What is the treatment for xerostomia (dry mouth)?

From the Guidelines

Dry mouth can be effectively treated with a combination of dietary modifications, topical measures, and pharmacological interventions, as recommended by the NCCN panel 1. The treatment approach should be driven by the baseline measurement of salivary glandular function, and not by the patient’s subjective feelings, as environmental and personal stressing factors may influence the subjective feeling of dryness, which often does not match with the objective measurement of glandular function 1. Some key treatment options include:

• Increasing water intake throughout the day and using sugar-free gum or lozenges to stimulate saliva production
• Using over-the-counter saliva substitutes like Biotène or XyliMelts to provide immediate relief
• Prescription options such as pilocarpine (Salagen) 5mg three times daily or cevimeline (Evoxac) 30mg three times daily, which stimulate saliva glands 1
• Avoiding alcohol-containing mouthwashes, caffeine, tobacco, and alcoholic beverages as they worsen dryness
• Using a humidifier at night to help prevent nighttime dryness
• Practicing good oral hygiene, including brushing twice daily with fluoride toothpaste, flossing daily, and using alcohol-free fluoride rinses to prevent tooth decay 1 It is essential to note that dry mouth can be a symptom of underlying conditions like Sjögren's syndrome or diabetes, and if it persists despite these measures, consulting a healthcare provider is crucial 1. In patients with moderate glandular dysfunction, pharmacological stimulation with muscarinic agonists like pilocarpine and cevimeline may be considered, although the evidence is limited, and the safety profile of these drugs should be carefully evaluated 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. Cevimeline is indicated for the treatment of symptoms of dry mouth in patients with Sjögren’s Syndrome.

The treatment for xerostomia (dry mouth) includes:

• Pilocarpine (PO), which is indicated for the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck, and for the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome 2
• Cevimeline (PO), which is indicated for the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome 3

From the Research

Treatment Options for Xerostomia

The treatment for xerostomia (dry mouth) can vary depending on the underlying cause and severity of the condition. Some of the treatment options include:

• Stimulation of the salivary glands through gum chewing or sucking sugar-free sweets, as well as medications, acupuncture, and electrostimulation 4
• Moistening the oral mucosa with a sip of water regularly during the day 4
• Saliva replacement therapy, which can be beneficial with proper instruction 4
• Fluoride rinse or gel to reduce the risk of caries in dentate patients 4
• Oral pilocarpine, which has been shown to improve symptoms in about 50% of patients with radiotherapy-induced xerostomia, although it can have adverse effects such as sweating, urinary frequency, and nausea 5
• Salivary stimulants such as Salagen and Evoxac, which are FDA-approved and effective in increasing salivary output 6
• Local therapies, including natural agents such as malic acid, thyme honey, and ginger, which have shown utility in managing dry mouth and improving oral health-related quality of life 7
• Systemic therapies, including immunosuppressants and cholinergic receptor agonists such as pilocarpine and cevimeline, which can stimulate salivation and potentially reduce gland damage in Sjögren's syndrome 8

Considerations for Treatment

When considering treatment options for xerostomia, it is essential to:

• Determine the underlying cause of the condition, such as salivary gland disease or radiation therapy 4, 5, 8
• Assess the severity of the condition and the patient's overall health status 4, 5, 6
• Monitor for potential adverse effects of treatment, such as those associated with oral pilocarpine 5
• Consider the patient's preferences and compliance with treatment, such as the use of salivary substitutes or stimulants 6, 7