Dry Mouth (Xerostomia)

Symptoms

If you do not produce adequate saliva, you might frequently experience some or all of the following symptoms:

• A feeling of stickiness or dryness in the mouth
• Saliva that appears thick and stringy
• Bad breath
• Difficulty chewing, swallowing, and speaking
• A dry or sore throat, sometimes accompanied by a hoarse voice
• A dry or grooved tongue
• An altered sense of taste
• Difficulty wearing dentures
• Lipstick sticking to the teeth

Saliva plays a crucial role in preventing tooth decay by rinsing away sugars and food particles and neutralising bacteria to make them less harmful. Insufficient saliva can lead to difficulties with tasting, chewing, and swallowing and may also impair proper digestion.

Causes

Dry mouth occurs when there is insufficient saliva production from the salivary glands to keep the mouth moist. Sometimes, these glands may not function properly due to:

• Medications: Hundreds of medications, including over-the-counter ones, can cause dry mouth. Medications used to treat high blood pressure, depression, and anxiety, as well as certain antihistamines, muscle relaxants, decongestants, and pain relievers, are likely to contribute to this condition.
• Ageing: Many elderly individuals develop signs of dry mouth as they age. Additionally, changes in how the body processes medications, poor nutrition, and chronic health conditions can lead to dry mouth.
• Cancer therapy: Cancer treatment drugs, such as chemotherapy, can alter the nature and quantity of saliva produced, usually temporarily, with normal flow returning after treatment. Radiation therapy to the head and neck can damage the salivary glands, leading to a significant reduction in saliva production. This effect may be temporary or permanent, depending on the radiation dosage and the area treated.
• Nerve damage: Injuries or surgical procedures causing nerve damage in the head or neck can result in dry mouth.
• Other medical conditions: Dry mouth may result from certain health conditions like diabetes, Alzheimer’s disease, stroke, or a yeast infection in the mouth. Autoimmune diseases like Sjögren's syndrome or HIV/AIDS can also cause dry mouth.
• Snoring and mouth breathing: Breathing and snoring through an open mouth can contribute to dry mouth.
• Tobacco and alcohol use: Alcohol consumption and smoking or chewing tobacco can exacerbate dry mouth.
• Use of drugs: The use of methamphetamine can lead to severe dry mouth, which may result in dental damage. Additionally, using marijuana can contribute to dry mouth.

Risk Factors

The risk of developing dry mouth is higher in individuals who:

• Use medications that list dry mouth as a potential side effect
• Are undergoing cancer treatment
• Have nerve damage in the head and neck area
• Have medical conditions such as stroke, diabetes, Sjögren's syndrome, Alzheimer’s disease, or HIV/AIDS
• Consume alcohol
• Use tobacco products
• Use illegal drugs
• Frequently consume acidic or sugary foods and sweets

Complications

A lack of sufficient saliva and persistent dry mouth can lead to complications such as:

• Increased plaque formation, tooth decay, and periodontal disease
• Mouth sores
• A yeast infection in the mouth, known as thrush
• Cracked lips or sores at the corners of the mouth
• Poor nutrition due to difficulties with chewing and swallowing

Diagnosis

To determine the cause of your dry mouth, your doctor will start by reviewing your medical history and the medications you are taking, including any over-the-counter drugs. They will also conduct a thorough examination of your mouth.

In some cases, you may require blood tests, imaging scans of the salivary glands, or tests to measure saliva production. These diagnostic tests can help identify the underlying cause of dry mouth. If Sjögren's syndrome is suspected, a biopsy may be performed, where a small sample of cells is taken from the salivary glands in the lip and sent to a lab for testing.

Treatment

The treatment for dry mouth depends on its cause. Your doctor may:

• Adjust medications causing dry mouth: If a specific medication is identified as the cause, your doctor may adjust the dosage or switch to an alternative medication that does not cause dry mouth.
• Recommend products to help moisturise your mouth: These may include prescription medications or over-the-counter mouth rinses, artificial saliva, or moisturisers designed to lubricate the mouth. Mouthwashes formulated for dry mouth, particularly those containing xylitol, may be effective.

For severe dry mouth caused by Sjögren's syndrome or radiation therapy for head and neck cancer, your doctor might prescribe medication to help stimulate saliva production.

Lifestyle and Home Remedies

In addition to medical advice, these measures may help alleviate dry mouth symptoms:

• Drink water or sugar-free beverages frequently, or suck on ice chips to keep your mouth moist. Drinking water while eating can also aid in chewing and swallowing.
• Chew sugar-free gum or suck on sugar-free hard sweets. Products containing xylitol can help prevent tooth decay, although xylitol, often found in sugar-free gum and sweets, can cause diarrhoea or gas if consumed in large amounts.
• Use over-the-counter saliva substitutes with xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray. Alternatively, try saliva substitutes containing carboxymethylcellulose or hydroxyethyl cellulose.
• Breathe through your nose instead of your mouth. If snoring causes you to breathe through your mouth at night, seek treatment for snoring.
• Increase the moisture in the air at night by using a room humidifier.
• Moisturise your lips to soothe any dryness or cracking.

Avoid products that may worsen your symptoms, such as:

• Caffeine and alcohol: Both can cause dryness and irritation. Avoid using mouthwashes that contain alcohol.
• Tobacco: If you smoke or chew tobacco, consider quitting, as tobacco products can dry out and irritate the mouth.
• Over-the-counter antihistamines and decongestants: These medications can exacerbate dry mouth.
• Sugary or acidic foods and sweets: These increase the risk of cavities. Avoid spicy or salty foods, which can cause irritation.

Saliva is essential for maintaining a healthy mouth and teeth. Therefore, practising these measures to protect your teeth can also help with dry mouth:

• Brush with fluoride toothpaste and floss daily. Ask your dentist about the potential benefits of using prescription fluoride toothpaste, which contains betaine, or a tooth gel that neutralises bacterial acids.
• Use fluoride rinses. Your dentist may fit your teeth with fluoride trays, which you fill with fluoride and wear at night to prevent tooth decay. They may also suggest brushing with fluoride gel before bed or using a weekly chlorhexidine rinse.
• Visit your dentist at least twice a year. Regular check-ups and plaque removal can help prevent cavities.

A Note from MD

Occasionally experiencing dry mouth is normal and usually indicates that your body needs more hydration. However, if dry mouth becomes persistent, it could be a sign of xerostomia. Although dry mouth may seem harmless, it can significantly affect your teeth and gums over time. Therefore, it is essential to visit a specialist if you notice any symptoms. They can help determine the underlying causes and develop a tailored treatment plan.