Treatment of Atrophic Glossitis in Xerostomia (Dry Mouth)

Atrophic glossitis presents with a smooth, erythematous tongue and frequently co-occurs with xerostomia. Dry mouth is among the most consistently documented associated findings in this condition, appearing in the majority of affected patients across multiple study cohorts.

Clinical scenario: Atrophic glossitis in a patient with xerostomia (dry mouth). Studies report xerostomia in 70–79% of atrophic glossitis patients, making it a clinically central feature that directly informs treatment selection.

Treatment approach — partial overview

Management in this setting centres on salivary substitution and stimulation strategies, combining topical lubricant preparations with, where clinically indicated, systemic sialagogue therapy. The complete regimen — including specific agent selection, contraindication criteria, and sequencing — is available in the full protocol.

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References

DOI: 10.1016/j.jfma.2019.04.015

Our previous studies found xerostomia in 79.0% of 176 AG patients and in 70.1% of 1064 AG patients.

AG patients with dry mouth can be treated by artificial salivas, continuous sips of water throughout the day, taking the sugarless candy to stimulate salivary secretion, using oral lubricant containing lactoperoxidase, lysozyme and lactoferrin (e.g., biotene mouth rinse and Oralbalance moisturizing gel), and systemic administration of sialagogue such as pilocarpine (Salagen, each tablet contains 7.5 mg pilocarpine hydrochloride, three to four times daily; a parasympathomimetic and muscarinic agonist with particular effect on muscarinic acetylcholine receptor M3) or cevimeline (Evoxac, 30 mg/cap, three times daily; a parasympathomimetic and muscarinic agonist with particular effect on M3 receptors).

Both pilocarpine and cevimeline are contraindicated in patients with asthma or narrow-angle glaucoma.

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