Dry Mouth – Xerostomia

Xerostomia is known as dry mouth and results from reduced or absent saliva flow. Xerostomia is not a disease, but it may be a symptom of various medical conditions, a side effect of a radiation to the head and neck, or a side effect of a large number of medications. It may or may not be associated with decreased function of the salivary glands. Xerostomia affects approximately 20 percent of the elderly. However, xerostomia in the elderly may have more to do with the medications that older people take then the affects of age alone

If you have a dry mouth you should take an active role in the management of your dry mouth in order to minimize the risk of this condition. Dry mouth can lead to cavities, sores in the mouth and various infections of the tissues and gums. Every day you should inspect your mouth for any signs of cavities, red or ulcerated gums or soft tissues. Each day you should brush and floss twice daily using a soft bristled toothbrush and a mildly flavored low-abrasive fluoride toothpaste.

Fluoride rinses should be held in your mouth for one minute before expectorating. Fluoride gels can be applied to your toothbrush and left in place for two to three minutes before expectorating. No beverage should be consumed for at least 30 minutes after the fluoride application.

Because of your susceptibility to cavities you should avoid sugary acidic foods and beverages. You should also avoid irritating foods that are dry, spicy, astringent or excessively hot or cold. If possible, tobacco and alcohol intake should be eliminated to control dental caries. Lubricants such as Orajel® or Vaseline® and glycerin swabs on the lips and under dentures may relieve drying, cracking, soreness, and gum irritation.

If you suffer more at night and are a mouth breather a cold air humidifier may help.

Dentures should not be worn at night. Dentures should be soaked in a denture cleansing solution and cleaned with a toothbrush.

Saliva stimulants such as sugarless candies (especially with Xylitol) and chewing gum, may be used to stimulate saliva flow. You should take frequent sips of water throughout the day and to suck on ice chips. Eating foods such as carrots or celery may also help . Addition of flavor enhancers such as herbs, condiments and fruit extracts may make food be more palatable if your food is tasting bland, papery, salty or otherwise unpleasant.

There are several over-the-counter products that are available to provide assistance in the management of dry mouth. These products range from saliva substitutes and stimulants to products designed to minimize dental problems.

Saliva substitutes:

Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. These substitutes are available commercially, but they can also be made by a pharmacist. Artificial salivas are formulated to mimic natural saliva, but they do not stimulate salivary gland production. Therefore, they must be considered as replacement therapy rather than a cure.

Commercially available products come in a variety of formulations including solutions, sprays, gels and lozenges.

Some commercially available saliva substitutes include:

  • Carboxymethyl, or hydroxyethylcellulose solutions:
  • Entertainer´s Secret® (KLI Corp) , spray
  • Glandosane® (Kenwood/Bradley) spray
  • Moi-Stir® (Kingswood Labs) spray
  • Moi-Stir® Oral Swabsticks (Kingswood Labs) swabs
  • Optimoist® (Colgate-Palmolive) spray
  • Saliva Substitute® (Roxane Labs) liquid
  • Salivart® (Gebauer) preservative-free aerosol
  • Salix® (Scandinavian Natural Health & Beauty) tablets
  • V. A. Oralube® (Oral Dis. Res. Lab) sodium-free; liquid
  • Xero-Lube® Artificial Saliva (Scherer) sodium-free; spray
  • Mucopolysaccharide Solutions:
  • MouthKote® (Parnell) , spray

Saliva stimulants

Natrol Dry Mouth Relief utilizes a patented pharmaceutical grade of anhydrous crystalline maltose (ACM) to stimulate saliva production. As its effect is to stimulate functional salivary glands, it would not be appropriate if your salivary gland function has been lost through radiological treatment. However, in a clinical study of patients with Sjorgren’s Syndrome, ACM was shown to increase secretions. Natrol Dry Mouth Relief is formulated as lozenges which are to be dissolve in the mouth three times daily.

Toothpaste and other products

Biotene® and Oralbalance® products are available over-the-counter from Laclede, Inc. (These are antixerostomia products that contain three salivary enzymes, lactoperoxidase, glucose oxidase and lysozyme, specifically formulated to activate intra-oral bacterial systems.

Currently available formulations include:

  • Biotene® Dry Mouth Toothpaste
  • Biotene® Gentle Mouthwash
  • Biotene® Dry Mouth Gum
  • Oralbalance® Long-lasting Moisturizing Gel

Xylitol Products

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a reduction in new tooth decay, along with arrest of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods.

How to use Xylitol

It is not necessary to replace all sweeteners to get the dental benefits of xylitol. Look for xylitol sweetened products that encourage chewing or sucking to keep the xylitol in contact with your teeth. The best items use xylitol as the principal sweetener.

How much?

Studies show that 4 to 12 grams of xylitol per day are very effective. It´s easy to keep track of your xylitol intake. The “all xylitol” mints and gums contain about one gram of xylitol in each piece. You could begin with as little as one piece four times a day for a total of four grams. It is not necessary to use more than 15 grams per day as higher intakes yield diminishing dental benefits.

How often?

If used only occasionally or even as often as once a day, xylitol may NOT be effective, regardless of the amount. Use xylitol at least three, and preferably 5 times every day.


Use immediately after eating and clearing the mouth by swishing water, if possible. Between meals, replace ordinary chewing gum, breath mints, or breath spray with comparable xylitol products.

If you have additional questions or concerns, call our Washington, D.C. office at (202) 386-7100.