In the therapy of patients with persistent xerostomia, a basic distinction can be made between causal and symptomatic therapy.
Causal therapy
In the case of dry mouth, the first step is to determine the cause. If possible, a change in medication may provide relief. In the case of irreversible damage to the salivary glands, for example in the course of radiation therapy, often only symptomatic therapy remains. Sometimes, in the course of radiation, the submandibular gland can be surgically relocated out of the radiation area to prevent its damage and to prevent xerostomia. Furthermore, there is the possibility, if the tumor process allows it, to reduce the radiation dose in the area of a parotid gland in order to minimize the damage to the gland and thus prevent pronounced dry mouth. However, this must always be clarified on an individual basis and is always dependent on the location and extent of the tumor.
Symptomatic therapy
In cases of high-grade xerostomia, drug therapy with neostigmine, pilocarpine, nicotinamide, or bromhexine may be considered. However, a systematic clarification of possible interactions with the existing medication – taking into account possible side effects on the underlying disease – must be carried out beforehand. For symptomatic therapy of dry mouth, sucking sugar-free candies or chewing sugar-free gum can already be used in mild cases to stimulate salivary secretion.
In severe cases, artificial saliva substitutes (e.g., Artisial, Glandosane, Oralube, Siccasan) can be used as flavored or neutral substitutes, as well as oil rinses. In addition, artificial saliva spray solutions containing animal mucins or carboxymethylcellulose as lubricants and minerals and fluorides for caries prophylaxis are available.In particularly severe cases, administration of the parasympathomimetic pilocarpine systemically or as a mouth rinse can be used in addition to artificial saliva replacement solutions.
Practical recommendations for symptomatic therapy of xerostomia:
- Drink small amounts frequently (lemon or peppermint tea), which promotes salivation.
- Buttermilk and kefir promote the formation of mucus (rinse with water). Fresh milk is not suitable.
- Carrying a drinking bottle to moisten the mouth.
- Promoting the flow of saliva also act chewing gum, sour (sugar-free!) Sweets (sour drops) and sour fruit.
- For dry mouth, sucking frozen pieces of fruit and yogurt can provide relief. Good experience is available with frozen pineapple juice, which should be melted on the tongue.
- Prefer: juicy food, sauces, soups, pureed vegetables, mashed potatoes.
- Avoid: Crumbly and dry.
Furthermore, a close dental recall care of the patient is required:
- Professional dental cleaning (PZR)
- Oral hygiene consultation (due toincreased caries risk).
- Chemical infection prophylaxis (through antibacterial rinses).
- Fluoridation
- Nutritional counseling
