Patients with residual salivary gland function may benefit from using simple dietary measures such as eating carrots or celery, by chewing sugarless gums, and the use sialagogues. Pilocarpine hydrochloride (Salagen®), 5 mg, four times daily, or cevimeline hydrochloride (Evoxac®), 30 mg, four times daily are recommended initial dosing regimens.32 Common dose-dependent side effects include sweating, nausea, rhinitis, flushing, and increased urinary frequency. Pilocarpine and cevimeline are contraindicated in patients with uncontrolled asthma or narrow angle glaucoma and should be used with caution in patients with significant cardiovascular disease.
Patients without functioning salivary glands may benefit from frequently rinsing with saline, a sodium bicarbonate solution, or a 0.5% aqueous solution of sodium carboxymethyl cellulose (formulated by the local pharmacist). A variety of over-the-counter saliva substitutes, moisturizers, and mouthwashes are also available (Box C). However, there is no strong evidence that any of these products are effective in predictably relieving the symptoms of dry mouth. Furthermore, patient acceptance is depends on taste, duration of perceived lubrication, delivery system, and cost.
Box C. Some of the Available OTC Moisturizers and Mouthwashes.
One of these over-the-counter products, Biotène®, is available in toothpaste, mouthwash, moisturizing gel, and gum formulations (Figure 1). The active ingredient in the toothpaste is sodium monophosphate; all product formulations contain the enzymes glucose oxidase, lactoferrin, lysozyme, and lactoperoxidase; plaque biofilm (PBF) products also contain mutanase and dextranase. Patients may benefit from using Biotène® products; however, by themselves they do not appear to significantly reduce S. mutans counts, which is a reliable indicator of dental plaque formation.37,38
Figure 1. Biotène Products.