Dry mouth, or xerostomia (zeer-o-STOE-me-uh), refers to any condition in which your mouth is unusually dry. Most often, dry mouth is the result of a decrease in saliva produced by the glands in your mouth (salivary glands), and it's frequently a side effect of medication. Less often, dry mouth may be caused by a condition that directly affects the salivary glands.

Dry mouth is a common problem. It can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth, as well as your appetite and enjoyment of food.

Saliva helps prevent tooth decay by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. Saliva also enhances your ability to taste and makes it easier to swallow. In addition, enzymes in saliva aid in digestion.

Treatment for dry mouth depends on the cause.

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

  • Dryness in your mouth or throat
  • Saliva that seems thick and stringy
  • Bad breath
  • Difficulty chewing, speaking and swallowing
  • A changed sense of taste
  • Problems wearing dentures
  • More frequent tooth decay
  • Gum irritation and gum disease

In women, dry mouth may result in lipstick sticking to the teeth.

When to see a doctor

If you've noticed persistent dry mouth signs and symptoms, make an appointment with your family doctor or your dentist.

Dry mouth has numerous causes:

  • Medications. Hundreds of medications, including many over-the-counter drugs, produce dry mouth as a side effect. Among the more likely types to cause problems are some of the drugs used to treat depression, nerve pain (neuropathy) and anxiety, as well as some antihistamines, decongestants, muscle relaxants and pain medications.
  • Aging. The aging process doesn't necessarily cause dry mouth. However, older people are more likely to take medications that may cause dry mouth, and they're more likely to have other health conditions that can cause dry mouth.
  • Cancer therapy. Chemotherapy drugs can change the nature of saliva and the amount produced. This may be temporary, with normal salivary flow returning after treatment has been completed. Radiation treatments to your head and neck can damage salivary glands, causing a marked decrease in saliva production. This can be temporary or permanent, depending on the radiation dose and area treated.
  • Nerve damage. An injury or surgery that causes nerve damage to your head and neck area can result in dry mouth.
  • Other health conditions. Dry mouth can be a consequence of certain health conditions, including the autoimmune disease Sjogren's syndrome or HIV/AIDS. Stroke and Alzheimer's disease may cause a perception of dry mouth, even though the salivary glands are functioning normally. Snoring and breathing with your mouth open also can contribute to dry mouth.
  • Tobacco use. Smoking or chewing tobacco can increase dry mouth symptoms.
  • Methamphetamine use. Methamphetamine use can cause severe dry mouth and damage to teeth, a condition also known as "meth mouth."

If you don't have enough saliva and develop dry mouth, this can lead to:

  • Increased plaque, tooth decay and gum disease
  • Mouth sores
  • Fungal infection in your mouth
  • Coated tongue
  • Sores or split skin at the corners of your mouth
  • Cracked lips
  • Poor nutrition from having problems with chewing and swallowing

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're experiencing, including any that may seem unrelated to the reason for your appointment.
  • Key personal information, including any major stresses or recent life changes, which may contribute to dry mouth.
  • All prescribed medications, vitamins, other supplements and over-the-counter medications you're taking, including the dosages.
  • Questions to ask your doctor or dentist.

For dry mouth, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What are other possible causes?
  • What kinds of tests do I need?
  • Is my condition likely temporary or long term (chronic)?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist?
  • 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 any other questions you have.

What to expect from your doctor

Your doctor or dentist is likely to ask you several questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor or dentist may ask:

  • When did you start experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • Have you started taking any new medications recently?
  • Do you smoke or chew tobacco?
  • How much alcohol do you drink?
  • Does anything improve your symptoms or stimulate saliva flow?
  • What, if anything, appears to worsen your symptoms?

To determine if you have dry mouth, your doctor or dentist likely will examine your mouth and review your medical history and all medications you're taking, including over-the-counter medications.

Sometimes you may need blood tests, imaging scans of your salivary glands or tests that measure how much saliva you produce to identify the cause of your dry mouth. If your doctor suspects your dry mouth is caused by Sjogren's syndrome, a small sample of cells (biopsy) taken from salivary glands in your lip may be sent for testing.

Your treatment depends on the cause of your dry mouth. Your doctor or dentist may:

  • Change medications that cause dry mouth. If your doctor believes medication to be the cause, he or she may adjust your dosage or switch you to another medication that doesn't cause a dry mouth.
  • Recommend products to moisturize your mouth. These can include prescription or over-the-counter mouth rinses, artificial saliva or moisturizers to lubricate your mouth.

If you have severe dry mouth, your doctor or dentist may:

  • Prescribe medication that stimulates saliva. Your doctor may consider prescribing pilocarpine (Salagen) or cevimeline (Evoxac) to stimulate saliva production.
  • Protect your teeth. To prevent cavities, your dentist might fit you for fluoride trays, which you fill with fluoride and wear over your teeth for a few minutes at night. Your dentist may also recommend weekly use of a chlorhexidine rinse to control cavities.

In addition to the advice from your doctor or dentist, these tips may help relieve your dry mouth symptoms:

  • Sip water or sugar-free drinks or suck ice chips throughout the day to moisten your mouth, and drink water during meals to aid chewing and swallowing.
  • Chew sugar-free gum or suck on sugar-free hard candies. However, in some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause diarrhea or cramps if consumed in large amounts.
  • Try over-the-counter 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 Oral Balance.
  • Breathe through your nose, not your mouth. You may need to seek treatment for snoring that causes you to breathe through your mouth during the night.
  • Add moisture to the air at night with a room humidifier.
  • Moisturize your lips to soothe dry or cracked areas.

Avoid 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.
  • All tobacco. If you smoke or chew tobacco, stop, because tobacco products can dry and irritate your mouth.
  • Over-the-counter antihistamines and decongestants. These can worsen your dry mouth.
  • Sugary or acidic foods and candies. They increase the risk of tooth decay. Also avoid spicy or salty food because they can cause irritation.

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

  • Brush with a fluoride toothpaste and floss your teeth. Ask your dentist if you might benefit from prescription fluoride toothpaste, toothpaste containing betaine, or a tooth gel to neutralize bacteria acids.
  • Use a fluoride rinse or brush-on fluoride gel before bedtime.
  • See your dentist at least twice yearly to have your teeth examined and plaque removed, to help prevent tooth decay.

Several herbal remedies have been used historically to treat dry mouth, such as teas made from marshmallow or slippery elm, but there are no recent studies showing benefit or harm in using them for dry mouth.

Electroacupuncture, which involves stimulating traditional acupuncture points on the skin using electrodes rather than the traditional needles, looks promising in some studies on dry mouth treatment. However, researchers are still working to determine whether this therapy is truly better than others for dry mouth.

May 10, 2014