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Dry Mouth Symptoms

Some of the procedures with which dry mouth and its symptoms are managed include:

• Saliva substitutes
• Saliva stimulants
• Interferon-alpha
• Meticulous observance of oral hygiene
• Lifestyle modifications

Saliva Substitutes

Research to develop products that mimic the unique properties and characteristics of saliva has been so far disappointing. There are, however, products available known as saliva substitutes that are designed to replicate the lubricating and wetting function of natural saliva. They are used mostly by patients with moderate to severe dry mouth since they must be applied frequently and patients with less severe symptoms find this very inconvenient. In addition, many find the taste of the substitutes to be unappetizing.

Saliva substitutes are formulated either as sprays, lozenges, or gels. Examples of saliva substitutes include:

• Glandosane
• Moi-Stir
• Salivart
• Oralbalance - this is a moisturizing gel that is reported to be longer lasting than others and is usually used at night.

It is helpful to speak to your health care provider or to a pharmacist regarding the benefits of each type of saliva substitute and to help evaluate which one might be best for you. Sometimes patients need to try more than one before they are satisfied with the extent of relief for their dry mouth.

Saliva Stimulants

There are various methods used to stimulate saliva including:

• Frequent ingestion of sugar-free drinks. Hydration of the mouth is a mainstay of nonpharmaceutical measures for managing dry mouth.
• Chewing sugar-free gum
• Sucking sugar-free lozenges
• Sucking maltose lozenges such as Natrol Dry Mouth that contains anhydrous crystalline maltose (ACM). ACM stimulates saliva production for patients who retain residual functional glandular tissue. It has been shown to objectively increase secretions and improve subjective reports of oral symptoms in patients with Sjogren's syndrome. The lozenges can be taken three times a day.

If the patient finds these suggestions inadequate, there are medications that have been developed to treat sicca symptoms. Research actively continues to identify medications that effectively stimulate the production of saliva and tears to relieve symptoms of the sicca syndrome. Drugs known as secretagogues (general secretory stimulants) or sialogogues (salivary stimulants) are designed to stimulate the production of saliva in patients who have some residual salivary gland function.

The most commonly used sialogogues are muscarinic agonists that stimulate the M1 and M3 receptors on the salivary glands resulting in increased salivary secretion and they have been found to be highly effective. Significant objective (measurable) and subjective improvement is associated with these drugs. Approximately 60% of patients notice improvements of dry mouth symptoms with secretory stimulant drugs. They are usually well tolerated and not associated with significant side effects.

Muscarinic agonists approved by the U.S. Food and Drug Administration (FDA) for the treatment of dry mouth associated with Sjogren's syndrome are pilocarpine and cevimeline.

Pilocarpine (Salagen)

This drug was approved by the FDA for the treatment of dry mouth in 1998. Some patients also report relief from symptoms of dry eye when using this drug. Typically, salivary flow rate is reported to increase within 15 minutes of administering the drug and a peak flow rate is maintained for up to four hours. Pilocarpine is classified as a Pregnancy Category C drug, meaning that animal studies have shown an adverse effect on the fetus but there are no adequate and well controlled studies on pregnant women.