What are the treatments for dryness in the throat?

Treatment of Throat Dryness

For throat dryness, begin with non-pharmacological salivary stimulation using sugar-free gum or xylitol lozenges as first-line therapy, escalating to pharmacological agents like pilocarpine (5 mg four times daily) for moderate dysfunction, or saliva substitutes for severe cases—but only after measuring baseline salivary flow rates to guide treatment selection. 1, 2

Mandatory Initial Assessment

Before initiating any treatment, measure whole salivary flow rates to objectively determine glandular function, as subjective feelings of throat dryness often do not correlate with actual salivary output. 3, 2 This baseline measurement is critical because environmental and personal stressing factors may influence subjective symptoms, leading to inappropriate therapy choices if treatment is based solely on patient-reported symptoms. 3, 2

Rule out unrelated conditions such as candidiasis, burning mouth syndrome, medication side effects, mouth breathing, anxiety, depression, or oxygen therapy use before attributing symptoms to salivary dysfunction. 3, 4

Treatment Algorithm Based on Severity

Mild Glandular Dysfunction (Preserved Salivary Output)

Non-pharmacological stimulation is the preferred first-line approach: 3, 1, 2

• Gustatory stimulants: Use sugar-free acidic candies, xylitol lozenges, or pastilles to chemically stimulate saliva production. 3, 1, 2 Xylitol-containing products offer dual benefits by stimulating saliva while protecting against dental caries. 1, 2

• Mechanical stimulants: Sugar-free chewing gum provides mechanical stimulation and has been shown to increase salivary flow rate by approximately 8 g/10 minutes compared to control products. 3, 1, 5

• Hydration optimization: Increase water intake throughout the day, but be aware that bottled water with pH below 5.2-5.5 can cause enamel erosion, and pH below 6.8 can erode root dentin—choose neutral or alkaline pH water. 1, 4, 6

• Dietary modifications: Avoid crunchy, spicy, acidic, or hot foods that exacerbate discomfort, and limit caffeine consumption which worsens dry mouth symptoms. 1, 4

Important caveat: No strong evidence suggests one non-pharmacological intervention is superior to another, so patient preference should guide selection within this category. 3, 1

Moderate Glandular Dysfunction (Reduced Salivary Output)

Pharmacological stimulation with muscarinic agonists: 1, 2

• Pilocarpine: 5 mg orally four times daily, with potential dose escalation up to 30 mg/day for improved efficacy. 1, 2 Monitor carefully for side effects including excessive sweating, nausea, and bronchoconstriction. 1, 2

• Cevimeline: Alternative muscarinic agonist with similar mechanism but potentially better tolerance profile. 1, 2

Critical pitfall: These medications require careful monitoring, especially in older adults, due to their cholinergic side effects. 1

Severe Glandular Dysfunction (Minimal/No Salivary Output)

Saliva substitution is the preferred approach when glands cannot be stimulated: 3, 1, 2

• Use products with neutral pH containing fluoride and electrolytes to mimic natural saliva composition. 3, 1, 2

• Available formulations include oral sprays, gels, and rinses—methylcellulose/hyaluronate-based substitutes are preservative-free and particularly useful. 1, 2

• Xylitol-containing oral sprays provide temporary symptomatic relief plus protection against dental caries. 1, 2

Supportive Measures for All Severity Levels

• Use specialized toothpastes and rinses designed for dry mouth that are less irritating and contain fluoride. 1, 4

• Provide indoor air humidification in dry, arid environments. 3

• For patients experiencing persistent throat awareness or clearing, ice cold carbonated water may help break the vicious cycle of throat clearing. 7

• Nebulized isotonic saline may offset phonatory changes from dry air exposure in patients with chronic airway dryness. 8

Dental Complications Prevention

Prescribe fluoride rinses or gels for all dentate patients with throat dryness/xerostomia to mitigate caries risk, as untreated severe dry mouth can lead to dental caries and tooth loss. 1, 2

When to Escalate Care

Consult a healthcare provider or refer for specialty evaluation when: 1, 2

• Symptoms are severe and persistent despite management strategies
• Symptoms significantly affect quality of life
• Signs of dental complications appear (caries, tooth loss)
• Underlying systemic disease is suspected (autoimmune conditions, diabetes, thyroid dysfunction) 4