Dry Mouth

Dry Mouth

Also called: Xerostomia

Summary

Dry mouth, also known as xerostomia, occurs when the salivary glands in the mouth do not produce enough saliva to keep it moist. Most people experience dry mouth once in a while, such as when they are nervous, upset or under stress. Dry mouth can also be a symptom of inadequate fluid intake, which can result in dehydration (loss of fluids from the body).

Occasional xerostomia is not usually a cause for concern and can be relieved by drinking plenty of fluids, especially water. Implementing lifestyle changes, such as reducing intake of caffeine and avoiding use of alcohol and tobacco, also help relieve dry mouth. However, chronic dry mouth may be a symptom of an illness, such as diabetes, that requires medical treatment.

In addition to dry mouth, a patient may experience other symptoms that may help physicians determine the cause of xerostomia. These include dysphagia (difficulty swallowing), sore throat, bad breath and headache.

It is recommended that patients contact a physician if they have prolonged dry mouth, especially if it is accompanied by diarrhea, fever, fatigue or unexplained weight loss. Chronic xerostomia may be a sign of an underlying illness and can result in complications including tooth decay and gum disease.

Many elderly people experience dry mouth. However, xerostomia is not a normal part of aging. Most xerostomia occurring in elderly patients is caused by the use of certain medications. Dry mouth is a common side effect of various drugs including antidiarrheals, antispasmodics and high blood pressure medications.

Other common causes of dry mouth include:

  • Loss of fluids from the body (dehydration).
  • Infections (e.g., mumps, parotitis) resulting in inflammation of the salivary glands.
  • Chronic illnesses (e.g., diabetes, sarcoidosis).
  • Abnormal growths (e.g., tumors) in the salivary glands.

In many cases, xerostomia does not require immediate medical care and can be relieved by drinking more fluids or using over-the-counter saliva substitutes. However, if dry mouth persists or worsens after relief attempts, patients should contact a physician to avoid complications such as tooth decay.

Some causes of dry mouth require medical attention and prescription medications. For instance, if the salivary glands are not functioning properly, a physician may prescribe medication that stimulates the glands to produce more saliva. Other causes of dry mouth, such as tumors in the salivary glands, may require surgical treatment.

Patients experiencing dry mouth are urged to take care of their teeth by regular flossing and brushing to prevent tooth decay. Patients should also get their teeth examined and cleaned by a dentist at least twice a year.

About dry mouth

Dry mouth, also known as xerostomia, is fairly common. Most people have dry mouth once in a while, such as when they are nervous, upset or under stress. Dry mouth may also indicate inadequate fluid intake, which can result in dehydration (loss of fluids from the body).

In most cases, xerostomia can be relieved simply by drinking plenty of fluids, especially water. However, persistent dry mouth may a sign of an underlying illness, such as diabetes, that requires medical treatment.

The mouth contains three major pairs of salivary glands. The parotid glands, located just behind the angle of the jaw (below and in front of the ears) are the largest. Deep inside the mouth, lie two smaller pairs called the sublingual and submandibular glands. In addition to these major glands, various tiny salivary glands are distributed throughout the mouth. All together, the salivary glands produce about 3 pints of saliva per day in the average adult.

Saliva is a fluid composed of water, electrolytes, mucus and enzymes, and is secreted by tiny ducts (openings) in the salivary glands. It lubricates and helps keep the mouth clean by reducing damaging acids in the mouth and by controlling bacterial growth that can dissolve tooth enamel or lead to mouth infections. Saliva also helps people taste and swallow foods and serves an important function of the digestive system – it breaks down food for digestion. The volume and type of saliva secretion is controlled by the autonomic nervous system (the part of the nervous system – composed of the brain, spinal cord and nerves – that controls involuntary body functions).

When there is a blockage, inflammation or malfunction of the salivary glands, the production and flow of saliva can be affected. Secretion of saliva can decrease substantially and become almost nonexistent. As a result, the mouth can feel excessively dry.

Most elderly people often experience dry mouth. However, it is not a normal part of aging. Dry mouth occurring in elderly patients is usually related to the use of certain medications (e.g., hypertension drugs) that cause this side effect.

Chronic dry mouth can interfere with tasting, chewing, swallowing, speaking and even wearing dentures. It can also result in bad breath and increase the risk of tooth decay (dental cavities) and gum disease(inflammation and infection of the tissues and bone that support the teeth)due to the accumulation of bacteria in the mouth.

Prolonged dry mouth not caused by inadequate fluid intake can be a symptom of an illness, disorder or a side effect of a medication that affects the salivary glands. Patients experiencing chronic dry mouth are urged to consult their physician to avoid complications, such as tooth decay.

Other symptoms related to dry mouth

People with chronic dry mouth (xerostomia) often experience difficulty tasting, chewing, swallowing foods (dysphagia) and speaking due to the lack of saliva in their mouth.

Dry mouth may be accompanied by a variety of other symptoms, which may provide some clues as to its cause. Symptoms can include:

  • Pain or a burning, tingling sensation in the mouth (odynophagia)

  • Sore throat or hoarseness

  • Cracked lips and/or mouth sores (lesions)

  • Thick and/or stringy saliva
  • Excessive plaque (a soft, sticky substance composed mainly of bacteria) in the teeth

  • Tooth decay

  • Gum disease

  • Tongue that is dry, red and/or raw
  • Halitosis (bad breath)

  • Altered taste

  • Frequent thirst

  • Dry nasal passages

  • Headache

  • Dry, flaky skin including hair and nails

  • Excessive or decreased urination and/or dark-colored urine

  • Nausea and vomiting

  • Diarrhea or constipation

  • Unexplained weight loss

  • Fatigue

  • Fever or chills

Patients experiencing prolonged dry mouth along with any of these symptoms are urged to contact a physician for a health evaluation and to prevent complications including tooth decay.

Potential causes of dry mouth

Most people experience dry mouth (xerostomia) once in a while, such as when they are nervous, upset or under stress. This is temporary and goes away as soon as the person relaxes. Dry mouth can also be a sign of inadequate fluid intake, which can result in dehydration (loss of fluids from the body). Many gastrointestinal disorders including gastroenteritis and foodborne illness can also result in dehydration due to severe diarrhea and vomiting, which may cause dry mouth. Dehydration can be alleviated or avoided by drinking plenty of fluids, especially water.

Individuals can also experience dry mouth when the glands in their mouth that produce saliva, called salivary glands, become blocked, inflamed or malfunction. As a result, there may not be enough saliva to keep the mouth moist. For example, some infectious diseases caused by bacteria or viruses (e.g., mumps, parotitis) may cause temporary swelling of the salivary glands, resulting in dry mouth.

Other common factors that can affect the salivary glands and lead to chronic dry mouth include:

  • Medications. Dry mouth is a common side effect of hundreds of drugs. Medications that may cause dry mouth include:

    • Gastrointestinal medications (e.g., antiemetics, antidiarrheals, antispasmodics, proton pump inhibitors). Medications used for treating many conditions affecting the digestive system, including nausea and vomiting, persistent diarrhea, abdominal cramping and excess stomach acid.

    • Antihistamines. Medications used to relieve or prevent allergy or allergy-like symptoms. They may also be used to treat sleeplessness, anxiety, motion sickness and other conditions.

    • Psychiatric medications (e.g., tricyclic antidepressants, antipsychotics). Prescription drugs used to control symptoms associated with many different types of mental illness, such as depression and psychosis.

    • Chemotherapy drugs. Medications used in the treatment of various forms of cancer including that of the digestive system.

    • Heart drugs (e.g., antiarrhythmics, antihypertensives, diuretics). Medications used for the treatment of heart conditions such as abnormal heart rhythms (beats), high blood pressure and heart failure.

    •  Illegal drugs (e.g., marijuana, methamphetamines)
       
  • Chronic illnesses. Some diseases, especially if left untreated, can affect the salivary glands and result in persistent dry mouth. These include:

    • Diabetes mellitus. A disorder in the body’s ability to break down glucose (blood sugar).

    • Hypothyroidism. A condition in which the thyroid gland – located at the base of the neck – fails to produce enough thyroid hormone, which helps regulate body growth and metabolism.

    • Sarcoidosis. An inflammatory disease in which multiple small deposits of abnormal, non-cancerous tissue  called granulomas form in the liver, lungs, spleen and other organs.

    • Sjögren’s syndrome. An autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva.

    • Kidney failure. The loss of the ability of the kidneys to excrete wastes, concentrate urine and conserve electrolytes. Patients with chronic kidney failure (such as those on dialysis) are usually on fluid-restricted diets, which can cause dry mouth.

    • Burning mouth syndrome. A disorder of unknown cause that involves a sensation of burning and pain in the tongue, gums, roof of the mouth, and cheeks. The condition is more common among postmenopausal women.

    • HIV/AIDS. Human immunodeficiency virus (HIV) is the virus that causes AIDS (acquired immune deficiency syndrome). This affects the body’s ability to fight infection. There is no cure and the disease is potentially fatal.

    • Alzheimer’s disease. A neurological condition causing loss of mental functions such as learning and memory.

    • Parkinson’s disease. A neurological condition causing tremors and problems with movement and speech.

  • Stones and tumors in the salivary glands. The mouth can become dry when abnormal growths develop in the tubes (ducts) that lead from the salivary glands to the mouth. These lesions can block the flow of saliva.

  • Nerve damage. Trauma to the head or neck from an injury or a surgical procedure may damage the nerves that prompt the salivary glands to produce saliva, resulting in dry mouth. Radiation therapy used in the treatment of cancer of the head, mouth or neck can also result in permanent dry mouth.

  • Surgical removal of salivary glands.

In addition, smoking or chewing tobacco and alcohol consumption can affect the production of saliva and result in dry mouth. Other factors that can contribute include prolonged snoring, breathing through the mouth and low humidity in the air.

Treatment and prevention of dry mouth

In many cases, dry mouth (xerostomia) does not require immediate medical care. Patients can typically find relief by:

  • Drinking plenty of fluids, especially water, to avoid dehydration. People should consume a minimum of six to eight 8-ounce servings of water throughout the day.

    In addition, patients with dry mouth should sip water or a sugarless drink during meals, which can make chewing and swallowing easier. It may also help improve the taste of food.
  • Chewing sugarless gum or sucking on sugarless hard candy. This can stimulate the flow of saliva and restore moisture to the mouth. And because these do not contain sugar, they do not increase the risk of tooth decay. However, lemon-flavored candies should be avoided because these can increase the acidity of saliva, which increases the risk of tooth decay, especially in patients with dry mouth.
  • Using saliva substitutes. These over-the-counter products are available in gel and spray forms. They mimic some of the properties of saliva and can restore moisture to the mouth.
  • Avoiding or reducing intake of caffeine. This stimulant and diuretic can be found in coffee, tea, soft drinks, chocolate and some over-the-counter drugs. Excessive consumption can contribute to dehydration, which can lead to dry mouth.
  • Avoiding spicy foods, which can irritate a dry mouth.
  • Avoiding cigarette smoking and alcohol consumption. These can cause and/or exacerbate xerostomia.
  • Breathing through the nose, instead of the mouth.
  • Using a room humidifier (a device that increases the amount of moisture in the air), especially at night. This is particularly recommended for people who snore or live in dry, arid climates.

If dry mouth persists or worsens after trying these methods, patients should contact a physician or dentist to avoid complications such as tooth decay. To determine the cause of dry mouth, a physician or dentist will examine the patient’s mouth and review their medical history. Tests such as blood tests and imaging tests may also be performed.

Some causes of dry mouth require medical attention and prescription medications. For instance, if dry mouth is caused by the use of certain medications (e.g., antispasmodics), a physician may change the medication or adjust its dosage. If the salivary glands are not functioning properly, a physician may prescribe medications to stimulate the glands to produce more saliva. Other causes of dry mouth, such as abnormal growths (e.g., stones, tumors) in the salivary glands, may require surgical treatment.

Patients experiencing chronic dry mouth are urged to take care of their teeth by keeping them clean to prevent tooth decay and gum disease(inflammation and infection of the tissues and bone that support the teeth). Careful brushing and flossing of the teeth (and dentures) is recommended after every meal, especially when consuming foods that contain sugar. Patients should use toothpaste and oral rinses containing fluoride, a compound that helps prevent tooth decay. In addition, patients should get their teeth examined and cleaned by a dentist (dental health expert) at least twice a year.

Questions for your doctor regarding dry mouth

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding dry mouth:

  1. Is my dry mouth a symptom of a serious condition?
  2. Given my medical history, should I worry about my dry mouth?
  3. Will drinking water alone relieve my dry mouth?
  4. What other methods can I try to provide relief?
  5. Should I also see a dentist for my oral health?
  6. Do I have any signs of tooth decay or gum disease due to my chronic dry mouth?
  7. What is the best way to prevent tooth decay?
  8. How can I improve my breath?
  9. Are there any foods I should avoid that can worsen my dry mouth?
  10. Will I require surgery to relieve my chronic dry mouth?
  11. What is the best way to prevent recurring dry mouth?
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