What are the recommended first-line treatments for managing xerostomia in adults?

First-line treatments for managing xerostomia (dry mouth) in adults focus on addressing underlying causes and implementing simple saliva stimulatory measures. Initially, it is important to identify and, if possible, modify any causative factors such as adverse drug effects, dehydration, anxiety, or oral infections like candidiasis NICE CKS.

Non-pharmacological interventions include: frequent sips of cold unsweetened drinks, use of sprays or ice cubes, sugar-free chewing gum, boiled sweets, pastilles, or mints to stimulate saliva production NICE CKS. Regular oral hygiene, including tongue cleaning and denture care, and maintaining adequate fluid intake are also recommended NICE CKS.

If symptom relief is inadequate, topical treatments may be considered: these include topical saliva stimulants and artificial saliva substitutes, which help moisten the oral mucosa but do not contain active drug ingredients NICE CKS. Care should be taken to avoid acidic or sugary products that may increase tooth decay risk NICE CKS.

Pharmacological options for more persistent xerostomia include systemic saliva stimulants such as pilocarpine, a muscarinic agonist, which has shown efficacy particularly in radiation-induced xerostomia, as supported by recent literature Watanapokasin et al. 2024. Pilocarpine can be used as needed to improve salivary flow, but its use should be balanced against potential side effects NICE CKS Watanapokasin et al. 2024.

Overall, the management strategy is stepwise: start with non-pharmacological measures and oral hygiene, progress to topical agents if needed, and consider systemic stimulants like pilocarpine for refractory cases, always addressing underlying causes where possible NICE CKS Hayslett & Marshall 2025.