Produce acidic pH, dry oral tissues, cause enamel erosion, and exhaust salivary mechanisms 1
- Glycerin-based products: Dry the mouth rather than moisturize 2
- Petroleum-based lip products: Cause drying and cracking 2
- Anticholinergic medications: Consider medication review and possible alternatives when possible, as these are major contributors to xerostomia 4
Dental Care
- Regular dental check-ups: At minimum every 6 months 2
- Remineralizing pastes: Use products containing calcium and phosphate 2
- Fluoride: Higher concentration fluoride toothpaste to prevent dental caries 5
Monitoring and Follow-up
- Monitor for signs of dental caries and oral infections
- Assess symptom response and adjust therapy accordingly
- Report persistent or worsening symptoms to healthcare provider
- Consider medication review if xerostomia persists despite management measures
By following this structured approach to treating medication-induced xerostomia, patients can experience significant improvement in oral comfort and quality of life while preventing complications such as dental caries and oral infections.