What are the EULAR treatment guidelines for dry mouth in Sjögren syndrome?

Updated: Mar 05, 2021
  • Author: Sriya K Ranatunga, MD, MPH; Chief Editor: Herbert S Diamond, MD  more...
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Baseline evaluation of salivary gland function, including measurement of whole salivary flows, and exclusion of unrelated conditions, is recommended before starting treatment for oral dryness.        

The preferred first therapeutic approach for oral dryness according to salivary gland function may be as follows:

  • Mild dysfunction - Nonpharmacological stimulation (eg, sugar-free acidic candies, lozenges, xylitol, sugar-free chewing gum)
  • Moderate dysfunction - Pharmacological stimulation (eg, pilocarpine, cevimeline; anetholtrithione, bromhexine, N-acetylcysteine in cases of intolerance or non-response)       
  • Severe dysfunction - Saliva substitution  

The guidelines recommend against using any of the following for oral dryness:

  • Hydroxychloroquine
  • Oral glucocorticoids
  • Immunosuppressive agents 
  • Rituximab

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