Hi, there are to my knowledge no really good remedies for dry mouth. What you can have the patient try is e.g. Canola oil or a really good Olive oil. Have them take a spoon full an aply it all over the mucosa either with the tong or a swab.

Good luck! Sincerely Dr. K Schander

Yes there are some:

Sugar-less candies

Carry on a bottle with water and drink frequently a small volume of it.

Use a marbel in the mouth, to "over stimulate" salivary glands

Sorry, I have not the references with me.

Hi Dr Schander and thank you for your suggestion. It seems practical to use especially in our country where we cherish olive oil. It is available in every home. How long do you think that its effect can last?

Thank you Rc Castrejon-perez. You suggested something that is helpful for most patients. Some of them unfortunately can not tolerate the taste of sugar substitutes and opt for sugary candies against our advice.

Hi Dr Najla Dar-Odeh, there are all great suggestions, but I we may consider all as palliative care for dry mouth for permanent salivary gland damage. As far I know, tehre is no good medication over the counter to solve thist problem. Good luck! Elvira

Hi. Dr. Irne Morales from Fcaulty of Dentritry of University of Chile got a grant from FONIS - CONICYT last year, to research about that, and she is conducting a Randomized clinical trial to evaluate the efficacy of a saliva substitute home manufacturing

http://www.odontologia.uchile.cl/noticias/87270/odontologia-busca-generar-saliva-artificial-elaborada-en-casa

http://www.odontologia.uchile.cl/noticias/87270/odontologia-busca-generar-saliva-artificial-elaborada-en-casa

Thank you Elvira. What is tehre?

Thanks Chris Ivanoff. The remedies you suggested are available everywhere and almost every one likes celery, parsley and red pepper. I am interested in the mouth wash you suggested since it may also be helpful for patients with normal salivary flow rate too.

Hi Cornejo. The research you referred to seems very interesting. It is my bad luck that I don't know Spanish.

sorry, my speeling mistake.. I reffered Dr Castrejon-Perez and Dr Kerstin Schander comments

What I suggest to my clients here in the U.S. with Sjogren's is Thayers Dry Mouth Spray. It may be hard to find but it works well.

there are any number of herbs -we classify them broadly as "sialogogues" - as they promote the production of saliva. For example, cardamom pods, not chewed but placed between the teeth and the cheek are mild acting but sufficient for many - there are others

In Brazil there Jaborandi extract as herbal medicine, but it is always necessary to have some amount of parenchyma remaining functional.

A popular sialogogues; the Anethole-trithione is present in the star anise and fennel. I guess that infusions of these herbs may have some beneficial effect. Of course, if there is still some amount of glandular parenchyma to stimulate

Sprinkle red pepper on your food or mixing it into tomato juice may stimulate saliva production in small amount other wise it may lead to stomattise

5) Sprinkle red pepper on your food or mixing it into tomato juice may stimulate saliva production

Hi, this is my first time responding to a discussion on this forum. I do find the topic very interesting and stimulating. You got me thinking!

If these salivary glands are irreversibly damaged, how effective can therapy be? However,I think that the properties of fruits such as citrus,pawpaw and mangoes can be explored on their effect on the salivary glands.

Very true Chris. My grandmother used to soak her denture in sodium bicarbonate, the very same mouth wash that is used to relieve mucositis associated with radiotherapy.

I appreciate your response Vernanda. I can also say that my patients, who suffer the most , are the ones that get me thinking. This time it was a 60-year old lady, Her scintiscan showed zero function in the salivary glands. Her dry mouth is so severe that you can hear her clicking sound from a far distance. Despite all her suffering, she is optimistic, smiles all the time, and tells poems that she wrote about her beloved ones.So to answer your question, I don't know how effective therapy could be for some one who lost all salivary function.

Thanks for your response, Najla. I hope that research can eventually find a solution for these patients.

Hi Najla,

In my opinion an importan tissue is to assure that the patient is well hydrated.

Moreover, although you asked specifically about natural remedies, and some of them have already been suggested, I indicate the phototherapy with low intensity laser or LED as an option.

I believe that light therapy is a good option as it does not interfere with the medication that the patient would possibly be using.

Best regards!

Thank you Luiz. Can you elaborate more on phototherapy?

Thank you Adrianne. I have to check that the herbs you suggested are available in Jordan.

Hi Najla, there are some studies showing clinical improvements using hand touch techniques, such as Reiki, in diminishing stress levels and pain and in increasing salivary IgA secretion between others, in different study groups and especially in elderly. My personal experience is that hand touch techniques may change the paradigm of a condition. If the patient is receptive, may be you could suggest it, without any promise of cure. As you mentioned, I also think that it is true that we learn from our patients. All the best.

dear Gisela,

But have you had any experience using this technique with people suffering from irreversible damage to their glands?

Hi, fenugreek is often recommended for increases in lactation. It apparently increases all other body secretions, to the point where sweating can become an issue, and including salivation.

Hi Gisela and thank you for your suggestion. Do you think that it will work for patients with zero- function salivary glands? I would be grateful to know a reference that explains this method.

Dear Najla and Esther, I have not experienced this technique (Reiki) or other hand healing techniques in Sjogren´s Syndrome cases. However, there is some nice evidence in the literature in other conditions. Here I am attaching six references, but, you will find more using pub med and searching for the terms Reiki or Johrei.

(1) Abe K, Ichinomiya R, Kanai T, Yamamoto K. Effect of a Japanese energy healing method known as Johrei on viability and proliferation of cultured cancer cells in vitro. J Altern Complement Med 2012; 18(3):221-228.

(2) Cuneo CL, Curtis Cooper MR, Drew CS, Naoum-Heffernan C, Sherman T, Walz K et al. The effect of Reiki on work-related stress of the registered nurse. J Holist Nurs 2011; 29(1):33-43.

(3) Díaz-Rodríguez L A-MMC-VIF-LCPMF-PC. The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure. Rev Lat Am Enfermagem 2011; 19(5):1132-1138.

(4) Meland B. Effects of Reiki on pain and anxiety in the elderly diagnosed with dementia: a series of case reports. Altern Ther Health Med 2009; 15(4):56-57.

(5) Reece K, Schwartz GE, Brooks AJ, Nangle G. Positive well-being changes associated with giving and receiving Johrei healing. J Altern Complement Med 2005; 11(3):455-457.

(6) Richeson NE, Spross JA, Lutz K, Peng C. Effects of Reiki on anxiety, depression, pain, and physiological factors in community-dwelling older adults. Res Gerontol Nurs 2010; 3(3):187-199.

Najla, my personal opinion, you continue applying what traditional Medicine has to offer and add a hand healing energy technique. As the patient, apparently, loves herself and life, God may help by means of these fantastic instruments. Basically, the changes happen in the extra-physical body (non visible), which may influence the physical body.

Thank you so much Gisela for these nice references. I never thought that I may use herbs or non-traditional methods in treating my patients, but I know that science should be open to all appropriate possibilities. And as clinicians, it is our commitment to our patients that leads us to explore new treatment methodologies even if it means that we become students once again.

Chewing gooseberries and lemon juice can also help in stimulating salivary glands

Thank you Priya. Acidic foods like citrus fruits have been suggested before. My patient tried them but unfortunately she could not stand the acidity, may be because oral mucosa is atrophic in her case.

Hello Najla, This is Anna Maria, I'm Pharmacist specialized in nutrition. On my humble opinion, it depends if the person has Sjogren's Syndrome, or total damage of salivary glands due to other illnessess. In any case, as far as I know, because my self I'm quite affected by mouth dryness, is a good thing to have a certain amount of olive oil into the mouth, during one or two minutes, moving into the mouth, before having a meal. Another think is change texture of some dry foods, with adding water, sauces or other liquids. Unfortunately, except citrics, I don'know other natural remedies. I hope this can help!! Anna Maria

Hi Najla! There are some papers on pubmed discussing that issue, Try laser therepy and xerostomia.

Best regards!

Hi, in México we use Opuntia ficus-indica infusions, like saliva sustitue, Is cheap, and can be made 4-5 litres, and be keeped in refrigeration. The prescription is at libitum.

Thank you Anna Maria. Olive oil is present in every Jordanian home and it is also considered a holy plant by Muslims. I believe that it will be a practicalsolution for my patient.

Hi Daniel and thank you. This fruit is seasonal in Jordan but being made as infusion for long-term use is a good alternative.

Hi Luiz, and thank you. I checked pubmed and found one case report on the use of low-level laser for the treatment of dry mouth. There was also one review on this topic written in Serbian. The question is: can it work for patients with complete damage of the salivary glands as in advanced Sjogren's syndrome?

Hello Najla. There is a review in Australian Dental Journal

http://onlinelibrary.wiley.com/doi/10.1111/adj.12023/pdf

In Greece, we use - among others- a natural gum from the island of Chios (Chios chewing gum)

Thank you Popie. I found the file very valuable.

Yes, your condition can be managed with artificial saliva so see your dentist or a maxillofacial surgon.

For lubrication, several patients have found olive oil helpful. Castor oil has been suggested but it might not taste as nice. Coconut oil is an alternative and pure virgin coconut oil is also sweet. Half a teaspoonful of the oil can be spread throughout the mouth with the tongue, to lubricate the mucosa and helps prevent it drying out, and then swallowed. Particularly, helpful at night when the mouth dries out if they mouth breathe. A lot of patients manage with swigs of water. I let my patients decide on what works best for them.

About this matter, many tooth paste have astringents. May be would be better don"t use it.

You are absolutely right Daniel. People in my region like to use miswak to clean their teeth. It may be a good option.

Thank you Najla I had never heard of miswak, and I really like this idea. esther

Thank you Esther, People in the Arabic Peninsula used it more than 1400 years ago to clean their teeth and have a good mouth odor. Kindly follow the link below, it is a nice paper on miswak.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249923/

What a rich discussion .. Thanks Dr Najla

But It think we should make a clear difference between patients with residual, poor salivary flow and those with zero function ... since salivary stimulants, in my opinion, can worsen symptoms of those with Zero salivary function .... I found Olive oil and coconut oil are good for the majority of dry mouths ... Moreover we have to make sure that patients who do not have tracheostomy after surgery are not mouth breathers .. understandably this my be an exacerbating factor for dry mouth

Thank you Mostafa Ammar. Olive oil seems to be the most favored remedy as suggested by many colleagues on this forum. As I explained before, the category of patients seeking help here are those with no function at all in the salivary glands due to Sjogren's syndrome or oncotherapy. So salivary substitutes and not stimulants are needed.

Thanks a million Chris for your efforts to explain what was vague to me. Perhaps laser has a place afterall in treating dry mouth.

I also thank you Chris!

Thank you Patricia . Forgive my ignorance, I don't know Spanish. I think that I have to learn Spanish in the near future :))

There are several natural options in my review of the literature but all are palliative.

Folk therapy approach: for xerostomia it is recommended to chew fresh Echinacea root, because it promotes the secretion of saliva. Some vegetable juices and teas (chamomile, sage and echinacea) are also are very useful because they eliminate the symptom ...

Thank you Neeta and Tatjana. My main concern is patients with zero salivary function

Very good question but so far there is no real solution for these people as Najla said if the salivary grands damages due to radiotherapy so no saliva to stimulate, there is nit much option in the Market.

That is true Aylin. Treatments at this stage are palliative so choosing the herbal option may be more convenient to patients to overcome the many side effects that medicines may have.

When you mention herbal options, could you give me some examples?

Thanks

Contributors to this question suggested some kinds of fruits, and leafy vegetables. I think that these are helpful in patients with functional salivary tissue.Other contributors suggested oils like olive oil. This, I think, may be more helpful.

Olive oil alone???

Other oils that were suggested include linseed, and castor oil. Milk and water are also good home remedies.

Try papaya, which contain the enzyme papain, can help reduce the thickness of secretions ( refer.Camp-Sorrell, 2005)

Acupuncture significantly improves stimulated and unstimulated salivary flow rates (Bhide et al., 2009). It is theorized that acupuncture stimulates the parasympathetic nervous system, resulting in an increase in the local blood flow to the salivary glands, increasing salivary production and possible regeneration of tissue (Jung et al., 2008; Wong, 2008). Another possible mechanism of action of acupuncture is stimulation of minor salivary glands present in non-irradiated buccal mucosa. Further research of acupuncture is necessary prior to the recommendation for widespread clinical implementation in xerostomia treatment (Bhide et al., 2009; Jung et al., 2008; Wong, Ahuja, Yuen, & King, 2003

Hello Najla, as prosthodontist we alleviate xerostomia symptom by asking the patient to use milk as saliva substitute this aid to buffer the mouth and lubricate the mucosa moreover it aids to remineralize teeth as these patients will suffer from high score carious teeth and periodontitis , if some of the gland is still functioning we advise the patient to use lemon, or chew sugar free gums the better is those containing sorbitol to stimulate saliva or chew a piece of bee wax, citric acid products may also be recommended

Thank you Balsam, I think that milk is a good option like many other alkaline mouth washes: sodium bicarb or Mallox

You may want to read the paper by M Singh et al 2008 on the effect of Omega 3 on dry mouth and dry eye....

Citric Acid, Bee wax, sips of water, Papaya, Avocado, may be helpful.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jul;112(1):e15-20. doi: 10.1016/j.tripleo.2011.01.039. Epub 2011 Apr 20.

A comparison of salivary substitutes versus a natural sialogogue (citric acid) in patients complaining of dry mouth as an adverse drug reaction: a clinical, randomized controlled study.

Femiano F, Rullo R, di Spirito F, Lanza A, Festa VM, Cirillo N.

The internet has many sites addressing this issue - I've found this particular site to be one of the most evidence based

http://www.peoplespharmacy.com/build/mt-search.cgi?IncludeBlogs=1&limit=20&search=remedies+for+dry+mouth

People's Pharamcy

A product that has "mostly natural" ingredients is MI Paste or Tooth Mousse, (GC America) it is casein (milk product) based and is good for lubrication of the oral soft tissues and remineralizing hard tissues.

Dr Meharry http://www.llu.edu/dentistry/cdr/meharry.page

reminded me of an excellent product which I believe some of my colleagues have used.

Thanks a lot Dr Liviu and Dr Reda for your valuable contributions. I also thank Dr Michael and Dr Janus for the nice advice. I have reviewed the literature during the past few months looking for evidence-based research on natural remedies for the severe dry mouth associated with irreversibly-damaged salivary glands. Some remedies were actually investigated for dry mouth and others were investigated for the dry eyes and these can possibly be used for the dry mouth. These remedies include: water (of course), milk, oils ( olive, linseed, castor, sesame, canola, clove), and aloe vera.

Try "Biotene" mouth wash. Specially designed for xerostomia no matter the etiology is.

Dear Najla,

This is really a challenge during clinical practice! Nevertheless, besides the acupuncture, which is really a good therapy, I would recommend the intake of pilocarpine 2%. You could dilute 3 to 4 drops in water (cup of coffee) and ask to your patient use it 3 times daily, before the main meals. There are some cautions related to contraindications and side effects that can be found in the package leaflet. Moreover, I do not endorse the use of lemon once dry mouth is accompanied by a decrease of bucal pH, which leads an increase of dental cavities, mainly root ones. Furthermore, the mucosae use to be more sensitive to acids and aromatic foods. Hence, I would recommend gargles with magnesium hydroxide, warning to not drink the solution. Additionally, to avoid using toothpaste with sodium lauryl sulfate, gantrez or troclosan.

Additionally, it would be interesting to make a mouthguard to be used with neutral fluoride at home. There is a new technology to stimulate salivary glands, GenNarino (www.saliwell.com.br) . There are some articles about it in my profile that you can download. It really works.

All the best,

Denise Falcão

Thank you Dr Ayman. Biotene MW has many ingredients that are good for the dry mouth, but can we consider it a natural remedy?

Your advice Denise is really appreciated and should be taken into consideration for dry mouth patients.

Dr najla, always active and hopefully always.

I got alot of positive feedback from my patients who complained of dry mouth after watching for good water intake and chewing Arabic gum or suger free gum,which I spouse helped stimulate salivation.

Dear Najla, forgive me for not having read all the comments before making my suggestion, maybe is here already.

There are mouthwashes and gels based on hyaluronic acid (very pure, no damaging additivs), that are recomended for various irritations of the oral cavity and not only. The soothing and protecting properties of this molecule are remarkable. It is not a real therapy, I guess, but I suppoose it can protect the mucosa by maintaining a certain degree of moisture, with all consequent benefits.

I have experienced the relief myself, when I had a dry mouth problem (I tended to sleep with the mouth opened due to a certain therapy for a while and I developed very soon sores - the gel, applied on the mucosa reduced very much the distress).

Best regards.

Thank you Blake for your suggestion. Actually, i don't think that hyaluronic acid had been suggested by scientists answering this question. Hyaluronic acid has indeed a place in the management of many oral lesions. It was suggested for inflammatory lesions in particular like ginigivitis.But, excuse my humble knowledge, I am not aware of its uses in the treatment of dry mouth. You said that it is a personal experience, can you suggest a certain brand name?

I admit that neither I know of any specific indication of the hyaluronic acid for this purpose (not a surprising fact after all, I am just a dentistry student), I only shared my own experience, hoping it could prove useful. I had some samples received at a congress and when I had my problem I though it may help me to try them.

In Italy there are several brand names of gel: Gengigel (according to the inscription on the box, it is registered by Ricefarma from Milan, www.ricefarma.com), or Aftamed, available in pharmacies and not so costly (Gengigel and Aftamed, 20 ml, costs around 10 euro, not so expensive here). There is yet another brand of gel, whose name I do not recall, which is designed to be more time resistant and adesive to the mucosa, similar to a patch. For the mouthwashes with hyaluronic acid, I do not know any brand name or the price. They may be even more helpful.

I would appreciate if someone could share their opinion on this subject.

Thank you Blake once more for your contribution. Based on your answers, I think that you are an A student :). Yes, in my country we have Gengigel which is used primarily for gingival problems, that is why I asked you for the brand names. After I read your answer, I looked for hyaluronic acid's medical uses in pubmed, and guess what, it is used for the dry eye. I liked an article written by researchers from Italy (Barabino et al, 2014) about the use of hyaluronic acid and Tamarind seed (another natural product) for the dry eye.

You can ask your patient to use bottle of water and from time to time rinse his mouth and then swallow I tried this with my patient and now he is highly satisfied . I tried many thing with him as milk,olive oil,coconut oil and many natural materials but the simplest and naturally available is water.

Thank you Sahar, all your suggestions are available and I believe would be practical for many patients.

We were working with aloe vera gel on oral submucous fibrosis cases

and we got some astonishing results when it comes to the reduction of burning

sensation, we have also worked with termeric and got some positive results as

well. So, considering my first hand experience with aloe vera gel and termeric

i guess using these two will help in reduction of burning sensation as well in syndrome associated patients.

Thank you Anshita. There has been a lot of work done on aloe vera and it has been found efficient in the treatment of many oral conditions like ulcers. Do you have a certain brand name for aloe vera and tumeric, or do you prepare them in your lab?

hi najla, i am so sorry for the delay, aloe vera gel which we used was from "penta biosciences", mumbai, India. and we prepared turmeric at our own lab. if you r interested more in it you can go through this article

Article Efficacy of aloe vera gel as an adjuvant treatment of oral s...

Thanks a lot Anshita. Do you have any thing published on tumeric?

pleasure is all mine Dr Najla, i am so glad that i got chance to partcipate in such a rich discussion. we have not got any publication yet on turmeric because we are still working on it, hopefully we will finish it up by this year.

Dear Anshita, my admiration and appreciation go to the marvelous research done in India to resurrect herbal medicine in the treatment of oral disease, and looking forward to see your completed work on tumeric.

thank you so much for encouraging words Dr Najla, i appreciate it. looking forward for further discussion with you in future.

I think first of all , we should check if there is any candidiasis. Treat it. Then make sure about good oral hygiene and then we can use water, sugar free chewing gums or salivary substitutes. We should also reassure the patient that the condition is not dangerous .

In Croatia we advise patients to use tea of marshmallow root (1 tablespoon of tea poored with 1 dcl of cold water and left during the night, to be used during the day).

hopefully this will help.

cheers

Thank you Vanja. I had no idea that there is a plant named marshmallow ! Is the tea for drinking or rinsing the mouth?

It is normally tea used for drinking, normally it is given to kids when having respiratory problems, coughing, etc

There is various way to increase the salivary flow such as

1.Mechanical (Masticatory) Stimulants like sugarless gums

2.Chemical Stimulants like solution containing citric acid (Lemon)

3.Electrical Stimulant like Intra-oral electronic stimulator of saliva

4. Pharmacologic Stimulant like drugs (Pilocarpine )

5.Oral Moisturizers / Salivary Substitutes like solutions (substance containing carboxymethyl cellulose and hydroxyethyl cellulose, Water-glycerin agent) and gel (Glycerate polymer)

Regards

Abhay Das