Dry mouth treatment: irreversible or permanent xerostomia

The treatment of dry mouth depends on several factors, but mainly the problem or the underlying disease causing dry mouth.

In cases of irreversible xerostomia (due to autoimmune diseases, removal of glands, and atrophy of the glands from radiation or aging) there are no treatments that restore the functionality of the salivary glands. The only treatments possible are symptomatic methods like mechanical stimulation, acidic-substances or sialogogue drugs.

The key to treatment in these cases are stimulate and replace. On the one hand, the salivary glands which are partially functional must be stimulated and, on the other hand, saliva substitutes are necessary to balance the lack of saliva.

Depending on the number of glands affected and the existence or lack of glandular reserve (glands that maintain some activity), dry mouth will be higher or lower but permanent in any case.

Patients should take an active role in the treatment of their dry mouth, especially in cases of irreversible dry mouth and must avoid risk factors such as smoking or drinking alcohol, that would aggravate the situation.

Methods to stimulate saliva production

Mechanical stimulation

This stimulation can be performed by chewing sugarless gum or other foods that require a lot of chewing (carrots or celery). It is even possible to keep olive or cherry pits in your mouth. Sugarless candies or gum with xylitol work too.

Acidic substances

Acidic substances stimulate salivary secretion (lemonade, for example). The problem with this is that it causes demineralization of tooth enamel and can cause cavities.
In this article we talk about the risks of lemon and other acidic substances for dry mouth.

Sialogogue drugs

The substances that promote the secretion of saliva are called sialogogues. These substances may be systemic (drugs) or topical agents (gustatory stimulants).

Sialogogue drugs stimulate HEALTHY glandular tissue, so for them to work there must be some residual glandular activity. Some of these drugs are pilocarpine, cevimeline, anetoltritione, betanecol, carbacholine, broxmexine, pyridostigmine, sorbitol, neostigmine and distigmine.

Pilocarpine stimulates secretion from the salivary glands, lacrimals, gastrics and intestinal, pancreatic and respiratory tract. Pilocarpine has a large number of adverse effects which we will discuss in another article.

Although we dedicate a more extensive article to this, I must say that sialogogue drugs have many adverse side effects that require medical professionals to examine each case individually to weight the pros an cons of their use. These are drugs that cannot be taken without medical supervision.

Saliva replacement therapy

Replacement therapy is based on artificial saliva, a substitute to natural saliva. These are solutions with enzyme content that mimics saliva and recovers oral lining with a slippery and wet film that maintains the mouth hydrated and balanced.

Artificial saliva can have various formulations, but in general these solutions contain mucin glycoproteins or, different concentrations of fluorine and different ingredients such as Betaine, Allantoin, Aloe vera or Xylitol.

There are also formulations with malic acid to stimulate salivary secretion without erosive effects on the enamel.

Lack of saliva due to radiation therapy or chemotherapy

If the lack of saliva is due to radiation therapy or chemotherapy, there are other drugs like amifostine that reduces the side effects of radiotherapy.

Prevention of oral complications

In addition to the above procedures, it is essential to maintain good oral hygiene to prevent cavities and oral infections. People with xerostomia should use a toothbrush with soft bristles in their daily oral hygiene that will not irritate the gums, as well as fluoride toothpastes, and mouthwashes without alcohol. Furthermore they should visit the dentist several times a year to assess the status and health of their mouth.