NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST)
Dry mouth is a side effect or a symptom, almost never a disease in itself. Read the drug list first - anticholinergics, tricyclic antidepressants, antihistamines, diuretics and opioids are the usual culprits - then check for diabetes, dehydration, mouth-breathing, Sjogren's syndrome and previous head-and-neck radiotherapy. Frequent sips of water, sugar-free gum and fluoride toothpaste achieve more than anything available on prescription here. - Assess, then decide
Same approach in a child: mouth-breathing, dehydration and medication are the usual causes. A persistently dry mouth in a child is not normal and is worth a cause being found.
No dose - assessment step, no medicine given
No licensed saliva-stimulating medicine is marketed in Egypt - pilocarpine is registered only as eye drops and hair lotions - so a drug row here would promise something a Cairo pharmacy cannot dispense. The saliva substitutes that are sold (Artificial Saliva oral spray, around 8 EGP) are appliances rather than licensed medicines, carry no labelled dose, and are used as often as comfort requires.
- A dry mouth loses its protection against decay. Dental review, fluoride toothpaste and not sipping sugary drinks all day matter more here than any medicine.
- Dry mouth with dry eyes, or with joint pain or parotid swelling, suggests Sjogren's syndrome - check anti-Ro and anti-La antibodies and refer.
- Oral pilocarpine, the drug used for this elsewhere, is not marketed in Egypt in any oral form. Do not write for it expecting it to be dispensed.
- If a causative drug can be stopped, reduced or swapped, that single change usually does more than everything else combined.
- Persistent dry mouth with oral thrush is common - the saliva that normally keeps candida in check is gone. Treat the thrush and the dryness separately.
- RED FLAG - Complications include oral candidiasis, periodontitis, accelerated dental caries, and impaired oral intake leading to poor nutrition.