Quality Resource Guide

Xerostomia Revisited 5th Edition

www.metdental.com

A large number of remedies have been developed

for replacing saliva and alleviating the discomfort

associated with xerostomia and are summarized

Table 4

These are formulated to function

as saliva substitutes and also to replicate some

of the constituents in natural saliva. Although

available OTC, these moistening agents may have

a limited duration of action that may require frequent

re-administration and consequently are not cost-

effective. Some newer products, however, have been

developed that provide longer intervals of efficacy.

These are available as oral solutions, aerosols,

sprays, gels, lozenges or troches (

Table 4

). The

relative efficacy of these remedies, however, could

not be determined based on an extensive systematic

review of multiple studies that have evaluated various

xerostomic therapies. That review found no evidence

that any of the currently available agents were more

effective in alleviating xerostomia.

Furthermore,

these products contain similar ingredients that would

contribute to the difficultly with distinguishing among

them for their efficacy. In addition, the inherent

variability of patient perceptions and their thresholds

for discomfort from xerostomia, irrespective of the

degree of their hyposalivation, is affected by the

differences in salivary secretions from the major

and minor salivary glands as previously described.

Various flavoring agents in these saliva substitutes,

in conjunction with taste preferences and altered

taste perception secondary to xerostomia may

be additional confounders in the assessment of

these palliative agents. Based on these variables,

it is unlikely that evidence-based outcomes could

determine the relative efficacy of saliva substitutes

that are currently available.

There is some evidence that chewing sugar-free

gum and use of lozenges may stimulate salivary

flow, but this can only be effective if the patient has

residual and functional salivary gland tissue with

some natural salivary flow.

Two

pharmacologic

agents,

pilocarpine

and

cevimeline (

Table 4

) can stimulate salivary

secretions provided that the patient has residual

and functional glandular tissue. Since these drugs

require systemic administration in order to stimulate

the cholinergic receptors of the salivary glands,

Table 4 - Products and Preventive Strategies for Xerostomic Patients

Salivary Stimulants

Prescription Pharmacologic Agents

Pilocarpine (Salagen®)

Cevimeline (Evoxac®)

Prescription Electrostimulation Devices (GenNarino Saliwell Ltd

)

Over-the-Counter Electrostimulation Devices (Saliwell

)

Over-the-Counter Moisturizing Saliva Substitutes

Biotene Oral Balance® Moisturizing Products

Biotene Dry Mouth Moisturizing® Spray

TheraBreath Dry Mounth® Oral Rinse

Lozenges and Patches

OraMoist® Patches

Optimoist Oral Moisturizer-Colgate Oral®

TheraBreath Dry Mouth ® Lozenges

ACT Total Care Dry® Mouth Lozenges

Xylitol-containing Lozenges

Oracoat Xylimelts®

ACT Dry Mouth Lozenges®

Xylitol Sprays

Allday 100% Xylitol Dry Mouth Spray®

Spry Xylitol Moisturizing Mouth Spray®

Xylitol-containing Candies/Mints

PRO-SYS Xylitol Lollipops®

Spry Xylitol Mints®

Dr. John’s Inspired Spray®

Sweets Sugar Free®

3M ESPE TheraMints 100% Xylitol®

Xylitol-containing Chewing Gums

Epic Dental 100% Xylitol Gum®

PUR Gum Aspartame Free®

XyliChew Soft Chewing Gum®

Spry Xylitol Gum®

Mighteaﬂow® chewing gum

Ice Cubes from Ice Breakers® (not 100% xylitol)

Alcohol-free mouth rinses

Listerine Total Care Zero Anticavity Mouthwash®

Crest Pro-Health Multi-Protection Refreshing Mouthwash®

Biotene Dry Mouth Oral Rinse®

Biotene Dry Mouth Gentle Oral Rinse®

Candidal Infections

Mycostatin® oral suspension

Mycostatin®pastilles

Mycelex® troches

PerioGard®, Peridex® alcohol-free oral rinse