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Living With Sjögren’s


Management of Dry Mouth

General Measures

The following tips help to reduce dry mouth symptoms:

  • Sip water or sugarless drinks often
  • Let small ice chips melt in your mouth
  • Avoid drinks with caffeine, such as coffee, tea, and some sodas – caffeine can dry out the mouth
  • Sip water or a sugarless drink during meals. This will make chewing and swallowing easier, and may also improve the taste of food
  • Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow; citrus, cinnamon or mint-flavored candies are good choices
  • Do not use tobacco or alcohol, they dry out the mouth
  • Be aware that spicy or salty foods may cause pain in a dry mouth
  • Use a humidifier at night

Stimulation of Saliva Flow

Increasing salivary flow can be achieved by chewing sugar-free gum, sucking on lozenges or sugar-free candies, or taking certain medications. Commonly used over-the-counter products include Xyli-Melt and Salese lozenges and dry mouth products (gel, spray, toothpaste). Snacking on carrots or celery may also help. Products that contain xylitol can help reduce the risk for dental decay.

Pilocarpine (Salagen) and cevimeline (Evoxac) are prescription medications that stimulate saliva production. Both are used to treat dry mouth by stimulating saliva flow. They should not be used if you have asthma, glaucoma, or heart arrhythmias. The most common side effect is excessive sweating. To minimize this, it is best to start the medication with one pill at bedtime and then increase after one week to one pill in the morning and one pill in the evening. After another week, increase to one pill three times a day. Other potential side effects include upset stomach or throwing up, nose stuffiness, and lowered night eyesight. You can take the drug with or without food. It can take up to 2 months for these medications to have full effect.

Minimize the use of medications that can cause a dry mouth. Many of these are prescription medications (such as anti-depressants, muscle relaxants, and anti-spasmodics for overactive bladders and bowel cramps). Talk with your physician as to whether these types of medications can be discontinued. Some over-the-counter medications can also cause a dry mouth, such as anti-histamines and decongestants.

Salivary Substitutes

Artificial saliva or saliva substitutes can be used to replace moisture and lubricate the mouth. These substitutes are available commercially and come in a variety of formulations including solutions, sprays, gels and lozenges. In general, they contain an agent to increase viscosity, such as carboxymethylcellulose or hydroxyethylcellulose, minerals such as calcium and phosphate ions and fluoride, preservatives such as methyl- or propylparaben, and flavoring and related agents. It is worthwhile to check out “dry mouth” products on Amazon. They have many different ones, and reviewing the website will give you a sense of what is available. Try different ones to find the best for you. Patient preference regarding taste, mode of use, etc are key factors in choosing one.


Eat sugary foods only during a regular meal. Eliminate dietary sugar (e.g., sucrose, glucose, and fructose) intake between meals, both in terms of snacks and beverages. Purchase “sugar-free” snacks and candies (not “sugarless,” which often contain “less” sugar rather than no sugar!). These sugar-free snacks contain sweetening agents that do not cause dental caries, such as xylitol, sorbitol, saccharin, aspartame, or sucralose. There is evidence that the use of a xylitol-containing gum or candy four to five times a day for 5 minutes after meals and snacks can reduce caries-producing bacteria.

Do not sip on carbonated beverages (e.g. a can of soda) between meals. The acidity of the beverage cannot be buffered without food and this prolonged fermentable carbohydrate and acidity in the mouth promotes dental decay. Should you drink, drink quickly (including juices). Try to consume juices that are fortified with calcium and fluoride and rinse with water afterwards.

Dental Care

Practice scrupulous oral hygiene. Brush and floss regularly and use fluoride daily. Your teeth should be cleansed at least twice daily using a soft bristled electric toothbrush and mildly flavored (avoid strong minty flavor) low-abrasive toothpaste. Choose “dry mouth” toothpastes. They do not contain sodium lauryl sulfate, a chemical in most regular toothpastes which may contribute to the formation of canker sores. Avoid whitening, tartar control, or smokers toothpastes since these contain abrasives. For the first 30 seconds, use the dry brush and brush the lingual (inside) surface of your teeth, then moisten toothbrush and apply a dry mouth toothpaste and brush for 1.5 minutes.

Floss between all adjoining teeth at least once daily to remove dental plaque. Carry a travel toothbrush and toothpaste with you to work and brush after meals and snacks. Do not brush immediately after consuming acidic beverages or food (lot of food and fruits, including salad dressings, are acidic). Instead rinse mouth with plain water or low fluoride containing rinse and brush after half an hour.

If you are at low-to-moderate risk of caries, you should use a 0.05% sodium fluoride mouth rinse (available over the counter) for 1-2 min. daily, before sleep. Hold the sodium fluoride rinse in your mouth for at least one minute before expectorating.

If you are at high risk of caries, your dentist or physician should prescribe 1.1% neutral sodium fluoride toothpaste (such as Prevident 5000 or SF 5000) to be used once daily in place of your regular toothpaste. Prescription fluoride toothpastes can be applied with a toothbrush and left in place for two to three minutes before expectorating. Do not swallow the prescription fluoride toothpaste. If dental caries develop in spite of daily use of topical fluoride, a soft acrylic carrier can be constructed for nighttime use of fluoride gels.


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*All information contained within the Johns Hopkins Jerome L. Green Sjogren’s Center website is intended for educational purposes only. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.