There is a whole shelf of it now. Rinses, sprays, gels, lozenges, discs that stick to your gum overnight, toothpastes that cost five times what toothpaste used to cost. Patients arrive with a bag of it and ask whether any of it is worth the money.
We do not sell any of these products. We hand out samples sometimes, and that is the extent of it. So what follows has nothing riding on which one you choose.
There is a one-page shopping list you can print, with no prices on it, and we keep copies at the front desk.
Start with the uncomfortable finding
A Cochrane review looked at 36 randomized trials of topical dry mouth treatments, covering 1,597 people, and concluded that there is no strong evidence that any topical therapy is effective for relieving the symptom of dry mouth. Only one of those 36 trials was at low risk of bias. Seventeen were at high risk.
Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R. Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev. 2011;(12):CD008934.
The one thing that did hold up: chewing gum raises saliva in people who still have some secretory capacity left. Not a product. Chewing.
That does not mean the products are useless. It means the evidence behind the comfort claims is thin, and you should buy them for what they actually do rather than what the box implies.
The useful way to think about all of it: these are adjuncts for maintaining the microbiome in a dry environment. None of them fix the dryness. A dry mouth shifts the ecology toward the acid-tolerant species that cause decay, and the products worth buying are the ones that support the environment while it is compromised.
Three different jobs, and only one of them changes what happens to your teeth
Almost every product on that shelf falls into one of three groups, and the groups are not interchangeable.
- Comfort. Makes a dry mouth feel wetter for a while. Palliative, and that is a real thing to want at three in the morning. It does not affect decay.
- Protection. Fluoride, nano-hydroxyapatite, xylitol, pH support. Does nothing for how dry your mouth feels, and is the half that decides whether you keep your teeth.
- Stimulation. Prescription medication that makes the glands themselves produce more. Your physician’s territory, and worth raising if the dryness is severe.
Here is the failure we see most. Somebody buys from the comfort shelf, feels better, and reasonably concludes they have dealt with it. Two years later they have four cavities. The comfort products are the ones that advertise. The protective ones are the ones that matter.
Comfort products
Biotene
The one most people already own, and it is fine for comfort. It is a moisturizer. Use it if it makes your mouth feel better, and do not expect it to protect a tooth, because that is not what it is for. If Biotene is the only thing you are doing about a dry mouth, you are doing half the job.
XyliMelts
A small disc that sticks to the outside of your gum and dissolves slowly, releasing xylitol over several hours. Our patients like these more than anything else on this page, and the reason is timing: it is the only product built to last through the night, which is exactly when saliva bottoms out and when most dry-mouth damage happens.
Being straight about the evidence: the published study had fifteen people and no control group, comparing each person against themselves. Perceived wetness improved more than threefold. That is weak by research standards.
Burgess J, Lee P. XyliMelts time-release adhering discs for night-time oral dryness. Int J Dent Hyg. 2012;10(2):118-21.
So this is a case where patient experience runs ahead of the literature. The mechanism is sound, the xylitol is doing something useful on its own, and nobody has run the trial that would settle it. We suggest them anyway.
Sprays, gels and rinses for dryness
Plenty of these exist and most are much the same. Use them at bedtime, which is when they earn their keep. Avoid anything with alcohol in it, which dries the tissue you are trying to soothe.
Protective products
Xylitol gum and mints
The most evidence-supported thing on this page, and the cheapest. Chewing raises flow on demand, and xylitol cannot be fermented into acid by the bacteria that cause decay. About five times a day, and after meals is the best timing.
CariFree
Built specifically around the chemistry of a dry mouth rather than the feeling of one. The line splits into a treatment phase and a maintenance phase, and includes a toothpaste gel carrying both nano-hydroxyapatite and fluoride, a treatment rinse, a daily pH support rinse, and a fluoride-free nano-hydroxyapatite gel for people who would rather avoid fluoride.
The pH idea is the important part. With low saliva, plaque stays acidic long after eating because there is not enough buffering capacity to bring it back toward neutral. These products are aimed at that problem rather than at dryness.
High-fluoride toothpaste, or nano-hydroxyapatite
Every night, last thing, spit but do not rinse. We run both tracks here. If you would rather avoid fluoride, a nano-hydroxyapatite paste is a real option and not a consolation prize.
MI Paste, and why we stopped using it
MI Paste is the CPP-ACP product, and it was on everyone’s list for years. We do not really use it anymore, for two reasons.
It is made from milk protein, and for anyone with a dairy allergy that is a serious problem. The active ingredient is derived from milk casein, and the manufacturer says it should not be used by patients with a milk protein allergy.
One distinction worth making, because it cuts both ways. This is a true milk allergy, not lactose intolerance. The lactose content is under 0.01 percent, so being lactose intolerant is not a reason to avoid it. Having a dairy allergy very much is.
The second reason is more ordinary. It needs a tray to work properly. Smearing it on with a finger does not hold it against the teeth long enough to do much. Without a custom tray it is mostly an expensive way to have minty fingers.
Nano-hydroxyapatite does a similar job without either problem, so that is where we point people now. If you are already using MI Paste, have a tray, and have no dairy allergy, there is no reason to throw it out.
GC America product information for MI Paste and MI Paste Plus. Azarpazhooh A, Limeback H. Clinical efficacy of casein derivatives: a systematic review of the literature. J Am Dent Assoc. 2008;139(7):915-24.
Oral probiotics
Some of our patients swear by these. Others take them for a month and notice nothing. The research explains a good part of that split.
They do not make more saliva. In a three-month randomized trial of 54 adults with low saliva flow, probiotic chewing gum did no better than plain gum. Chewing itself raised flow in both groups.
Where they have shown something is yeast. A dry mouth is an easy place for candida to overgrow, and in older adults, trials pooled together found probiotics cut the odds of oral candida roughly in half. So if your dry mouth comes with burning, a coated tongue or cracked corners of the mouth, a probiotic is a reasonable thing to try, and it is worth letting us take a look as well.
For cavities, the evidence is still too thin to recommend them. They belong in the same category as everything else on this page: an adjunct for keeping the mouth’s bacteria in balance while saliva is low, not a replacement for it.
No one brand has been shown to beat the others, so this one is trial and error. Give a product about a month. If you notice nothing, try a different one or stop. A few you will come across, in alphabetical order:
- BioGaia Prodentis. Lozenges with a Lactobacillus reuteri strain, one of the more widely studied for oral health. biogaia.com
- BLIS K12 and M18. Streptococcus salivarius strains originally isolated from healthy mouths, sold as BLIS lozenges and inside a number of other brands. Check the label for the strain name.
- Bristle. An oral health probiotic from the company that makes an oral microbiome saliva test. bristlehealth.com
- Great Oral Health. Chewable tablets combining BLIS K12 and M18 with several Lactobacillus strains. greatoralhealth.com
- ProBiora. Tablets built on a patented three-strain blend, sold in adult and kids’ versions. probiorahealth.com
- StellaLife. Prebiotic and probiotic lozenges, including BLIS M18. stellalife.com
There are many others. Formulas change often, so read the label for the strains and follow the directions on the package.
Gueimonde L, Vesterlund S, García-Pola MJ, et al. Supplementation of xylitol-containing chewing gum with probiotics: a double blind, randomised pilot study focusing on saliva flow and saliva properties. Food Funct. 2016;7(3):1601-9. Ai R, Wei J, Ma D, et al. A meta-analysis of randomized trials assessing the effects of probiotic preparations on oral candidiasis in the elderly. Arch Oral Biol. 2017;83:187-192 (three trials, 595 people; pooled odds ratio 0.54). Gruner D, Paris S, Schwendicke F. Probiotics for managing caries and periodontitis: systematic review and meta-analysis. J Dent. 2016;48:16-25.
Rinses, specifically
Our general position on mouthwash has not changed for dry mouth: a rinse alone is not going to stop cavities, because plaque is sticky and most rinses are too mild to break it up. Brushing and cleaning between the teeth does the work a rinse cannot.
That said, when a rinse is wanted, we start people on CloSYS, which is mild and alcohol-free. StellaLife is our choice after surgery. Swish and NOBS are alcohol-free options built around hydroxyapatite and xylitol rather than antiseptics.
When the dryness is severe
If the glands themselves are badly affected, there are prescription medications that stimulate them directly. That is a conversation with your physician rather than with us, and it is worth having if you are miserable and nothing on this page has moved the needle.
It is also worth asking your prescriber whether any of your medications can be moved to the morning, reduced, or swapped within the same class. Never stop anything yourself.
What we would actually buy
If you asked us to spend your money for you, in order:
- Xylitol gum or mints, five times a day, after meals. Cheapest thing here and the best evidence.
- A remineralizing paste every night, high-fluoride or nano-hydroxyapatite, spit and do not rinse.
- XyliMelts at night if the night-time dryness is what is bothering you.
- A pH-support product such as the CariFree line if decay is already happening rather than merely threatening.
- A comfort product of your choosing, including the Biotene you already own.
- An oral probiotic, if burning, a coated tongue or yeast is part of the picture. Try one for about a month.
And the thing that costs nothing: a humidifier in the bedroom, which in this climate does more than most of what is on the shelf.
If chewing is the part you cannot do
Everything above leans on chewing, and chewing is the one recommendation that assumes teeth. If you wear a complete denture, or you are missing back teeth, or chewing is uncomfortable, the top of that list is not available to you in the same way.
That is not a small asterisk. It is the same people twice: a dry mouth is most common in older patients taking several medications, and so is a reduced ability to chew. The best-evidenced thing we know of is least available to the people who need it most.
What changes if that is you:
- XyliMelts do not require chewing. The disc adheres and dissolves on its own, which is why they move up the list rather than down it.
- The protective half matters more, not less. If you cannot raise your own flow on demand, remineralizing every night and controlling pH is carrying more of the load.
- Tell us chewing is hard. It is worth saying out loud at a visit, because it is usually treatable and because it rarely gets mentioned on its own.
Print that list here. It fits on one page, has brand websites rather than prices, and there is a QR code on it that brings you back to this article. There is also a general dry mouth sheet covering everything that is not a product.
Worth bringing up
If you are buying dry mouth products, something is driving the dryness, and that is the more useful conversation. Here is the long version, and how we approach it. A saliva test measures flow, buffering and resting pH, which are three separate things, and the feeling of dryness does not always match the measurement.
Call 702-734-0776 or tell us what’s going on.
We have no financial relationship with any product named here and do not sell them. Product formulations change, so check the label. General information, and not a substitute for an exam.