Strategies for Addressing Xerostomia

Most commonly, xerostomia in older adults is medication-related. Polypharmacy---use of multiple medications---may be due to a patient seeing multiple prescribers, or may be related to a "prescribing cascade," when more medications are given to address the side effects of other medications. In these cases, it may be helpful for the patient to talk with their primary care provider, often a geriatrician, about their dry mouth. Raising awareness of this problem may encourage changes in medication, or reduction or elimination of some drugs, which may have less side effects while still providing health benefit.

When medications are not possible, the dental team can make recommendations for oral comfort.

  • Adequate hydration- consuming adequate amounts of water is important for good health and the necessary moist environment for the mouth, nose and throat. The Institute of Medicine determined an adequate intake (AI) for men is roughly about 13 cups (3 liters) of total beverages a day. The AI for women is about 9 cups (2.2 liters) of total beverages a day.
  • Adequate humidification of the home is important, especially during the winter months. This may be done as an adjunct to the heating system or with an independent humidifier.
  • Moisturizers can be applied to the lips and oral mucosa. Creams or balms with lanolin can be helpful for dry lips, and gels (Biotene Oral Balance) can be applied to the oral mucosa prior to sleep.
  • Moisturizing mouth sprays are available from a number of companies, including Biotene, Oasis, XClear and others. Some include xylitol, which is noncariogenic. Patients truly differ in terms of preference of taste and feel, and some prefer to carry a small spray bottle filled with water.
  • Several companies provide lozenges for dry mouth (Salese, MedActive, other) which are intended to provide longer lasting comfort.
  • Sialogogues are typically drugs intended to encourage parasympathetic nervous system activity and increase salivation. They are indicated more for xerostomia not caused by medications, such as radiation therapy of the autoimmune condition Sjogrens syndrome.