OTCs Today
Mary Warner
Dry mouth, also known as xerostomia, occurs when insufficient saliva is produced to keep the mouth moist. A person with normal salivary flow produces up to 1.5 L of saliva every 24 hours, and up to 46% of the population is said to be afflicted with persistent dry mouth. This can lead to a range of symptoms, including a sticky or dry feeling in the mouth, cracked lips, mouth sores, bad breath, difficulty chewing, swallowing, or speaking, and even an increased risk of tooth decay and infections.
What causes dry mouth?
Several factors can contribute to dry mouth, including medication adverse effects, underlying medical conditions, and certain lifestyle choices. Many medications, both prescription and OTC, can cause dry mouth. Common culprits include anticholinergics (tiotropium, scopolamine, atropine, and oxybutynin), first-generation antihistamines (diphenhydramine, chlorpheniramine, and hydroxyzine HCl), antidepressants (SSRIs and SNRIs such as citalopram, paroxetine, and sertraline), stimulants (amphetamine salts and methylphenidate), opioids (morphine and oxycodone), benzodiazepines (alprazolam and diazepam), and antipsychotic medications (clozapine and quetiapine).
In addition, gabapentin; Parkinson’s disease medications, such as benztropine; some heart and BP medications, such as furosemide and propranolol; muscle relaxers, such as tizanidine; and nausea medications, such as promethazine can also cause dry mouth. Older patients, who are more likely to be taking multiple medications for chronic diseases, are more commonly affected by dry mouth. However, if the medication causing dry mouth can be discontinued, normal salivary flow may resume in some cases.
Medical conditions such as Sjögren’s syndrome, diabetes, and HIV can also affect saliva production, as can nerve damage, smoking, and alcohol consumption. Even breathing through the mouth can cause dry mouth, especially at night.
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Examples of OTC artificial saliva products
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Brand name
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Primary ingredients
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ACT Dry Mouth Lozenges
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Isomalt, xylitol, glycerin, natural and artificial flavors, sucralose, beta-carotene
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Biotene Dry Mouth Oral Rinse, Biotene Dry Mouth Moisturizing Spray
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Glycerin, water, sorbitol, xylitol, carbomer, hydroxyethyl cellulose, sodium hydroxide purified water, glycerin, xylitol, PEG-60 hydrogenated castor oil, VP/VA copolymer, flavor, sodium benzoate, xanthan gum, methylparaben, propylparaben, sodium saccharin, cetylpyridinium chloride
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Entertainer’s Secret Spray
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Sodium carboxymethylcellulose, dibasic sodium phosphate, potassium chloride, parabens, aloe vera gel, glycerin
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Biotene Dry Mouth Gum
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Titanium dioxide, lecithin, xylitol, carnauba wax, sorbitol, resinous glaze, natural and artificial flavors, maltitol syrup, potassium acesulfame, glucose oxidase, lactoperoxidase, potassium thiocyanate, gum base
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OraCoat XyliMelts
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Acacia gum, cellulose gum, mild natural mint, calcium carbonate, magnesium stearate
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Treatment and management
The objectives of self-treatment of xerostomia are to relieve the discomfort of dry mouth, reduce the risk of dental decay, and prevent and treat infections and periodontal disease. Simple steps to treat dry mouth include drinking plenty of water, chewing sugar-free gum or sucking on sugar-free hard candy, avoiding alcohol and caffeine, avoiding smoking, and using lip balm.
Artificial saliva products, designed to mimic natural saliva, are available for relieving the discomfort of dry mouth. They are available as sprays, gums, and gels and typically consist of carboxymethyl or hydroxyethylcellulose solutions with or without fluoride. However, these products lack the many naturally occurring protective components that are present in natural saliva (digestive and bactericidal enzymes and other naturally occurring proteins) and don’t stimulate salivary glands to increase natural saliva production. As such, they are considered replacement therapy, not a cure for xerostomia.
What to tell your patients
Advise patients to pay particular attention to the medications they are taking and talk with their pharmacist or physician about possible discontinuation of medications that may cause dry mouth. Ensure that they are aware of the benefits of not smoking and limiting caffeine consumption. Finally, advise patients to see their dentist regularly to avoid dental complications from dry mouth.
For further information, please see the section on Orofacial Pain and Discomfort in APhA’s Handbook of Nonprescription Drugs, available from the bookstore on pharmacist.com or in APhA OTC online at pharmacylibrary.com. ■