Selected nonprescription products for management of dry mouth

Category Brand name Ingredients

Saliva-stimulant chewing gum

Toothpaste

Biotene dry mouth gum

Various brands

Biotene antibacterial dry mouth toothpaste

polyglycitol, sorbitol, gum base, xylitol, hydrogenated starch, artificial flavor, titanium dioxide, lecithin, resinous glaze, acesulfame K, potassium thiocynate, lactoperoxidase-glucose oxidase.

xylitol

lactoperoxidase glucose oxidase, lysozyme, lactoferin, sodium monofluorophosphate

Orajel dry mouth moisturizing toothpaste

fluoride, antioxidants, citric acid, methylparaben

TABLE 6

Cont’d

Category Brand name Ingredients

Oral moisturizer/ saliva stiumlant

Biotene Oral Balance dry mouth moisturizer, gel

hydroxyethylcellulose, Beta-D-Glucose, sodium phosphate, aloe vera, potassium thiocynate, lysozyme, lactoferrin, glucose oxidase, lactoperoxidase

Biotene moisturizing mouth spray

purified water, polyglycitol, propylene glycol, sunflower oil, xylitol, milk protein extract, xantham gum, potassium sorbate, acesulfame K, flavor, rosemary extract, disodium phosphate, potassium thiocyanate, lysozyme, lactoferrin, lactoperoxidase

Tom’s of Maine natural anticavi-tiy fluoride toothpaste for dry mouth

Oral moisturizers

Biotene Oral Balance dry mouth moisturizer gel

 

In working with patients to select appropriate OTC products for self-management of dry mouth, pharmacists should be prepared to help patients understand the importance of good oral care, read labels carefully and select products that are most appropriate for their needs. In addition to encouraging patients to schedule regular visits with their dentist, pharmacists can recommend appropriate OTC products designed to assist in the management of dry mouth (Table 6).

 

SALIVARY STIMULANTS

Stimulation of saliva can be accomplished by use of salivary flow stimulants, such as sugarless hard candies and chewing gum. Selected products are listed in Table 6. ¹² According to the ADA, any commercial sugarless gum or lozenge used more than twice a day can provide symptomatic relief. Xylitol, a sugar-free sweetener, is the most common ingredient used in salivary stimulants and has shown to reduce the risk of development of dental caries, reduce plaque formation and increase salivary flow. Results from various studies have suggested that xylitol

sodium monofluorophosphate, xylitol, glycerin

glycerol polymethacrylate, polyglycitol, xylitol

 

may have specific mechanisms of its own in reducing dental caries beyond those of stimulating saliva. ^18,19 Although the ADA does not have a position statement on the use of xylitol, the American Academy of Pediatric Dentistry does recognize its benefits and supports its use in the improvement of oral health care. Citric acid and other sweeteners, such as sorbitol, mannitol, aspartame, acesulfame and malitiol, are additional ingredients present in chewing gum and lozenges to promote good health care. Studies comparing sorbitol-containing gum with xylitol-containing gum have shown xylitol to be superior in prevention of dental caries. ^18,19

 

SALIVA SUBSTITUTES

Saliva substitutes or oral lubricants do not stimulate saliva but instead mimic natural saliva to manage the symptoms of dry mouth. They work by replacing and providing moisture and lubrication to the mouth. These products are available as solutions, sprays, swabs and gels. Regardless of the formulation, the ingredients of saliva substitutes are made to resemble saliva’s viscosity (e.g., glycerin

Oasis mouth moisturizing spray

Orajel dry mouth relief

Orajel dry mouth moisturizing spray

Stoppers 4 Stop dry mouth spray

 

and carboxymethylcellulose, hydrox-ymethylcellulose) and mineral content (e.g., calcium ions, phosphate ions, fluoride). ^{3, 9} Many products will contain preservatives (e.g., methylparaben), flavorings (e.g., mint or lemon) and sweeteners (e.g., xylitol or sorbitol). ^{3, 9} Patients on sodium-re-stricted diets should avoid those products that contain sodium. There are no specific dosing guidelines for these products, but they should be used before bedtime or speaking and used as often as needed. Unin-

purified water, polyglycitol, propylene glycol, sunflower oil, xylitol, milk protein extract, xantham gum, potassium sorbate, acesulfame K, flavor, rosemary extract, disodium phosphate, potassium thiocyanate, lysozyme, lactoferrin, lactoperoxidase

glycerin, calcium disodium, EDTA, citric acid, dicalcium phosphate, flavor, methylparaben, propylparaben, purified water, sorbitol, sucralose, thione complex (a patented proprietary blend of antioxidants), xanthan gum.

glycerin, water purified, flavor, sodium saccharin, xanthan gum, potassium sorbate, xylitol, ascorbic acid, camellia sinensis leaf extract, vitis vinifera seed extract (grape)

deionized water, glycerin, xylitol, hydroxyethylcellulose, lysozyme, lactoferrin, glucose oxidase, natural spearmint flavor, sodium benzoate

 

tentional swallowing of the substitute requires frequent administration of these products resulting in adherence issues for some patients. Selected saliva substitutes are included in Table 6.

 

PHARMACOLOGICAL STIMULANTS

Two prescription medications, pilocarpine (Salagen) and cevimeline (Evoxac), are FDA approved for treatment of dry mouth associated with Sjorgen’s syndrome. Both medications are cholinergic agents that bind to the muscarinic M3 receptor in the