Dry mouth (xerostomia) is a common condition that has multiple possible causes. It results from either a decrease in the production of saliva or a change in saliva’s composition. Dry mouth is frequently associated with the use of certain medications and is common in patients undergoing radiation therapy. Individuals with Sjogren’s syndrome have chronic dry mouth that requires long-term care. Compounded treatments include a topical dry mouth spray that can be applied directly to the mouth or troches to relieve symptoms quickly.

Causes of Dry Mouth

Dry mouth can make it feel like the mouth is full of cotton and make eating and speaking difficult. It can lead to a dry tongue, thick saliva, and cracks in the lips. Dry mouth can happen to anyone but certain individuals are more susceptible. Some common causes of dry mouth include:

Medications: The use of prescription medications is one of the most common causes of dry mouth. There are hundreds of medications that have dry mouth as a side effect. Because of this, elderly patients are more susceptible to developing dry mouth because they are more likely to be on multiple medications.

Sjogren’s syndrome: This autoimmune condition affects the body’s ability to create mucus, tears, and saliva. With this condition, the body’s immune system attacks the glands that create saliva which leads to dry mouth.

Radiation therapy and chemotherapy: Patients undergoing radiation therapy are especially susceptible to developing dry mouth. Radiation therapy and cancer treatments for the head and neck can damage salivary glands. If treatment is discontinued, the glands will usually produce saliva again.

Diseases: Certain diseases like diabetes can affect saliva production. Medications used to treat diabetes combined with high blood sugar levels can often lead to dry mouth. Other diseases that may be associated with dry mouth are lupus, rheumatoid arthritis, HIV/AIDS, Parkinson’s disease, and others.

Dehydration: Even mild dehydration may make the mouth feel dry. Drinking water regularly throughout the day is a good way to manage dry mouth.

Dry mouth can be more serious than the pain and discomfort it causes. It can lead to oral complications like periodontal infections and dental caries. Saliva helps maintain the health of the mouth through its antimicrobial and cleansing activity. When saliva production is slowed, bacteria in the mouth can grow and cause infections that exacerbate oral problems.

Treatments for Dry Mouth

Occasional dry mouth may go away on its own. However if it is a persistent problem then a medicated treatment may be prescribed. The cause needs to be addressed but until it can be identified medicated treatments can provide relief. If dry mouth is being caused by a particular medication and it is severe, another type of medication may be tried. If there is an infection that is causing dry mouth, symptoms usually will disappear once the infection is treated. In other cases, such as for patients with Sjogren’s syndrome, long-term treatment is required. Some of the treatment options available from a compounding pharmacy for treating dry mouth include:

• Pilocarpine troches or spray: Pilocarpine is a cholinergic agonist that increases secretions by the glands that produce saliva and tears. For treating dry mouth it is called a “sialagogue” – a stimulant for saliva production. In one placebo-controlled study, patients had 2-3 times the saliva production after taking pilocarpine. Pilocarpine can be made by a compounding pharmacy in the form of a troche. Commercially available pilocarpine only comes in tablet form.
• Mucolox alternative gel: A gel that contains a mucolox alternative is sometimes referred to as an “artificial saliva” gel. Our alternative to mucolox is also used in formulations for treating infections of the sinuses in many of our nasal sprays.
• Xylitol: Xylitol can be added to a formulation with a mucolox alternative and other ingredients. Xylitol is an ingredient commonly found in sugar-free chewing gum.
• Mouthwashes: Compounded mouthwashes can combine multiple ingredients together to treat various oral conditions. Magic mouthwashes can contain lidocaine, diphenhydramine, antifungals, and other ingredients for treating stomatitis. These mouthwashes may help reduce infections and oral complications caused by dry mouth.

Additional Treatment Measures

In addition to medications there are other measures that can be taken to improve dry mouth including:

• Drinking plenty of water and sipping cold fluids.
• Sucking on lozenges or ice.
• Chewing gum can stimulate saliva production.
• Avoiding spicy foods, alcohol, coffee, and smoking.
• Avoiding mouthwashes that contain alcohol.

Research

• Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. – JAMA Internal Medicine
• An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia. – Australian Dental Journal