Remedies for xerostomia

People who snore and those who are forced to sleep with an open mouth due to a cold often experience the unpleasant feeling of a dry mouth. Doctors refer to a permanent condition of a dry mouth as xerostomia. Persons affected often have a sensation that their tongue sticks to the palate. Speaking, chewing and swallowing are made difficult. The sense of taste is also impaired. Saliva enhances the impulses to the taste buds. Patients suffering from xerostomia therefore often have the need to season their meals more. If the saliva can no longer fulfil its function, the risk of inflammations and infections of the oral mucosa will increase. In most cases, the first signs are bad breath.

Teeth can be affected too, as without a sufficient quantity of saliva the self-cleaning ability is reduced. Consequently, an increased amount of sediments and plaque are formed on the teeth. Furthermore, the buffering effect and the remineralisation of the dental enamel are impaired so that caries has it easier.

The most frequent cause of xerostomia is simply an advanced age. The production of saliva decreases by natural process with the years of life. Unnoticeable at first, the complaints and constraints become clearer over time. Experts assume that about one third of the elderly living in care homes are affected. As a result of a disease, xerostomia occurs within the Sjögren syndrome. This autoimmune disorder is directed against the cells of the salivary and lacrimal glands, resulting in extreme dryness of the mouth and the eyes. The mucous membranes of nose, larynx, bronchial tubes and the vagina can also be affected.

In the case of cancerous diseases in the mouth, jaws and throat area it is normally necessary to operate and/or to use a radiotherapy treatment. If in such a case the salivary glands are removed or are permanently damaged by the radiation, the result will be lifelong xerostomia. Not least, pharmacotherapy can also lead to a dry mouth. If a customer complains at the pharmacy about a dry mouth, it is essential that PTA and the pharmacist enquire if and which medication the customer is taking. Xerostomia is relatively frequently an unwanted effect of for example antidepressants, benzodiazepines, neuroleptics, antihistamines of the first generation, anticholinergics, Beta-2 sympathomimetics as well as of some cancer medication.

The treatment of xerostomia depends on its cause. If the insufficient production of saliva has been caused by a drug substance, an alternative drug without this side effect should, if possible, be switched to. If there is a Sjögren Syndrome, the therapy mostly includes administering corticoids or biologicals. Furthermore, the direct parasympathomimetic drug pilocarpine (Salagen®) is also used which, inter alia, stimulates the production of saliva and lacrimation. The drug has also been approved for the treatment of xerostomia as a result of a radiation therapy of cancerous diseases in the area of the head and the throat.

In the case of an age-related reduction of saliva, simple remedies rank first. Individually they may have little effect but together they can mostly mitigate the complaints and prevent the consequences. To start with, adequate fluid intake throughout the day must be ensured. A dry indoor climate can be improved by airing the room regularly and using a room humidifier.

Another very helpful remedy is sugar-free chewing gum. Chewing triggers an impulse which stimulates the production of saliva.

To prevent any consequential damages to the teeth patients should ensure thorough dental hygiene. This also prevents unpleasant bad breath and infections in the oral cavity. For persons with xerostomia it is most important to have their teeth regularly checked by a dentist.

If the above does not result in a satisfactory outcome, PTA and pharmacists can recommend the use of a so-called artificial saliva. By now there is a large supply of products in many different dosage forms available, such as lozenges, spray, gel or mouth rinsing solutions. These preparations not only serve to pleasantly moisten the mouth but also to protect the dental enamel by means of buffering and remineralisation. Not all patients find artificial saliva pleasant or like its taste and flavour. Sometimes they need to do some testing until they find the right product acceptable to them. Highly viscous gels are particularly suitable for patients with very strong symptoms or for the night, whereas mouth rinses are more appropriate for mild cases. Sprays and lozenges work well for in-between and on the go.