Dry Mouth (Xerostomia)

  • Medical Author:
    Steven B. Horne, DDS

    Dr. Steve Horne began his career at Brigham Young University obtaining his BA in English. He earned his doctorate of dental surgery in 2007 from the University of Southern California where his pursuit for academic excellence landed him on the dean's list. He was recognized for his superior clinical skills and invited to help teach other dental students in courses on restorative dentistry, prosthodontics, and tooth anatomy. During dental school, he provided dental care for underserved populations of Los Angeles and Orange County, Mexico, and Costa Rica with the international volunteer organization AYUDA. After graduation from USC, Dr. Horne entered active duty with the U.S. Army and practiced dentistry at Fort Knox, Kentucky, for four years. During this time, in 2010, he was deployed as part of a medical unit to Baghdad, Iraq, to provide dental and triage support to military and civilian workers who were involved in the effort there. During his military service, he received multiple Army Achievement Medals, the Army Commendation Medal, and served as company commander. After leaving the Army in 2011, Dr. Horne joined a private practice in La Jolla, Calif., and became credentialed with Scripps Memorial Hospital La Jolla as a dental consultant. Health and education are of paramount importance to Dr. Horne, and since 2012, he has been writing dental articles for MedicineNet and WebMD to provide accurate information about oral health to the public. He is a member of the American Dental Association (ADA), Academy of General Dentistry (AGD), California Dental Association (CDA), and the San Diego County Dental Society and American Academy of Cosmetic Dentistry (AACD). He is a preferred provider with Invisalign and spends countless hours each year pursuing continuing education in order to maintain a standard of excellence in dentistry. Dr. Horne has been married for 15 years to his wife, Christy. They have 3-year-old twins, Camille and Trent, and very recently welcomed their third child, Colette Elise, on July 6! The heart and soul of the family is Roscoe, their chocolate Labrador.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is dry mouth?

Dry mouth is a condition that results from a decreased volume of saliva in the mouth. Dry mouth is also called xerostomia. Xerostomia can make it difficult to speak, eat, and digest food and can lead to malnutrition. Extreme dry mouth and salivary gland dysfunction can produce significant anxiety, permanent mouth and throat disorders, and can impair a person's quality of life.

How common is dry mouth?

Dry mouth affects about 10% of all people and tends to be more prevalent in women than men. Disorders of saliva production affect elderly people and those who are taking prescription and nonprescription medications most frequently.

What are the benefits of saliva?

Saliva is an essential part of a healthy mouth and is often taken for granted. The lubricating properties of saliva provide comfort and help protect the oral tissues against ulcers, sores, and other frictional movements that accompany normal eating and speaking. Saliva neutralizes acids and helps defend against tooth decay, and bacterial, viral, or fungal threats. Saliva helps digest food and helps teeth in remineralization. Saliva is also a very essential contributor to a person's ability to taste, as it acts as a solvent for the taste stimuli. When saliva volume is insufficient, all of these functions are impaired.

What causes dry mouth?

There are many causes of dry mouth. Dry mouth most commonly occurs as a side effect of medications that cause decreased saliva production, including high blood pressure medications, antihistamines, antidepressants, diuretics, nonsteroidal anti-inflammatories, narcotics, and many others. There are over 400 commonly used medications that can cause dry mouth. Other causes of dry mouth include dehydration, radiation treatments to treat cancerous tumors of the head and neck, salivary gland diseases, removal of salivary glands, diabetes, smoking, using chewing tobacco, hormonal imbalances, mouth breathing, sleep apnea, cystic fibrosis, mumps, and autoimmune disorders such as Sjögren's syndrome, rheumatoid arthritis, HIV/AIDS, and systemic lupus erythematosus. Eating disorders, such as bulimia and anorexia, are other risk factors for developing xerostomia. Salivary production can be decreased if a major salivary duct becomes blocked, such as from a salivary stone or infection. Dry mouth will often occur during pregnancy or breastfeeding due to dehydration and hormonal changes. Other risk factors include stress, anxiety, and depression. Alzheimer's disease and Parkinson's disease often lead to dehydration, making a person constantly at risk for dry mouth. These along with stroke can cause a perception of dry mouth even if salivary function is adequate, due to the diminished ability to perceive oral sensations. Nerve damage or trauma to the head and neck can affect the nerves that provide sensation to the mouth and result in a feeling of dry mouth.

Quick GuideDry Mouth: Causes, Side Effects, Symptoms, and More With Pictures

Dry Mouth: Causes, Side Effects, Symptoms, and More With Pictures

Dry Mouth Causes

Dry mouth is more than just feeling thirsty. You get it when your mouth makes very little saliva -- or even none at all. What little saliva you have might be thick and stringy. Saliva helps you taste food and drinks and it helps you digest food. It flushes food particles away from your teeth and helps prevent tooth decay. Another name for dry mouth is xerostomia.

More than 400 types of medications can cause dry mouth, including:

  • non-prescription drugs for allergies and cold symptoms, and
  • many prescription drugs for high blood pressure,
  • overactive bladder, and
  • mental health issues.

You can also get dry mouth after some medical treatments such as cancer radiation, which can hurt the glands that make saliva. Chemotherapy sometimes causes saliva to thicken and make the mouth feel dry.

What are the signs and symptoms of dry mouth?

People complaining of dry mouth may exhibit some or all of the following symptoms:

Fungal infections occurring in an individual with dry mouth may be associated with another underlying disease or disorder such as Addison's disease, HIV, or diabetes. The most common sign of fungal infection of the mouth is burning tongue or white or dark plaque on the tongue or soft tissues of the mouth. Frequently, a dry mouth may manifest mostly at night during sleeping, especially in mouth-breathers

How do health care professionals diagnose dry mouth?

When dry mouth is observed, the dentist can be helpful in determining the cause of dry mouth and obtaining a proper diagnosis. The diagnosis will help in developing a plan for management and treatment. The dentist will inspect the main salivary glands and ducts to check for blockages and may measure both stimulated and unstimulated salivary flow. The lips, tongue, and oral tissues will all be inspected for dryness. Sometimes a patient will still complain of dry mouth even if salivary flow is adequate. Since the symptoms of dry mouth vary greatly from individual to individual, treatments vary. Sometimes treatments are given for prolonged, chronic complaint of dry mouth, even without clinical signs of changes within the mouth. The dentist can be an important resource for specific information to manage dry mouth.

What is the treatment for dry mouth?

Those seeking treatment for dry mouth will most likely want something to provide comfort and relief. Treatment for dry mouth can be divided into the following four categories: saliva preservation, saliva substitution, saliva stimulation, and prevention of caries, and yeast (Candida) infection.

Saliva preservation: If salivary content is low, one must do as much as possible to keep the oral tissues as moist as possible and limit the things that can dry the mouth out. Those experiencing dry mouth should try to breathe through their nose as much as possible, and limit mouth breathing. Avoiding caffeine, alcohol, and tobacco is very important. Using a humidifier to introduce more moisture to a room or at bedside can be helpful, especially while sleeping. Don't use OTC antihistamines or decongestants, as they can dry the mouth out as well.

Saliva substitution: There are many home remedies to help replace the moisture that saliva provides to the mouth. These include drinking water more frequently throughout the day, especially while eating. Sucking ice chips throughout the day will help the mouth remain as moist as possible. A mouthwash can be helpful, but it can also be harmful. When selecting a mouthwash, the person must choose a product that doesn't contain alcohol, such as Biotene, for alcohol-based products will only cause further mouth dryness. Artificial OTC saliva substitutes and oral lubricants containing glycerin will provide help during eating and speaking. They won't cure xerostomia, but will provide some relief. Moisturizing the lips with a balm or Vaseline can also be helpful.

Saliva stimulation: Chewing gum can help stimulate salivary flow, but it is important to remember not to use gum or candies that have sugar in them or the person will be placed at greater risk for developing cavities. Sugar-free lemon drops or other hard candies can also help stimulate the salivary glands. Other remedies include medications that help increase salivary flow such as pilocarpine (Salagen) and cevimeline (Evoxac). These prescription medications are to be avoided by people with asthma or glaucoma.

Prevention of caries and Candida infection: Cavities, gingivitis, periodontal disease, and fungal infections are common complications of dry mouth. A dry oral environment makes plaque control more difficult, so meticulous oral care and hygiene becomes essential in preventing rampant caries, gingivitis, and periodontal disease. The affected individual should incorporate a low-sugar diet and begin daily use of fluoride treatments and antimicrobial rinses to combat the effects oral dryness has on the teeth and oral tissues. Prescription toothpastes that contain more fluoride, calcium, and phosphate will help protect and remineralize teeth where necessary. Frequent visits to the dentist are necessary to help manage these complications. Since people with dry mouth often develop fungal infections such as thrush (oral candidiasis), they may require topical antifungal treatment such as rinses and dissolving tablets. Dentures often harbor fungal infections, so they should be soaked daily in chlorhexidine or 1% bleach.

Is it possible to prevent dry mouth?

There is really no way to prevent dry mouth, only the side effects of dry mouth. It is vital to detect, diagnose, and treat xerostomia as early as possible to avoid the devastating consequences of chronic dry mouth on dental and overall health.

What is the prognosis of dry mouth?

The prognosis (outlook) depends on the underlying cause of the dry mouth. Management should be focused on eliminating the cause when possible, such as with dehydration, anemia, and stress. If the cause can't be eliminated, then it is necessary to keep the affected person as comfortable and free from caries and Candida yeast infection as possible. By using simple techniques to help stimulate saliva, substitute for saliva, and protect the teeth and surrounding tissues, one can expect a very good prognosis for avoiding the side effects of dry mouth.

REFERENCES:

Conviser, Jenny H., et al. "JADA Continuing Education: Oral care behavior after purging in a sample of women with bulimia nervosa." JADA 145.4 Apr. 2014: 352-354.

Little, James W., et al. Dental Management of the Medically Compromised Patient, 6th ed. St. Louis, Mo.: Mosby, 2002.

Neville, Brad W., et al. Oral and Maxillofacial Pathology, 2nd ed. Philadelphia, Pa.: W.B. Saunders Company, 2002.

Turner, M. D. and J. A. Ship. "Dry mouth and its effects on the oral health of elderly people." Journal of the American Dental Association 138 Suppl (2007): 15S-20S.

Wiener, R. Constance, et al. "Hyposalivation and Xerostomia in Dentate Older Adults." JADA 141.3 Mar. 2010: 279-284.

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Reviewed on 2/11/2016
References
REFERENCES:

Conviser, Jenny H., et al. "JADA Continuing Education: Oral care behavior after purging in a sample of women with bulimia nervosa." JADA 145.4 Apr. 2014: 352-354.

Little, James W., et al. Dental Management of the Medically Compromised Patient, 6th ed. St. Louis, Mo.: Mosby, 2002.

Neville, Brad W., et al. Oral and Maxillofacial Pathology, 2nd ed. Philadelphia, Pa.: W.B. Saunders Company, 2002.

Turner, M. D. and J. A. Ship. "Dry mouth and its effects on the oral health of elderly people." Journal of the American Dental Association 138 Suppl (2007): 15S-20S.

Wiener, R. Constance, et al. "Hyposalivation and Xerostomia in Dentate Older Adults." JADA 141.3 Mar. 2010: 279-284.

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