Does 0.9% Sodium Chloride Help with Mouth Dryness?
Yes, 0.9% saline rinses can soothe the mouth and provide symptomatic relief for mouth dryness, particularly in patients with stomatitis/mucositis, though evidence for its effectiveness as a primary treatment for xerostomia is limited. 1
Evidence for Use in Stomatitis/Mucositis
The strongest guideline evidence supports 0.9% saline rinses specifically for stomatitis and mucositis management, not necessarily for general xerostomia:
For grade 1 stomatitis/mucositis, oral rinses with 0.9% saline or sodium bicarbonate can soothe the mouth and are recommended as first-line symptomatic treatment while continuing therapy at current doses 1
Expert consensus from ESMO recommends that patients rinse their mouth with a bland non-alcoholic, sodium bicarbonate containing mouthwash (which often includes saline) four to six times daily for prevention, and up to hourly for active treatment of stomatitis 1
The MASCC/ISOO oral care plan specifically recommends frequent rinsing (three times daily) with a combination of 0.5% sodium bicarbonate and 0.9% saline, with intensified use when the mouth is dry 1
Limitations for General Xerostomia
Important caveat: The evidence for 0.9% saline as a primary treatment for chronic dry mouth (xerostomia) is weak:
A 2011 Cochrane systematic review found no strong evidence that any topical therapy, including saline rinses, is effective for relieving the symptom of dry mouth in chronic xerostomia patients 2
Research shows that patients with dry mouth have altered mucin glycosylation and reduced saliva rheological properties (spinnbarkeit), suggesting that simple saline rinses cannot replicate the complex lubricating properties of normal saliva 3
Practical Clinical Algorithm
When to recommend 0.9% saline rinses:
Primary indication: Patients with stomatitis/mucositis from cancer therapy, EGFR-TKIs, or other causes - use as soothing rinse 4-6 times daily 1
Adjunctive use: As part of basic oral hygiene in any patient with mouth dryness to maintain oral cleanliness and provide temporary moisture 1
Preparation: Mix 0.9% sodium chloride with 0.5% sodium bicarbonate for optimal effect 1
When NOT to rely on saline alone:
Chronic xerostomia from Sjögren's syndrome, radiation therapy, or medications requires more specialized interventions such as saliva stimulants (if residual gland function exists), saliva substitutes, or mucoadhesive products 2, 4
Patients should be advised to drink plenty of water and use lip balms in addition to rinses 1
Consider oxygenated glycerol triester (OGT) spray, which shows superior effectiveness compared to simple electrolyte sprays (approximately 2 points better on a 10-point VAS scale) 2
Common Pitfalls to Avoid
Do not use saline as the sole treatment for chronic dry mouth - it provides temporary relief but does not address underlying salivary dysfunction 2
Ensure non-alcoholic formulations - alcoholic mouthwashes should be avoided as they can worsen dryness 1
Do not confuse with hypotonic solutions - only isotonic 0.9% saline should be used, not plain water or hypotonic solutions 1
Recognize underreporting - patients frequently fail to report mouth dryness to physicians (only 44% report it), so proactive assessment is essential 5