- Frequent recalls to address increased caries risk, mainly due to hyposalivation
- Emphasis on good oral hygiene
- Frequent fluoride applications
- Encourage frequent hydration
- Encourage avoidance of coffee, alcohol and tobacco products
- Encourage use of sugar-free gums
- Increase salivary flow with systemic sialologues:
pilocarpine – 5 mg tid; start with 2.5 mg bid, increase by small increments at intervals of 4-6 weeks. Do not exceed 10 mg/dose to a maximum of 30 mg/day;
cevimeline – 30 mg tid; start with a lower dosage and increase incrementally;
bethanecol – 10 to 50 mg tid or qid; start with a lower dosage and increase incrementally.
Side-effects may include increased urinary frequency, increased sweating, flushing, headaches, nausea, and abdominal pain. To reduce side-effects,medications should be taken 1 hour before or 2 hours after meals.
- Enhance oral discomfort with lubricating gels and mucin sprays
- Recognize and treat oral candidiasis
- Suggest the use of humidifiers at night, avoid dry and smoky environments