How To Treat and Manage Dry Mouth (Xerostomia)

Dry mouth, or xerostomia, occurs when there is not enough saliva (or “spit”) to lubricate the tongue, gums, and inside of the cheeks. Saliva is critical for chewing, swallowing, digestion, protecting against infection, and keeping teeth clean.

Dry mouth is often a temporary response to stress or nervousness. Chronic dry mouth can be a sign of medication side effects, certain health conditions (such as Sjogren’s syndrome), nerve damage, and radiation therapy.

Treatments focus on restoring hydration in the mouth and preventing relapses. Addressing the underlying cause of dry mouth should lead to complete recovery. 

Alongside changes in habits and lifestyle, prescribed and over-the-counter (OTC) medications can play a central role in managing dry mouth. They do this by promoting saliva production or serving as a synthetic replacement. Here are some of the medications that may be used:

Prescription

Oral or topical medications can stimulate saliva production. Known as sialogogues, these include:

• Salagen (pilocarpine hydrochloride): Salagen stimulates acetylcholine, a neurotransmitter that promotes saliva production. The United States Food and Drug Administration (FDA) has approved it for those undergoing radiation treatment or who have Sjogren’s syndrome.
• Evoxac (cevimeline): Evoxac tablets stimulate saliva production and are FDA-approved for those with Sjogren’s syndrome. Common side effects include sweats, nausea, rhinitis (nasal passage inflammation), diarrhea, and increased urination.
• Numoisyn (sorbitol): Sorbitol is a lozenge that stimulates the taste pathways in the tongue and mouth. It is used as needed to manage dry mouth and symptoms of treatments like radiation therapies. Rare adverse events include allergic reactions (rash, hives, swelling, wheezing, and skin symptoms), mouth irritation, and changes in taste. 
• Topical physostigmine: Physostigmine is a topical gel applied directly into the mouth. It is normally used to treat glaucoma (an eye disease) but can also treat dry mouth.

Over-The-Counter (OTC)

Over-the-counter (OTC) sprays, lozenges, and other saliva-stimulating aids can help manage dry mouth. These include the following medications:

• Malic acid: Malic acid helps manage the feeling of dryness in your mouth and boosts saliva production. It is available as a mouthwash (Xerodent) or mouth spray (Dentaid).
• XyliMelt: XyliMelt discs dissolve in your mouth, gradually stimulating saliva and providing prolonged protection from dry mouth. In one study, three weeks of regular use significantly improved symptoms and increased saliva production. 
• Lozenges or sprays: Specialized lozenges or sprays, such as Salese or Biotene, are available OTC and work like prescription Numoisyn. Ingredients like sorbitol help prevent tooth damage, which can be a side effect of some other products. 
• Salivary substitutes: OTC salivary substitutes, which come in gels or sprays, are taken as needed. Instead of stimulating saliva, they mimic it. These include Xerostom, Bucalsone, and other products containing cellulose gum and minerals such as phosphate, calcium, and fluoride.

In persistent and difficult cases, healthcare providers consider surgery to repair the salivary glands, where saliva is produced. Sialendoscopy has emerged as a minimally invasive alternative to open surgery.

Surgeons use an endoscope, a tiny flexible tube with a light and camera, to examine salivary glands in the mouth. They then make small cuts or changes to the tissue to stimulate saliva flow. With this minimally invasive procedure, complications are rare.

Lifestyle changes are generally considered before medications or other methods. They can treat the causes of dry mouth and prevent it from occurring in the first place. Strategies that may help include:

• Change medications: Blood pressure medications, certain antidepressants, anticholinergic drugs, diuretics, and antiepileptics (or antiseizure medications) are among the many medications that can cause dry mouth.
• Drink water: Regularly sipping water can help keep your mouth lubricated. Adults should have 9-12 glasses of water daily.
• Avoid caffeine: The caffeine in coffee, tea, and some sodas can also cause dry mouth. Limiting these beverages can help prevent dry mouth and dehydration.
• Avoid or quit smoking: Along with other health effects, smoking tobacco can also lead to dry mouth. Avoiding this habit can help manage this condition.
• Chew flavorless gum: Chewing sugar-free, flavorless gum or sucking sugar-free hard candy can help your body make more saliva.
• Limit or stop alcohol: Alcohol can also dry out the inside of your mouth. Limiting your drinking or stopping entirely can help you manage xerostomia.
• Use a humidifier: Dry air in the home, especially at night, can increase the risk of dry mouth. Try a humidifier while sleeping to help prevent this issue.

While dry mouth is not fatal, it can significantly impact your quality of life and cause several health problems. If left untreated, potential complications include:

• Poor nutrition, resulting from poor digestion
• Gingivitis and periodontitis, which are gum diseases
• Cavities and tooth enamel erosion
• Halitosis, or chronic bad breath
• Fungal infection of the mouth, known as candidiasis

Dry mouth can be managed and even cured, depending on the underlying cause. If smoking, alcohol, or medications are causing your dry mouth, addressing these causes can cure it.

Dry mouth is more persistent and difficult to treat when linked to radiation treatment, Sjogren’s syndrome, or chronic disease. Current therapies can help ease your symptoms.

If you have chronic dry mouth, it’s important to know how to reduce your symptoms. Because saliva is so important for oral health, keeping up with dental care is critical. This means brushing your teeth at least twice daily, flossing daily, and visiting your dentist for a yearly cleaning and checkup.

Alongside any prescribed medications or OTC methods, living with this issue often means talking to your dentist or healthcare provider, adopting lifestyle changes, and taking steps to prevent complications.