Dry mouth

Overview

Dry mouth, also called xerostomia (zeer-o-STOE-me-uh), is when the salivary glands in the mouth don't make enough saliva to keep the mouth wet. Dry mouth often is due to aging, the side effects of certain medicines or radiation therapy for cancer. Less often, a condition directly affecting the salivary glands can cause dry mouth. You also may experience dry mouth temporarily if you are thirsty or feel anxious about something.

For some people, dry mouth is only annoying. For others, dry mouth can greatly affect general health and the health of teeth and gums. Also, it can affect how much people eat and how much they enjoy what they eat.

Treatment for dry mouth depends on the cause.

Symptoms

If you're not producing enough saliva, you may notice these symptoms all or most of the time:

• Dryness or a feeling of stickiness in your mouth.
• Saliva that seems thick and stringy.
• Bad breath.
• Having a hard time chewing, speaking and swallowing.
• Dry or sore throat and hoarseness.
• Dry or grooved tongue.
• A changed sense of taste.
• Problems wearing dentures.
• Lipstick stuck to teeth.

Saliva helps prevent tooth decay by washing away sugar and food particles and making bacteria neutral and less harmful. When you don't have enough saliva, you may find it harder to taste, chew and swallow. You also may have a hard time digesting food.

When to see a doctor

If you have dry mouth symptoms that don't go away, make an appointment with your healthcare professional.

Causes

Dry mouth is caused when the salivary glands in the mouth don't make enough saliva to keep the mouth wet. Sometimes these glands may not work properly due to:

• Medicines. Hundreds of medicines, including many medicines available without a prescription, can cause dry mouth. Among the medicines more likely to cause problems are those for depression, high blood pressure and anxiety, as well as some antihistamines, decongestants, muscle relaxants and pain relievers.
• Aging. Many older people have symptoms of dry mouth as they age. Certain changes in how the body processes medicine, poor nutrition and long-term health problems can cause dry mouth.
• Cancer therapy. Medicine to treat cancer, called chemotherapy, can change the nature of saliva and the amount produced. This may be for a limited time, with typical salivary flow returning after treatment ends. Radiation treatments to the head and neck can damage salivary glands, greatly lowering saliva production. This may be for a limited time, or it could be lasting, depending on the radiation dose and area treated.
• Nerve damage. An injury or surgery that causes nerve damage to the head and neck area can be due to dry mouth.
• Other health conditions. Dry mouth can be due to certain health conditions, such as diabetes, stroke, a yeast infection in the mouth or Alzheimer's disease. Or dry mouth could be due to autoimmune diseases, such as Sjogren syndrome or HIV/AIDS.
• Snoring and mouth breathing. Snoring and breathing with the mouth open can lead to dry mouth.
• Tobacco and alcohol use. Drinking alcohol and smoking or chewing tobacco can lead to more dry mouth symptoms.
• Use of legal or illegal drugs that may be sold on the streets. Methamphetamine use can cause serious dry mouth, and it can damage teeth. Marijuana use also can cause dry mouth.

Risk factors

Risk of dry mouth is higher in people who:

• Take medicines that have dry mouth listed as a possible side effect.
• Are being treated for cancer.
• Have nerve damage in the head and neck area.
• Have other health conditions, such as diabetes, stroke, Alzheimer's disease, Sjogren syndrome or HIV/AIDS.
• Use tobacco products.
• Drink alcohol.
• Use street drugs.
• Eat sugary or acidic foods or candies.

Complications

Not having enough saliva and getting dry mouth can lead to:

• Increased plaque, tooth decay and gum disease.
• Mouth sores.
• A yeast infection in the mouth, also known as thrush.
• Sores or split skin at the corners of the mouth, or cracked lips.
• Poor nutrition from having problems with chewing and swallowing.

Diagnosis

To determine the cause of your dry mouth, your healthcare professional reviews your medical history and the medicines you take, including medicines available without a prescription. Your healthcare professional also looks in your mouth.

Sometimes you may need blood tests, imaging scans of your salivary glands or tests to measure how much saliva you produce. These scans and tests can help find the cause of your dry mouth. If your healthcare professional suspects that Sjogren syndrome is causing your dry mouth, a small sample of cells taken from salivary glands in your lip may be sent for testing. This procedure is called a biopsy.

Treatment

Your treatment depends on the cause of your dry mouth. Your healthcare professional may:

• Change medicines that cause dry mouth. If your healthcare professional thinks a medicine is the cause, your dose may be changed. Or you may switch to another medicine that doesn't cause dry mouth.
• Recommend products to moisturize your mouth. These products can include prescription medicines or mouth rinses available without a prescription, artificial saliva, or moisturizers to lubricate your mouth. Mouthwashes designed for dry mouth, especially ones with xylitol, can be effective. Examples include Biotene Dry Mouth Oral Rinse or Act Dry Mouth Mouthwash.

If your mouth is extremely dry due to Sjogren syndrome or radiation treatment for head and neck cancer, your healthcare professional may prescribe pilocarpine (Salagen) to help you make more saliva. Or cevimeline (Evoxac) may be prescribed to help you make more saliva if you have Sjogren syndrome.

Lifestyle and home remedies

In addition to your healthcare professional's advice, these tips may ease dry mouth symptoms:

• Sip water or sugar-free drinks or suck on ice chips. Do this throughout the day to moisten your mouth. Also, drink water during meals to make it easier to chew and swallow.
• Chew sugar-free gum or suck on sugar-free hard candies. Products that contain xylitol also may help prevent cavities. But xylitol, which is often found in sugar-free gum and sugar-free candies, may cause some people to have gas or diarrhea if they consume it in large amounts.
• Try saliva substitutes that contain xylitol and are available without a prescription. These include Mouth Kote or Oasis Moisturizing Mouth Spray. Or try saliva substitutes that contain carboxymethylcellulose (kahr-bok-see-meth-ul-SEL-u-lohs) or hydroxyethyl cellulose (hi-drok-see-ETH-ul SEL-u-lohs), such as Biotene Dry Mouth Oralbalance Gel.
• Breathe through your nose, not your mouth. You may need to seek treatment for snoring if it causes you to breathe through your mouth during the night.
• Add moisture to the air at night. Use a room humidifier.
• Moisturize your lips. This helps soothe dry or cracked areas.

Stay away from products that can make your symptoms worse. These include:

• Caffeine and alcohol. These products can cause dryness and irritation. Don't use a mouthwash that contains alcohol.
• Tobacco. If you smoke or chew tobacco, stop. Tobacco products can dry and irritate your mouth.
• Antihistamines and decongestants available without a prescription. These medicines can worsen your dry mouth.
• Sugary or acidic foods and candies. These foods raise the risk of tooth decay. Also, stay away from spicy or salty foods because they can cause irritation.

Saliva is important to maintain the health of your teeth and mouth. Taking these steps to protect your teeth also may help your dry mouth:

• Brush with a fluoride toothpaste and floss your teeth. Ask your dentist if you might benefit from prescription fluoride toothpaste, a toothpaste containing betaine or a tooth gel to neutralize bacteria acids.
• Use fluoride or rinses. To prevent cavities, your dentist might fit you for fluoride trays, which you fill with fluoride and wear over your teeth at night. Your dentist also may recommend that you brush on fluoride gel before bedtime or use a chlorhexidine rinse weekly.
• See your dentist at least twice yearly. Have your teeth examined and plaque removed to help prevent tooth decay.

Preparing for an appointment

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Any symptoms you have, including any that don't seem to be related to the reason you made your appointment.
• Key personal information, including any major stresses or recent life changes that may be causing your dry mouth.
• All prescribed medicines, vitamins, herbs, other supplements and medicine available without a prescription that you take, including the doses.
• Questions to ask your healthcare professional.

Some basic questions to ask your healthcare professional include:

• What is likely causing my dry mouth?
• What are other possible causes?
• Is my condition temporary or will it last a long time?
• What's the best course of action?
• I have other health conditions. Could this be related to any of them?
• Do I need to follow any restrictions?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your healthcare professional likely will ask you several questions. Be ready to answer them to save time to go over any points you want to spend more time on.

Your healthcare professional may ask:

• When did you start having symptoms?
• Do you have symptoms all the time or only sometimes?
• Have you started taking any new medicines recently?
• Do you smoke or chew tobacco?
• How much alcohol do you drink?
• Does anything make your symptoms better or make more saliva?
• What, if anything, appears to worsen your symptoms?