dry mouth

Available treatments
Artificial saliva
This can provide useful relief of dry mouth. A properly balanced artificial saliva should be of a neutral pH and contain electrolytes (including fluoride) to correspond approximately to the composition of saliva.

Artificial saliva offers little advantage compared with simple measures for most patients. The few available studies are of poor quality, but suggest that many patients find no additional benefit with carmellose-based preparations compared with frequent tea, coffee, milk, or fruit juice.1 In addition, some patients find carmellose-based products feel sticky.
The duration of action of mucin products is only 10 to 15 minutes.
Long-term use of acidic products may demineralise tooth enamel. Glandosane® spray, Salivix® pastilles, and SST® tablets are acidic products.
Sugar-free chewing gum is as effective as artificial salivas.2
Consider using an artificial saliva containing mucin or lactoperoxidase when simple measures have been tried, but symptoms remain troublesome. The pH of some artificial saliva products may be inappropriate.

Luborant® is licensed for any condition giving rise to a dry mouth.
Biotene Oralbalance® BioXtra®, Glandosane®, Saliva Orthana®, and Saliveze®, have Advisory Committee on Borderline Substances (ACBS) approval for dry mouth associated only with radiotherapy or Sjögren’s syndrome.
Salivix® pastilles, which act locally as salivary stimulants, are also available and have similar ACBS approval.
SST® tablets may be prescribed for dry mouth in patients with salivary gland impairment and patent salivary ducts.

Pilocarpine tablets
These are licensed for the treatment of xerostomia following:

Irradiation for head and neck cancer
Dry mouth and dry eyes (xerophthalmia) in Sjögren’s syndrome
It can be considered for difficult cases.

Most patients with drug-induced dry mouth usually respond to treatment after the first dose.3
Only about 50% of patients with radiotherapy-induced dry mouth respond to treatment, and it may take up to 3 months before a response is seen.3
Pilocarpine 5 mg three times a day is more effective than artificial saliva, but also has more adverse effects, e.g. sweating, dizziness, rhinitis, urinary frequency, and blurred vision.
Acupuncture may be a useful alternative to pilocarpine in resistant cases.4
They are effective only in patients who have some residual salivary gland function. If there is no response they should be discontinued.
There is a risk of increased urethral smooth muscle tone and renal colic.
Adequate fluid intake should be maintained to avoid dehydration associated with excessive sweating.
Patients should be counselled that blurred vision or dizziness may affect performance of skilled tasks, e.g. driving, particularly at night or in reduced lighting.