A guide for treating the xerostomia patient: 7 products for dry mouth relief

Xerostomia, or "dry mouth," affects a significant portion of the population. It can be caused by patient medications, autoimmune diseases, and head and neck radiation. A decreased amount of saliva in a patient's mouth can have devastating oral effects: Caries may run rampant due to lack of salivary flow and pH imbalance, the mucosa may split or crack or ulcers may develop, and speaking or swallowing may become difficult.

It is important for dental hygienists to offer patients with xerostomia some options for treating the symptoms of an excessively dry mouth. Before beginning to research this issue, I knew of only a few products that could help with salivary stimulation and oral mucosa lubrication. It has been helpful to learn about the various options available so that I can recommend the best products available for each patient.

The following is an overview of my favorite seven products . . .

ACT Total Care Anticavity Fluoride Rinse for Dry Mouth

Ingredients of note: .02% sodium fluoride; xylitol
To use: Swish ten milliliters for one minute twice daily. Do not eat or drink for 30 minutes after use.
Effect: Moisturizes and coats oral tissues and protects enamel
Flavor: Mint
Rx: Available directly to the patient, online and in stores
My two cents: Any product I can get a xerostomia patient to use that contains fluoride is a good thing. I think a fluoride rinse would be a good adjunct for most xerostomia patients in order to help reduce decay.

ACT Dry Mouth Lozenges

Ingredients of note: Xylitol
To use: Allow a lozenge to dissolve slowly in the mouth as many times as needed daily.
Effect: Stimulates saliva production
Flavor: Mint
Rx: Available directly to the patient, online and in stores
My two cents: In my opinion, this lozenge had the best mint flavor of any product I tried. The lozenges are large so it can be difficult to talk with one in the mouth, but they dissolve when tucked into the vestibule.

BasicBites by Ortek Therapeutics

Ingredients of note: Xylitol; arginine; bicarbonate; calcium carbonate
To use: After brushing and flossing, take one BasicBites soft chew and let it soften in your mouth. Then, chew it to cover all surfaces of all teeth. Use twice daily.
Effect: Balances oral pH and coats teeth in calcium carbonate to protect enamel
Flavor: Chocolate
Rx: Available directly to the patient, online only
My two cents: This product was unlike any other that I tried and would be a good option for patients with mild xerostomia who don't enjoy mint flavors or constantly having a mint or lozenge in their mouths.

3M ESPE TheraMints 100% Xylitol-Sweetened Mints

Ingredients of note: Xylitol
To use: Allow a mint to slowly dissolve in the mouth as many times as needed daily.
Effect: Stimulates saliva production
Flavor: Mint and fruit flavors available
Rx: Available directly to the patient, online only
My two cents: This product comes with a convenient travel tin, so the patient can carry just a few around instead of the whole bottle of 520 mints. The flavor is very minty! This product is great for patients who deal with mild daytime xerostomia and who may need the help of a discreet mint to stimulate salivary flow.

Allday Dry Mouth Spray from Elevate Oral Care

Ingredients of note: Xylitol
To use: Spray on the tongue and rub tongue over all tooth surfaces for at least five seconds as many times as needed daily.
Effect: Moisturizes oral mucosa and protects enamel
Flavor: Mint (mild)
Rx: Available directly to the patient, online only
My two cents: Application of this spray is quick and easy and would be good for patients suffering from all-day xerostomia, as they can use it whenever needed. This spray also provides instant relief from dry mouth since it coats all the oral tissues so the patient won't have to wait for salivary glands to be stimulated.

XyliMelts by Oracoat

Ingredients of note: Xylitol
To use: Place a disc at the gum line near the molars with the tan, adhesive side touching the gums, and do not move the disc for ten seconds so it will adhere.
Effect: Increases saliva production
Flavor: Mint (mild)
Rx: Available directly to the patient, online and in stores
My two cents: These discs adhere to the attached gingiva near the molars but do not disrupt speaking, so they are an excellent option for patients who need xerostomia relief throughout the day but who may not be able to sneak off to the bathroom to use a mouth rinse or spray product. They also dissolve very slowly and may prove to be an excellent choice for patients who deal with nighttime xerostomia.

SalivaMax by Forward Science

Ingredients of note: Super-saturated calcium phosphate
To use: Mix one packet of powder into one ounce of water and stir. Swish half of the liquid in the mouth for one minute, and spit it out. Then, repeat with the other half of the liquid. Use two to ten times daily as needed.
Effect: Balances oral pH and reduces hyposalivation, xerostomia, and mucositis
Flavor: None—when used, this product tastes like slightly salty water.
Rx: Available only by prescription
My two cents: Most over-the-counter products for xerostomia relief are not evaluated by or registered with the Food and Drug Administration (FDA). SalivaMax, however, is FDA-approved. Forward Science also has easy-to-use oral pH test strips, called phID, available to monitor patients' salivary pH. This is a good product for both mild and severe xerostomia patients as it can be used up to ten times daily.

The opportunity to try these products has better equipped me to offer helpful suggestions to my patients who are suffering from any degree of xerostomia. By knowing the products that are available, I am better able to offer directions based on each patient's particular needs. Ultimately, my most likely recommendations for any specific patient would be a combination of some of products described above.