Managing Severe Dry Mouth in Patients with Sjögren's Syndrome

Severe dry mouth in xerostomia?

Hello Doctor: My mother is 76 years old and has been suffering from Sjögren's syndrome for over 20 years.
She also has hepatitis C, which has recently been successfully treated, and she is now virus-free.
My mother has severe dry eye syndrome, and in the past six months, her dry mouth has led to difficulty swallowing, significantly affecting her diet and causing noticeable weight loss.
She has been under the care of a rheumatologist and is on medication, but there has been no improvement.
Could you please advise on any medications or methods that could help alleviate my mother's severe dry mouth? Thank you!

Miss Lin, 50~59 year old female. Ask Date: 2022/05/29

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Currently, there are effective medications available to alleviate the symptoms of xerostomia, particularly dry mouth, which you can discuss with your primary care physician.
Additionally, there are some over-the-counter mouth rinses that can help relieve dry mouth, such as Biotene, which is available in mouthwash, spray, and gel formulations.
You may want to check with your local pharmacy for these options.
This message is from the Department of Allergy, Immunology, and Rheumatology at Changhua Hospital, Ministry of Health and Welfare, and we care about your well-being.

Reply Date: 2022/05/29

More Info

Managing severe dry mouth, or xerostomia, in patients with Sjögren's syndrome can be quite challenging, especially in older adults who may have additional health concerns. Given your mother's long-standing history of Sjögren's syndrome and her recent struggles with severe dry mouth and swallowing difficulties, it is crucial to adopt a comprehensive approach to her management.

Understanding Sjögren's Syndrome and Dry Mouth
Sjögren's syndrome is an autoimmune disorder characterized by the infiltration of lymphocytes into exocrine glands, leading to their dysfunction. This results in reduced saliva and tear production, causing symptoms such as dry mouth and dry eyes. In your mother's case, the severe dry mouth not only affects her comfort but also her ability to eat, which can lead to weight loss and nutritional deficiencies.

Treatment Options for Severe Dry Mouth
1. Saliva Substitutes and Stimulants: Over-the-counter saliva substitutes can provide temporary relief from dry mouth symptoms. These products mimic natural saliva and can help lubricate the oral cavity. Additionally, medications such as pilocarpine (Salagen) and cevimeline (Evoxac) are prescription medications that stimulate saliva production. These medications can be particularly effective for patients with Sjögren's syndrome.

2. Hydration and Dietary Adjustments: Encourage your mother to stay well-hydrated by drinking plenty of fluids throughout the day. Soft, moist foods can also make swallowing easier. Foods that are less dry and more hydrating, such as soups, stews, and smoothies, may be beneficial. Avoiding spicy, acidic, or overly salty foods can help reduce irritation in the mouth.

3. Oral Hygiene: Maintaining good oral hygiene is essential for patients with dry mouth, as they are at a higher risk for dental caries and oral infections. Regular dental check-ups and the use of fluoride toothpaste can help protect her teeth. Additionally, using alcohol-free mouthwashes can help keep the mouth moist without causing irritation.

4. Humidifiers: Using a humidifier in her living space, especially at night, can help maintain moisture in the air and alleviate some symptoms of dry mouth.

5. Consultation with Specialists: If your mother has not seen a dentist or an oral medicine specialist recently, it may be beneficial to do so. These professionals can provide tailored advice and treatment options specific to her condition. They may also recommend therapies such as sialogogues, which are substances that stimulate the secretion of saliva.

6. Addressing Underlying Conditions: Since your mother has a history of hepatitis C, it is essential to ensure that her liver function is stable and that any medications she is taking do not exacerbate her dry mouth. Regular follow-ups with her healthcare provider can help monitor her overall health and adjust her treatment plan as necessary.

7. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture or herbal remedies. However, it is crucial to discuss these options with her healthcare provider to ensure they are safe and appropriate for her condition.

Conclusion
Managing severe dry mouth in patients with Sjögren's syndrome requires a multifaceted approach that includes pharmacological treatments, lifestyle modifications, and regular monitoring by healthcare professionals. Given your mother's specific situation, it is essential to work closely with her healthcare team to find the most effective strategies for her. Encouraging her to communicate openly about her symptoms and any changes in her condition will help ensure that she receives the best possible care.

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