Dry mouth

Dry mouth, or xerostomia (zeer-o-STOE-me-uh), refers to a condition in which the salivary glands in your mouth don't make enough saliva to keep your mouth wet. Dry mouth is often due to the side effect of certain medications or aging issues or as a result of radiation therapy for cancer. Less often, dry mouth may be caused by a condition that directly affects the salivary glands.

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 chew and swallow. In addition, enzymes in saliva aid in digestion.

Decreased saliva and dry mouth can range from being merely a nuisance to something that has a major impact on your general health and the health of your teeth and gums, as well as your appetite and enjoyment of food.

Treatment for dry mouth depends on the cause.

Symptoms

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

• Dryness or a feeling of stickiness in your mouth
• Saliva that seems thick and stringy
• Bad breath
• Difficulty chewing, speaking and swallowing
• Dry or sore throat and hoarseness
• Dry or grooved tongue
• A changed sense of taste
• Problems wearing dentures

In addition, 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 doctor.

Causes

Dry mouth is caused when the salivary glands in the mouth don't make enough saliva to keep your mouth wet. These glands may not work properly as the result of:

• 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, high blood pressure and anxiety, as well as some antihistamines, decongestants, muscle relaxants and pain medications.
• Aging. Many older people experience dry mouth as they age. Contributing factors include the use of certain medications, changes in the body's ability to process medication, inadequate nutrition, and having long-term health problems.
• 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 is completed. Radiation treatments to your head and neck can damage salivary glands, causing a marked decrease in saliva production. This may 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 due to certain health conditions, such as diabetes, stroke, yeast infection (thrush) in your mouth or Alzheimer's disease, or due to autoimmune diseases, such as Sjogren's syndrome or HIV/AIDS. Snoring and breathing with your mouth open also can contribute to dry mouth.
• Tobacco and alcohol use. Drinking alcohol and smoking or chewing tobacco can increase dry mouth symptoms.
• Recreational drug use. Methamphetamine use can cause severe dry mouth and damage to teeth, a condition also known as "meth mouth." Marijuana also can cause dry mouth.

Complications

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

• Increased plaque, tooth decay and gum disease
• Mouth sores
• Yeast infection in your mouth (thrush)
• Sores or split skin at the corners of your mouth, or cracked lips
• Poor nutrition from having problems with chewing and swallowing

Diagnosis

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

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.

Treatment

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. Mouthwashes designed for dry mouth, especially ones with xylitol, can be effective, such as Biotene Dry Mouth Oral Rinse or Act Dry Mouth Mouthwash, which also offer protection against tooth decay.

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

• Prescribe medication that stimulates saliva. Your doctor may prescribe 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 at night. Your dentist may also recommend weekly use of a chlorhexidine rinse to control cavities.

Lifestyle and home remedies

In addition to the advice from your doctor, 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. Products that contain xylitol may also help prevent cavities. However, in some people, xylitol, which is often found in sugar-free gum or sugar-free candies, may cause gas or diarrhea if consumed in large amounts.
• Try over-the-counter saliva substitutes that contain xylitol, such as Mouth Kote or Oasis Moisturizing Mouth Spray, or 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 OralBalance Moisturizing 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 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. These 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.

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'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, herbs, other supplements and over-the-counter medications you're taking, including the dosages
• Questions to ask your doctor

Some basic questions to ask your doctor include:

• What is likely causing my dry mouth?
• What are other possible causes?
• Is my condition likely temporary or long term?
• What's the best course of action?
• I have other health conditions. Could this be related to any of them?
• Are there any restrictions that I need to follow?
• 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 doctor is likely to ask you several questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor 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?

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