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Peter assures you that he does not
smoke or chew tobacco. He quit
smoking over 20 years ago. Peter enjoys a
glass of beer most nights, but does not
drink to excess. He has never been a
mouth breather, so is doubtful this is
causing his symptoms. It does not appear
that lifestyle factors are causing Peter’s
Some medicines can cause dry mouth
(see Table 1). In the elderly population,
medicines are the most common
cause of salivary gland hypofunction,
and subsequent dry mouth.
It is reported that up to 80% of cases of
xerostomia are caused by medicines.
Anticholinergics are the most common
agent to be implicated in cases of dry
are amongst the strongest inhibitors
of salivation as a result of their
You confirm that Peter has been
experiencing a dry mouth for around
2 weeks now. He mentioned that he
commenced taking endep around three
weeks ago. Peter confirms that he did not
experience an issue with dry mouth
previous to starting endep. Given that
tricyclic antidepressants such as endep
are strongly implicated in causing dry
mouth, and the fact that Peter’s dry mouth
only started soon after he initiated
therapy with endep, it appears that this is
the most likely cause of his current
symptoms. You refer Peter to his doctor for
Saliva plays an important role in
the mouth, serving to assist with
functions such as talking, chewing,
tasting, and swallowing.
Additionally, enzymes found within
saliva assist with the digestion of starch
and fats and help to balance the oral
flora to prevent oral cavity infections.
Initially, the oral cavity of the patient
should be thoroughly examined by the
doctor in the assessment of xerostomia.
The overall treatment for xerostomia
is divided into three approaches –
general measures, salivary substitutes
and salivary stimulants.
The management of dry mouth is
primarily aimed at the appropriate
treatment of the underlying condition.9
In cases where medicine has been
identified as a cause of dry mouth, it is
suggested that the agent be replaced or
withdrawn if possible.9 Other general or
supportive measures include drinking a
minimum of two litres of fluid per day to
maintain hydration levels, and to avoid
irritants such as smoking, alcohol and
Patients can also
chew sugar-free gums, sweets or celery to
try and stimulate salivation.
patients, sucking on ice chips has been
shown to be effective.
the use of a bicarbonate mouth wash
may be effective (half a teaspoon of
bicarbonate powder in a glass of warm
water) in relieving symptoms.
The use of artificial saliva can assist
with the symptoms of dry mouth.
Saliva substitutes act to create a
moisture-retaining coating over the
oral mucosa when applied at frequent
intervals throughout the day.
Products are available as a spray, liquid,
gel, lozenges and pastilles, and are
manufactured with a neutral pH and an
electrolyte content to match the natural
14,16 Salivary substitutes can be
either mucin- or methylcellulose-based
A simple salivary stimulant is
The use of chewing
gum, in association with regular
mouthwashes, have been shown to
improve the symptoms of dry mouth.
In palliative care patients, ascorbic acid
tablets has been reported to relieve
xerostomia, but in the long term
they may affect the tooth enamel.
In addition, malic acid, which is naturally
found in pears and apples may help
to stimulate salivary flow, but can also
damage tooth enamel in the long term.
There is also limited evidence to support
the use of oral parasympathetic drugs
in the treatment of dry mouth.
Agents such as pilocarpine and
pyridostigmine may have some
effectiveness, but further research
There are also some non-
pharmacological interventions that
may assist with the treatment of
15 electrostimulation of
the salivary glands and low-level laser
therapy may increase the production
Acupuncture needling of
various trigger points on the body may
also increase salivary rate, but evidence
“lifestyle factors such as
smoking, chewing tobacco,
drinking alcohol, and
habitual mouth breathing
can also contribute to
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