Page 6

Quality Resource Guide –

Xerostomia Revisited 4th Edition

www.metdental.com

One approach to restoring salivary gland function

may entail the use of sialagogue or secretagogue

medications that stimulate secretions from the

glands. These agents are classified as cholinergic

agonists (Table 4). Their efficacy, however, is

limited to patients whose salivary glands have

functional secretory components. Since these

drugs require systemic administration in order

to stimulate the cholinergic receptors of the

salivary glands, they can also cause a variety of

uncomfortable or intolerable side effects. These

include flushing and sweating. At higher doses

they can cause urinary frequency, abdominal

cramping, and diarrhea. These salivary stimulents

are contraindicated in patients with asthma,

glaucoma, and cardiac arrhythmias.

For the management of the unpleasant symptoms

of xerostomia and to contribute to a sensation of

oral moistness, a number of products have been

developed that are designed to replace saliva and

also provide ingredients that simulate those in

natural saliva (Table 4). They are available over-

the- counter, but their duration of efficacy may

be brief, and frequent re-administration may not

be cost effective. These products are available

as oral solutions, aerosols, sprays, gels, or

mouth swabs. Sugarless chewing gum may also

aid in keeping the mouth moist by stimulating

some natural salivary flow. Agents that contain

glycerin may be effective by contributing to a

sensation of increased moistness by increasing

oral lubrication (Table 4). An extensive systematic

review of multiple studies that have evaluated

the comparable efficacy of various xerostomic

therapies found no evidence that any of the

currently available remedies was particularly

effective. In this regard it should be noted

that it is difficult to accurately assess the

therapeutic efficacy of any intervention because

of the inherent variation in salivary function

between patients and the wide range of highly

subjective perceptions of patients’ xerostomic

symptoms. As noted in the introduction of this

Guide, there also appears to be little correlation

between patient symptoms and the degree of

hyposalivation. Long-term and costly placebo-

controlled clinical trials would be required to

determine whether or not saliva replacement

therapies are effective in preventing or reducing

the symptoms of xerostomia.

Furthermore,

evidence-based outcomes of such studies would

not ensure that a product is more effective if

based solely on patient assessment.

A non-foaming (non-detergent) dentifrice

that does not contain sodium lauryl sulfate is

recommended for xerostomic patients, since

this ingredient, contained in most dentifrices,

can have a deleterious effect on the protective

mucin layer of the oral mucosa that is already

compromised in these patients.

Other palliative strategies include frequent

sipping of water or holding ice chips in the

mouth. Use of a humidifier, particularly at night,

may offset the reduced amount of saliva that is

produced during sleep, and may be particularly

beneficial for mouth breathers.

Table 4 - Therapeutic Options for Xerostomic Patients*

Pharmacologic Salivary Stimulants

Pilocarpine (Salagen®)

Cevimeline (Evoxac®)

Examples of Saliva Substitutes

Biotene® Oral Balance® products

Moi-Stir® products

MouthKote®

Optimoist®

Salivart®

Oasis® moisturizing mouth wash

(contains glycerin)

Tom’s of Maine® natural anticavity ﬂuoride mouthwash for a dry mouth (contains glycerin)

Examples of Fluoride Supplements Over-the-counter

Gel-Kam® gel

ACT®, Fluorigard® rinse

Prescription

Fluoritab® drops

Thera-Flur® drops

Karigel® gel

PreviDent® dentifrice or gel

Fluorinse® rinse

Lozi-tab® chewable tablet

Karidium® chewable tablet

Duraﬂor® varnish

Electrostimulation devices

Candidal Infections

Mycostatin® oral suspension

Mycostatin® pastilles

Mycelex® troche

Source:

Wynn RL, Meiller TF, Crossley HL. 2007-2008 Drug Information Handbook for Dentistry. 13th ed.

Hudson, OH: Lexi-Comp; 2007; pp 1812-1820.